It was a good appointment. Since we've been through so much already, he had a lot of data and history to look at! First of all, I really liked and appreciated his honesty. He, like Dr. Hope, talked about donor being a very viable option and one that would greatly increase our chances. He also realized that, if we decided to cycle, we are probably looking at one more chance before going to donor. I just really appreciated that he didn't try to tell us that there are multiple things we should try and we should do them there blah blah blah.
But, he did say that they have a protocol that he does think can be successful. They have seen women in exactly my position - normal FSH, low ovarian reserve, several failed IVF's - who have had success. He thinks they can get to a minimum of 4-5 eggs, but is not counting out 7 or 8. But, what's really different is that he is looking at a two-pronged approach - more eggs AND increased embryo quality.
The protocol is called estrogen priming. I'll write more about it another day, but, basically, it involves using estrogen and ganirelix before the cycle begins to try to get more follicles, and, therefore, hopefully, more eggs. For simulation, he recommends 450 of Follistim PLUS 150 Menopur. I've always done the 450 Follistim, so, this adds even more drug to the mix! And, he said that this is a long, slow protocol. That's going to be a lot of needles!
As for improving quality, he recommends a process called co-culture. Basically, they do an endometrial biopsy, take some of your lining, and then, when they have fertilized embryos, rather than putting them just in a dish to develop, they lay them on this blanket of your lining. I'll write more about this after I do some reseach. It makes perfect sense to me - put the embryos in an environment closest to in the uterus and they will be happier than in a plastic dish. Their studies have shown it to improve embryo quality (mine have all had 20-30% fragmentation). In fact, their patients who have the greatest success with it are 38 and have 3.1 failed IVF's. OK, I'll be 39 on Monday, but, still, that's pretty darn close to describing me!!
Finally, he knows I've had 2 saline sonograms and the results of those were fine, but, given that I've now had 2 pregnancy losses, he wants to look a little closer and just make sure there's nothing else going on in my uterus that might be impeding a successful pregnancy (small fibroids, polyps, scar tissue - things that can't be seen in a saline sonogram). So, I'm scheduled for a hysteroscopy at the end of this month.
All in all, I'm encouraged! Of course, I would have loved to hear that he thinks he can get 15 eggs, but, I knew that wouldn't be the case and, frankly, I'd have been very suspect if he had said that. I think he's being very realistic - he thinks this new protocol can really work for me, as it has for many other women in my situation - but he was also very open about if we had to make the decision to convert to IUI he would do it and not take us to retrieval.
Basically, in his words, if this protocol doesn't work for me, work being defined as getting a decent number of eggs/embryos, he doesn't think anything will work and would then advise us to move to donor eggs, although he does really believe this can be successful.
So, some hope. I have a lot to take in and I'm sure I'll have a more "feelings-based" post coming soon, after this more clinical one. I'm off to research!