Answers to my questions...

This is an email I wrote to my RE and her responses....

My period is due in the next 10 days so I wanted to touch base with you.  I’d like to do estrogen priming next cycle followed by a stimulation/retrieval cycle (January).   I have lots of ideas/questions, I hope you don’t mind!!  

1.  Estrogen Priming - What is the plan for this?    From my research I’d test for my LH surge then 9/10 days later start estrogen patches (change every other day), add ganirelix daily for 3 days starting the day after I start the patches, and continue patches until my next period starts.

"Your plan sounds about right, there are many protocols. Honestly, I will confer with our IVF director about her experience with this as I very rarely do priming cycles."

2. Fresh vs. Frozen Transfer - Something is still gnawing at me about doing a fresh transfer.   I am concerned about my auto immune issues  (hashimoto’s, psoriasis, gluten sensitivity).  As far as my implantation record is concerned, I am 0 for 2 with fresh transfers and 3 for 3 with frozen.  Is this really coincidence or is it a pattern?   Maybe my body is not in a hospitable state for embryos after going through IVF?   For example, after the this last stimulation cycle (the one I converted to an IUI) my TSH went up an entire point in only a week.  I know we spoke about this before and you didn’t think I needed to wait citing the 80+% success rates at CC for fresh blast transfers.  Believe me, I want to be in that 80+%!  But I want to conserve my embryos as well.   Maybe just transfer 1 instead of 2 so there are more to freeze for FET attempts?  This leads into #3….

"I'll have to read your next my chart, but I would say let's see how high your E2 levels go with the fresh stimulation before we decide on fresh versus frozen. There is some data that high estrogen levels are associated with decreased implantation rates. So if you are hyperstimulated or have high E2 levels, we may want to go for a frozen."

3. Steroids – I speak with a lot of women going through infertility on a daily basis.  Some of these ladies have a plethora of autoimmune issues as well.  They have seen success by adding in steroids earlier and more of them prior to transfer.  Can we prepare my body weeks before the transfer with steroids instead of the usual dosage given to patients?

"We treat many patients with autoimmune issues. High dose steroids carry risk and have not been shown in scientific studies to improve pregnancy rates in women with hashimoto’s, psoriasis, or gluten sensitivity. I would not recommend."

4. Intralipids – This goes along with #3, can we administer Intralipids (a synthetic produc), a week or more prior to embryo transfer?   I have read about success doing this as well for women with auto immune issues.

"Lipid infusions have been extensively studied and actually appear to decrease pregnancy rates."

5. Humira – I saw a commercial for a psoriasis drug the other day and as I google it I read that people with auto immune issues are being prescribed Humira prior to/during(?) IVF cycles to increase success.  I thought this was interesting and wondered if you knew anything about it.  I have psoriasis so I wonder if I should take this before an IVF cycle?

"I don't have experience with Humira. If you were prescribed Humira for your psoriasis, you could continue it, but I personally wouldn't prescribe it to affect your chances with IVF. We couldn't predict how this would influence your chance and it could be harmful. "

6. Meds – Can we order my meds soon?  

"Nurses can order your meds asap once we have picked protocol (as I mentioned I will ask IVF director about preferred priming protocol)"

7. EmbryoGlue 

"We do routinely use embryo glue on frozen cycles. On fresh cycles, it had no effect on our pregnancy rates."

8. Intrauterine HCG – A study placing 500 IU of HCG during transfer yielded higher success rates.

"I am familiar with this study, it was not a good study and we would not recommend doing this!"