One couple was taken in at 3pm. They brought me in to a room at 3:27pm, telling me he was running on time today. DH wasn't even there yet, but they said they'd bring him in to join me when he arrived. He got there at 3:30pm. We kept being hopeful that Dr H would join us, as we'd hear footsteps or a door opening elsewhere in the clinic, but no such luck. Come 4:55pm, Dr H finally came in.
The meeting felt a little rushed, as he basically stood up while I still had 1-2 more questions to go, and said that he was running behind and had to get going. Not really fair that the other couple (that obviously had things to discuss) got 1.5 hours with him, and we barely got 30min.
As for the answers to my questions:
- When can DH donate a sample for freezing as backup? Call LQ, book a time. If the sample's crap, they won't freeze it and will tell you to come again. Abstain 48h before donating. If you're super worried you'll miss the container, just wash hands and penis well, and don't worry so much about not touching the inside (the instructions said to NOT at any cost touch the inside of the container with penis or your hands).
- Why 7 days between OCP and stims? If start stims sooner, it's likely just wasted effort as things are still shut down from the pill. It's possible to start too late. If I stop the pill on the 10th (Friday), and have my baseline on the 16th (Thurs), there's a small possibility that I'll be told to start stims on the 16th instead of the 17th as planned. Just depends how things look.
- How do you pick the starting dose for the stims? Best way is to base it off a previous IVF cycle. Otherwise, it's a bit of a guess. With my antral follicle count being 15+ on each side, he said he's worried that I could hyperstimulate. 150IU would be a conservative start in my case. If I want to be aggressive, he'd be willing to go to 187.5IU. 225IU would be way too much. He'd be really happy if we ended up with 10-18 nice follicles at ER. More than 20, he'd be worrying about hyperstimulation and then we'd have to discuss freezing everything to let it settle, not using the HCG post-ER support. If there are only 4-5 developing, he'd convert me to an IUI and aim for a better cycle for the IVF.
- The orgalutran 1/2 dose is a little out of the ordinary protocol-wise. Everyone uses full dose. He's had other skinny patients like me use the full dose and be oversuppressed, with a low LH, and then produce bad quality eggs as a result. No thanks! If needed, we'll do bloodwork daily and adjust the dose, though it's possible we might miss out on a surge.
- How do you track the progesterone? They check it before ET to make sure the levels are good. Sounded like they'd keep an eye on it for me if I wanted them to afterwards.
- How do you figure out if we're pregnant when I'm on HCG support too? The dose will supposedly give me blood values around 30, so if I get a beta in the hundreds, I'm pregnant.
- Will you keep me on the HCG during the first trimester? Sure, he's done it for a number of patients with histories of early miscarriages. Just wouldn't be able to do it if I hyperstimulate, as that would make things worse.
- Should I be on or off naltrexone? On or off 81mg ASA? Doesn't think either make a difference. No evidence naltrexone helps.
- Will I really be getting ativan/morphine/atropine for retrieval like the paperwork said, when my protocol said I'd be getting midazolam/fentanyl? He was shocked at that one. The paperwork was dated 2005, and he said it was totally out of date now. Took the copy from us to look into it, and said he'd send us the current info.
Supposedly my sonohysterogram was fine. Good flow out the left tube, not much, if any out the right. I know both were fine last July on the HSG. At any rate, they think it was just preferential flow out the left. And with one open, it was a bit of a moot point about the other, since we're doing IVF, and OHIP will only help out if both are blocked. At least it was entirely painless, start to finish, and the catheter passed easily through my pesky cervix.
OK, I'd better get back to studying again. My motivation is waning, but only 1.5 weeks left before the big exams!

2 comments:
That's nuts about the wait time - I don't mind waiting, but my DH would've been fuming.
The starting stim dose does seem to be a guess. I started at 150 last time, since I didn't respond to 175 for my IUI, but then overresponded. So I'm nervous about my starting dose, and I think I will ask for monitoring sooner than what they've booked me for. With PCOS, ya never know...
Thx for the info on the progesterone and HCG - I'm going to want them to keep an eye on that, too.
Good news on the SHG. From what I've read, blocked tubes aren't good for IVF (something about fluid leakage back into the uterus, thereby disturbing implantation?), but I'm not an expert on that - you sound fine! Good to go!
Oh, and we are indeed $11000 experiments! We are using the last of our savings (accrued from selling our house) to finance this. It is really, really depressing.
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