I need your help!

My phone consultation with CCRM is fast approaching. Faster, since I got a call from Dr. Schoolcraft’s assistant last week, asking to move up my appointment from September 16 to August 26. It may even happen sooner, as I added my name to the cancellation list. (I got one call last Friday asking me if I would do the consultation ‘right now’. I declined, since I want to have C on the phone with me!)

I also recently learned that I need to be thorough about preparing my questions prior to the phone consultation. A friend from my Resolve support group is a patient of Dr. Schoolcraft’s, and she said that he basically calls and says, “So, what questions do you have for me?” She said if I’m not ready to drive the conversation, it could be a very short one… Not exactly what I’m looking to pay $250 for!

So I’m asking for your help in compiling questions for Dr. Schoolcraft. Here’s what I have so far:

Regarding the protocol:

* Do you recommend trying low stim (like last time) vs. high stim?

*Would you use Ganirelix (antagonist) vs. microdose Lupron (agonist)? Or another drug?

*What do you think about estrogen- and/or testosterone-priming?

*Assuming we were able to get any embryos, would you go for a fresh vs. frozen transfer?

Regarding my lifestyle:

*Am I taking the right set & doses of supplements?

* Should I be taking PQQ (recommended by my acupuncturist) to promote mitochondria generation?

*Should I be avoiding alcohol? Caffeine? Exercise? For three months prior to cycling? During my cycle? During stims?

* Is limited exposure to organic solvents (in the context of teaching lab courses) a problem?

Regarding our prognosis:

* In your experience, does taking the aforementioned supplements actually make a difference? In AMH and/or FSH levels? In number of eggs retrieved? In embryos that make it to blast? In ultimate pregnancy outcomes?

*How much variability do you expect from cycle to cycle? In other words, is it worth trying a particular protocol again if the first cycle yielded nothing?

* Do you recommend trying to do multiple retrievals to try and ‘bank’ embryos? How many embryos is ‘enough’?

* What do you estimate our chances of success with my eggs to be?

* If you think it’s worth trying with our eggs, what new information would change your mind? At what point should we seriously consider donor eggs?

Regarding CCRM:

*What do you think accounts for CCRM’s remarkable success rates?

*What can CCRM do to improve my prognosis relative to my local clinic?

*How would we go about scheduling a cycle with CCRM, given my & C’s work schedules? (I can’t exactly take off for 10 consecutive days in the middle of the semester!)

*What would be the cost per cycle with CCRM?

*If, due to scheduling constraints, we opt to do another cycle locally before cycling with CCRM, do you have any recommendations for our local cycle? (With regard to stims? freeze day? other?)

Out of curiosity:

* What causes DOR? In other words, what could I have done differently (besides have babies in my twenties…)? Could my career choice (organic chemistry) have contributed?

 

And…what else?

Hit me with your awesome questions!

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17 Comments

  1. I applaud you for coming up with all these questions. They are well thought out and relevant. One thing I have read and learned about CCRM in the last two years from online sources and people who have gone there is that CCRM most likely will do high high stim. So I am curious to know how Dr. Schoolcraft would answer the questions about low stim. I’ll try to think of more questions for you but I think you have covered a lot there!

    Reply
    • Thanks Isabelle. I’ll let you know what Schoolcraft says. As a preview, my Resolve buddy asked a similar question and got an answer to the effect that, “There is no evidence to support the claim that high stims ‘damage’ the eggs or lead to poorer IVF outcomes.”

      My local clinic is supposedly about to publish their results showing that my low stim protocol is better for poor responders…but it didn’t seem to do much for me, so who knows!

      Reply
  2. I think you have done a great job! I would love to know his answer to the last question as well.

    Reply
  3. I would ask about genetic testing is available, what he would recommend, and what would give you the best bang for your buck.

    I’d also ask about other tests to ensure your uterus is receptive and that nothing else is preventing you from getting pregnant. It’s fine to have a diagnosis but do they stop considering other potential issues once they have a diagnosis?

    Regarding cycling I would ask if they allow patients to do cycle monitoring at a home clinic and just arrive at CCRM for a retrieval and transfer. I’ve read a few other ladies who have done cycles at CCRM and it sounds like they hang out there the entire cycle. I was able to monitor at home and only fly to my clinic for my retrievals and transfers. It minmized the amount of work that I missed but did somewhat increase the amount of other stress.

    Reply
    • Thanks Evelyn! As always, your comments are very helpful.

      Regarding the cycles, I know from a couple of friends who have cycled at CCRM that they encourage you to do the monitoring appointments at home, and then just travel one day for a full workup, and then come back a day or two prior to retrieval and stay through transfer. Still, I think the minimum time there is a week or so, which would be too much for me to miss during the semester…

      Reply
  4. Wow, you’ve done a lot of work on those questions. I can’t really think of much else, except maybe some questions regarding the benefits of the various stims? My last cycle I was on Gonal F and Menopur, with Orgalutron (what my clinic calls Ganirelix) to prevent ovulation. My RE suggested at our last meeting that I would take Suprefact this time instead of Orgalutron to prevent ovulation, as the embryologist indicated that sometimes you can get a better cohort of eggs on Suprefact. I have no idea why, or how. I also know that some people do different stim drugs too. Maybe you could ask what particular stims he feels would work best with DOR? I have to admit I’m super curious to hear what he has to say, being DOR myself. I might use the answers as ammo to talk to my own RE! Want me to send you my share of the $250?? 😉

    Reply
    • Thanks Aramis. Asking about the specific drugs is a great idea! And I’ll definitely post his responses (or what I can remember of his responses…)

      I’ll send you a bill. Or, if you prefer, I’ll let you buy me a beer the next time I’m in Toronto. 😉

      Reply
  5. I almost don’t want to comment because I have nothing to add, but I wanted to leave some encouragement! You’ve obviously given a lot of thought to this and have done a great job coming up with questions. Good luck! I hope you get all the answers you need.

    Reply
  6. I certainly have nothing to add- you seem to have thought this through very thoroughly. Good luck to you! I sincerely hope this consultation gives you some clarity!

    Reply
  7. Great questions, knalani. I’m so impressed with your thoroughness. Like Aramis, I feel like you’ll need to send me a bill for my portion of the consult.

    Reply
  8. Great questions! I don’t have anything to add, but will be asking some similar ones at my appointment tomorrow. I am curious to hear what if anything they say about the causes of DOR. From what I’ve researched, apart from a genetic flaw or trauma to the ovaries, the answer is “we have no clue.”

    Reply
  9. Tp

     /  August 7, 2013

    I am stimming at CCRM as we speak and my experience so far is that they have a lot of protocols to fit to your needs. My last clinic went with higher stims than they are and it seems like they have a few more tricks up their sleeve as you go along to optimize the cycle. I’ll have to see how the rest of this goes though. PS I am forty so I am in the ‘old’ category. Good luck and excellent questions!

    Reply
  10. Miralen

     /  August 8, 2013

    Hi, I’m new to your blog. I found it while searching for some info on estrogen levels in the follicular phase and I really like the scientific bent being a chemist myself (although you’d consider me one from the dark side 😉 I’m an inorganic). I haven’t been able to read too many of your posts yet but am working my way through them. I found some info on how the CBFM is able to measure E3G and will post it in the comments of that blog later.

    Now to my response for this post. A little of my history is I found out I had DOR when TTC our second, my AMH was 2.7 (I think is Aus we use different units as this was only 1/3 of ‘normal/average’ for a woman my age) and my fertility Dr expected me to be a poor responder to IVF drugs. We were going to do a ‘flare’ cycle but discovered we had hit the jackpot three days before we were to start. We are trying to beat the odds and hit the jackpot again to finish our family with one more, not overly hopeful but giving it a shot.

    I guess my question is for you first as I don’t know what protocols you’ve discussed, does your clinic, or CCRM, do ‘flare’ cycles? I’ve been on TTC with ART forums for some time and have supported quite a few online friends through their IVF cycles but can’t remember lots of the protocol details, ie antagonist vs agonist etc. Many were the standard down reg with a few modifications of stim types or levels but there were a few flare cycles (one a friend just 30 with DOR/POF and poor responder who has boy/girl twins turning 1 this Saturday) The Flare protocol is meant to be better to those of us with DOR/POF and starts on CD1 with stims rather than doing the down reg stuff first. My protocol was going to be 250 Puregon from CD1 with 150 Pregynl every other day and we’d add Cetrotide/Orgalutran when I had a 14mm follie then trigger with Pregynl at the appropriate time. My Dr said if I got 6 eggs (?follies, can’t remember) we’d be doing extremely well.

    Anyway, sorry for the essay. I’ve probably not provided much help or info you haven’t already researched but maybe there is something done differently over here that could be new to you? My clinic (one of the preeminent research clinics whose cultures are used worldwide) also has a new IVF culture medium that gives better results for oldies, or those whose ovaries think they are older, I’ll see if I can find the flyer and let you know about it as its quite new
    All the best
    Miralen

    Reply
  11. Best of luck with your consultation. I don’t have any questions to add to your list, but I know I asked my Recurrent Pregnancy Loss specialist the same question about working in chemistry and my eggs- I worked as a chemist for many years in undergraduate and did some inorganic chemistry work through graduate school. I always blamed that for my initial miscarriages, but I have since had several egg retrievals with good/ok quality and normal chromosomes, so I guess I was wrong. But I would still love to hear Dr. S’s thoughts! /MMB

    Reply
  1. A rousing game of ‘Guess Dr. Schoolcraft’s Answer’ | the infertile chemist

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