Jeff was away traveling and I had a day of appointments with Doctor 1 (our original RE at original clinic) and Dr L at a new clinic, Boston IVF.
I had been preparing all week looking over my records, researching clinical studies,reviewing ASRM guidelines, and inquiring with women around the country about their protocols. Having recurrent implantation failure and recurrent miscarriage is very rare and the researching surrounding it is lacking, to say the least. Woman’s health is underrepresented in medical studies in general, and recurrent pregnancy loss only affects 1% of the population. Only some of that 1% ever get a clear diagnosis and the others (like me) are left with the term “unexplained infertility”. I desperately wish that I can find answers as to “why” this is happening to me, but the best I can hope for is “where do we go from here”. I have a LONG list of questions and protocol possibilities that I would like their perspective on.
Boston IVF:
Continues to suggest that I try a natural FET with Lovenox and embryo glue. Although the Lovenox is not typically prescribed in the IVF world, Boston IVF has run its own in house studies and it has been shown as effective for women with recurrent implantation failure. “Lovenox works by preventing the formation of clots in the placenta or embryo, while increasing the growth factor hormones (insulin-like)in the uterus, making it more likely the embryo will remain implanted. Lovenox also suppresses the immune system’s response to the IVF treatment, so the body will not reject the implanted embryo.” (ivfprescriptions.com) (most clinics will not use this because 1. they do not believe in the immunological factors and 2. I test negative for blood clotting) The embryo glue is a nickname for hyaluronic acid which is supposed to mimic the conditions of the uterus and help with implantation. The natural FET is just a protocol that requires more monitoring because it is based on your body’s natural cycle. Since I ovulate regularly every month, she would like to try and sync up with my body’s schedule, as opposed to using the medication to “take control” of my body’s cycle and force it to ovulate via medication. I love that this is a completely different plan than we have tried before, and I have read some success stories of women who have used Lovenox. As an alternative, if we choose to do so, she is also willing to consult with Braverman, in the event that we decide to seek his opinion. This would save us on expenses, since Boston IVF is in network, and she could prescribe the medications and I could have my bloodwork and monitoring appointments all close by and covered by insurance.
W&I:
Does not stray from any ASRM guidelines and will only use protocols that have been proven effective in random clinical trials. (This is a problem for me because there are not many random clinical trials that address women in my situation). I asked about Lovenox and they have only used it for blood clotting disorders, and never for a frozen transfer.
They have not heard of embryo glue(which is crazy to me because it is fairly common terminology among women undergoing IVF). This doctor is suggesting Receptiva DX test (another uterine biopsy that would test for BCL6 markers that COULD indicate endometriosis). She mentions that she has not done this test with any patients before but it is fairly new and she would be willing to try it. This is concerning to me for three reasons. 1. I have been asking about the possibility of endometriosis for 6 months now and it was completely brushed off by the other doctor as not even being a possibility. 2. Receptiva DX is not “fairly new”, the research behind BCL6 has been available since 2017 and 3. The treatment plan if I tested positive would be 3 months of Lupron shots (which basically “suppresses” the endometriosis by putting your body into early, but “temporary” menopause). The research I have found on Lupron is not positive and can have detrimental effects on your body and hormones long term. I would rather have another laparoscopy done by Dr. Braverman’s team who specialize in endometriosis to accurately diagnosis whether I have it, and then effectively remove it versus taking 3 months of Lupron to temporarily suppress it and risk long term complications.
Based on these meetings, Jeff and I decided to proceed with Boston IVF for an egg retrieval, and transfer. In the event that it does not work, we will pursue Dr. Braverman for a full immunological work-up.
But first…Even though I had a hysteroscopy in December that determined my uterine lining was clear, it is standard procedure to have another one after a D & C (or MVA in my case). This has to happen at a certain time in my cycle so I have to wait for my next period, and then schedule it. More waiting…
I will wait by Mumford and Sons
“But I’ll kneel down
Wait for now
And I’ll kneel down
Know my ground
And I will wait, I will wait for you
And I will wait, I will wait for you”
breakdown and rally 