We met with Dr H this afternoon. They couldn't find the stim sheet from IVF #1, since he'd apparently appropriated it from my chart to figure out what to do next, and because he'd spent so much time dealing with my crappy cycle last month.
He thinks the same thing I did about attempt #1: I was probably too suppressed from the birth control pill, and might have done better with a little more LH in my system (mine was at 1 to start with and dropped to 0). He said he's never seen oversuppression from the pill before, but has seen similar results with lupron. And he was shocked that it happened to me, given the ovarian reserve I've apparently got. He's convinced that there are good eggs in me, we just need the right protocol to get them. And he thinks that I just don't produce enough hormones to stimulate my ovaries properly, and need a bit more of a boost from the meds, along with no suppression from the pill or lupron.
My AMH levels came back at 47.4. The results sheet says that 0-2.2 is very low ovarian reserve, 2.2-15.7 is low, 15.7-28.6 is medium, 28.6-48.5 is high, and >48.5 is a high level, suspicious for PCO or granulosa cell tumors. So I'm at the very highest end of high ovarian reserve, which I think is probably a good thing. Whew.
So the plan is to do a natural start cycle. I'm 14dpo now, so I'm betting AF will arrive on Sat or Sun. Then I'm to call in day 1 to the clinic, and come in on day3 or day4 for baseline to see if I've got any cysts that will throw the whole plan out the window. He said that normally they'd start stims on day3, but that given the low hormone levels he expects to see in me, I should be able to start later (like day 5 or 6), which would ensure that my retrieval is after my Royal College Oral Exam on May 29th. It will be another antagonist cycle, but we'll stim with a combination of Gonal-F and Menopur to ensure I keep some LH activity going. So far he's put me down for 150IU Gonal-F and 150IU Menopur (!), but that may get decreased depending on what the baseline shows. I think I might prefer 112.5IU Gonal-F, but I'll have to trust him. He asked if we wanted to be more agressive and risk overstimulation rather than understimulation, and I said I would. After all, he doesn't like to increase the doses of stims, but will decrease them if the levels are rising too fast.
Now I'll just have to hope God has the right plan in mind for this cycle. I don't want to start AF too soon or stim too fast. In fact a Sunday or Monday start to AF would be great. I started spotting today though, so I'm not too hopeful that it'll hold off a couple more days. I'm probably nuts to do the exam and stims at the same time, but I'm not sure how waiting till the end of June/early July will be that much better. Ugh.
As long as I have no cysts going wild in there, things ought to be ok to start again right away.
And in other news, my FIL is doing great after his bypass on Thursday. He's already out of the ICU, and is doing as well as they could possibly have hoped for. I hope he continues to shine!
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3 comments:
Kate that sounds like a good plan to me althugh I am no where as knowledgeable about the whole medication stims process as you are. Your FIL is in my thoughts big hugs to you and your DH as I am sure you will need them.
That plan makes perfect sense to me. I expect your results are going to be far different than the first time. I hope you're feeling good about it.
Glad to hear that FIL is recovering (I know how awful things like that are - I hope your DH is hanging in there).
Good luck studying!
Like you Kate, I'd rather more gonal instead of menopur. It doesn't work as well as the gonal and if you have good eggs you don't need to depend much on it (menopur). Go with your intuition.
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