I had my day-12 visit with my RE on Thursday evening to see how things were coming along for our 4th FET. The ultrasound showed my lining measuring in at around 7mm and my estrogen level was 232ng/L. Do any of you know if there is an optimal estrogen level for a hormone replacement cycle FET? Did your REs want your estrogen to be above/below a certain level before introducing the progesterone?
My RE said my lining looked good in comparison to past cycles. On the one hand this was reassuring, but there was still that pesky little voice in the back of my mind asking how the heck she can compare considering how little I feel she remembers about our history each time I meet with her. I’m sure some of this is in my head, but I also know that she is extremely busy and overbooked. On Thursday she was running 1.5 hours late, which is not uncommon for my appointments. I also couldn’t help noticing how the patients scheduled with the other RE in the office arrived and were relatively quickly called in for their appointments, while the waiting room filled with women waiting to see my RE (something I’ve also noticed at past appointments). I’ve been debating changing to one of the other REs in the practice since our first failed FET because I was bothered by how little my RE remembered about us and our cycles each time we met with her. One example that comes to mind is a conversation I had with here after our first negative fresh cycle. I asked her if I needed to keep taking the baby aspirin and she proceeded to ask me why I had been prescribed the baby aspirin, at which point I had to reminded her that she had prescribed it for my thin endometrial lining. Things seem to be improving slightly on the memory front, but we have also been in her office quite a bit over the past 10 months, so that’s the least I would hope for.
I talked to my acupuncturist a few months ago about the fact that I was debating asking to change to one of the other REs in the practice, but how I was afraid it would be looked upon poorly. She said I shouldn’t worry about what other people would think and that if I didn’t feel comfortable with my current RE I shouldn’t hesitate to ask to switch. I still have mixed feelings about changing.
For the moment I’ve managed to get most of my appointments outside of my work hours, which makes the fact that my RE is consistently running 1-2hrs behind more bearable. I’m afraid that if I ask to change REs, it will be viewed badly by the practice and that it will have repercussions on my care like not being able to schedule appointments outside of my work hours. I have nothing to back these fears up, but they’re still preventing me from asking the secretaries how it works when a patient chooses to switch to another RE in the practice. And now that we are on our fourth FET, the little voice in the back of my mind is also playing the devils advocate by asking questions like if it’s not silly to change now that my RE is just starting to remember us a bit better and who’s to know if the other RE will be any better. But at the same time we are still not pregnant and I have read some positive feedback about the other RE on IVF forums.
Sorry for the long rant. I would greatly appreciate any advice or stories of your experiences in regards similar situations!
Getting back to this FET cycle…My RE said that see was happy with my lining and for me to go ahead and start the progesterone suppositories today for a day-5 transfer on Wednesday. This surprised me a little because I though 7mm was a bit thin and last month she had me on estrogen for 20 days because she wanted to get my lining past 8mm. It took more than a week for my lining to go from 7mm to 8mm, which is much slower than the 1-2mm every other day rate that I’ve read online. When I got home, I talked to my husband about this and he said that maybe she wanted to do the transfer next week because the French All Saints’ Day holidays are the following week and that he wouldn’t be surprised if she was going to be out of the office. The little voice in the back of my mind was nodding away with a little smirk and an “I told you so” ;-).
My RE also did an endometrial biopsy on Thursday to test for inflammatory markers and told me again that the actual physical scarping of the lining can sometimes help with implantation. I remembered reading about this a while back, but I also thought I remembered that it was recommended to do this procedure in the month preceding the transfer and not during the actual transfer cycle. When I was in my RE’s office on Thursday I wasn’t sure if I remembered correctly, so I didn’t say anything. I am always torn between being proactive and the risk of being the pesky ungracious patient who questions a doctor’s professional and well-founded decision. Now I regret not asking because I just searched for the article online and reread the conclusions. The article is a Cochrane Systematic Review, which is pretty much as good as it gets when it comes to evidenced based research. The review found that the key to the biopsy for improving implantation was the timing of the biopsy and from what I understand Thursday was not the right time for me :-(…[sigh]…[grrrrrrr]:
Nastri CO, Gibreel A, Raine-Fenning N, Maheshwari A, Ferriani RA, et al. Endometrial Injury in Women Undergoing Assisted Reproductive Techniques. Cochrane Database Syst Rev. 2012; 7:CD00951.
“Implantation is the process by which an embryo embeds and then develops within the womb. Implantation is an essential step in any assisted reproductive technique (ART) such as in vitro fertilisation (IVF). It has been suggested that the chances of implantation are enhanced by intentional endometrial injury, such as endometrial biopsy or curettage, prior to the replacement of the embryo. We found five clinical trials that had evaluated the effect of endometrial injury on the outcome of ART. These studies suggest that endometrial injury performed in the month before starting ovulation induction improves the chances of a woman achieving a pregnancy and delivering a baby. Contrary to this, endometrial injury performed only a few days before transferring the embryo to the uterus apparently reduces the chances of pregnancy. None of the studies provided sufficient evidence for definitive conclusions to be made about the effect of endometrial injury on complications such as miscarriage, multiple pregnancy, pain and vaginal bleeding.”
Any thoughts? (for those of you who are still reading the end of this post that is turning out to be much longer than I’d anticipated)
[Sigh (again)]…[wheels churning in my head]…I wasn’t sure exactly how this blog would help me, but I think writing this has helped me realize that it’s probably time to at least ask the secretaries if it’s possible to schedule a trial appointment with the other RE.