Yesterday Casey and I met with the RE to go over our protocol for IVF and ask questions about our IVF calendar and the procedure itself. I am terrified to start this process. What if it doesn't work? Their is no other "next step." If this doesn't work, I know that I will never have a biological child. I am really comfortable with the idea of adoption, but that doesn't change my fear about all of this. But, I can't be afraid that it will fail. I just need to move forward with this.
Typically, an IVF cycle is given a 65% chance of success, however given my AMH levels we were told our odds are in the 30-45% range. However, our RE thinks that given my response rate to medications so far, it is possible that while my quantity is low my quality is still good (with age, both quantity and quality decline but little is known about quality in young patients with low AMH). If we get at least 8 mature eggs, the doctor thinks our chances will go up, maybe even as high as 65%. Of course, he could be wrong and I could have quantity and quality issues, which would increase the number of "dud" or empty follicles they might retrieve. Quality issues can result in many follicles not containing an egg. We want lots of follicles all with eggs during stimulation! I've been told that some women (those who get lots of follicles) get so large during IVF that they have to buy maternity pants to combat the bloat. Luckily for me, its summer and I have lots of flowy sundresses!
As far as embryo transfer, our REs office has a strict policy that in women under 35, they implant a maximum of three embryos and typically only two embryos. With two embryos, the twinning rate is 20%. That seems like an acceptable outcome to me (I mean really, I'm all for three embryos, but that won't be decided until we see the embryo quality and retrieval and ICSI). We talked a bit about this during our consultation yesterday, but the main take-away seemed to be that it is out of our control and will be decided after retrieval.
I have posted our IVF Calendar for all to see and plan to keep it updated as things change (you can also access it using the IVF Calendar Tab on the ribbon above). And they will change. This whole calendar is subject to my bodies response rate.
On April 26th I started taking oral contraceptives to "turn my body off" and an antibiotic (I'm not sure the purpose of it - but I am dutifully taking it). I also increased my dosage of folic acid (1,600 mg in addition to what it is in my prenatal) and began taking Vitamin D to prepare my body for everything to come. The wonderful nurse at my clinic recommended I also take a probiotic supplement because all of these medications can cause upset stomachs and that at least gives my digestive system a bit of a boost.
Tomorrow I go into the office for a Fluid Test and Trial Embryo Transfer. This allows the RE to make a "roadmap' of my uterus so there are no surprises in June when he attempts the real embryo transfer.
Next Thursday I start Lupron Injections, which RE explained will help ensure that all of my follicles grow together at the same rate.
We will start stimulation on April 22 and from then on I will have frequent appointments for sonograms and labs so the RE can monitor my progress and adjust medication doses as necessary. He is hoping to see AT LEAST 8 mature eggs and won't go forward with the IVF cycle unless he sees 6 mature eggs. (If I have less than 6, it will be converted to an IUI cycle). The constant monitoring through blood work and sonograms will help ensure I hit this "magic number" without over-stimulation. (Over-stimulation is a condition that affects roughly 10% of IVF cycles where a patient gets too many eggs to continue. Given my AMH numbers, I am not as risk for this, but it is something to be aware of. I am more at risk of under-stimulation which occurs when a woman doesn't get enough eggs to complete the cycle.) During this time, I was told I should keep my schedule very flexible and very open as the timing of the labs and sonograms during the day will be controlled by my bodies response and not up for negotiation.
Our retrieval date is tentatively scheduled for Saturday, June 2 with embryo transfer a few days later on June 5.