Tuesday, April 9, 2013

Poor Ovarian Reserve...

It has taken me a few days to be ready to write this post. For one, it was way too nice out this weekend to be inside on the computer and I have the sunburn and sore muscles to prove it. (But my yard looks much better!) Secondly, I needed processing time.

Before I go into details of my appointment, I want to say I love Dr. Silber and the whole staff! They were all so nice, just like everyone says. I was not disappointed. :)

My ultrasound appointment was at 2:00 and my appointment with Dr. Silber at 3:00. The purpose of the u/s is to look at the ovaries, get an antral follicle count in each ovary and measure the uterine lining. The follicles are where the egg(s) grow and the antral follicle count is an indicator of your remaining reproductive years.

The girl performing my u/s was so sweet. She asked if I had ever had a trans vaginal ultrasound before. I told her yes, close to ten of them! I didn't ask any questions while she was performing the u/s because I knew that she wasn't supposed to tell me anything, that Dr. Silber wanted to know the results and discuss them with me.

When our name was finally called, I was so excited. I knew I was about to meet an amazing person. Someone who has helped so many people. He introduced himself and we sat at a small round table. The first thing he noticed was Ryan's Razorback shirt and Cardinals hat. He commented on them and then gave his brief spill about the infertility epidemic. Then he said something that I was not expecting at all. "Well your antral follicle count was 7, which tells us that you have a low egg reserve." I about fell out of my chair. I looked over at Ryan and he had the same look I am sure I had.

He went on to explain what exactly that meant. Basically I do not have as many eggs as I should at my age and that is why I haven't been able to achieve pregnancy on my own. I asked him what the count should be at my age and he said at least 20! Oh my. He said that I had two in one ovary and five in the other. That the count would vary with each cycle but that I would never have the normal amount. I told him that this was the first time I was ever hearing this (even after going to Little Rock for 6 months and having approximately 8 - 10 previous ultrasounds). I told him that they never told me my follicle count but that they would measure the two or three biggest ones each time. He said that was because the doctor was the one doing the u/s and that they don't take the time with each patient to do a complete ultrasound. [What?!?! Does this make sense at all?!? It took less than 15 minutes and is non-invasive and affordable!]

This is the chart that will forever be burned into my memory, that left a hairline crack in my heart:

I fall in that last line, the line that has a lovely dash under years until last child. But praise the Lord for creating people like Dr. Silber. People's whose passion for science and others has helped people like me fulfill their dreams! I know that from this point forward in our journey that we are in the two most capable sets of hands there is: God's and Dr. Silber's! And for this I am grateful!

His plan for us is to do several back to back cycles of minimal stimulation IVF. He thinks that we will need several cycles in order to retrieve enough eggs and store up as many embryos as possible. Mini IVF is like traditional IVF minus the daily injections of hormones for months. He said that I would not benefit from these high levels of hormones. That the purpose of them is to produce a high egg count for retrieval. But that even with the massive amounts of hormones my body would probably not produce any more eggs than usual. The goal of mini IVF is to recruit a only a few high quality eggs. The harvest, fertilization, culture and transfer of those eggs/embryos does not differ from routine IVF.  We are shooting for quality over quantity! He has hopes that based on my age my eggs should still be of high quality. Of course, there is no guarantee of this. But we won't know until we try and I have to keep the faith and think happy thoughts about my eggs until then!

So here's the way that mini IVF works:
  • Call the clinic on day 1 of my next cycle {end of April/beginning of May}
  • Begin and end birth control pills on days instructed by my coordinator (sweet Joan), somewhere between 21 to 28 days of birth control pills
  • Start period {end of May/beginning of June}
  • On day 3 of cycle begin 50mg Clomid and continue until ultrasound monitoring shows the follicles are ready for ovulation
  • On days 8, 10, and 12 add in 150iu of Follistim (FSH injections)
  • Begin monitoring (blood work and ultrasound) when instructed
  • When blood work and ultrasound look good we will do the egg retrieval {target date June 14}
  • Eggs that are retrieved will be injected with sperm by a needle (ICSI)
  • Resulting embryos will be frozen by new technique of vitrification
Dr. Silber wants us to do the process a few times to get as many embryos frozen as possible before making any transfers. This is because even if we have a handful of embryos there is no guarantee that those embryos will implant in my uterus and form into a baby. And also because if I were to get pregnant within the first couple of transfers (placing embryos in the uterus) I need to have some embryos frozen for future babies. I need to do this in order to insure I will still have a chance of having another child if I become pregnant during the first or second transfer. Because if I was to get pregnant but didn't have any embryos left for the future I may not have any eggs by the time we are ready for another child.

I am hoping we will get several excellent embryos and not have to do more than 3 rounds of retrieval. He would be happy if we could get at least 4 or 5 eggs during each retrieval and even more happy if all or most fertilize and turn into embryos. This is where we will find out the quality of my eggs. The number of eggs retrieved each time will vary as will the embryo count. The goal at this point in the journey is not to get pregnant but to get as many Walker baby embryos frozen as we can!

After Dr. Silber and we are comfortable with the amount of frozen embryos we will do a transfer. The number of embryos transferred would depend on the quality of the embryo. These are things to be determined. However, they will not preform a transfer until 3 months have passed since your last retrieval. Therefore, we are looking at winter as the earliest possibility of a transfer.

I tried to explain it the best way I could but if you would like to learn more you can go to Dr. Silber's website: http://www.infertile.com/infertility-treatments/ivf-in-vitro-fertilization.htm

There will be more posts once I get more information. I expect our huge package of detailed instructions at the beginning of next week. The inpatient, information starved side of me wishes I had this in my hand already! But the side of me that will get me through this says "one day at a time!"

Side note: I went to bed early last night because Ryan was watching the NCAA championship game and I was exhausted. Anyway when he did come to bed he went on about how good the game was and then said "Oh and I read your blog. It is really good babe." :) :) :) I had told him a couple of weeks ago when I started it but he never asked to read it and I never asked or pressured him to. This melted my heart. Again thank you God for him!