Finally had my appointment!!

1983Lindsey2 · June 2015

So, I am all set to go forward with IVF for trying for baby #2! I am going to a different clinic than I did for #1 and they only do IVF's every other month and July is full so I have to wait for September for an egg retrieval. I have to redo all my blood work and do a SHG. I will start the birth control pills in August. The doctor said that assuming my AFC and my tests are the same as they were two years ago when I did fertility treatments, he wants to do an antagonist protocol due to high AFC. I do not have any hormone issues, or have never in the past, but do have a high AFC. I was concerned about understimming like I did when I tried IUI converted to IVF but then back to IUI due to understimming, for my 6th fertility cycle with #1. It was basically an antagonist protocol because I was on BCP's for a cyst for a month prior and then started up follitism for my IUI. Halfway through I had 20 follicles that were 10mm and they suggested converting ti IVF and upping my meds by a lot, which I did, and I didn't make enough so we converted back to IUI with 4 mature, and 3 maybe mature. This resulted in my healthy singleton. He said he will just start me on higher meds and work down, as opposed to starting lower like before and working up. He feels that we will be successful with creating 20-30 eggs ideally if I have the same AFC as I did 2 years ago. We will find out when we do the baseline and redo the blood work. We are going to do a freeze all so we can go all out with egg production. This clinic has the best rates of success in the state and are using new technology that I had never even heard of. They will be doing some sperm sample testing that they didn't offer at my big clinic I went to with #1 and that will better tell if we need ICSI. The first clinic said we would need it due to low morphology, but he said that this new test is much better and can tell a lot more, and they only do ICSI 40% of the time compared to 60% at my old clinic. Apparently new studies are showing better implantation rates if you do not use ICSI. I had never heard this. The sperm test is called acrosome reaction tests. I am surprised that my old clinic, the biggest in the area, didn't offer it. Anyhow, I am a little bummed that I cannot get into the July cycle, but September will be here soon enough and I can start birth control in August. That just gives me more time to lose the last 10-15 lbs I wanted to lose and be a very healthy BMI.

CTinNV · June 2015

Congratulations on a great consultation! I'm especially interested in the new technology and tests available. It's fascinating how things progress, even in a short time.

My DH's sperm is great, but we did ICSI because we are doing PGD-AS testing. The specialty lab, Natera, strongly prefers fertilization via ICSI (they say that it eliminates the chance of multiple sperm contributing genetic material to the embryos) but doesn't require it.

I am very interested to hear what you learned about the possible effect on implantation rate with ICSI. It's all such a changing science, but I absolutely hope great things for you this September!

fuzzbumble · June 2015

Yay! Glad you have a plan!

efhoping2010 · June 2015

YAY! You have been waiting so long for that consult, glad you are moving forward

Your comment about ICSI is interesting.

My clinic requires ICSI for any type of genetic testing for embryos/blasts.

Wishing you well on testing!

1983Lindsey2 · June 2015

@CTinNV and @efhoping2010 we are doing PGD testing as well. The company they use is Reprogenetics.

As far as the lower birth rate, I put the link to the site below. The doctor didn't go into a lot of detail about the implantation rate or live birth rate, just said that they like to use this test first and see if ICSI is really necessary because studies have shown that the rate is better when you don't use ICSI if you don't have to. Apparently this new sperm test can tell a lot more about the sperm, like if their cone head falls off as it is supposed to, etc. And if all that looks good, he said that we shouldn't do it, even with low morphology, because it has been shown to lower success rates. I was very surprised as we had always been told at our old clinic we would need ICSI. The new clinic I am going to has this link about it and the more advanced sperm test to see if it is actually necessary for us. https://www.pomafertility.com/fertility-services/icsi/ The graph at the bottom shows something about a 5-25% decrease in live birth rate when using ICSI when not indicated (It says that below the title of the graph at the bottom of the section ICSI fertilization and success rates). Our doctor said their ICSI rate is closer to 40%, as opposed to most clinics who are around 60% (Like our old clinic). The doctor at the new clinic used to be the best doctor at my old bigger clinic, but he left and started his own practice and is about 6k less expensive and has better success rates, (66% after a transfer at the new clinic vs. 43% at the old clinic for my age group). This is my old clinics data https://seattlefertility.com/success-rates vs my new clinics data https://www.pomafertility.com/ivf-success-rates/. We may end up needing ICSI, but I figure doing the semen test to make sure cannot hurt.

Here is the link about the more advanced sperm test: https://www.pomafertility.com/patients/infertility/acrosome-reaction-test-ar/

NB817 · June 2015

YAY!!!! Glad you have your plan!! And this new sperm testing is VERY interesting!!

Frenchteachermama · June 2015

Great update!

STL34 · June 2015

Good luck!

ellebelle2384 · June 2015

Yay for a great consult! Sorry for the wait but everything else sounds great. And that is really interesting about ICSI. My RE's lab also uses Reprogenetics and we are doing PGS but were told that we had to do ICSI for that. (Although it ended up not mattering for us because DH's morphology came back at 2% so we would have done ICSI any way for that).

Flamingemu · June 2015

Sounds like a great consultation. I hope the summer passes quickly for you.

1983Lindsey2 · June 2015

@ellebelle2384 we might very well end up needing it too because H also has 2% morphology like your DH, or he did two years ago anyway. It will be interesting what this test shows.

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Finally had my appointment!!

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