Question 1. What's your take on why this keeps happening? Lining? Aneuploidy? Something else?
A: Most likely aneuploidy. She'd like to see my lining get to at least 7, and there's no way to rule it out for sure, but everything suggests it's an egg issue for these last two CPs, not a lining issue, while the Dec and 2016 CPs were probably lining.
2. Let's talk prednisone again.
A: If I want an immune protocol, CCRM isn't the right clinic. She will put me on low dose prednisone for my next cycle. (I brought a list of six peer reviewed journal articles supporting this. I also acknowledge that I could find just as many that show no result.)
3. Lining was thicker in May. Does that suggest it could improve or give us ideas on what to do to improve it?
A: It could improve. It's most likely that having more days of estrogen exposure due to the long stim was what helped it. As a result, we'll take the following approach: 1 estrace/day vaginally until the dominant follicle hits 14, then increase to 2. We'll keep using the viagra. Estrogen is what makes the lining trilaminar, nothing else can change the pattern, so there's no way to help that.
4. Do my lining issues indicate I need a repeat hysteropscopy?
A: Not yet. We've seen it trilaminar since my last surgery, and we've seen it up to 6.7. I've also been through a lot of "instrumentation", no reason at this time to repeat. We looked at my u/s from trigger day, and there is no clear pattern. When I asked why, she noted that it's probably because things were thicker in some spots than in others. At this point we really just have to hope for the best in future cycles.
5. Ovaries didn't respond until we backed off the estrogen. Thoughts?
A: Largely addressed this with #3. We'll reduce the estrogen and aim to stim for ~12 days - longer than many of my cycles, but shorter than this most recent one.
6. We ordered cetrotide after our August '17 regroup. When would I use it?
A: Only if your LH was rising indicating ovulation. The estrogen seems to be supressing that really well for you, so there's been no need. That might change if we try to stim you for 12 days, so hang on to it.
7. Best guess on our chance of pregnancy if we continue this approach? Where's the tipping point when we should move to IVF, either OE or DE?
A: Impossible to say. She noted that we clearly have fertilization and embryos that reach 12-14 days every time, so she would expect that even if we only retrieved 2-3 eggs, we'd get a blast or two. It's a numbers game as to whether those would be euploid or not. Obviously, changing to donor eggs makes the numbers more likely to fall in our favor. The advantage of IVF is it would allow us to rule out aneuploidy as a problem, and eliminate many of the worries about a late first-tri loss. The disadvantage is that we'd probably only get 2-3 eggs. Also, even euploid blasts don't implant and do miscarry, so IVF would really be diagnostic.
8. If we moved to IVF, is it possible to get a better lining if we don't care about ovulation?
A: Maybe. My OI protocol is their 'poor lining kitchen sink' protocol, so it might give us our best chance. We could try delestrogen injections plus vaginal estrace and vaginal viargra in a mock FET to see what my lining did, and that might get better. Hard to predict. She'd really like to see me at 7 before a FET, and I have gotten to 7 before.
9. If we did IVF, is there any way to improve ovarianresponse?
A: We could do a clomid/FSH cycle if it's IVF and we don't care about lining. That might get us another follicle or two. Still, don't expect more than 2-3 embryos.
10. If we did OE IVF, is there anything we could do to improve egg quality?
A: We could add in HGH. In fact, we could add that now. So, Saizen goes into my current protocol.
11. Do I retake doxy for a future cycle?
A: Yes, unless it's making me really sick.
12. Is a plan of ~3 more OI/TI cycles, followed by a mock FET to test lining, then OE/DE IVF if lining is good enough, reasonable?
A: Yes. Probably wise to test lining before investing in IVF of any sort.
I'm really happy with this. If we throw my current meds, plus prednisone, plus HGH into the mix for 3 attempts and I'm still not pregnant with a baby that can reach the second tri, I'll feel pretty good that we're not going to find the 'gold egg' from my ovaries via IVF, and we can move to DE or DINK. That's a different decision point.
It sounds like you have a really good plan, and best of luck with it. This comment is probably useless given how much research you've done, but what helped me with my lining issues was acupuncture. I was on estrogen for my FET, and my estrogen levels were perfect but my lining stalled for a week at 6.5. The doctors wanted to move forward with the transfer, since I'd had no progress and there was nothing they could do to improve my estrogen. I went to acupuncture twice, and my lining jumped to 8.3 by the next week. The research on acupuncture is really mixed in terms of fertility treatment, but it has been shown to increase blood flow so I think in at least some women it might help with lining issues. Best of luck to you.
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