Jeff was traveling out of state again, and I had a day of appointments with Dr. C (our original RE at W&I) and Dr. L at 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 research 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 wished that I could find answers as to “why” this is happening to me, but the best I could hope for was, “Where do we go from here.” I had a LONG list of questions and protocol possibilities for which I would like their perspective.
Boston IVF:
Continued 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 natural schedule, as opposed to using the medication to “take it over.” I absolutely 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 NY, in the event that we decide to seek his opinion. This would save us on expenses, since Boston IVF is in network. She could prescribe the medications, and I could have my bloodwork and monitoring appointments all close by and covered by insurance, rather than completely paying out of pocket and traveling to NY.
After leaving optimistic about that meeting, I left and drove across town to our current clinic.
W&I:
I met with our first original doctor (that had gone on maternity leave). This clinic 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 women with 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 a 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 because it is fairly new, but 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 six 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 three months of Lupron shots (which basically “suppresses” the endometriosis by putting your body into early, but “temporary” menopause). The research I have done on Lupron is not positive, and can have detrimental effects on your body and hormones long term. If I was going to pursue the possibility of endometriosis, I would rather have another laparoscopy done by Dr. Braverman’s team, specializing in endometriosis, to accurately diagnose 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 talked, and decided to proceed with Boston IVF for a transfer. In the event that it was unsuccessful, we would pursue Dr. Braverman for a full immunological work-up. This plan seemed like the best option because if the transfer failed, we would still work with her in conjunction with Braverman (after July 1 when my out of pocket insurance re-set).
We are confident in our decision, 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 MVA. This has to happen at a certain time in my cycle so I have to wait for my next period, and then schedule it.
“Sometimes we never know what’s wrong without the pain
sometimes the hardest thing and the right thing are the same…”
All at Once by The Fray
breakdown and rally 