Tuesday, November 15, 2011

Oh Happy Day!

As you know, my follow up with Dr. Braverman was today...and I couldn't be happier. Although my labs look screwy individually, as a whole, they are not bad at all. He confirmed that my husband and I have 3 partial matches; 1 DQ Alpha, 1 HLA-A, and 1 HLA-B. He said anything under 5 matches is no big deal. Also, after looking everything over carefully, he said that my immune system seems to be doing all of the right things. Once I am pregnant again he wants to repeat these tests just to be sure that it stays this way. So here is the plan: I am currently still waiting for the bleeding to stop from my lap. It is still bright red but it seems to have slowed down a teeny-tiny bit. Once the bleeding comes to a stop, I will stop my BCP and wait for AF. I will go in on CD3 for baselines and that is when the games will begin.
  1. We are doing a Flare protocol. I will be using 5 units Lupron, 300iu of Follistim and 300iu of Menopur. Originally he wasn't going to use Menopur but since historically my LH is below 2 (more like 0.38) he said that I need a product with LH in it.
  2. No more Prednisone or IvIg!! I am SO happy about this. If for some reason my levels increase with pregnancy once my immune panel is rechecked, then I may need IvIg but as of right now, I don't.
  3. Lovenox-I am still starting on 30mg but he said that a week after I start it, my clinic needs to do a Heparin Anti-XA level four hours after my dose to see if the dose is sufficient as some people need much high doses. I will also be starting the Lovenox on CD3 instead of after ET as he said my elevated APA's are pretty significant and need treatment early. The Lovenox is stopped 48hrs prior to ER and then restarted two days after ET. I am also to start baby aspirin too but that is nothing new. 
  4. Neupogen-Yup, my insurance covered it!! After going back and forth with this, he has decided to hold off on the Sub Q injections and instead do uterine washes using it. The first uterine wash will be on CD7 or 8 and then the second 48 hours later. He said a 300mcg vial is diluted with 1cc saline and slowly injected like an IUI is done.
  5. Trigger Shot-Instead of Noveral he wants me to use two Ovidrel injections, not one. He just isn't a huge fan of urinary based products. 
  6. Progesterone Supplements-No more Crinone!! Instead he wants me to increase my PIO to 2cc's every night and then have a progesterone level one week after ER. 
  7. Other Supplements-He wants me on Maxi-Greens (which I already ordered), 600iu of Vitamin E, 3mg Melatonin nightly (start both of these now), and Viagra Suppositories 50mg twice a day starting once menses stops. 
  8. Metformin-I am currently on 2000mg a day but I am having a hard time handling such a large dose in the morning so he said that I could drop down to 500mg in the morning and 1000mg at night if need be. 
  9. TSH Levels-Even though I do not have a documented thyroid problem, my thyroid gets a bit overactive after ET and with pregnancy. My TSH needs to be drawn weekly to see where it is at. He said that if it is consistently over 2 or even close to 2.5 that I need to start on 25mcg of Synthroid a day. If it goes up to 3 or so (like it did last time) he said 50mcg should be used.
  10. Transfer-I should aim for a Day 5 transfer if I have enough embryos and not transfer any more than 4. 
  11. Additional Testing-In addition to the progesterone level seven days after ER and the Heparin Anti-XA level, he wants the entire immune panel repeated once I get a positive beta and then again periodically. These tests are covered by my insurance but the bloods cost about $120 to ship but I guess that I can't complain. Also the T-regs (blood test) need to be repeated with a positive test and every few weeks after that. 
So there you have it. That was my appointment in a nut shell. His office is ordering my Viagra and having it shipped to me and the only thing that I need to do is have my clinic send him some images of my uterine lining mid cycle. Thank god my clinic digitally stores everything as I can have them email those images right over. Now all I can do is wait...for this stupid bleeding to stop!

1 comment:

  1. Wow that is alot to take in.. You sound like youhave all your ducks in a row. Also, your doctor sounds amazing.