I emailed my nurse right back to tell her this and beg for a date change. I'm pretty sure my biopsy in Nov was fine - a pinch for the local to the cervix so she could dilate it for the biopsy, and then not much after that. I could feel something going on, but don't remember getting particularly crampy or anything. My first sonohysterogram was worse than that. But with a $4000 exam and being able to start my real job come July riding on these licensing exams, I really would rather not risk being crampy and bleeding and trying to concentrate on the test.
Luckily, it seems she was working today, because I got an email back saying that my biopsy is now 8am on April 8th. Thank God!
So my proposed dates are:
March 18th - start OCP
March 26th - sonohysterogram, follow-up with Dr H
April 8th - endometrial biopsy (I think with Dr P)
April 10th - last OCP
April 16th - pre-start U/S and bloodwork
April 17th - start stims (150IU Gonal-F)
April 20th, 22nd, 24th, 26th - U/S and bloodwork
April 22nd - likely add in Orgalutran
April 28th - estimated ER
May 3rd - estimated ET
May 4th - start progesterone/estrogen/HCG support
Now I just have a few questions for Dr H on Thursday:
- Why 7 days between last OCP and starting stims - I think in the literature you start on day2-day5 of your cycle, and I usually got AF 2 days after the last pill
- How do they pick the starting dose of Gonal-F? A friend just cycled with a similar case to mine and did 225IU + 75 Puregon to start. She got 20 eggs, 18 mature, 14 fertilized with ICSI...
- How many eggs are we shooting for here?
- Will I be monitored more closely if things start to take off - I don't want to be too late starting the Orgalutran
- Will they monitor the LH too and possibly add in low-dose HCG or LH if it's low - I've read that too-low LH has a negative effect on pregnancy rates
- How will we monitor progesterone and figure out if I'm pregnant (given the HCG support, which I'm totally in favor of)
Of course at some point I'll just have to let go and trust that they know what they're doing. I'm just trying to be a backseat driver here. As always.
4 comments:
The clinic seems pretty A-OK with date changes. So it's great that you'll be able to focus 100% -or at least as much as is humanly possible - on your exam. (I've never had that endometrial biopsy done, so I'm pleased to know that it's not that bad.)
Do you know if post-luteal HCG support is standard at this clinic? I'd like to be on that, too, if necessary.
Have you met Dr P? I had her for my SHG, and thought she was great. She went to great lengths to explain everything. I made a naughty joke at her expense (she said she hoped she'd see me again soon, and I said I hope not), and she looked shocked and then burst out laughing. Yes, I'm bad. :)
From what I know about PCOS and stims, 150 seems to be the starting dose for many women. That's what I was started at for IVF #1, too, and it turned out to be too much. But I think it's worth asking about.
Re: # of eggs. He told me that we were shooting for around 8, but I think we'll get more. I hope so, anyway, since we had fertilization problems last time.
Re: low HCG and LH and progesterone. I want to know that, too.
Re: letting go. I think it's good to keep doctors on their toes. (But maybe I shouldn't be saying that to you, future Dr.! lol)
I don't think the HCG support is standard, but with two miscarriages under my belt, documented low progesterone for cycles without support, and documented low progesterone at the time of my first BFP (despite just coming off HCG support), I think he's going all out here. I don't see why you shouldn't be able to get it if you ask for it. I don't think it can hurt, it can just mean that it takes you longer to sort out if you have a positive beta because you're pregnant, or because of the HCG boosters. If this thing works, I'll be asking to stay on HCG twice weekly till about the 9 week mark - read some study showing that it prevented miscarriage in some women in whom it threatened.
Haven't met Dr P yet - maybe she'll be doing my SHG?
Oh, I guess I'd better also ask who would be doing the retrieval/transfer if we don't hit the magic 3 days that week (since he's gone the Thurs/Fri). I sure hope he's back on the weekend!
Kate, my friend just got pregnant on low dose gonal f (I think 75). She had two embryos transferred and is now pregnant wih triplets after one blast split.
As for retrieval and transfer, Dr H is almost accurate. For my two cycles, everything went as planned (er & et), same for my friend, except the first time when she did ivf and all her embryos were arresting. Dr H did an emergency transfer on day 3 and she got pregnant.
All the best OHW & Kate.
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