A commentary on the practice of medicine and what lies ahead.

One of the worst things that I realize I do during the TTC process is become too immersed in it. When I was trying to get pregnant, I would google and run pubmed searches till I could practically recite the study results; I chased down every possibility I could think of, and I thought of a lot.Some of that paid off though. I just wish I had done less of it.

The same issues are starting to rear their heads back again now. I've examined practically every study that compares IVF protocols and have obsessively examined those that look at  blastocyst aneuploidy and quality.But anyway, I think I've learned a lot, and I'll be updating both the science of infertility page, and creating a new section on IVF. 

I was talking with my RE's wife (also an RE; a really sweet lady who did my retrieval) about how well this cycle worked out and I commented that a lot of it might have been due to the protocol I tailored for myself (I also tweaked it on the fly) and she joked that I should consult for the more difficult cases, and I quipped back that I would, if I got paid for it. But there is an important take home message here: even among a group of patients labeled "infertile," there are subsets with unique issues. Recognizing those issues, tailoring each protocol individually, being invested in the tiny details, and making changes based on those details as the treatment proceeds may be what is required to optimize your treatment.

As an example, I decided to check LH levels during my treatment (my RE only checks E2). Everybody responds different to both the agonist or the antagonist. I realized that with the antagonist, my LH was getting too suppressed, my E2 was not rising as it should have been (E2 production DOES require LH), and the follicles on the right were lagging (13 mm, as opposed to 19 mm on my left).  I decided to add back LH (in the form of menagon) on the last day of stims. We did not check E2 or follicle growth after that, but the results on egg retrieval day were fabulous; my right ovary had caught up and made even more mature eggs than my left. Was the situation helped by the low-dose LH add back? Impossible to say, but plausible.

Unfortunately, few take such a detail-oriented approach, or have the sort of attitude necessary for such an approach. While patients of a particular disease type fall into into subsets, medical treatments today use a broad strokes approach; the same freaking approach is used to treat everybody who comes your way. I have rarely ever met a doctor who is maverick and intuitive and adjusts the protocol (ANY treatment protocol) on the fly. It takes a rare sort of personality to do that. What REs do when you do not respond (which is the club-on-the-head approach of pushing the stim dose up higher and higher) does not count.

The only doctor I've come in contact with who is truly intuitive and maverick and can to an extent accurately delineate between the shades of grey of human biology is my mother, and the sort of intuitiveness about what is the issue and what may work that she has is extremely uncommon. Her results speak for themselves; she is in a field where the doctors end up doing very little to help their patients, while her methods produce a near to full recovery in a pretty high percentage of her patients. 

Btw, when she was giving me sub-cutaneous injections, we discovered something nifty: Instead of squeezing a wad of skin for sub-cut injections, try stretching the skin out with your fingers; I did not even feel the needle go in. The few times I got the traditional grab-fatty-skin-and-plunge-needle-into-the-pinched-up-wad-of-skin approach (from the nurses at the clinic), it hurt way more.  

Anyway, I digress. Coming back to medical approach and its effect on the success rate, there are some IVF clinics in the world that may show a level of success that surpasses that of their peers, and one of them is CCRM. I visited their webpage for the first time the other day, and I was impressed. Forget about protocol optimization (but please, blog visitors, feel free to talk about your experience with respect to this, it would be very useful), they use an embryoscope that minutely tracks the growth of each embryo, they do PGD, and they freeze their embies one per vial (they have to, if they are doing PGD)...I was practically salivating. But god knows, I don't want to go through another IVF or pregnancy again. Anyway, the time of reckoning is coming up quickly. Transfer to the surrogate occurs on Tuesday.

Then begins an interminably long wait: my RE's clinic believes in testing 12 days after a 5-day blastocyst transfer, which does not seem logical. It would make sense if you were doing a 3-day cleavage embryo transfer (because then you would be testing on the 15th day of embryonic life), but it just prolongs the wait (and the torture) if you want to wait until the 17th day of embryonic life. And given that in every pregnancy (even the one with the Trisomy 4 blastocyst), I had a positive HPT by the 10th day of embryonic life, my RE's assertion that "testing 10 days after 5-day transfer may be too early" cannot be taken seriously. Let us see how putting my foot down goes. But here we go again, soon.