Warning: Lengthy Post!
Yesterday we had our IVF consultation and met Dr. Loret de Mola (I’ll refer to him as Dr. LdM for short) for the first time. My overall first impression of him is good. He is very serious and knowledgeable and explained things exceedingly well which Joe and I both noticed right away and is a quality that is important to me. He has some things that he wants us to do initially before we start a cycle and I was happy to hear his concerns and how he wants to address them.
First off, a hysteroscopy, using a camera to examine the cervix and the uterus, will be done as soon as my period comes, probably in the next 8-10 days. I will also start a LH surge indicator around the same time in preparation for an endometrial biopsy. Dr. LdM has concerns about why the embryos have not implanted after 3 cycles. The endometrial biopsy will test for Beta-3 Integrin, it’s a protein that is necessary for implantation and is only present in a small window of a cycle, hence why I am doing the LH surge indicator. The biopsy needs to be done within a certain timeframe. It will be sent off to a lab and they will test for the protein. If it’s present, then we’ve ruled out that as an issue, if it’s not then another protocol will be added to my cycle. He is also going to take some specific bloodwork at one of these two appointments. The endo biopsy is something that I asked my previous doctor for and he said he didn’t feel it was necessary.
Once these two procedures are done we can move forward with an IVF cycle. He wants me to do a one-time dose of Lupron Depot which differs from the Lupron that suppresses ovulation. A Lupron Depot is what is used to prevent and diminish endometriosis. I had never been given a real diagnosis from my previous doctor and when I had my lap, he said that he removed some endo, but never indicated what stage I had. Dr. LdM believes that I have Stage II-Mild which is more than what I thought I actually had. I’ve been lucky that it’s never been debilitating for me, but it something that we need to address. The Lupron Depot is good for 30 days and will be taken at the beginning of my cycle while I’m taking BCP.
For the actual IVF cycle he wants to see me on less FSH (the drug that makes the eggs) than my previous fresh which was 200units x day. He said that I respond too well which is a problem; he wants to see me on 150 or 100units and then monitor me every couple days to see how I am responding. He said that once you get to 20+ follicles, their quality reduces significantly. If you recall, last time I had 34 follicles which is too many. He wants to see between 10-15. I have two options for trigger, either a Lupron or an Ovidrel trigger which we will determine when we get closer to starting meds. They will also have me on a steroid, Medrol along with Doxycycline for an antibiotic. I’ve never had a steroid in my protocol before, but it is something that I’ve wanted so I’m happy to add that.
For fertilization he said we do not need ICSI (where they take an individual sperm in a needle and inject it into an egg) this time. Some believe that ICSI is “better”, but in reality, it isn’t necessarily better for everyone. If you don’t have MFI (male factor infertility), then ICSI is not needed. He said that most often they will ICSI your best follicles leaving the lower quality follicles to fertilize on their own. For me this could be part of the problem. I had more embryos fertilize on their own than I did with ICSI. I’m happy that we aren’t doing things that we don’t need. He was happy with Joe’s semen analyses that he’s had. I am definitely the problem, which is tough, but we have known that for a while. I am thrilled that we are doing some different things to try to solve this problem and beat this.
We will not be doing PGS/PGD at this time. He said that it’s very expensive and wouldn’t be a huge benefit to us. He did say that they have new technology recently approved by the FDA about 3 weeks ago called Eeva. Its non-invasive testing that is done to the embryos to aid in picking the best ones. What it basically does is flashes a beam of light into special incubators that the embryos are in every 90 seconds and they can watch the embryos develop much closer and pick the best ones. The only downside is they only have 3 incubators so they can only do this for 3 people at a time. He said we are great candidates for it, but it will depend on availability at the time of our cycle. Please cross your fingers that we will be able to use this technology. You even get a video of your embryos and get to see how they grew over the 3-5 days in the incubators. I think it’s awesome that they are so open to using such a new technology and I’m really hoping that we get to be part of it!
The last thing he asked me is why, if I already have 4 frozen embryos do I not want to use those first. I told him that I refuse to keep doing the same thing over and over. My previous doctor was not open to changing the protocol and did not seem to monitor some of the vital things that Dr. LdM thinks we should be watching. I told him that I was afraid that they would just push transferring 2 embryos on me and that is not something I’m open to at this time. I told him that after 3 failed IVF cycles and no changes to how things were being done that a second opinion and a fresh outlook were necessary, at least in my mind. He said that was fair and that he understood my concerns.
Joe and I are both really happy with Dr. LdM and are excited for what’s to come. I feel a lot better about things and I don’t feel nearly as anxious to get things started as I have been in the past. I’m not wishing my days away, I’m just taking things as they come. I think this 4 month break that we’ve been on has been such a blessing and what we really needed. This is what will hopefully work for me and my situation, everyone is different so I hope that no one takes any offense to anything that I’ve said in this post. Thank you all so much for following along and supporting us on this journey!