Showing posts with label consult. Show all posts
Showing posts with label consult. Show all posts

Tuesday, June 17, 2014

Phone Consult & Short Vacation

First off, I have to apologize for being MIA for a couple of weeks.  If you have been waiting for me to update here, I'm sorry it took me so long.

On 6/4, I had my post transfer phone consult with Dr. Keenan.  He was genuinely sorry and disappointed that our transfer didn't work out.  He said everyone at the clinic were shocked and disappointed that I was not pregnant.  He said there was no good reason why I did not get pregnant.  My lining was good.  The transfer went well.  The embryos were of good quality.  I had an endometrial biopsy done prior to my transfer, and that should have increased my chances.  He doesn't think it is an issue with the embryos since we had embryos from 3 different donor families for all three of my transfers, and each family has had successful pregnancies.

He suspects that I may have implantation issues.  I asked him what that means and he said there is something in the uterus that is not favorable for implantation, but it may be impossible to really know what it is.   He said there are not much research done on implantation issues in humans (since it would threaten a pregnancy).  I asked him about additional testing for issues such as autoimmune issues, as suggested by others.  He said there is no evidence of autoimmune issues causing EARLY pregnancy losses like a chemical pregnancy as in my case.

I asked about the 3 attempt per pregnancy policy at NEDC and if he would make an exception.  He said most women should get pregnant by their third try.  I can't remember his actual words, but it was pretty much no.  He did however bring up the topic of special needs embryos.  He said there is possibly a chance we could try again with special needs embryos, though he was not comfortable with it.  These are embryos that may have a higher risk of medical conditions and is usually overlooked by adoptive families, such as embryos where siblings have been born with a heart condition or downs syndrome, or a parent is HIV positive, etc.  A transfer wish these embryos would be treated the same as other transfers, meaning I would still need a current home study.   He said if that is something Babe and I are interested in, then he will have Angie, the coordinator contact us.  That afternoon itself, Angie emailed me that Dr. Keenan had approved us to do another transfer with special needs embryos and wanted to know if we wanted to see the profiles.  I told her we had not decided and would like her know when/if we were ready to see those profiles.

So, at this point, we don't really know what our next steps are.  We could do another round at NEDC with special needs embryos but I am not sure if I am comfortable with that at this point in time.  We could try another agency or clinic that does embryo adoption or embryo donation, but we would want to make sure if there are any issues that we can rule out that can affect implantation, such as autoimmune issues.  Or we could focus on going back on the route of traditional adoption.  We are currently in a holding pattern as to our next steps.

Instead of making a decision, Babe decided that I needed a break from all this and sent me on a short vacation to Florida.  He would have come with me but he does not have much vacations days.  I went to visit a friend from high school, one I have not seen since I was 15!  It was fun catching up, and it was nice to be able to chat with her about our journey.  She too had gone through infertility, had a couple  of miscarriages and now has a 5-year old son.  We went on a glass bottom boat ride in Key Largo, toured the Everglades on an airboat, checked out alligators, held a baby alligator in my hands, ate some fantastic key lime pies, and checked out the (in)famous South Beach of Miami.  And that is the reason for my delayed update here on my blog.

Checking out fish and corals on the glass bottom boat

View from the back of the boat

Some of the homes and boat in Key Largo

Our neighboring airboat hunting for alligators

The (in)famous South Beach of Miami

Sunday, February 9, 2014

Post Transfer Consult

This last few days has been pretty tough.  To add insult to injury, the night of my 3rd beta, my nose started running, and I have been down with a cold.

Thank you for the many kind comments here and from those on FB as well as texts from friends.  I've had a ton on thoughts running through my head, trying to process this and next steps.  But that will have to wait for a later post.

On Thursday, I had my post transfer consult with Dr. Keenan.  He actually called me earlier than our scheduled appointment time because he had some free time.  Since I was available, I spoke with him then.  In the end, he ran out of time to answer all my questions. 

This phone consult wasn't that much different from my first one from my November transfer.
  • Though not as great as my last transfer, embryos were good at 3AA, 2AB and 2BC (though 2BC was not expected to survive).  The embryos were not an issue.
  • The transfer went fine without any problems and my lining was good.
  • There was nothing after the transfer that would have cause this not to work.  I wasn't sick and was pretty relaxed.  
  • There was no reason why this transfer wouldn't have worked again.  
  • There is no reason medically why we can't try again.  It would be up to Babe and I if we are emotionally ready or want to try again. 
  • I asked about his thoughts about how my first beta was so high and it dropping after that, and he didn't know why that would happen either.
  • I said, based on my research, though no one really know for sure why it happens, chemical pregnancies are usually due to abnormalities in the chromosomes of the developing embryos.  I asked him if he thought this was true in our case since we have had embryos from two different set of donors so far.  He said it is usually true, but we can never be sure since they cannot test the embryos for abnormalities at transfer time.
  • I also asked for clarification about the quality of the embryo at transfer time (4AA, 6AA, etc), is that any way tied to abnormalities in the chromosomes of the embryo, and he said no.  He cannot tell if there are any abnormalities in the chromosomes in the embryos unless they were specifically tested for that.
  • I asked if for our next transfer, would we still only transfer 2 or would he consider 3 since it would be our last try and also I am over 40.  He said he would not transfer 3 unless they don't think a third one would not survive (like the last transfer in January).
  • I also asked about what the percentage is of women that have gone through a third transfer at NEDC and is still not successful.  He said he didn't have a number that he could provide, but it was very low.  I'm not really sure what I expected from him with this question.  I guess I was just curious... as I seem to alway seem to be one of those in the statistics.
He suggested that I do an endometrial biopsy before the start of the cycle for my next transfer.  He just wants to make sure there is nothing abnormal and make sure everything is good in the uterus.  

Since we have only 2 embryos left from our current donor family, we have to pick another donor family.  He suggested we consider picking a family with embryos that are at either the 2PN (2 day) or multicells (3 day) stage.  Our current 2 embryos are blastocysts (5 day).  If we pick new embryos from a different stage, we will not be able to use our current embryos for this next transfer as our primary as they embryos have to be at the same stage.  

Dr. Keenan said we should consider switching to 2PNs or multicells just to try something different for the next transfer.  There is no real medical reason to do so, but to try something different.  Having said that, he also suggested we consider the family that is right for us, and also to look at the age of the wife at the time the embryos were created.

After speaking with the doc, I found out that the March transfer calendar is fully booked.  So we will now have to wait till May for our next transfer.  Until then we have to:
  1. Pick a new donor family, including deciding what stage embryos we want to adopt, as it will determine how many donor families we can pick from
  2. Get an endometrial biopsy done before start of my cycle for the May transfer.