Saturday, September 7, 2013

Our Pre-IVF Appointment

Yesterday we had our pre-IVF appointment in Hamilton. It went very well and Hubby and I are both much more relaxed about the process. :)

We travelled up (3hrs) on Thursday, had an interesting meal at a restaurant named after a lizard, and stayed in a nearly-brand new motel which was superb. Our appointment was for 11.40am on Friday 6th September so after a breakfast at a kitchen over in East-Hamilton, we had some time to kill.

A walk around the lake sounded like a fine idea, but the wind got up and then it got nasty-bitter, so much so that my ears were aching bad :( So we experimented with the navigation app on Hubby's new phone and drove to the botanic gardens which wasn't so windy-pants.

The appointment itself was very good. We learnt a lot and left feeling like the process is truly underway now.

In the waiting room, our old doctor walked in and although she smiled and said hi, she couldn't really look Hubby in the eye. Awkward! :/ For a moment there I thought there had been some mistake and we would still have to see her.

But our new doc, the head of the clinic Dr S came out and greeted us shortly afterwards. He was very friendly and seemed genuinely happy to meet with us. First up, he mentioned how he was familiar with our file and he confirmed that we had now transferred to his care. The relief I felt at hearing this was quite surprisingly strong and I immediately felt confident about our treatment - for I think the first time ever.

Dr S explained that we would be good candidates for a newer IVF regimen. As he put it, at least there was some silver-lining to having to wait so long! So we will be using a drug called Elonva which is a one-shot injection that replaces 7 daily FSH injections. Personally, I don't mind having to do injections (hey, I do about 8 a day already!) but I like the other benefit of Elonva: the action profile seems to make sense to me. He explained how it has been created by taking the FSH molecule, which has a half life of about a day, and combining it with a segment of the hCG molecule which imparts it's 7 day half. He said the results are equivalent or better to what they are seeing as with patients using the traditional daily injections. Oh yeah, and no down-regulation will be necessary with this protocol which means no menopause which is the most terrific news you can give to a woman, let alone a T1D woman! Yay! :D

We discussed my AMH test (which was 9.35 about a year ago) and Dr S advised that I should do another one that day since it would be funded as part of the cycle. We talked about how it is kind of useful to have such long term (3 years worth) data on my FSH (latest: 5.5), oestradiol and AMH levels.

Since we have good quality sperm frozen already, it all came down to what my body is doing. I must say I was immediately nervous when Dr S said he wanted to re-check the AMH since it was just at the cusp of the "green" level last time, but he didn't expect it to have altered too much, and he explained how it is variable. He wouldn't be worried unless it was 3 or below, and treatment wouldn't change unless it was below 5 or above 20.

We talked about my diabetes and how that is controlled, and this time it it felt like I was really being listened to when I spoke about my diabetes treatment. Because it DOES matter. I told him how I will be going on a pump on September 18th (in fact, my prescription was written last week and I should pick it up from the pharmacy this coming week! Exciting!), and Hubby talked about how I need any IV lines placed as early as possible to avoid my veins collapsing with a hypo in pre-op.

I had prepared a short list of questions with Hubby the night before, and they had pretty much all been answered before I even got to ask them :) The only thing he raised that I wasn't expecting was that both of us would need to do a short course of antibiotics, and that because of my diabetes I would need some antibiotics prior to egg retrieval / transfer (I can't remember which oops).

One thing that we spent a lot of time on was getting an idea of possible scenarios and outcomes. Although we have been given a 40 - 50% chance of IVF working, there are many ways this could play out:

  • IVF stimulation works perfectly first time (best guess for drugs, dosages, and timing)
  • Could result in a positive pregnancy test, which could result in a baby... or not.
  • I could get OHSS (Ovarian Hyper Stimulation Syndrome) which would probably mean the cancellation of the cycle while I recover.
  • Dr S expects us to retrieve about 10 eggs, although this is of course just a guess. Out of that he estimates we may get 1 - 3 usable blastocysts, so maybe one or two to freeze. But maybe none. I really hope we get some to freeze!
  • If I make it through the stims alright, but get OHSS which makes embryo transfer not a good plan, then we could do a "freeze all" cycle, which apparently has very good outcomes and Dr S said that there is some research to suggest that all IVD cycles should be freeze all so that the woman can rest and recover her body for best possible chances.
  • So depending on what the embryologist thinks, we may end up transferring day 3 or day 5. Only day 5 embryos are frozen, and of course there is the chance that they may all need to be frozen if I am in no fit state for a transfer.
  • If this first transfer is unsuccessful, then we can continue and do FETs with the remaining frosties. These are all considered part of our first cycle. If none of these work, then we can apply for a second funded cycle, but there would be a waiting time of between 6 and 12 months for this. Any pregnancy from the first cycle negates the second funded round of treatment. I am not sure if by "pregnancy" they mean "live birth" or just a positive pregnancy test??? Will have to find out, not that it will change much...
We discussed the fact that I would need a high-risk obstetrician, and although I knew this, I asked if we should secure one now or wait until I'm actually pregnant? His opinion was that we didn't need any more pre-conception counselling (although he offered us IVF counselling - which would have been useful, like, 3 years ago maybe!!) and he recommended one out of the two high-risk OBs in our home town. Now I need to find out a) how expensive they are to attend privately, and b) since I am diabetic I will be needed one anyway, so could I choose which one? I wonder...

Dr S wanted to do an internal ultrasound to check my follicles (antral follicle count), so we got to meet our new nurse and even before I'd seen her, I was behind a curtain stripping of my pants lol. I was pleased with myself for wearing cute socks and entirely by accident! We got on well immediately and it was all so much easier and relaxed than with the previous doc and her nurse. So, anyway. No pants, ultrasound, Hubby, nurse and doc in the room with me. Should have been unnerving but I always find any chance to look at my insides just fascinating. I was asking lots of questions and the doc explained it very well, showing that my uterus is looking good with lining and no polyps (which I had been worried about), and then looking at the right ovary which proved hard to find as normal, then the left. All up I had 11 follicles with one showing the corpus luteum - a burst follicle indicating I had probably ovulated the day before on the 5th Sept. Interesting, as this means I will finally be able to work out precisely how long my lutenising phase is. :P

Although I was worried about what the AMH re-test might show (we won't get the answers for another two weeks) Dr S said that the antral follicle count number usually is very closely related to the AMH number, and he expected my AMH re-test to come in anywhere between 8 - 11. So, good, predictable news. In fact, the whole appointment was just all about good news!

After the scan, we went through to the nurse's office to discuss our plan and have our drug training, which although was not scheduled for the day, they decided would be fine to do so we wouldn't have to make another trip up just to be taught how to do a handful of injections. I mean, really. I have done tens of thousands of injections. I am NOT freaked out by needles, only by the actual drugs themselves. Who knows what holy-hell they are going to play on my diabetes?

She gave us our plan, and discussed how it would all occur. We got our drugs in a little green cooler bag, just about the right size for a six-pack, along with a sharps container and enough alcohol wipes to do 36 injections - just a bit overkill. I only have 1 Elonva injection to stimulate egg growth, then about 5 Orgalutran injections to prevent premature ovulation, and other meds will be added later as they work out how my cycle is progressing. The FSH may need to be topped up, and of course there will be a trigger shot at some stage.

I got three scripts for antibiotics, plus blood-draw forms and a serial blood draw card to make things easier but it turns out that I won't have to do any in hometown, and it looks like there will be approx 3 more trips up to Hamilton (1 for scan and blood draw, 1 for egg retrieval, 1 for transfer) I think. Just as well we've found a really good motel. It will be hard getting time off work, because Hubby is just starting in his new position and I have a rigid weekly schedule, but I have given my employer over 1 years heads-up so there can't be any complaints there, I will just have to do a lot of prep work so my job can be covered appropriately. 

Oh yeah, and did I mention that I am turning bionic on September the 18th? More to come on that adventure... :)

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