Monday, July 7, 2008

21 - Follow-up phone consultation (July 1st, 2008)

On July 1st, the doctor gave us the results of our ivf work-up over the phone. According to the doctor, the sperm morphology tested the same at CCRM as it did at the University of Michigan (i.e., there is still a morphology problem). This was slightly frustrating and a bit of a surprise - the day after the testing, a CCRM nurse called us and told us that although his sperm morphology was 3% (they like to see 4%), because the rest of the sperm analysis numbers were very good, his sperm was considered "not an issue" (exact words). So prior to this July 1st phone consultation, we were really under the impression that although we would probably continue with IVF, there was a strong possibility that we would not have to do the ICSI procedure (where they inject a single sperm into the egg). The ICSI procedure is about $2500 additional and the sperm aren't given the luxury of fertilizing the egg on their own (which there is some conflicting research about whether or not this ICSI process increases the chances of genetic issues). So the fact that the sperm morphology was still below normal was little bit of a blow, but not a complete surprise....based on the University of Michigan numbers, Dr. Surrey said from our very first phone consultation that we would probably be good candidates for ICSI.

As for me, all my numbers came back fine (which we pretty much knew before we left the work-up) except for my AMH - anti mullerian hormone. This is a new hormone that some clinics are testing (within the last year or so). I have found it very difficult to get a lot of information about this (I asked CCRM and even they couldn't provide me with much additional information). Basically, they think it is an indicator of ovarian reserve and how the patient with respond to the stimulating drugs (low AMH meaning that there is also a low ovarian reserve and less of a response to the drugs). I had an AMH level of .5 and CCRM would like to see an AMH level of 1.0. This is a little confusing to me (and I think actually confusing to the doctor) because all the other hormone testing was fine and I had 18 resting follicles. Needless to say I was (and continue to be) concerned about this AMH number. However, Dr. Surrey assured me that based on the overall picture, we were still good candidates for ivf. The .5 AMH just means that he will put me on a very high protocal of drugs to compensate for any possible difficulties in the stimulation process.

At first, I took the news of this low AMH pretty hard, but the more I thought about it, the more I was grateful that CCRM tests this hormone. If we were going someplace that didn't test this hormone (a lot of places still don't), they probably would have put us on a very low stimulation drug protocal (based on all my other tests), which may not have worked.

So we just got our schedule via email. We start the antibiotic today (doxycycline) and will take it for 10 days. Then it looks like I start the Lupron. I will call the nurse today to see about the next step, which is ordering the meds.

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