Hello, new specialist

Today Andrew and I met with a new specialist in reproductive medicine.  He has been practicing for over 25 years, and he is the founder and medical director of one of the most renowned clinics in the nation.  Lucky for us, this clinic is right here in Colorado, less than 20 miles from our home.  Dr. Schoolcraft has restored some faith and hope for us that we will be able to conceive again.

Through our consult, we learned some significant and disappointing information.  Per his expert opinion, our Reproductive Endocrinologist (our first specialist) failed to administer specific tests prior to our IVF cycle--tests that could help us achieve the best possible outcome.  In addition, it seems that our previous doctor took a step in the IVF cycle that should not have been taken.

Let's see if I can break this down accurately...

In May of 2014, I had an HSG done, which is an xray of the pelvic cavity with dye.  This is done to look at the uterus and fallopian tubes.  At that time, my right fallopian tube was blocked proximally and my left tube was blocked distally.  Given the findings on this xray, along with my history of endometriosis and our failed attempts at trying to conceive, I underwent a laparoscopic procedure in August of 2014.  In that surgery, my Reproductive Endocrinologist was able to clear both fallopian tubes and remove adhesions from endometriosis.  She was certain that we would get pregnant within the next six months.  But, when we didn't, we decided to move forward with IVF.

Our new doctor, Dr. Schoolcraft, is concerned about that left fallopian tube, which was previously blocked distally.  Although it was cleared with the surgery in August 2014, it could have become blocked again by the time we started IVF.  When a tube is blocked distally, any fluid that tries to flow from the uterus through the tube it gets stuck at the end of the tube, and the tube dilates.  When the tube can't hold any more fluid, the fluid has no choice but to exit the tube from where it entered--back down into the uterus.  By this time, the fluid is toxic and could end a pregnancy.  This is one potential reason that the IVF cycle was not successful.  Our Reproductive Endocrinologist should have looked at the fallopian tubes again via xray prior to IVF.

This next one, I know I am going to screw up, but I will try to explain it.  Dr. Schoolcraft recommends that I have a biopsy of my endometrium (in the uterus) to ensure that I have the necessary beta 3 receptors.  Without these receptors, a pregnancy is not likely to be successful.  Another thing that should have been done before IVF, and another potential reason for the failed cycle.

When we started learning more about the IVF process and the embryo transfer, we learned that there are fresh embryos and frozen embryos.  Fresh embryos are what was recommended by our Reproductive Endocrinologist.  This just means that after the eggs were retrieved, they were fertilized and then transferred into my uterus (one on day 5 and one on day 6).  It was explained to us that going through IVF that way doesn't allow my body to resume to its normal state following all of the stimulation medications I was on for IVF.  The stimulation medications were to help my ovaries develop more follicles for egg retrieval.  Estrogen is present with eggs.  So, in a normal cycle where a female has one follicle/egg, her estrogen is around 300 pg/ml.  At IVF, I had 12 follicles with nine eggs, which means that my estrogen level was probably over 2,000 pg/ml.  The problem?  Estrogen is the fuel for endometriosis.  When estrogen is high, endometriosis flares, and the immune system responds by killing off anything that it recognizes as foreign (hmmm...an embryo, maybe?).  This is why Dr. Schoolcraft recommends freezing the embryos, giving the estrogen time to decrease back down to its normal level.  Once that happens, the embryos can be thawed and transferred, reducing the risk of the embryo being attacked by the immune system.  So complicated, right?!

Now, back to my earlier note that we had one embryo transferred on day five and one on day six.  While we were ecstatic to have that second embryo transferred on day six, we now know that it should have never been done.  Dr. Schoolcraft said that is unheard of and potentially put our first embryo in danger.  An embryo that isn't developed normally by day five should never be transferred at a later date because it is clearly not normal.  So, it is possible that this day six transfer disrupted the first good quality embryo or created a toxic environment.

So, we discussed going through a second round of IVF with our new doctor.  He believes that we will be able to get pregnant with my eggs.  We were told by our first doctor that donor eggs would be the next step for us.  But, our new doctor says it is much too premature to even consider.  He has helped other couples, in which the woman has worse ovarian reserve than I do, become pregnant with IVF.  He is optimistic!

Overall, we are so disappointed.  We put a lot of trust and faith (and money!!) into our first specialist.   How could this have happened?  She, too, has been practicing for over 25 years and is well known in the state.  But, we are now with Dr. Schoolcraft, who has come highly recommended by physicians and peers.  While his treatment will be more expensive, we have more faith now.

Our next steps with our new doctor are to get another HSG done (xray of the uterus and fallopian tubes), and let me just say to the ladies reading this, it is a very uncomfortable procedure to go through.  After the first one, I promised myself I would never go through it again, but here I am, getting ready to face the discomfort again.  In addition, our doctor would like to perform a hysteroscopy and the endometrium biopsy.  I will also have to go through quite a bit of lab work.  Once the results from all of these tests come back, Dr. Schoolcraft will be able to determine the protocol for our next IVF cycle.  We can potentially start within the next two months!  We are trying to stay optimistic that we will be able to financially go through this again (and soon!).

 

Patiently waiting...

Although we are emotionally and physically ready to start the second round of IVF, we are not financially there yet.  Those of you that have generously donated to our IVF fund, thank you, thank you, thank you.  All of our donations are sitting in an account, waiting to be put to excellent use--creating a baby!

We are gradually adding to the account ourselves as well.  In addition, we've applied for discounts, grants, and medical financing, but we have repeatedly been denied.  We make too much money for such assistance, yet, we don't make enough money to pay for multiple rounds of IVF, especially in one year.  And, thanks to our "great" state of Colorado, infertility isn't viewed as a medical need, so we have no insurance coverage.

This would be easier on our wallets if we had time to save and spread out the cycles.  But, given my poor reproductive health, having another baby is an urgent matter.  Per my doctor and lab results, I could reach menopause within two years.  Ugh...scary!

In the meantime, we have scheduled an appointment with a different fertility specialist in the area.  We are very happy with our current doctor, but it could be helpful to get a second opinion on my reproductive health and the avenue we take for conception.  This new doctor has been practicing for 30 years, is well known in the state, and has higher-than-average success rates.  The down side---he is much more expensive.  Our appointment is on June 25th, and we will provide an update afterwards.