Wednesday, 4 January 2012

This'll Take A Second

I told you, just before Christmas, that my Doctor was brilliant. I didn't tell you the whole story.

The day after my appointment – completely out of the blue, she did the unheard of. She called me, apropos of nothing, to say that she’d been having another look at my notes and decided that next time they’d split the eggs retrieved and let half fertilise normally and use ICSI (manually injecting a sperm into the egg) for the other half. This was because my fertilisation rates for round one and three were quite as high as they’d like (round one, 12 out of 20 fertilised; round two I had a brilliant 14 out of 18 and round three a very disappointing eight out of 18).

No one has ever been so wonderfully proactive on my behalf. But there remained a lingering doubt. This clinic has had three opportunities to impregnate me and failed on each occasion, I wondered whether it was time to move on regardless.

So in December I furtively booked another appointment with a specialist who seems to be the 'go-to' guy for Recurrent Implantation Failure (my current diagnosis - unexplained infertility was getting so passé). This dude tests everything and tries almost anything. So I wanted to know what he would recommend for us.

Luckily I had been warned to do my homework first, and cautioned that his manner didn’t extend to small talk. I had barely sat down in the chair when he asked me why I was there. I didn’t feel “Doh! Why do you think? Dipstick” was an appropriate answer, so started to outline my infertility history, and then the avalanche of questions began.

“What dose of Clexane did you take?”
“How thick was your womb lining on your first and second attempt?”
“How many eggs did they retrieve?”

These questions I felt pretty confident answering but he pretty soon pushed beyond my knowledge:

“What type of growth hormone did you take?” Is there more than one?
“Why did they put you on the long protocol?” Umm... I didn’t think to ask.

I was expected to have the answer to every question at my fingertips and to be fair I literally did because I had lugged with me all 166 pages of my health records, but try leafing through that when you are asked what drugs dosage you were on for IVF number two and them immediately after being questioned on whether you had a specific Chlamydia test in 2009.

It wasn’t a bad experience at all, and he was on the ball scribbling notes and double checking things. But I really felt the pressure and thought longingly of my original clinic who would, in theory, know the answers to these questions because they did the treatment. (Although to be fair I have had to remind my original clinic of a few salient points when they’ve misread/ misunderstood my notes in the past).

This doctor had quite a strong accent so when he began to tell us what he’d recommend and why, I felt pretty confident that I got about half of what he said. The husband meanwhile sat there nodding sagely every so often but he clearly had no idea what was being suggested. I saw him out of the corner of my eye looking bewildered but I daren’t catch his eye in case I got the giggles.

The Doctor wanted to do the following:

Womb lining tests and clear out. My clinic is also planning a complete womb scrape before the next round. So that covers that.

Chromosome testing. We sent off out bloods with our other clinic before Christmas for this and await the results as I type.

The Thyroid test he suggested was also done before Christmas. I got the result yesterday and my thyroid function is quite normal, so that can be crossed off the list.

The big ones, and ones he is famous for, are the immunology tests. These were quite complex; he rattled off a number of tests faster than I could write, and when I asked the receptionist – at the end of the session – to go through them with me she gave me the lab names (FGA 4, FGA 6) which meant even less. Eventually I managed to get them to email me a list of the tests with names that any normal person would understand, you know things like Natural Killer cells and Leukocyte Antibody detection.

What you don’t know what they are?

Losers.

The tests were:
Natural killer cells
TH1/TH2 cytokine ratio
Leukocyte Antibody detection (for both of us)
HLA Antibody DQ alpha Antigens (again we'd both have that)

Ok so I had help from the Fertility Friends encyclopedia of immunology telling me the what the tests were for and what the treatment options are. And frankly this post has gone on long enough already so if you want to know the details I urge you to go over and read - but be warned it is complex and mind blowing.

Suffice to say there was a lot to look through. Most of the tests center round whether the cells in my uterus or antibodies I produce are attacking any embryo's that have the audacity to try and implant.

Adding up the cost of just these tests came to over £1,500.

Ouchy.

However, the majority of the treatment suggestions are Intralipids.

Intralipids.

Intra - bloody - lipids.

My clinic has already said I can do this next time with them anyway, for a fee of just under £300.

So guess what my plan is?

Stay with my current clinic and make sure I get the do get the Intralipid treatment this time, but forget the actual tests.

However, I am really glad I got a second opinion. It has given me a lot to think about and much more confidence in my original clinic's plans.



12 comments:

  1. Smart thinking there - when you get the same answers with the second opinion, you feel better about the whole affair. It sounds like a good plan.

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  2. It's all sounding good to me - they are doing what the 'superdoc' would do , just without the tests. Which if any came back with a result, would be treated with intralipids. So I'm all for saving the pennies and sticking with where you are!

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  3. Oh good, I'm so glad you did this so you don't have to be wondering "what if..." Sounds like your current clinic is the way to go - I love how proactive your doctor is being, that is amazing. I am really rooting for you this next time - let's hope the intralipids makes the difference and gets you pregnant!

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  4. we did a 50/50 fertilization too - 50% natural and 50% ICSI - all mature eggs fertilized :) I'm hoping this cycle is the one for you and the Intralipids do the trick!

    Can you ask your clinic to do the Immunology tests? - I asked my RE and he ran them for us to rule that out.

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  5. Ooh, so glad you got a second opinion! That immunology stuff is tricky! I belong to a reproductive immunology group on yahoo and those tests names (results, and treatments) come up all the time. There are only a couple of labs in the states that will run them, and about the same number of docs that will actually treat based on the results. The intralipids sound like a great idea! You are so lucky you can get them so cheap! I believe it's significantly more expensive in the states. Oh, and be advised, it's not just a one time deal with the intralipids (from what I hear on the immunology boards)...the ladies get their levels tested before a cycle, during a cycle, after a BFP then every month (maybe) once they are pregnant and the intralipids treatment may be necessary every several weeks during a pregnancy to keep the NK cells (among others) in line. It works for A LOT of ladies!! I hope it works for you too!!! That would be most excellent! Rooting you on Liz!!!

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  6. I interviewed this company once, 'Research Instruments' based in Cornwall, for an article. I was gob smacked by the amazing stuff they can do. World leaders in IVF lab instruments and ICSI technology and making instruments and teeny tiny needles etc. for putting sperms into eggs. http://www.research-instruments.com/static/products.
    Thought you'd enjoy all the mechanical processes alongside the medical tests as a distraction ;-)
    Good luck!

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  7. Good for you. I have to say that immunology testing just pissed me off. I did test positive for elevated natural killer cells and had intralipids on my last round of IVF.

    However, what pissed me off was that the treatment was SIGNIFICANTLY less expensive than the tests. It made me wonder, why don't they just do intralipids proactively as a preventative measure and skip the super expensive tests (particularly for someone with multiple failed ivfs under their belt)?

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  8. Sounds like a good plan. I have no tolerance for doctors I can't understand, I don't need small talk but please speak good English.

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  9. That is awesome you got a second opinion and learned what all the options are. Sounds like you have an awesome plan!

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  10. Sandy in Florida6 January 2012 at 20:32

    My - head - is - swimming.... So much information. You're doing great, keep it up.

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  11. Sounds just like what I went through after getting my second opinion! Except that once my RE found out I was thinking of switching doctors (he practically begged me to stay) and lured me in with discounts, promises of more personalized care and about $700 of free meds! Let's hope that all adds up to a take home baby this time!!!

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  12. I think your getting a second opinion - even if you don't go with it - is a very smart idea. And the solution to everything, the intralipids, must have been music to your ears. Liz, you're really going to have so many bases covered (including ICSI'ing half, which I think is an excellent idea and can circumvent a number of issues right there...unless they have to, you know, extract the swimmers from your husband's family jewels as they were supposed to do with mine...in which case: ouchie:).

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