Results, Set up and Schedule- Getting ready for IVF2 (with IMSI and EEVA) July 2013

I have had numerous tests undertaken at my new clinic which I listed out in an earlier blog post. I attended a consultation in June with my husband to discuss the results. The outcome of these was as follows:

For husband-

Sperm DNA fragmentation was normal at 5%. Motility now at normal range for the first time. Morphology ok. Count at an all time high of 5 million, still very low but vastly better than before and over twice what it was when we did ICSI last year. He was feeling quite good after this. Endocrinology and karyotyping tests had been carried out in our previous clinic and the new clinic did not require them to be repeated.

For me-

Karyotyping- normal female karyotype

Thrombophilia/Blood clotting- no issues

Chlamydia- negative

Fasting insulin/glucose- normal, in fact low

Chicago Bloods (Immunes tests)- mostly normal but slight elevation on one (CD56) which will be treated with intralipids during my cycle, with possibly steroids added also.

Anti-Thyroid Antibodies- the presence of these was the main finding.

I tested postive for the presence of both anti-TG (9.29 IU/mL on a scale of 0.01-4.11) and more particularly anti-TPO antibodies (71.20 IU/mL on a scale of 0.01-5.61). I don’t fully understand the significance of these but it seems they can have an impact on fertility if unchecked and on a person’s likelihood of developing a thyroid disorder if they don’t have one already. My TSH (thyroid stimulating hormone) had come back as 3 in the GP’s tests which is normal in their book but the clinic prefer to see it between 1 and 2 for fertility purposes. My Free T4 was just barely in normal range, erring on the low side.

The clinic explained that I have a sub-optimal thyroid function for fertility with a tendency towards having a slightly underactive thyroid. The presence of the anti thyroid antibodies means that when my thyroid is required to work harder, for example in pregnancy, the anti-thyroid antibodies attack it. It seems the antibodies cannot be eliminated but if the TSH is kept low, they will be quiet. Accordingly I was placed on a drug called Eltroxin (levothyroxine sodium) at 50 mcg daily. I had a repeat test of TSH and Free T4 at the GP a couple of weeks later and the TSH is now down to 1.9 and the Free T4 has risen a little more so hopefully that will help.

The consultant also put me on Metformin which is actually a diabetes drug often given to girls with PCOS. I don’t have PCOS (or diabetes) but the consultant thinks I may have slight polycystic tendencies due to a high amh for my age (was 34.87 pmol at just before age 40 last year) and retrieving 17 eggs last year. Perhaps he is aiming for less but better eggs and this is part of that process. I am not really enjoying this drug as it makes me feel a bit queasy sometimes though it helps if I take it with food. I am currently on 3 x 500mg daily and will soon switch to 850mg twice daily.

I received a cycle outline from the clinic with a list of dates on when to stop/start drugs and prompts to schedule scans, intralipid infusions etc. A provisional date of 2nd September was posted for egg retrieval with a 5 day transfer recommended with IMSI and EEVA. The main determining factor was when I could get a hysteroscopy scheduled which the consultant arranged to be done at an external private maternity hospital rather than within the clinic- perhaps because it was my first one. As the gynaecologist I was now to see was on holiday I had a little wait but the initial consultation was scheduled for Friday 26th July and the hysteroscopy for 2nd August. I also had to schedule an endometrial scratch at a certain point. I had hoped to lump this in with the hysteroscopy and be sedated but as the clinic prefer to do the scratch themselves, I will have to go there and experience it in full consciousness. I have had two of these scratches already in my previous clinic and found them very painful, if short. It has been scheduled for August 8th.

At my previous clinic I had to collect medications in the attached hospital pharmacy. However as this new clinic does not have a hospital attached, my script was faxed to one of the designated pharmacies of my choosing. I just ring them 2 days in advance of when I want to collect them.

I am now scheduled to start down regulation on 10th August. Unlike my previous clinic, I have been put on the pill as part of my down regulation, so it will be a slightly different experience this time round even though the core down regulation and stimulation drugs are the same [Suprecur nasal spray (buserelin) and Puregon (Follitropin beta)]

I had a little trouble initially with the schedule as we have been designated for IMSI (Intracytoplasmic Morphologically-Selected Sperm Injection) and the clinic only do one IMSI per day- it’s an extremely magnified version of ICSI- the difference between 500 and 5000 times magnification I believe. It is designed for couples with severe male factor issues (who may not have had luck with ICSI). We also had to get scheduled for EEVA (Early Embryo Viability Assessment) which is a time lapse video system to monitor embryo development in hopes of choosing the one(s) most likely to have potential to develop into a baby. I guess with our aging eggs and problem sperm we need all the help we can get. It doesn’t come cheap though. That overdue house painting job might have to be put off another while yet. A house move is currently out of the question as my bank balance dwindles rapidly….

Whatever happens, I want us to feel we have tried everything and I think we are certainly getting there, if not yet in outcome, then certainly in effort! I realise as the clock ticks ever more loudly that we are hoping for miracles.

I just don’t want to have regrets that we did not try whatever was available to us. I really hope that somewhere in all of this will be the key to unlock the door to the realisation of our dream of a child. Part of me is excited and hopeful at our new start in a new place with a new regime but part of me is also completely and utterly terrified.

I guess the well known phrase ‘Feel the Fear and do it anyway’ really applies now! I’ll just go and grab my parachute…

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