The new plan

Well, the scan today revealed as suspected - the embryo did implant, but has not continued to grow successfully. The specialist showed me where the sac was and told me that by the look of the scan, he is expecting me to miscarry naturally once I stop the meds so I shouldn't need a D&C which is great news. I'm actually feeling ok about it having had all this time to prepare. He assured me that there was nothing that I did wrong, the embryo was just not capable of becoming a baby. In about 20% of cases, there is something chromosonally wrong with the embryo and it doesn't continue to develop into a viable pregnancy.

So...the plan for the next cycle. It will indeed be a stim cycle, he definately agreed with me that it would be the best way to go with only one frozen embryo. We discussed the cycle and have decided on a down reg cycle with 125iU of Puregon and blast transfer. I have the option of starting straight away - as it was a HRT cycle, the miscarriage won't have any affect on the next cycle, providing that there is no hcg left before I start (as it can affect egg quality)

So, I stop all existing meds today, go onto the pill on Tuesday next week, blood test on Wednesday to check if the hcg level has gone back to 0, then an appointment on Thursday to pick up the meds, starting Synarel (a nasal spray) that day. (Although he is also talking about using another drug in place of Synarel which is a once only injection...to be decided at the appointment next week.) Next step is the Puregon (a form of Follicle Stimulating Hormone, given as a daily injection). As mentioned, he is putting me on 125iU - it is a reasonably small dose, but I haven't been on a dose that high before, last time I was on 100iU. But, I trust his judgement.

After that comes the egg pick up (EPU). I have talked to him about the possibility of a local anaesthetic instead of a general (which it is normally done under). I get very nervous about generals and find the recovery a bit difficult. Especially now that I have my son to look after, and my husband leaves for work at around midnight. After a general, you are supposed to have someone with you for 24 hours - not only do I not have that, but I am also responsible for my son in that time. He has suggested that it may be possible and we can discuss that as the time gets closer. As mentioned, he is also planning a blastocyst transfer which means that the embryos are grown to day 5 before transfer.

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For those not familiar with the IVF process, here is a very simple summary:

Sequence of Steps for an IVF Treatment Cycle
Suppression of own hormones using nasal spray ( & contraceptive pill)
Follicle growth (stimulation by injections)
Ovulation timing (based on ultrasound scans)
Trigger of follicles (one off injection)
Collecting the eggs from the follicles
Collection and preparation of sperm
Insemination of eggs with sperm
Progesterone support (twice daily pessaries)
Assessment of fertilisation
Embryo division & growth
Embryo transfer to the uterus
Embryo freezing (if any surplus embryos)
Pregnancy blood test (approx 2 weeks later)
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I'm feeling quite good about this plan, very nervous about going back to a full stim cycle, but still feeling ok about it. Until the appointment, I really didn't think that I would be able to continue with IVF right now, but it has inspired me to want to keep going. I feel so much better after having a really good talk with my specialist today. I talked to him about the quantitive blood tests - he still strongly disagrees with doing them. His belief is that they can't tell you anything so they shouldn't be used. He is very involved in the industry and has quite strong opinions about the way that things are done in the medical profession. He is very well respected though and apparently has the best success rates in QLD, so I do have to consider that. But, he was still happy to discuss it with me (and I think if I pushed, he would give me the blood tests). He did joke that he should form a support group for me and the other patients who are very 'involved' in their treatment process, but he also assured me that it was a good thing and that he is more than happy for me to remain as involved as I like, asking as many questions as I like and contributing to the decisions along the way. After our talk today, I am back to feeling very confident with my choice of clinic/specialist.

So, onwards and upwards I guess. I have the next week to decide if I am happy to jump straight back in, if not all I need to do is phone to cancel the appointment, stay on the pill, then make another appointment for whenever I want and I can start straight away from then. At this stage I am leaning towards just jumping straight back in, but I will make my final decision over the weekend after consulting with my hubby a bit more and looking into our finances.