We Have a Plan!

Today's consult with CCRM's local office went well. The doctor asked me to sum up what's going on in my own words, but also seemed to be well versed in my medical history. It was clear she had read all the files sent over, as she brought up things I didn't mention. She agreed with the goal of getting a pregnancy that lasts for 9 months, and didn't claim the issues to date were bad luck. While she agreed that my AMH means we should move with some speed, she also reminded me that it's really most relevant to IVF. Since we've gotten pregnant 3 times thus far, she told me, nicely, to stop worrying about it.

Unlike my OB, who said that uterine lining thickness only matters for IVF, Dr. B at CCRM expressed concern about my lining based on the sonohystogram in May. DH asked her to explain and she said that the lining helps to nourish the pregnancy during/around implantation, and therefore is important. Her target is 8mm. She noted that thin lining can occur when you have a short follicular phase. Alas, that isn't an explanation for me, since I typically have a 14-17 day follicular phase, which is normal. Increasing estrogen should help build the lining, and we know from my last labs that my estradiol is low.

Given all of this, her recommendation was twofold. First, proceed with additional testing of other potential factors to explain the losses. I'll cover the testing in a later post. Second, unless that testing identifies a cause, we'll treat the lining issue. Doing that will entail FSH injections and vaginal estrace to build lining, along with monitoring and timed intercourse. Post ovulation, I'll use progesterone for luteal phase support, although she doesn't think there was any issue with my progesterone level of 14 during the last chemical pregnancy. Testing is to be completed this cycle, monitoring and medication next cycle.

I also asked about lifestyle changes I could make. I was told no caffeine, no alcohol, keep eating fruits and veggies, keep exercising. Easy peasy - all of that I already do. I asked about DHEA due to my low AMH and she said she'd just read a meta analysis that found DHEA had no impact on DOR other than causing acne. She's taken it off her recommendations list. Note to self: she told me she'd give me her supplements list, but she didn't, so I need to follow up.

Overall I feel really good about this as an approach to see if we can address the miscarriages. I have a few follow up questions I'll need to ask the nurses, that didn't arise until after I looked at the written instructions, but I don't think that will be a huge problem.