Thursday, July 31, 2008

Donor Update

I received an email yesterday from the clinic: the donor has 20 antral follicles!! That's 2 more than she had last month. My understanding is that that the more antral follicles (up to 26) the better the IVF outcome--meaning more usable eggs. Does that mean that we're looking at retrieving around 20 eggs? More? Less? Would anyone out there share her experience on antral follicles and retreival? In any case, we're pretty excited about that number.

And yes, I have gained weight since starting this whole process a year ago. I was blaming myself and the wine I've been drinking until my regular OB suggested that the prednisone I'm taking for 10 days to 2 weeks per month (after ovulation, when we were trying on our own) wasn't helping any. I still think I need to be very careful of everything I eat and also how much I exercise so I won't blow up before we actually get pregnant.

And speaking of weight, I've been really surprised at how fat I've thought I was and how apparently, I'm not nearly as fat as I thought. All the donors we've seen are very, very cute and normal looking in their weight. Even our donor, who I'd say is quite "normal" as far as weight goes has a slightly higher BMI than I do. Actually, I'm not sure that means I'm thinner than she is--I am a tall woman with a tiny frame with tiny bones and this donor is normal height and it looks like she has a wonderful bone structure (it's one of the reasons we picked her---she actually has "cheeks" and a "jawline" unlike my husband and me whose horse faces simply fade into our necks).

There's not a lot to feel positive in the DE process, but finding out I'm not as fat as I thought I was---priceless. Well, that and having more children---winning the lottery.

Wednesday, July 30, 2008

Ramping Up The Meds

Well, we've moved on from just lupron to lupron, estrogen patches, heparin and prednisone. One odd thing here is that we're starting the heparin and prednisone now instead of when we start the PIO (i.e., at ovulation/retrieval).

I may have mentioned at some that there is a possibility that I have an auto-immune problem because I've had so many miscarriages since DS and only one of them (that we tested) came back with chromosonal problems. I usually think that the prednisone/heparin combination is just smoke and mirrors, but Hippogriffs just found out that if she hadn't used heparin her whole pg, she would have likely lost one of her twins. She thought it was a bit voodoo medicine, too, so it sort of freaks me out.


DE Daddy and I continue to marvel at the differences in protocol between clinics. Less estrogen patches and more heparin/prednisone early here, more estrogen patches and more heparin/prednisone later there. At our old clinic, the doctor pretty much would have kept me on prednisone and heparin for the whole pregnancy, I think. This clinic says only the first 12 weeks are needed.

It makes us think that this whole IVF/DE/auto-immune thing is more preference than science. The doctors don't run double-blind randomized designs to determine what the best treatment is, they just sort of go with what works. As long as this works with us, we don't really care. I'll give birth with bruises up one side of my watermelon belly and down the other, if that helps us have this baby. I don't really care.

No news on the donor stats yet. I'm dying to see how she is doing.

Sunday, July 20, 2008

ICSI: Good? Bad? WTF??

A NY Times article today suggests that ICSI can lead to birth defects, learning disabilities and sterility in boys. She does not cite any medical journals but says there could be problems.

I searched my academic databases to find a meta-analysis that argues ICSI does not cause more birth defects, a meta analysis that argues that IVF and ICSI have more birth defects than spontaneous conception, and a large study that shows no differences in birth defects for ICSI over IVF.

I trust large studies and meta analyses over single articles because these sorts of studies are able to account for odd blibs in procedures and studies that can cause errors in any one study. I also do not always trust the media because they like to exploit fears in their readers, and this is most definitely a possibility. I've emailed the author, Peggy Orenstein, to ask her to provide her reference for that suggestion and am waiting to hear back.

I know one of her main points is that IVF/DE/ART procedures are a market not a science. Nonetheless, I don't know whether to request that we don't use ICSI because of a potentially incorrect belief in a nominal increase in birth defects at the risk of decreasing our chances of success at having a baby come home with us from the hospital.

Final point: these are traditional IVF and ICSI, not DE IVF or ICSI. People using traditional IVF/ICSI have fertility problems to begin with (egg and/or sperm quality) that DE can take completely out of the equation. I have to keep reminding myself that DE IVF compared to traditional IVF is simply not a fair comparison.

I think I've talked myself back into using ICSI in our cycle.

Tuesday, July 15, 2008

Waiting Mode

We're in waiting mode over here at the DE Mommy household. I start Lupron on Sunday and come off BCPs 5 days after that and estrogen 8 days after that. Really, there's not much going on except starting the medication.

Of course, now I'm not as naive about the medication and I'm concerned that the estrogen patches look fewer in number and change over a greater number of days, but I think I'm on them for a longer period of time. So I guess everything is ok. I assume if it isn't they will let me know.

We continue to stalk the clinic's donor board. Although our current donor remains our favorite, we're still seeing if someone comes up looking exactly like me and absolutely ready to go in 3 weeks. It's not likely, but cognitively, it makes us like our current donor more.

We're also deciding what to do in case we have the exciting outcome of having "extras." Our clinic only fertilizes the first 20 eggs and then they freeze the rest. We have decided to offer these frozen eggs to a friend of ours who is having a hard time starting her family. It's sort of a pay it forward considering how we got here in the first place. And since our friend lives in California and is relatively close to our clinic, we will strongly encourage her to use this clinic to defrost and fertilize the eggs.

I'm still looking forward to posting on disclosure (what I've found in the literature) and the contributions of genetics to behavior (from an academic standpoint). But right now, I'd kind of like to be pregnant while that is happening. I'm not too keen on putting the cart before the horse in figuring out how we'll tell our child(ren) about egg donation before there's even a possibility of children.

Nonetheless, I have been pondering what we know and what we don't know about how genetics are affected in utero. I have a friend who just had her twins from egg donation (HOOORAY!!!!) and we're thinking that one of the twin's nose doesn't look like her husband's, doesn't look like the donor's, and may well look like hers! I keep thinking "wouldn't it be ironic to learn in 30 years time when we have enough surrogate and donor egg babies to learn that certain characteristics such as noses or curly hair come from certain genes being turned on or off or even just favored in utero and not prescribed from the moment of conception?"

We don't know. We just don't know. Until the last 20 years, we've never been able to tease apart the influence of the mother's genes and the influence of the uterus on fetal development. We may find out that there is more of an influence than was expected after some good research.

I am not saying that genes aren't important. But I think we don't yet know how much the womb affects genes in their development. And that may be something that's exciting for DE mommies and freaks the freak out of couples who use gestational surrogates.

Just my rambling to pass the time until I have something really exciting to post about.

Thursday, July 10, 2008

Protocol Differences Part II

I was going to leave this as a comment to my last post, but it was getting too long. And this is my blog, so what the heck.

It occurs to me that clinics don't have a real incentive to have better success rates if women continue to support them. More failures = more cycles = more money for them. That's a cynical view, I know, but ever since I was pg with DS, I am much more cynical about the medical profession. I'd rather think success rates in different DE clinics is due to differences in donor pools, but when their protocols significantly vary from the best (e.g., Crinone vs. PIO), I have my doubts.

Also, DE Daddy's father was a doctor. The protocols are not propietary. So if clinics aren't using the best methods, it's not because they are not available to them.

Of course, after our failed frozen egg cycle, our RE did discuss a learning curve. So changes in protocol do incur a learning curve. Our first clinic had a real set back moving from thawing 3 day old embies to thawing 5 day old embies. But by the time they learned how to do it, their success rate for FETs nearly doubled and approaches the success rate for their fresh cycles.

To be honest, we would have stayed at our first clinic if they had not failed so miserably at the frozen egg cycle. But then we finally understood that you can use any clinic in the country, or the world for that matter, for your IVF or DE cycle. Your home clinic can do all the monitoring and the more successful clinic can do the procedure. All you have to do is get to the clinic in time for the man to make a deposit and the woman be available for the transfer. What's an extra $1000 in plane tickets and hotel rooms when you're talking about a $25,000 procedure?

I think that's the only way we can get all the clinics to step up their success rates.

Tuesday, July 8, 2008

Protocol Starting

My DE coordinator sent me my schedule of meds for this cycle. It's pretty exciting to be moving ahead or at least doing something. Also, I'm not stressing out about this. It may be because I've changed my diet and no longer eat sugar (which can affect freaky out nerves), but also, I just feel intuitively that this is the right thing to do whether or not we actually get pregnant. I'm sure many veterans feel the same way at the beginning of a cycle when they don't know what will happen. But I do feel like we're on the right path.

I have to also admit that sometimes I get surprised when I read about other people's protocols at their clinics. I'm a research academic in the social sciences at a research intensive university. I don't make decisions to do things without thoroughly researching what I am doing. In fact, a friend and I were talking yesterday about how annoying it was to (think we) know more than our doctor does about our own particular fertility issues.

In any case, it worries me that clinics vary so much in their IVF or DE protocols. I'm less concerned about medical protocls (which already, I see differences between the two clinics in the number of estrogen patches they want me to use and when to change them as well as the amount of lupron they want me to use), but more on basic things like regularly scheduling 3 day instead of 5 day embryo transfer. The research solidly shows that 5 day transfers are more likely to be successful. Yet most of the folks I'm following in the blogosphere have clinics who routinely do a 3 day transfer. Both of the clinics I've worked with only do a 3 day transfer when things look really crappy, a sort of Hail Mary pass to your uterus. And they all grow the embryos out past 5 days before they freeze them to get the best ones possible.

This freaks me the freak out. Why are so many clinics not following the "best" practices for successful IVF and DE outcomes? 5 day transfers have double the success rates of 3 day transfers, no matter what the age of the mother. Why do some clinics continue to use 3 day transfers as their default? It also makes me a little angry, too, that other women who want a child just as much as I do are not getting the best chance they can. And I blame the doctors.