April 2016 - IVF #3, The Plan

Last Thursday, we met with the RE.  He was very positive about our options.  Disappointed in the androgen priming protocol, he wants to move on from that this time, and try something different.  Sometimes, he says, it's just about finding the right cocktail of medicines that will convince my ovaries to respond.  Now that we're on to round #3, it does start to feel like one big science experiment, and I'm the principle lab rat.

The options he mentioned were:

• Option 1: Go back to something similar to the first protocol
• Birth control (~2 weeks), less time than in round #1
• Gonal-F and Menopur combo
• Cetrotide antagonist
• Switch to double trigger shot
• Option 2: Change to "Lupron Flare" protocol
• Birth control to start (~2 weeks)
• Start shots with Lupron - used instead of Cetrotide to prevent ovulation too early
• Helps stimulate naturally produced Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH) from my own pituitary gland at the beginning of the cycle to hopefully promote more follicles to grow
• If you recall, FSH and LH are the two hormones in the injectable medicines, so this would make use of my own levels of these hormones in addition to the shots
• Swap in Follistim - used instead of Gonal-F
• He said this is just a brand difference "like Dr. Pepper instead of Coke" LoL!
• Stick with Menopur
• Option 3: What I'm calling "Low & Slow"
• We may have to recognize that we just aren't going to get that many follicles
• Perhaps the high-dosage route is hurting instead of helping
• Apply low-dosage for longer time to see if we can do better than previous cycles and focus on quality vs. quantity
• Add-on consideration: Add estrogen priming (no testosterone)
• Pro: Lower level of ovarian supression (bringing the system to a baseline level) at the beginning of the cycle than birth control, which will supress more.
• Con: Like the androgen priming, this takes a whole month of priming before even shots vs. ~2 weeks of birth control
• He said this was 6 vs. half-doz, so we said we would prefer the birth control if this doesn't make a substantive difference.

After a good amount of debate and discussion, he said he would really like to see us try Option 2, the Lupron protocol starting with birth control instead of the estrogen priming.  

Lupron protocols are pretty standard, actually.  They are used widely and often work quite well from what I have read previously.  Our RE on average has better success with Cetrotide, but he said that for some people, Lupron may actually work better.  I will learn more about it as we go, but I believe he called it a "microdose Lupron" protocol, which can be beneficial to low ovarian reserve cases like me.  For an example, I found this link to a typical microdose Lupron flare calendar of treatment (from another clinic, so mine might be different).  If mine is similar, this might mean shots two times a day!  Fun stuff!  Ultimately, it should help to stimulate my body's natural FSH  and LH and hopefully produce more follicles than round #2.  Sounds like a great option to try.  Using a different approach feels good, and gives us some hope.

Additionally, I'm glad he agreed to the birth control start, which is a lot shorter than the priming.  Emotionally, it was pretty difficult to have round #2 fail after working on it for 6 weeks.  Even though the shots portion was relatively short.

I'm actually getting used to the shots.  Glad to mix in the Follistim instead of just the straight Menopur, which stings and burns badly when injected alone and in high dosage.  Not sure how doing the Lupron shots twice daily will work, if that's indeed how they set me up.  With work, it might be tough to figure out how to do the morning dose.  I may have to keep it in the office fridge and do it in the bathroom...  Interested to see what Sharon (my nurse) gives me for instructions.

The one thing he said that has haunted me a little since Thursday was, "If this cycle doesn't work, we will need to regroup and discuss other options."  He said this gently and quickly talked about how he was optimistic about this protocol, but I am afraid already I know what this means.  If my eggs are both low quantity and quality and we can't get enough to be successful in getting pregnant at all, we have to consider eliminating my eggs as part of the equation vs. continuing on and on with protocols that won't likely work.  This means considering donor eggs, embryo adoption (if it is important to me to experience pregnancy), or just old-fashioned adoption.  Just the thought of this is a little soul-crushing.  It's admitting defeat for me, at least in some way.  It means that even if I do have a child, he or she won't be biologically mine.  While whatever children we raise would be 100% ours and loved 100% as much, they wouldn't have my eyes, or my curls, or my laugh...  

A million thoughts are rushing through my head on this.  Last night, the weight of it all got to me.  Tuesday is my baseline appointment before the birth control starts.  Here we go again, but with heavier implications if we fail.  I went from wanting to kick IVF ass last week to feeling a huge amount of despair.  I cried myself to sleep with Michael holding me and telling me it would all be ok.  I woke up at 2:30am and couldn't get back to sleep because my brain was really focusing in on the pressure of this round working well and what it means if it doesn't.  How many more rounds will they let us try before saying that there's little to no hope?  Is this it?  The next thing I knew, my alarm went off at 5:30am.  Sigh.

I know I'm getting carried away, but if you've read this blog from the start, you'll know that rational thinking doesn't always win out in this process!  My focus needs to be on this cycle and on being as positive as I can be for the current step to work.  As Michael said last night, "It might work out great and then all of that anxiety and despair would be suffered needlessly."  I will likely need to be reminded of that when I'm ears deep in hormones here in a couple of weeks.

Next step:  I will see my RE for baseline tests tomorrow, and maybe ask him a couple more questions on the protocol and maybe what "regroup" means...