SHER Institute IVF Consent Appointment

Today I had an appointment at the SHER Institute with Dr. Saleh. I got there at 1:15 for a beta (routine) so I could have my Uterine Mapping (Mock Embryo Transfer). Dr. Saleh said everything looked great and that we were on our way. Then we sat in his office with him to discuss the consent forms and questions we had. He also said he did not see a need for PGD or EMET (Embryo Marker Expression Test). This will save us a lot. He seems pretty positive about this working out.

This is a really funny, and I mean funny, hilarious and embarrasing story. The last week when I spoke to Dr. Saleh, he was telling me the things that DH should avoid in order to help his SDI results get better. To my understanding, one of the things he said was to avoid hot dogs > 100F. Well, when we were talking to him, DH asked why he had to avoid hot dogs. Dr. Saleh seemed surprised, and asked what he meant. "Well," said DH, "my wife said you had told her I should avoid hot dogs. Why?" "Yes," I said, "I have it in my notes from when we spoke last week." He started laughing so hard and said, "I said to avoid saunas and hot tubs > 100F, not hot dogs." I was so embarrased, I felt like part of the commercial, "Wanna get away?"

• DH will continue on Proceptin. Since his results were in the good to fair fertility potential, he said he does NOT need to re-do the SDI in June. Also, he said he does NOT need to have Semen Analysis. All he needs is his bloodwork. I have the requisition form, so he just needs to go to a Labcorp with it.
• I need to come back in on Monday to have the NKa bloodwork. He said since he had already run the APA (Anticardiolipin Ab, IgM, Qn) through Labcorp and it showed that I had a problem (usually their testing is a lot less sensitive but since it detected it, it means it's pretty bad!). Basically this means that when I become pregnant and the embryo attaches to my uterus, my body (blood vessel) will begin to release fat. Since it releases so much fat, it becomes a clot and this in turn prevents oxygen from reaching the baby. He said I should begin taking 81mg of aspirin STAT and for the rest of my life (especially during pregnancy)! While pregnant, he will aldo have me taking Heparin injections throughout the entire pregnancy. Also, he has decided he will up my medicine when I begin IVF (he said last IVF I was using 4 vials and so now he will up it to 5). Also, last time we had 12 out of 21 eggs that were good, so he is expecting that we get about 20 good ones this time and hopefully have enough for all the kids we plan on having. He will wait until the eggs reach 18mm and then trigger ovuation. Then, he will wait for them (after ICSI) to grow to D5 (blastocysts) and then transfer 2 to 3 embryos at this IVF. He also said that I will need to take additional folic acid, beside the amount in the prenatal vitamins, during pregnancy due to the MTHFR mutations.

My blood results showed the following:

• Anticardiolipin Ab, IgM, Qn = 13H MPL U/mL--indeterminate (normal 0-9). These are the ATA results I discussed above.
• Lupus Anticoagulant Reflex (PTT-LA) = 53.2H sec (normal 0.0-52.0). He said nothing about this.
• WBC = 3.6L x 10E3/uL (normal 4.0-10.5)--he didn't seem concerned about this when I asked him.
• CMV Ab, IgG (Cytomegalovirus) = 3.2H index--positive (normal 0.0-0.8)--he says we all have this and since it is IgG and not IgM, it means that I got it years ago, so no need to worry)
• Varicella Zoster IgG = >1.09 H index--positive (normal 0.00-0.90). This everyone who has had chicken pox will have, but nothing to worry about.
• Factor II, DNA Analysis, Single G-20210-A mutation identified (Heterozygote) resulting in inherited thrombophilia and a 3-fold increase for venous thrombosis (will take asa and heparin for this)
• MTHFR, DNA Analysis, two mutations (C677T and A1298C--homozygous mutation) identified, resulting in elevated homocysteine levels (associated with an increased risk of cerebrovascular disease, coronary artery disease, myocardial infarction, and venous thrombosis, and in women, pregnancy complications and an increased risk of fetal open nerual tube defects). For this reason I will be on dietary folic acid to lower homocysteine levels and reduce the recurrence of nerual tube defects).

Results for NK testing on Monday should be available within 10 days and he will discuss this with us then. He did say, though, that since I had the APA come out positive, there is a chance that I will also test positive for NK. He said he hopes I'm not positive for NK because it's a real hassle, but nothing that cannot be worked around if I do.

So we paid the deposit and we are set for the June 11 CD9 cycle. He said it doesn't matter that we will be traveling at the beginning of July. On the contrary, he said a vacation would be great. Plus, they have Labcorps everywhere so a blood test (beta) can be done. Tentatively, we will have ER on June 15th and then ET around June 20 or June 21. Beta will probably be on June 29th, so we will still be here in time to take beta here.

When I go on Monday, they will give me copies of all of the consent forms that we signed today, plus, they will give me the requistion form for Labcorp so that I can get the CD3 FSH and E2 drawn. After I begin BCP's (by May 1, but no later than May 18), I will schedule an appointment with the nurse for the IVF Nurse consult for a schedule of my IVF.

This is it! I must get back on my healthy eating habits strictly and exercise routine. I've lost 3 pounds this week, but I'm guessing it was all water retention. It will be really hard since sunday is Easter Sunday.