New doctor, new hope?

If you've been following our 'maybe baby' journey you might recall that I'd nicknamed our old doctor "Dr. Direct" due to his straight talking attitude. "Dr. Gentle" is the second doctor at the clinic who we only occasionally saw but seemed to have more empathy and was softly spoken. The first nickname that came to me about our doctor at the new fertility center was "Dr. Peppy"! She just seemed full of energy. Hubby commented afterwards she's probably a type A personality. She was nice and made a good impression. I think it will be easier if I use bullet points to sum up some of the main things from our appointment;

• She said we have done and tried everything already by now apart from me getting a uterine biopsy done. This is where they take a sample of your tissue and then you can have it tested for natural killer cells and/or plasma cells. If I have NK cells in my womb then the only way to treat it is to get the Intralipids infusions which I'm getting anyway for high NK cells in my blood so the doctor said there is no need to check for that. However if I were to have plasma cells, which seems to be some kind of infection then I'd need to take antibiotics for four weeks to get rid of it! She said it is unlikely that I have it but it would make sense to rule it out. The decision is up to us though. According to an information sheet she gave us, among couples with several failed IVFs/miscarriages behind them, between 10-20% of women in that group are found to have this issue. The whole thing would cost around 300€ out of pocket.


• She wouldn't suggest natural or mini IVF in our case. The follicles can be empty or contain immature eggs and it is often a wasted cycle. Since my health insurance will partially (50%) cover one more IVF it makes sense to do another full round. She discussed two possible stimulation protocols I could try. Her preferred one for me would be the long protocol. Around day 20 of my cycle I'd go there for a scan to make sure there are no cysts, then I'd use a special nose spray morning and night for about two weeks to down-regulate. Then your period comes and she said at this stage your hormones are at null and you then start to build them up from scratch with the injections. I'd have to go for two ultrasounds during the injection phase and then the egg retrieval would be around two weeks later. She recommends that protocol since I haven't tried it before and it *might* lead to them getting more eggs from me at the collection (no guarantees of course). She's seen it help some poor responders in the past.


• She recommended I should do the whole immune therapy stuff again. When I'd go in on day 20 for the ultrasound I would get the first Intralipid infusion done there, then the second one at egg retrieval stage and then third would be if I get a positive pregnancy test then every two weeks in first trimester. I'd also take the low dose steroids again after transfer plus the extra Granocyte injections. She acknowledged that those are a pain as they are expensive and not covered by health insurance (none of the immune therapy is). Last time we had to order the Granocyte meds from France since they are about 200€ cheaper there. Think it cost about 400€ for just five of those injections nonetheless! However if the Granocyte reduces my miscarriage risk of course I've no problem with it.


• She discussed some "extras" we could consider. For instance there is something called Assisted Hatching. This is where they use a laser to cut a tiny opening in the shell of the embryo to help it to get out better. We never went for it before as we just thought it sounded too artificial and that the embryo should be able to get out by itself! Hubby still thinks it's a waste of money but I'm conflicted about it now. I have read that when several IVFs have failed that it *could* help. It's so hard to know with these things. At some point when going through IVF you do end up thinking what's another 200-300€ in the long run since we've already spent so much on this and I want to give it our best shot. On the other hand I don't want us to waste our money on these unproven things. For our first round we paid extra for a thing called Embryo Glue. That isn't even offered at this clinic making me think it can't be so good after all!





• She talked about whether we'd want to let the embryos grow to day 5 this time. It would be a good idea if we were to have at least four but otherwise it could be a bit risky if we only have a few embryos. There is a theory that some embryos that don't survive in the lab might have lasted longer had they been transferred into the womb sooner.


• I'll mention here that PGS testing (genetic pre testing of embryos) isn't allowed in Germany unfortunately. ERA receptive testing which ecofeminist talks a lot about the importance of isn't available here either! You'd have to go to Spain for it we were told.


• The doctor wanted to take a blood sample in order to test my AMH and thyroid levels. When she phones me in two weeks with the results, then I can tell her if I have decided to do the uterine biopsy and if so make an appointment for it. She also wanted me to get a booster vaccine for polio & typhoid etc which I was also able to get there and then which was handy though it did give me a sore upper arm for days after!


• She said that yes some women do need to get their fallopian tube removed when it is blocked as sometimes the liquid inside it can drip down and cause a hostile environment. That was something I was worrying about recently. She gave me an ultrasound there and then to have a look but luckily my right tube, the blocked one, though slightly bumpy/bigger than it should be is not bad enough to require surgery to remove it


• We asked about our chances of trying naturally. Her answer was a little vague, along the lines of never say never but chances are very low. When there has been surgery or infection around the fallopian tubes then the tiny little hairs inside them can become stiffer making it very difficult for sperm/eggs to travel through them.


• I commented about how our embryos were great quality last time, plus I had done all the immune stuff and it still didn't work! She replied that even if everything is perfect, IVF still only has a 30-40% chance of working each time.


• In terms of supplements which I asked about, she said I could try taking 25mg of DHEA until IVF starts or I could take melatonin since both do more or less the same thing in terms of improving egg quality.


• We have a fair bit of paperwork to get sorted first if we want to change clinics. My health insurance approval is tied to the other place so we would have to reapply for approval. There is a requirement for couples doing IVF to get tested for HIV and hepatitis which we've already done so we'll need to ask our clinic for a printout of results. Also a different doctor not associated with a fertility clinic has to talk to any couple in Germany considering IVF about their options and tell them about the risks associated with IVF. We already had that talk ages ago but need to find the signed form otherwise we'll need to do it again.


• My gynecologist in the town where I live had offered that he could do some ultrasounds for me so that I wouldn't need to travel back and forth to the new clinic. However Dr. Peppy said that's not possible as they'd want to scan me themselves. Since I'm still not comfortable driving in Germany (haven't had enough experience here yet), I'll have to get public transport to reach the new clinic. It takes about 75 mins each way. It's not ideal obviously but I could catch up on my reading and try to get appointments that are either very early or late to work around my job or even take some half days off. It should be manageable.

Overall the appointment went well. That said, I left feeling very overwhelmed about it all and needed a day to get my thoughts straight. Hubby was a bit cynical saying of course they say we should do another round with them as they want the money and didn't feel convinced that anyone in the industry gives you unbiased advice. We had some differences of opinion on how to proceed but we are on the same page now. We've both agreed that we'll go for a fourth (and final IVF) at this new clinic.

I spent a few hours reading up about DHEA supplements and ended up totally confused about whether they would help me or not! On the one hand some studies have shown very positive effects for poor responders who take them. However I've also read studies disputing that. Some women on message boards talk about how they had much better IVF results after taking DHEA but then I read others saying it messed up their IVF and it was a wasted cycle! On top of that it can affect your thyroid and immune system apparently which concerns me since I already have immune and thyroid issues. I'm still on the fence. Melatonin has shown some promising results.

Something I did decide to order is Serrapetase. It's an enzyme found in silkworms and it's meant to dissolve old tissue in your body so it has even helped some women unblock their fallopian tubes and get rid of adhesions apparently! The doctor hadn't heard of it and it hasn't been clinically proven but I read through hundreds of reviews from people who bought the tablets and the majority were very positive. A few did mention it caused stomach upset so hopefully I won't be one of the unlucky ones with bad side effects. I've figured it's worth a try.

I an feeling quite overwhelmed at the thought of going through IVF again. I'm painfully well aware that just because we are trying a new protocol there is no guarantee that my body will respond better to it and grow more eggs so that's a concern! During the second round of IVF the doctor tried me on new meds and I only ended up getting one egg at the retrieval, my worst round. It was incredibly disappointing really. I've read online that poor responders generally have worse success rates than average. Even if I do get pregnant I'm anxious about having a another miscarriage. Hubby also commented that we could go through so much only to find out that something is wrong with the baby. It probably sounds like these are all very negative thoughts but I think we are just being realistic at this stage. We could be one of those couples that IVF just doesn't work for.

All that said, I am still hopeful. Sometimes I allow myself to fantasize about what it would be like to go to the doctor for a pregnancy ultrasound with my husband and see our baby moving around on screen, or how wonderful it would be to have our baby or babies growing inside me for nine months. I also imagine how amazing it would be having our child actually here with us! I'd love to bring him/her to trips to Ireland with me and there are so many people among our family and friends who would also have so much love for our potential offspring. I still hope and pray that this is something we will get to experience. However if it doesn't work out this Summer with our fourth IVF attempt, at least we'll know we gave it our best shot and be able to move forward without regrets.