Fantasy and post IVF visit

​Fri, 5/26: I had lived in my fantasy world when my period was almost a week late. In that magical realm, all the long-standing infertility struggles we had endured were magically resolved. A miracle had occurred, washing away all the exhaustion, fear, and pressure. We were on the verge of experiencing the joy of parenthood, which would bring a sense of fulfillment to our marriage and lead me down an exciting and challenging path. The presence of our little one filled me with excitement, instilling in me the determination and motivation to overcome any obstacles that might come my way. However, this fantasy ended abruptly today with the arrival of my period. Though it was late morning, I still lay in bed, closing my eyes and holding onto the fading remnants of that illusion before it vanished completely and I had to face the harsh reality of continuing this foggy journey.

Once my dream world had been shattered, I became worried about my period. It was bleeding but not fully. It was sparse and infrequent. I had no idea what’s going on with my body. I felt lost and clueless about what steps to take next in order to make the treatment work. Every time I dwelled on this journey, a wave of darkness, heaviness and disorientation washed over me. My once unwavering determination and desire for success were wearing thin…

Sun, 5/28, I was feeling down. When I thought about my unusually light, dark brown period, I was wondering if it had actually started. I started to question about the benefits of my diligent indulgence in various supplements (Ovasitol, fish oil, NeoQ10, prenatal vitamins, True Niagen, DHEA, and Vitamin D3) for over a year, hoping for a positive change in my IVF treatment. I have restricted myself not to do this or only do that to maintain a healthy lifestyle. Yet, regardless of my efforts, the result hasn’t changed. It seems the more treatments I have, the worse the results turn out. When I was hit by my period, I gave myself a day to temporarily forget that I’m an IVF patient. I skipped taking supplements which made me relieved, and ate whatever I wanted to pamper myself.

Tue, 5/30: I was nervous before the consultation with the doctor. I wasn’t confident that the doctor would be able to provide me with a definitive answer regarding the reasons behind the continuous failures or give me an effective solution for the next cycle. There were numerous questions I wanted to ask, but at the same time, I had a feeling that the doctor’s responses might not be new to me.

Anyway, below were basically my concerns and her explanations:

1. Baseline hormones: Estrogen of the 4th cycle was 32.8 pmol/L, compared to 19 pmol/L of the first one – it changed but the difference wasn’t much as both levels remained in the low range.

2. Baseline scan of AFC: It was good with 24 follicles (the 4th cycle) compared to 19 (the 1st).

3. AMH: 2.3 (the 4th cycle) compared to 2.7 (the 1st measured in March, 2022). Slightly decreased but is still a good number of egg reserves.

4. Dominant follicles during stimulation: It’s not unusual as long as the blood tests show normal results. Sometimes, doctors may consider sacrificing dominant follicles and prioritize the growth of smaller ones. However, in my case, it was likely that the giant follicle sucked up most of the medication, leaving little for the smaller ones, leading to their slow growth despite the normal blood tests. The doctor advised against prolonging the stimulation phase beyond 13 days as doing so could potentially lead to poor quality eggs. I’ve experienced the issue of dominant follicles in 3 cycles and each time the cycle was either canceled or only few eggs were retrieved. It’s still unclear what she can do to prevent it for the next cycle apart from prescribing birth control pills that I have taken in each previous cycle.

5. Decreased Estrogen during stimulation: During the recent stimulation, my estrogen decreased but then bounced back up the following day. Again, there was no single clear reason for this fluctuation. It could be attributed to factors such as Letrozole or Cetrotide or age or an unknown reason. There’s only certainty is that my body has responded extremely poorly to the drugs.

5. Light menstruation: Despite having a short, brown, and extremely light period, the doctor assured that it should not be a concern. She added that a heavy menstruation is more concerning to her.

6. High FSH: A year ago, my FSH was high, 15.9. When I consulted a Vietnamese IVF doctor, he told me to wait at least 3 months before proceeding with IVF; if I insisted on immediate treatment, “you would never be successful”, he emphasized. However, my IVF doctor and the embryologist didn’t take into account this marker when I first questioned them. I brought this up again today and she reaffirmed that FSH isn’t a determining factor in the pregnancy rate. According to her, AMH is more important. At my age, when the successful pregnancy rate is significantly reduced due to the higher rates of embryo abnormalities, the more eggs I have, the better the successful rate will be.

7. Protocol for next cycle: The doctor suggested two protocols for me to consider: the Cetrotide protocol and the microdose protocol. She mentioned these would be the only ones available for me, which contradicted what she said earlier about their being no limits to how many times I wanted to try; they always had treatments as long as we could afford them. (Maybe I misunderstood?!?) Anyway, I’m not dwelling much on it. I still stick with my plan to continue the treatment in Vietnam if my attempts here fail. My next cycle was scheduled for July 8, 2023 and the protocol will be microdose using Birth Control pills, Lupron, Gonal F and Menopur.

In general, the doctor couldn’t really pinpoint the causes of the issues, why it happened that way or give me an effective solution. All she has done and is going to is trying different protocols and hoping one of them will work for me.