The "long shot"

Okay, I am so behind in my blog reading and my google reader is overflowing, thanks to work no less. Seriously, don't they know I need my blog time? I normally don't post without first catching up with all of you, but I want to get this stuff down before I forget too much. I'll be stalking you all (your blogs that is) in the next couple of days. (You've been warned.) (;

We had officially received all the results from our CCRM testing a couple weeks ago so we scheduled a phone regroup with Dr. Schoolcraft for this past Tuesday. Because I clearly have control issues, I immediately requested copies of all our CCRM medical records so we could be looking at the same information that Schoolcraft was during the consult. I also wanted to have a copy of the test results for myself to see it all in black and white.

The records came on Monday (the day before our regroup) so we quickly scoured the test results and made sure everything looked normal.......and because I don't want to let this armchair RE degree I have earned go to waste.

Here is what I found:

10/07/08 - Initial Phone Consultation
History of Present Illness: Basic discussion of age, elevated FSH, endometriosis, and cycle history.

For discussion of cycle 1: "She had very severely fragmented embryos. All but one were severely fragmented. The cycle failed."

For discussion of cycle 2: "Quite a bit of fragmentation was noted and pregnancy failed. She has now been told she should pursue donor egg."

Assessment: 1) Diminished ovarian reserve. (2) History of poor embryo development.

10/24/08 - Regroup during 1-day work-up
"I regrouped with Brenda today about her upcoming plans for IVF at our center. She understands that she has poor quality embryos by history and that it is a long shot for her to conceive with IVF. Donor egg would be a much better option. The additional tests that I recommended in my initial consultation were detailed, as well. Genetic screening was recommended. All of her questions were addressed."

The "long shot" part is when the tears started to roll. For a brief moment, I was done. I didn't want to cycle at all and really saw no point. But as quickly as it came, it left. I need to do this because I need to have closure. It's a done deal and we are moving forward.

The plan for the appointment was to leave work and do the consult in the privacy of our own home, but because work loves to interfere with my personal life on such a regular basis we had to move to plan B. The hardware I was supposed to install on Monday morning was delayed to Monday afternoon and then to Tuesday morning and then, wouldn't you know it, I got the call at 12:30PM that they were finally ready for me. I called a coworker to see if he could cover for me during the 2:30 appointment, so that was workable. I then called M followed by CCRM to request that they call M's office phone. Aside from the whole carpooling thing (and napping on the drive in to work), the convenience of working for the same company has some added perks.

After trucking down all 88 steps and then 3 hills (or really one giant hill that goes from super steep to moderately steep to gentle slope), I arrived at M's office completely out of breath. (Note to self to look into gym membership). We asked alot of questions, but the noteworthy things we learned from Schoolcraft are:

1. M's morphology (3% on Krueger scale) is in the normal range for CCRM. He said that most clinics do not use Krueger's method correctly and that CCRM rarely sees morphology scores above 6-8%. He said that when he sees results this "high" that he believes there is a mix-up in their lab. He said that his people were sent to study with Krueger himself and learn the correct way to perform the test. While most labs use the scale, they don't perform the test the way it was intended. He said M's morphology was nothing to be concerned about and to not think twice about it, especially since the karyotype and sperm chromatin assay came back normal.
2. Standard techniques at their lab include 1) maturing eggs that aren't quite at maturation when they are removed and 2) removing fragmentation on severely fragmented embryos to help the other cells develop normally.
3. He seemed excited that I had started taking DHEA after our 1-day work-up and hopes this only helps us when we cycle. He said that it is not a bad idea to have my DHEA blood level checked to make sure it isn't too high, but that the research that has been done doesn't really correlate with a specific DHEA blood level to egg quality ratio. I'm a little concerned that they don't really know why this works, but studies have shown that 75mg of DHEA per day taken for a couple months before IVF can help with egg quality. My body is now one big science experiment anyway, so what the hell?!?
4. He was pleasantly surprised with our results and actually a bit confused as to why I don't stim very well and have such crappy embryos.

• FSH=8.45 (prefer 3.0 - 14.4)
• E2=31.4 (prefer under 84)
• LH=7.38 (prefer under 10)
• AFC=14
• AMH=4.20 (Normal levels are not listed, but this is what I found online):

What are normal AMH levels?
Normal AMH levels range between 0.7ng/ml to 3.5ng/ml. Levels below 0.3ng/ml are considered low, and indicate that lower numbers of eggs are within the ovary and decreased fertility. Between 0.3ng/ml to 0.7ng/ml are borderline low. Levels between 3.5ng/ml to 5.0ng/ml are borderline high, while anything above 5.0sng/ml is a high value and can indicate PCOS.
Seriously, this puts me in the "might overstimulate category!!

• Everything else came back normal too (both APA panels, anti-sperm antibodies, fragile X, cystic fibrosis, karyotype, beta 3 integrin, RPR, TSH, Free T4, and all the other regular blood crap they check).

If he were to cycle us with only these test results and no previous cycle information, Schoolcraft said he likely would have put me on the wrong protocol because the info just doesn't match the results.
Come on big money, that's the part we want to know too.
So as it stands now, we will plan to cycle in January using a microdose flare with growth hormone. I feel comfortable knowing we have done more extensive testing and hope and pray that his magical lab really does make all the difference in succeeding at our "long shot".
Oh, and of course the one day the guy in the office next to M decides to be there was on Tuesday. We could hear his conversation through the paper-thin walls very clearly so I am sure he got quite the education about sperm morphology, fragmented embryos, and oversupression. Welcome to IF, Mr. office neighbor.