WTF indeed.

      Well, I survived the WTF appointment.  We went in with questions in hand, and I think he was fairly ready for us.  He started by reviewing the cycle, which he was happy about my response.  He also proceeded to say that at this point, he feels that I am early diminished ovarian reserve, based on the quality and quantity of eggs I produce as well as the fact that none of our embryos ever make it to freeze.  Him reminding me of that fact made me teary.  I didn't want to cry in the appt; I wanted him to see the conversation as logical & factual-not emotional.  I just couldn't help it.  I'm so damn frustrated.  How is it even possible to be DOR when Im only 28?!  Ugh.  At least he's starting to put labels on things.  And I find relief that he said he still thinks it's possible for me to get pregnant-it just might take longer than it does for others.

       Next came the talk of what do we check and out came my list.  He agreed that we should check my insulin resistance and that it's possible I am atypical PCOS as well.  He suggested checking my androgens too since we hadn't done so.  He also agreed to check my vitamin D level since studies show being deficient can impede implantation and is common in heavier patients (plus the fact I don't see any sunlight at least 3 days a week and am pale as hell!)  He will do some of the immune testing I asked for and stated some of it he doesn't see enough research on so we'll hold off.  The final one we agreed to was a genetic carrier test.  The RE stated that it's very possible that with being DOR with no freezable embryos that we could be having genetic problems & could be why we aren't having success.  Initially when we consulted in August, we declined this test stating we would think about it again later if we hadn't had success.  Well, now it's time to check that too.  The good thing about that is that it'll check me for the genetic thrombophillias as well.  He also agreed to do a saline sonogram but said that he didn't think an endometrial biopsy would be beneficial at this time.  I can't say I'm disappointed about that. 

  As far as protocol changes, he's changing me from the antagonist to the long lupron protocol.  I'm a little nervous about that.  I dont know why but I felt some comfort knowing that I wouldn't ovulate early when I was on the ganerelix.  I suppose I'll just have to get used to the idea.  It also means I have at least 3 weeks of shots instead of 10 days.  But whatever it takes.  He is also tweaking my doses of follistim & menopur so I have more menopur.  Apparently my body must like it better.  We also talked about continuing the baby aspirin and adding prednisone (a steroid) to help with implantation.  I'm all for that!  Then depending on the outcome of the thrombophillia testing, he may add heparin.  We will stick with the Crinone, though he offered if I felt more comfortable, I can do every other day PIO in addition to it.  I'm not sure about that. 

  He also said it was okay to take the list of vitamins/supplements I brought him.  He just waned me to check what's in my prenatal vitamin so that I'm not overdosing on the fat soluable (ADEK) vitamins as it could be toxic.  I also got a green light for acupuncture.  I asked what he thought about reproductive immunology & he's not a huge believer in it.  Half of his testing & protocol changes are things that an RI would do.  I'm thinking that I should wait & see what happens with his testing before I make an appointment with an RI.  I had been on the fence about getting another opinion, but I am happy with the changes he's making and how receptive he was to my questions and input.  I think we'll stay put for now.  Jeremy made a good point of what would another doctor really do differently, and I don't really think anything.  I want to stay with who knows me. 

  I've agreed to cycle in April.  I was on the fence about it, due to the weight loss issue.  After talking to the RE about it, he said that as long as I'm eating and being more healthy overall, the number on the scale might not matter as much.  I still plan to lose as much as I can before cycling.  Originally he said 10%  and I'm already halfway there.  Every little bit helps.  So now all I have to do is wait till I get my next period to schedule all the labwork.  I could go in sooner, but the androgens are dependent on where I am in my cycle.  I'd rather go in once and get it all done than to go in multiple times and have to pay my copay each time.  The saline sono he said he could do either in the beginning half of my cycle or wait till I'm on the BCPs. 

  Overall, I feel good.  Nervous but good.  I'm just praying this will be it.