Moving forward: FET #2

Yesterday I met with my SIRM RE to discuss my next FET. We decided to try Neupogen, which did not come as a surprise to me, considering we had been discussing it over email. I will be doing 0.4mL every 4 days, starting the first day of progesterone. My WBC will not be monitored, which is a bit concerning to me, but I was assured the dose was small enough that I was not at any risk. I am encouraged by the small studies I have read so far about the high success rate with women who have unexplained RPL, but I know this is not a magic cure.  I felt sure PGS would be the answer, and it wasn’t. So I can’t really bring myself to put much stock in any treatments at this point.

It's like liquid gold. $600 for this tiny vial!
It’s like liquid gold. $600 for this tiny vial!

I also came away from this meeting pretty concerned about the quality of my remaining frozen embryos. What we transferred for my first FET that wound up a chemical pregnancy was a day 6 blast, and was my only expanded, best quality one. What we have left are 2 average-graded, unexpanded blasts. One is a day 5 which is fine, the other is a day 6. My understanding is an unexpanded blast at day 6 is no bueno.

My SIRM RE says it is definitely worth transferring both over two separate eSET’s because even “ugly” embryos can become babies. But I feel totally hopeless about the remaining day 6. The thought of investing time, money and more Lupron craziness on a cycle with a crappy embryo is really hard to swallow. My mind is made up that I want to transfer both remaining embryos next cycle, but my husband strongly disagrees.  He is very wary of the risks associated with twins, and while those are not lost on me, they are risks I am willing to accept.

I have no idea how we are going to come to a decision on this. For now I am taking the healthy, mature approach of avoiding discussing the topic simply because it stresses me out too much to deal with it right now.


Making progress!

I closed the loop this week on my tour de RE’s and sat down once more with my current RE. We discussed what I learned from my meetings with the other 2 RE’s and what we’ll do moving forward.

I have a hysteroscopy scheduled with him for tomorrow which I am nervous about since it is an operative hysteroscopy and I will be under anesthesia. The whole anesthesia/surgery/risks thing has me on edge but I hope the procedure is productive. Part of me wishes that they will find something in there that will give some sort of “Ah ha!” but I know realistically there probably won’t be any answers gleaned from the procedure. At least it will give me an excuse to lay around the rest of the day – We just started watching American Horror Story, so maybe a Netflix binge will be in store for my recovery.

As far as next steps: After the hysteroscopy, I’m going straight into a mock FET cycle. Basically I will do everything I would do for an FET, just without the transfer. Instead, an endometrial biopsy will be taken towards the end of the cycle and sent off to Yale for their EFT test. It is my understanding this test will tell us more about the receptivity of my uterus/endometrium. If the results come back abnormal, my current RE will confer with my other RE at SIRM to decide a course of treatment.

I am also working on completing some bloodwork ordered by the RE at SIRM. This includes:

  • Vitamin D (This already came back normal with a level of 54)
  • TSH/Free T4/Thyroid Antibodies (Also came back normal)
  • Natural Killer cells assay (To be completed next week)
  • TH1/TH2 (Also to be completed next week)

I have a feeling these results are all going to come back normal, and then we’ll still have no answers. Once the results are all in, I’ll get together with the RE at SIRM again to discuss treatment for my next FET, which I am thinking will be something in the fall.

2nd and 3rd opinions

I had consultations scheduled this week with RE’s at both Yale and SIRM. I am trying to get as many opinions and insights as possible before moving forward with another transfer.

Yesterday I met with an RE at Yale who I was told was a recurrent pregnancy loss specialist of sorts. Up until late last week, I had no intention of going there, but I ended up speaking with one of women on the board at Resolve (long story), and she highly recommended seeking an opinion at Yale. It just so happened they had a last minute cancellation for yesterday, so I was able to get in.

The meeting started off well, she asked a lot of questions about my history and I appreciated that she paid attention to every detail. But as the appointment progressed, I became less impressed. She is clearly not a proponent of any sort of empiric treatment and even pooh-pooh’d my use of Lovenox, baby aspirin and Metformin. She tried to tell me that my FET could have ended in a chemical pregnancy due to poor quality of the embryo after the thaw (Yeah, I don’t think so). And, she seemed to put a lot of stock in an endometrial scratch being the magic answer. All in all she just didn’t have a lot to offer, and because at this point I’m looking for a doctor to think outside the box, I knew when I walked out of there that there is no chance I’ll cycle there.

So today I had my long-awaited consultation at SIRM. The RE I met with has a great reputation, and he did not disappoint. He had some great suggestions and helped me start to formulate a plan to move forward. The best part is that he will not require me to do my transfer at SIRM, and is willing to let me cycle at UConn while he would just manage the immune portion of the protocol.

He already wrote up a requisition to test my Vitamin D, thyroid antibodies, natural killer cells, and T helper cells. He also suggested I work with my current RE to do a mock cycle leading up to my hysteroscopy, that way when he does the endometrial biopsy, the timing will be right to send a portion of the sample off to Yale for their endometrial function test. (Which ironically, the RE I met with at Yale also shot down). Depending on how the results for these tests come back, the possible treatments we are looking at are: Prednisone, intralipids, neupogen, and a long course of Lupron.

I have a meeting with my current RE on Monday to fill him in. It’s supposed to be my pre-op appointment for my hysteroscopy, but I am hoping he’ll agree to the mock cycle plan and push the surgery back. I know none of these things are going to be a silver bullet. But at the very least, if our next transfer fails I will know I did my best to introduce new treatments