FET Plan - 2 (addition of Dr. K's recommendations)

So I am home - one long day!!! My apt down in IL was at 1pm I had to wait 20min cause the nurse was still at lunch. Ummmm can you say REALLY!!! Did blood work first, went over lovenox shots gave me a kit on them. Lovenox is the medication for my blood clotting issues.

Then I talked with Dr. Kwak-Kim (she is such a fascinating Dr. so much knowledge). Went over her plan etc. She had me do a vag u/s to see if I ovulated this month as today was cd 25 and I DID a good size one on the left side, (take that RE) but my lining was thin. Overall what I thought was going to be a hr 1/2 max apt. took 2 1/2 hrs.

Oh the best part of today was I got to educate the Dr. about Infertility lol - I gave her a gift of a pair of my IF awareness ribbon earrings and she didn't know that blue/pink was the awareness colors and she had no idea what "baby dust" was as I gave her a HBW wristband and a small bottle of "baby dust". She thought it was all so cool and said she's been in this field for over 25years and this is the first she heard of the term "baby dust".

My dh napped in the car this time and I dealt with it all myself since he needed to rest to drive home again. We did find a little shorter route and cut out about 20-30min so that helped think we made it in 2hrs 30min. down there. Actually got there way early compared to last time leaving at same time too. Still a long trip when you do it all at once but we saved on not getting a hotel room this time.

Got blood lab orders, got prescriptions called in and a collection kit to send Dr.Kwak-Kim some blood so I can skip one trip there, maybe, depends if my RE will do it for me. Otherwise we got at least 3 more trips down there during the FET cycle if he won't, if he will then 1 before transfer and 1 after a pos preg test and maybe a few during the preg also.

I typed up all her scribbles and combined it with Dr. Olive sheet and e-mailed it to her nurse to go over just to make sure I understood it all before I go see my RE.

This morning before we left I had called my insurance to see about the status of authorization on IVIg, talked to 3 people and they first said yes it's authorized and copay is $65 then last one said not sure yet we need Dr. notes. Told the nurse this and she was like I sent them ALL then notes on the 25th so she re-faxed it all again today too then told me to not get my hopes up that what they told me this morning was going to happen as far as them authorizing it as a lot of times they see Dr. K and RI and go nope not for fertility reasons. Also she said some have issues with getting the Lovenox too. *SO PLEASE PRAY this does not happen to me and they DO authorized this medication. I need to also explore the option of Intraplids with Dr. Olive in WI just as a back - up plan as there is not way I can do 3-4k for ea. IVIg infusion if insurance won't cover it.

I am unsure if I can start this cycle as I am due for AF any day now and still have some loose ends to put together yet. Below is my new FET plan so far from the notes I put together and typed up tonight when I got home. Hoping the nurse will get back to me Monday or Tues as I asked her to go over my notes and make sure I got everything right, after that I can then make the apt to see Dr. Olive and get the medications I need from him called in. Seems like so much work, a go between two Dr. Long tiring day but one step closer.

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FET PLAN - 2 (combined with Dr. Kwak-Kim and Dr. Olive)

1.   Call Day 1 of menstrual cycle (call both Dr.’s)

2.   Per Dr. K - Highly suggested on cycle day 20 request a u/s to confirm ovulation with Dr. Olive before Lupron shots are started on day 21.  (reason; her cycles are longer (32-35ish days past few months) and it’s best to confirm follicle is released to cut down on starting Lupron too soon and causing the unreleased follicle to turn cystic.)

a.   *Vag u/s was done with Dr. K on 4/3 cd 25 and it was noted patient ovulated from left side, ovulation est on day 21, cycle maybe becoming more regular with thyroid function and homocysteine levels returned to normal along with weight loss of patient, lining though was on the thin side, blood flow issues to uterus – bf need to be min of 2 with 5 best and patient at 0, likely cause is clotting issue and Lovenox should help improve this.  

b.   Per Dr. K when Lupron is started also start Predisone 10mg 1x day 

3.   Dr. O - After aprox 10 days of lupron go to Dr. O for Baseline Visit/trial transfer, blood testing estradiol level.  Continue on Lupron if all is ok no cysts and low estradiol. Begin Estrace 2mg 3 times a day (already on baby aspirin 81mg per Dr. K)

a.   Per Dr. K - begin weekly TSH level blood testing for next 12 wks when estrace is begun as estrogen can lead to a raised TSH and must be monitored to keep under 2.0.

b.   Per Dr. K - when menstrual cycle begins blood testing needs to be done on cd1 or before cd3 at latest. (options are to return to ILL for blood draw, or ask if RE Dr. Olive can draw blood and that blood can be FedEx overnight to her lab for testing for ANA, NK assay F/U, and TH1/TH2 Cytokine Ratio) Rest of blood work (Plasminogen Activator Inhibitor – 1, CBC, TSH, FT3, FT4, and Comphrehensive Metabolic Chemistry) can be done locally and faxed to Dr. K.

c.   Per Dr. K - Cd6 begin Lovenex 40mg injections daily

4.   Per Dr. K - return to IL between CD 14-15 (after all bleeding has stopped). Do first IVIg infusion (still working to find out if insurance will authorize this, will need a back up plan so do need to know from Dr. Olive who can do Intraplids in WI and see if I can also get that authorized with insurance and set up in case IVIg is not a affordable option). Blood flow u/s will be done to check on effects of Lovenox and any adjustment in dosage as needed that day.

5.   Dr. O after 7-14 days of Estrace administration, go in and have u/s done to insure no follicles have grown and to determine the thickness and pattern of the endometrial lining. If the lining is less than 7mm or not multilayered the dose of Estrace will be increased and the u/s repeated in one week.

6.   Dr. O – When lining is appropriate discontinue Lupron and begin progesterone

a.   Dr. K would like me to take Progesterone Injections 2cc 100mg 1 xday in the morning and at night she wants me to do Prometriam oral pills 1x day to start then maybe up to 2. She feels crinone is not as effective but can use the stash of it I have on hand later in pregnancy so not to go to waste.

7.   Dr. O - day 5 or day 6 embryo (which all mine are this) is to be thawed and transferred you will undergo the transfer on the 6^th day of progesterone admin.

8.       Dr. O – day of embryo transfer schedule preg test

a.   Dr. K would like not only Quantitative BHCG, but Progesterone levels and Estradial levels done and faxed to her

b.   Dr. K if positive preg test return to IL and do second IVIg infusion (or second Intraplids in WI) She would like another u/s for blood flow with her to determine any adj to meds. Continued monitoring of NK cells etc. Will give me more instructions when time comes.

9.  Dr. O - estrace, progesterone and baby aspirin continue to week 11. Early preg u/s d 2-3wks after pos preg test.

a.  Dr. K with positive pregnancy test you will continue the prednisone increasing to 10 mg twice daily. If pregnancy is negative you will stop the prednisone if positive you will continue until instructed to stop. You will increase the Lovenox to twice daily with a positive pregnancy test and continue throughout the pregnancy, if negative you will stop the Lovenox.