We went for Consult #3 today, and it was fabulous! Today we met with a different doctor within the same practice as Consult #2. The embryology lab in this practice is impressive, so we couldn't let one crummy doctor turn us away.
Here's the run down:
- Testing - I'd do an insulin resistance test and a Celiac panel. Perhaps a genetic panel for John (we need to discuss).
- Lupron Protocol - This seems to be unanimous with all the doctors we've consulted with. Dr. M (today's doctor) explained it very clearly to us. Basically, the Lupron shuts down all of the hormones and allows the doctors to regulate everything without my body running interference.
- ICSI - no question about it, he'd want to do ICSI. Good.
- Assisted Hatching - this is standard procedure with this clinic (funny that Dr. K didn't mention it). They puncture a little hole in the shell on day three and he believes it gives the embryo more room to grow. Ok, I'm all for trying whatever tricks there are (though this is not covered by our insurance).
- FET - Dr. M explained that he usually goes into cycles with the understanding that the decision to do a fresh vs. frozen ET is made after watching the embryos grow in the lab. He said that he'd prefer to go with a planned FET in our case so that we can create the absolute ideal environment for any blasts that we may get. Embryos can be slow growers, but the uterus has its own window for when it is most likely to allow for implantation. It's possible for the embryos and the uterus to be out of sync, which reduces the chances of implantation.
- CCS - chromosome screening was presented as an option, though I don't know that we'd go this route.
- Triggering Sooner - many doctors want to wait to let the smaller follicles catch up, but Dr. M would rather trigger when the lead follicle is at 17 or 18mm. We'd get less eggs this way, but the thought is that the lead follicle is dominant for a reason (because it is the best quality). This would hopefully result in better quality (IVF #2 had a few 'degenerate' or past mature eggs)
- The Lab - simply put, it is just the best. They do over 3,000 IVF cycles a year, and (in Dr. M's words) the embryologists are OCD about every aspect of what they do. I feel 100% confident that if our embryos are going to make it anywhere, it'll be in their lab. If we get through this without any blastocysts to show for it, then only God will be able to create that miracle in the natural setting.
In a nutshell, Dr. M would want to focus on quality over quantity. He gave us hope, but didn't blow sunshine up our asses. He said that he didn't expect that we'd get 5-6 blasts, but said that he thought we could get 1-3.
How do we feel about it? Hopeful! At the moment, we are leaning towards this doctor and clinic. Now the question is, whether to wait another cycle (and piddle around with IUI #5) or to start the BCP prep while finishing up our consults (which we suspect will lead us back to this conclusion anyway). We discussed it, and said that we'll probably go with this clinic starting on the next cycle (as in TWO DAYS from now), but we're going to sleep on it.