RE update

March 21, 2008

Hi again!

So, the meeting yesterday with Dr. No-Nonsense went very well, as did G’s repeat SA–his numbers, while still low, were better this time. Last time his concentration was 1.5 million per ml, and this time it was 6 million per ml. I’m not sure, yet, what his total volume was (“normal” volume is at least 2 ml, and last time G’s volume was twice that, at 4 ml), but assuming it was at least 2 ml, that makes his total count at least 12 million, more than double last time’s total count. Yay! Dr. No-Nonsense attributes this to the longer abstinence time–five days instead of three–before the second test. She suggested that when we do the actual IVF cycle we should shoot for that, so his count will be as high as possible going in.

Dr. N-N also said ICSI, in which the best and brightest sperm are hand-selected and injected into the eggs, will be a definite for us. She explained the whole IVF process: two weeks of Lupron to suppress the normal cycle, eight to ten days of Gonadotropins to stimulate egg production, and then egg retrieval, fertilization via ICSI, and then transfer back into my uterus after either three days or five days, in hopes that one or two of the fertilized eggs will implant. She said in someone my age they are likely only to transfer two fertilized eggs, which would put twins risk at 25%. I thought, but didn’t say, that I see that number as a “chance,” not a “risk,” as I still sort of would like to have twins. I know I’m probably being naive about that, though.

I did ask about day-3 versus day-5 transfer, and she said they have good results with both; pregnancy rates for day-5 are somewhat higher, but that I shouldn’t stress out if we ended up doing day-3. We also talked, briefly, about cryopreservation of embryos–she said the clinic only freezes embryos if they are of extremely good quality, but that if we ended up with even a couple of extra that met these quality standards, she highly recommended that we grant permission to the clinic to freeze them. FET cycles cost less, are less invasive, and because quality is so important to the clinic, their pregnancy rates on FETs are almost as high as those on new IVF cycles. So that could be good news if we want a second child a couple of years down the road.

As far as downsides, we talked a bit about OHSS, which she said she doubted would be an issue for me because I don’t have PCOS and I do ovulate regularly, so I have average rather than unusually large egg reserves. But she said this was still a slim possibility, and to be aware of it as a reason for cycle cancellation. We also talked about the reverse, under-responding, and why we might have to cancel a cycle as a result of that–she also said she suspected this would not be an issue, because of my young age, but we should be aware sometimes happens.¬†Basically, she first let us know some of the things that could go wrong, before saying that she actually thought our prognosis very good. Why? Well, I’m young, my eggs are young, and G has at least some good sperm to work with. She actually said that she is “optimistic,” which has me pretty excited!

Now G has to make an appointment with a urologist, because she said that while there are a lot of potentially unworkable genetic reasons for low sperm count, there are also short-term fixable things, like hypothyroidism, and it might make sense to hold off on IVF if his issue is something like that. Honestly, I don’t know what that means in terms of our timetable; the urologist that Dr. N-N recommended happens to be on vacation this week, so I’m not sure when we’ll hear from his office on getting an appointment, and I’m not sure what G’s diagnosis, ultimately, will be. Still, the impression I got was that we could start a cycle as soon as we wanted after taking the IVF class next week. My only concern with going ahead before having the urologist weigh in is that if G’s sperm count issue is caused by something treatable, and Aetna got wind of it, there might be some question as to whether IVF should be covered for us or not. I definitely don’t want to start down this expensive road, only to find out that my insurance isn’t covering us after all!

So we’ll see. Either way, though, I’m pretty psyched about our ultimate prognosis being good. There *may* just be a pregnancy and a baby at the end of this for us after all. Woot!

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