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  #1  
February 24th, 2007, 12:25 AM
TheyGrowLikeWeeds's Avatar Platinum Supermommy
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Hey everyone! I'm Eliza (Elizabeth or Liz if you prefer).

My husband and I recently decided to TTC again. This time, however, we were recently given three different choices from my RE on what we can do from this point on. Conceiving naturally with little to no medical interventions has proven to be...well...less than productive . I've had now 5 miscarriages and have decided I no longer want to just keep trying without some serious intervention.

The three choices my doctor gave us were:

1. Progesterone shots (replacement therapy?) - Has anyone done this? I'm used to shots since I have MS and have had to give myself shots, but my mother said usually that shot is administered by a nurse at the office at given times. I don't know what to expect with that sort of therapy. My doctor wasn't sure how successful this would be for us, but thought it would be worth a chance since it seemed I was not producing a placenta (luteal phase defect?)

2. Hyperstimulation of the ovaries without IVF - The sounded interesting. My RE said it costs less than IVF and all it was was taking the controlled ovary hyperstimulation injection and letting my ovaries release whatever eggs it releases stimulate more progesterone to naturally release. The only effect that may be less desirable for us is that there's 1 in 20 chance of having more than three babies. I don't think I'm willing to take that gamble. Has anyone tried this method? How did it work out? I have heard it makes people really moody. Is that true?

3. Hyperstimulation of the ovaries with IVF - this being the most expensive therapy but more effective according to my doctor. He said he usually puts in 2-3 eggs (more often 3) and it actually has helped to make the body correctly produce the placenta and do what it's supposed to do. I suppose some of the happens because of the meds. I'd be monitored very closely to make sure the body is accepting the eggs as it should. In case of any immune issues, this therapy also seems to bypass that. It's not the answer to everything, but according to my RE, he's just had more success with this technique than just using the COH injections without the IVF. Has anyone here done this? Did it work? What was your experience?

We think we are going to try the progesterone shots first, but if that doesn't work, we want to go straight to IVF. I just want to risk too many babies. I'm a very fertile person and the idea of having more than three at once honestly scares me too much. Triplets scare me enough! The other thing that kinda scares me is the OHSS that I have heard can happen with the COH's. How common is that? Is it really painful?

I"m sorry for all the questions I'm spitting out here. I'm just nervous about getting into any of these therapies. It's so much to go through, but I really hope that something good will come out of all this. I've always believed that no matter what I do and how much I go through, that somehow my hubby and I will have a wonderful, healthy baby out of all this effort, but I do occasionally wonder if that is just not going to happen for us. We are willing to accept adoption, but we just aren't willing to do that yet. We both were adopted so we do know how wonderful adopting a child can be, but we both just want a natural baby between us so badly. We are just not willing to give up just yet.
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  #2  
February 24th, 2007, 04:16 AM
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Hi Eliza and a HUGE welcome to our board

I am co-host here and we love new members!!

I am sorry to hear of your losses and i hope you get that sticky bfp soon.
Wow that is a LOT of options huh?! You must feel very hopeful with all those options

We are starting ICSI on my next cycle and i cant wait.
We have ttc for almost 3 yrs and we both have probs.

I would think that IVF is a great option, other than the cost...Maybe you can get
insurance that covers that?

We are all here for you whatever you decide

Good luck!

Sarah
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  #3  
February 24th, 2007, 06:35 AM
Daisee37's Avatar Mega Super Mommy
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Eliza - First of all, welcome to the group. Here's my advice... often a luteal phase defect can be corrected with just some supplemental progesterone. There are 2 main ways of doing this - vaginal suppositories or progesterone in oil (PIO) shots. If your RE prefers the shots, don't worry too much about them. Lots of women have their husbands, friends, or nurses administer the shots to them every night. However, it is not impossible to do by yourself. During my last IVF cycle I was doing the PIO shots by myself every night and it really wasn't all that bad, plus, I wasn't dependent on anyone else so it made it a lot easier. The key to doing it alone: Ice for about 5-10 minutes beforehand to numb up the area, lay down on a bed or couch and twist so that you inject yourself in the side of the butt, and then rub it (and maybe apply heat) for about 2 minutes afterwards to help disperse the medicine (it'll hurt less that way). Once you get the hang of it, it's really not all that bad. So if you can do that method and not jump into ovarian stimulation or IVF, I'd suggest that. The other methods will both involve PIO shots anyway.

Anyway, good luck and let us know what you end up doing!

Eva
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  #4  
February 24th, 2007, 07:01 AM
TheyGrowLikeWeeds's Avatar Platinum Supermommy
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Well I had used the progesterone gel once for my third pregnancy but we didn't know if it worked at the time because apparently I had a septum that was found after that m/c but at the time, it was the longest I had been pregnant. Then after the septum removal I had a m/c at the time of my normal AF but it was obvious what was going on even though the pregnancy was not confirmed. Then my last m/c I had been on prometrium and again the baby lasted longer than ever (7w2d) but that too had not turned out well. That's why the doctor suggested the shots. I'm used to the shots because I have MS and when I am on the meds for MS I have to give myself shots all the time. One of the shots for MS is given just above the behind so I'm fairly used to having to reach around with a needle. I'm not worried about the shots for progesterone, but I am worried about the side effects and how effective it is.

I was tempted to go straight into IVF just because I was tired of aimlessly attempting to stay pregnant, but I do think my husband and I want to give it one more try at the romance end of things. There's not much romance in IVF At least from how it sounds.

Thank you very much for the welcome! Sometimes I just don't know where to go and I wasn't sure if I should post here I really am enjoying these boards. You all have helped me so much!
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  #5  
February 24th, 2007, 08:42 AM
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So why does your RE think that the risk of m/c is less with IVF? I just hadn't heard that before... and since it seems like you are able to get pg pretty easily, I'd think that there's got to be some other way to help you keep a pregnancy. Trust me, IVF is pretty brutal, especially if you have to go through it more than once. And all the medication side effects are only worse with IVF because you're on higher doses with IVF. Me personally, I actually didn't have many side effects at all though... maybe some tender boobs, but otherwise nothing too out of the norm for me. So it might not be so awful. I think the hardest part about IVF is just the number of steps it takes to get there... the meds, the daily ultrasounds and bloodwork, then the retrieval, then worrying about fertilization, then worrying about how many make it to the blast stage, then the transfer, then the 2ww along with more meds. I can't tell you what to do, but if there are other options that have a decent chance of working, I'd probably still try those out. Plus, IVF is the least romantic thing you can do. It's like, for normal baby-making you get to have all the sex you want... during IVF you're not allowed to have any. It's not too much fun. But if that's what it takes, then it's worth it, too.
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  #6  
February 24th, 2007, 09:37 AM
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Eliza ~ Welcome to our humble abode! I wish your ttc journey hadn't brought you here but since it did, we welcome you w/ open arms! I would add comments about your questions BUT the ladies have already covered them, LMAO! I have yet to experience prog shots as my RE has given me the suppositories but it seems to be the 1st step in resolving your LP defect. Hopefully that will do the trick & you will be able to carry a baby to term. Feel free to jump in here anytime you need support or have any questions!
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  #7  
February 24th, 2007, 12:10 PM
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Hi Eliza...welcome!

I'm very sorry for your losses but glad that you're on your way to a plan to hopefully get that sticky BFP!

I just wanted to jump in with my IVF experience and my 2 cents (take it or leave it lol).

IVF is not fun at all and if you have other options to try (which it sounds like you do) before going that route, I would do that. Not only is it easier physically and emotionally on you, but easier on the pocket book too. Plus, I'm a bit curious about your RE leaning towards IVF as a way to a sustainable pregnancy. That's a new one to me... IVF is really the mechanism to get someone pregnant, not to keep them pregnant. I've had 2 pregnancies through IVF and both have ended in m/c. I'm going through testing now to try and determine if there is a cause for those losses.

Since with you, getting pregnant doesn't seem to be the issue, I would think (in my very non medically educated opinion) that the progesterone shots may be your best bet.

As for your 3rd choice, stimulation with no IVF - I don't have any first hand experience on this one, but I do know that because of the risk of 3+ baby pregnancies, the approach taken by many clinics (I'm in Canada so it may be different for you) is to allow proceed in a cycle like this if there are not too many good follicles produced during stimulation. If there are more, then what would happen is they would proceed with IVF to remove all viable eggs, fertilize and then replace only 2 - 3 and freeze the rest.

Whatever you decide to do, I wish you tons of luck!
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  #8  
February 24th, 2007, 03:42 PM
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Well, from my understanding on what my doctor thinks about IVF and keeping pregnancies is that the IVF treatment can create a luteal phase defect, but the steroid hormones used can help the body create the luteum. Of course, I could be wrong, but he discussed that with me and that's kind of what I understood. Either the body naturally is stimulated to do the process or one of the meds does, but I believe he said the body will probably need the steroids. He said the steroid hormones has not been a problem for him though. I wish I could give a more confident response to this, but when we had the meeting to go over suggestions, it was hard to take everything in.

This wasn't the first time he said that he had used this method for people who body has an issue with progesterone production out of the ovaries. He said he's been successful using this method for this problem when nothing else has worked. But as far as what exactly happens in my body with this method, I'm not entirely sure.

He also is not convinced that it's due to progesterone levels. He said my last reading on the prog. levels was fine for him. It was at 13.1. He said every doctor is different. He's seen healthy pregnancies with even lower levels of progesterone. The other doctor in the office didn't like seeing anything below 15. Some doctors don't like levels below 10 or 5. He'd be fine with lower and would not have thought I needed the progesterone suppositories. He tends to prefer the body to make it's own that to supplement it, but he has used the shots in the past if the client wants to. He feels it certainly doesn't hurt to give it a try and he has seen it do some good things for people going through the luteal phase defect. He did not want to say that that was my problem exactly. In fact he didn't want to put a name on any of it. He seems to prefer working with the possible treatments than names. But as soon as I brought up the name luteal phase defect from my research, he immediately discussed progesterone replacement shots and said he'd give that a try if I like.

Then I asked about immunity and IUI. I had brought up that I read IVF is what's used for when the body begins to attack the egg due to a build up of immunity from repeated miscarriages. He doesn't like the immunity issue but he did discuss IVF with me. He said the immunity issue has been a big discussion amoung the RE doctors for a while and is still unclear. He didn't want to give me any definitive answer on the possibility of my body being immune, but he did agree that if I had any underlying infections, that could cause a problem. I asked him if my MS could be affecting my chances. He said he didn't know since everyone's body who has MS is so different, so it theoretically could. He was not as into trying IUI. He feels IVF is more effective. When we were talking about it, he brought up ARC which was program that consisted of women who want to try IVF at least a couple of times. Depending on how many women remain in the pool, when and if I dropped out, I'd get some if not all that money back, and I'd have to pay any money not returned. But if I get pregnant and it sticks, I will have to pay in full since the initial payment is a loan from them. He said, it's a way to try to keep the price down, but it's a bit of a gamble. It can really help when the attempts are unsuccessful, but the loan needs to be paid especially if the procedure is successful. I thought that was an interesting option.

He didn't want to jump on IVF immediately, because he didn't want me to have to spend so much. That's why he thought doing COH without IVF might be a little lighter on the wallet, but like I said, I wouldn't want to do that and then have to make any tough decisions on possibly removing any of the eggs. But, things may change. I think I'm going to try the progesterone shots first and see where it goes from there.
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  #9  
February 24th, 2007, 04:16 PM
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Welcome to the board and good luck with whatever you decide! We haven't started IVF yet, just started getting info from different clinics. That pool sounds like an interesting option! I wonder if any of the clinics here have that.
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  #10  
February 24th, 2007, 05:31 PM
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That's interesting. I'm a medical student, so I can't claim to know nearly as much as a doctor who's been doing this his whole life, but I'd be interested in hearing more about how exactly he thinks IVF helps prevent m/c's. I almost thought it was the opposite... then in the most medicated cycles where they're doing all the hormonal stuff for you and not letting you ovulate on your own, you're LESS likely to make a corpus luteum, which is the thing in the ovary that makes the progesterone. If he thinks the steroids or hormones or whatever will help with the progesterone issue, why not do those in conjunction with an IUI? Why must they be done with IVF? It just seems like such a drastic measure for someone who can get pregnant more easily.

Another question I have is whether you and your husband have had any genetic testing done. THe most common reason for 1st trimester abortions is a genetic defect in the embryo/fetus. There could be some sort of translocation that is preventing the embryo from surviving. If that were the case, then IVF with preimplantation genetic diagnosis would be of tremendous use to you guys.

I'm totally not trying to make you doubt your RE, because I'm sure he knows what he's talking about. It's just not something that makes sense to me from a physiologic standpoint with the education I have received so far in medical school. ANyway, if you find out any of these answers at your next appointment with him, let us know the answers, because now I'm sooo curious!'

Eva
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  #11  
February 24th, 2007, 06:05 PM
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Hi and welcome to our little board

I use ARC right now and they seem to be a really great company. Im using the flex benefit option right now to help pay for my IUI's. If they dont work Im going to use the IVF portion of their funding. From what they told me for every fresh cycle you purchase from them you will receive a FET (frozen) cycle basically for free, its just included in the cost of the 1st cycle which if i remember right is 10,000. 2 fresh cycles are 17,000 and then the purchase of 3 cycles at once is based on your personal medical history and cost of care in your area. The refund can only be purchased if you buy the 3 cycles at once. For me I think with the refund 3 cycles was going to run around 32,000 plus the cost of my medications. Then if the IVF doesnt result in a baby after all your fresh and frozen cycles all you will have to pay back is the refund amount which was like 5 or 8,000. The people are really helpful at ARC too. I deal with the same woman each time and she is the greatest, very caring and understanding. But i think that the possibility of having 3 fresh and 3 FET cyles (if you have enough eggs) is great for only spending 32,000. I wish every doctor participated in the ARC program!
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  #12  
February 24th, 2007, 07:15 PM
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Quote:
That's interesting. I'm a medical student, so I can't claim to know nearly as much as a doctor who's been doing this his whole life, but I'd be interested in hearing more about how exactly he thinks IVF helps prevent m/c's. I almost thought it was the opposite... then in the most medicated cycles where they're doing all the hormonal stuff for you and not letting you ovulate on your own, you're LESS likely to make a corpus luteum, which is the thing in the ovary that makes the progesterone. If he thinks the steroids or hormones or whatever will help with the progesterone issue, why not do those in conjunction with an IUI? Why must they be done with IVF? It just seems like such a drastic measure for someone who can get pregnant more easily.

Another question I have is whether you and your husband have had any genetic testing done. THe most common reason for 1st trimester abortions is a genetic defect in the embryo/fetus. There could be some sort of translocation that is preventing the embryo from surviving. If that were the case, then IVF with preimplantation genetic diagnosis would be of tremendous use to you guys.

I'm totally not trying to make you doubt your RE, because I'm sure he knows what he's talking about. It's just not something that makes sense to me from a physiologic standpoint with the education I have received so far in medical school. ANyway, if you find out any of these answers at your next appointment with him, let us know the answers, because now I'm sooo curious!'

Eva[/b]
We have had all the autoimmune tests and chromosome and genetics tests. They found nothing wrong. We've had an HSG and found I was slightly mishapped but not to the point where it should have any effect on whether or not I can hold a baby. I had a laporoscopy with a hyteroscopy and he found a very thin septum which he removed on the spot. We thought we found the cause. It may have been for some of my miscarriages, but apparently not all of them.

I think the idea behind how the IVF would help prevent m/c's is because of the closely watched medication that's supposed to help each stage of the development in the first trimester, but even though I too am in the medical field of study (medical assistant. Probably not as deep into the medical studies as you ), I can't say how much I understand of that. He did say how IVF usually does pose a luteal phase defect, meaning the corpus luteum is NOT produced with this method so he has to give the hormone to force the creation. The difference between IVF and IUI is that IUI the woman's body is naturally releasing the eggs which automatically tells the body to produce the progesterone. IUI would pose the same risk as just taking the COH and letting the sperm lay where they may and having multiples and then making that difficult decision of having to remove some eggs. I honestly am not sure I am ready to make that decision yet. In IVF, the eggs are removed before they are released which bypasses the body's natural reaction of producing the progesterone, so I'd most likely be having to take progesterone shots along with the other meds. I don't know exactly how everything works since we haven't discussed this method in detail. Eitherway, the doctor said, he has had a great deal of success using this method for people that have trouble keeping a baby.

I had also mentioned that I MAY be having some sort of immunity issue. Either because my body is too strong when fighting again the egg, I have a pre-existing infection in the area (UTI) that isn't going away (I am unaware if it's still around but so far it does not seem to be a problem until I get pregnant). If either of these are an issue, IVF is usually the treatment to keep the body from fighting against the egg too soon.

I am planting most of the time, so I'm not convinced my issue is luteal phase defect or only LPD either. But I really am willing to try whatever we feel I need to. The doctor does not seem to feel there's any reason why I should not be able to have a healthy baby due to the past tests. He is aware that there's a slight chance that my multiple sclerosis may have something to do with this. I MAY have a lesion where my reproductive system may be effected but it's highly uncommon and unlikely. I have a pinpoint abnormality in the T7 area of my spine, but that should really be effecting my digestive system and not my reproductive system.
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  #13  
February 24th, 2007, 09:59 PM
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Quote:
I wish I could give a more confident response to this, but when we had the meeting to go over suggestions, it was hard to take everything in.[/b]
Ah yes, I know that feeling well! It is definitely a lot of information to take in, especially when you're just starting down the road to treatment. Just take things one step at a time and it will all fall into place. It becomes a little less overwhelming the more treatment you receive. Although, the preference would be that you get a sticky BFP without having to go through too much treatment, because that's not really much fun either.

The most important thing is to be comfortable with your RE and trust in their ability. IVF treatment is very much tailored to the individual patient so what I've been through may not necessarily be what you'll go through.

It sounds like you're leaning towards the progesterone shots first - when will you be starting this?
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  #14  
February 24th, 2007, 10:11 PM
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I have to wait until Tuesday to find out. The doctor went over so much he isn't sure exactly with progesterone treatment he had discussed. They are waiting for the transcripts to come back on Tuesday to find the exact treatment he had suggested. No one there wants to give me the wrong thing, which I appreciate their double checking their notes. But I do think he's going to start the treatment as soon as he can. Once we decide the exact game plan, I'll go ahead and ask more specific questions about the treatment. Hopefully, I'll remember what he tells me this time. He's very patient and will go over everything over and over again if need be. He's good like that. He doesn't mind the questions. He also said if there's a test I want to go through, he'll look into it and try it out if it helps me.

I guess if this next treatment doesn't work, I'm going to consider looking into any tests to find out if IVF will actually be a good treatment. I do trust my doctor, but it's a lot of money to spend. My mother is being really generous and has offered to pay for the treatment. I wouldn't want her to waste her money if there's only a small chance that IVF will make any difference. He really thinks it will, but I guess I just have a few more questions if that ends up being the next step.
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  #15  
February 25th, 2007, 05:37 AM
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I guess I can see how IVF might be a more desirable way to go if you're really afraid of multiples. At first I was terrified, but I seem to not be getting pg at all, so my fear of multiples has drastically diminished. I guess that's why I'm as aggressive with my IUI and injectables as I am... in my mind, if I'm not getting pg at all, then even if I have 5 follicles release, I don't see much risk of having 3 or more babies. Twins would be fine... for me, that's just one less time I'd have to go through all this mess. But our issues are different, so it's a totally individual decision as to how much they're willing to take the risk of multiples and how many multiples they'd be ok with. IVF is definitely easier to control since you know the number you're transferring back in. But it still IS a pretty invasive cycle and just very complicated and stressful, so I'd get all the info I could before starting it.

I wonder if your RE has any studies showing how IVF helps prevent recurrent m/c's. You should ask him... I'd love to read up on that. Also, I just wonder if those hormones he uses in IVF could be used in IUI or other natural cycles, with the same monitoring and everything.

Well, good luck at your next meeting!!
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