SIRM Consultation...

Today marks the first of many 2nd opinions.

I had a great conversation with Dr. Dayal about my case. At first I was bummed because I thought Dr. Sher would be calling me himself but thats ok because I really liked what she had to say.

The first thing that I thought was funny was she asked me if I was a physician because of the detailed nature of medical terminology in my questionnaire. Hahaha....guess I really do Google too much :)

At any rate here is what she said:

The SIRM protocol is to provide dexamethasone with each cycle, with and after the stims.

They also would like to check for NK cells....if that is an issue, they treat with Intralipid therapy, not IVIG. They administer that via IV 5-7 days before the ET. It is around that time that the NK cells arrive in the uterine lining and the Intralipid modulates them and quiets them.

She would also like to repeat general labs like FSH, LH, E2, Prolactin, and Progesterone to see where my levels are at now. In addition, she would like to repeat my Anticardiolipin Antibodies, as I noted in 2009 they were elevated. Also she would repeat my Antithyroid Antibodies.

As for the ACA, treatment for elevated levels is with Lovenox. Technically I'm already being "treated" for this since I have Factor V Leiden and there wouldn't be anything further for this.

I mentioned that my ATA had been checked already previously but she said it was worth checking again. Over time the antibodies can increase especially if you have a progression of thyroid problems. Ironic, since I have had just that!! Over the years my TSH gets higher and higher without monitoring and my dose has been increased a few times just in a year. Hmmmm....!!!

She then went on to talk about protocol. This is what I found interesting....she doesn't think that I have an egg quality issue per say. Rather, its not that the quality of eggs in my reserve are bad its just the over abundance of LH infiltrating my system. To begin with, my LH is elevated. Then, you add in the MDL flare which increases LH. Then you add in daily Menopur which contains LH.  Its been shown that high concentration of LH can reduce quality of the eggs produced.

Her suggestion is to actually put me on BCP to completely shut down my system in hopes of lowering my baseline LH. The FVL is a concern, but I'd already be on Lovenox. Then, I would not be on the MDL flare protocol at all. Menopur would be giving sparingly, possibly every few days only as needed. Also, she would try to stim me longer than my 10-11 days. My e2 jumps high and plateaus so they would try for a gradual increase to give the follicles more time to grow and develop properly.
They offer two types of "Comparative Genomic Hybridization" screening, aka CGH or another form of PGS, a chromosomal screening of embryos. The first is called Micro Array. It gives a quick result (within 48 hours) but has a high level of error. This is the only one test done in the states. The other one is called Metaphase but the results have to be shipped to Europe as no one in the states offers this test. They egg bank so you have lots of embryos to be tested and screened. They sample them on day 3, send the results, freeze on day 5 and then when results come back you come back for an FET to transfer the chromsomally normal embryos. The chances of an embryo that is normal from CGH testing is 64% chance of resulting in a live birth though. This test costs $5,000 however !!

I told her I'd be happy with getting less eggs but all mature and all fertilizing and having them grow to good looking blasts and not doing any genetic screening. She agreed....she also said that 90% of embryos that make it to blast are chromosomally normal. That put my mind at ease about that topic!!

Basically, I'm considered RIF for sure (Repeat Implantation Failure) but its most likely to be caused by an excess of LH in my system but possibly an immune system failure too. Most of the labs she can send me a packet, I'd get blood drawn around here, and ship it off to their lab for testing. My cycle would have to be at their facility the last 5-6 days of stims plus for ER and ET.

I still have other consults left to get in February so I think this is a great start. Anal retentive me put a two spreadsheets together. One detailed IVF cycle information and one to keep all my 2nd opinions put together. I was pretty impressed with SIRM so far...maybe next year, Jim and I will have to take a week vacation to St. Louis ....since ya know, vacations are how you make babies afterall :)