I had my phone consult yesterday with CCRM. I think it went pretty well for the most part. I already really like Dr. Schoolcraft as he is all business, very direct, extremely knowledgeable and able to educate others well, no fluff, no personality (which is fine by me), and hopefully the man I will one day credit for my future spawn! He didn't give me false hope as Dr. Awadalla always did. I'm so glad we switched REs! Here is a brief run down of some of the things that Dr. Sch and I discussed.
First of all, he thinks we could be dealing with an egg problem. Interesting since Dr. A always lead us to believe it was slight MFI, if not his favorite, "unexplained diagnosis". But, according to Dr. Sch, even though I make lots of eggs, we don't have embies that are growing to 5 days in a lab. He thinks this is more than likely due to poor lab conditions that exist in many RE clinics that are not conducive to growing embies out to blast. He uses a vitrification technique that enables more embies to continue to thrive beyond 3 days. If an embie doesn't make it to blast, it's an egg problem (probably a genetic defect). Worst case scenario (and btw my greatest fear): none of our embies make it to 5 day. But, if they won't grow in his lab, they won't grow anywhere, so we'll have to think about other routes to a baby at that point. But I will have an answer, which is what I wanted and why we're going all the way to Denver.
He also wants to do the Beta-3 integrin endometrial biopsy. He feels that this should help us understand if I'm missing these "uterine sticky glue" receptors and maybe that's why the embies aren't implanting. He does not feel a laparoscopy is necessary for me (which is again a difference b/t him and Dr. A). He said a lap would show one of three things: 1) normal, 2) scar tissue, and 3) endometriosis. #1 and #2 he doesn't care about and #3 doesn't matter since we're doing IVF provided I have the above receptors from the biopsy. If I am missing those receptors, then I'll get treated with depot Lupron following our ER for a few months. If we were not doing IVF, then a lap could be considered, but we are no longer in that boat at this time.
Our one-day work-up appt. has been scheduled for July 3rd. This is great because both Steve and I are off work for the July 4th holiday for both 7-3 and 7-4 (yay for not having to burn vacation time!). We are doing tons of testing at this appt. I'll be getting a hysteroscopy as part of the standard work-up and Dr. Sch does suspect PCOS (since I had 33 eggs retrieved which is too many). If so, he'll add Metformin to my drug cocktail. Also, he orders tons of chromosomal testing to begin to rule out genetic issues from both of us. And, we will also be getting the anti-sperm antibody test (also part of the work-up). We'll know more about what protocol we'll be doing after the testing and bloodwork are complete. He did say that he doesn't use pure FSH alone and would use a FSH + LH combo with me and decrease the stims as we get further into the cycle to prevent OHSS and 33 eggs being retrieved...
Finally, we're doing CGH testing on all blasts (provided we have them at Day 5). This takes about 8 weeks to complete but is better than PGD because you are testing the placental cells in CGH (of at least 100 cell blast) vs. PGD which only tests from the embie, which has only a few cells at Day 2 or 3 and you do have the potential to harm the embryo. CGH tests all 23 chromosomes and PGD only tests 9/23 chromosomes. I think only a few centers in the country do CGH testing. We will do a FET after the results are back.
Denver here we come!!
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