Embryo Transfer #6: Frustrations

So DW is on cycle day 9 today of her FET cycle. So far, she’s had blood work and ultrasounds done during her previous cycle, and during this treatment cycle on day 3, and her next will be on day 12 (Friday). We have been with this clinic since 2012, and it really hasn’t been feasible for us to change clinics because of all the monitoring that needs to be done before work. This clinic has 4 locations, which makes them fairly convenient for us, since we work in two different cities. However, our relationship with them isn’t without significant frustration…. 

I’ve had time to cool off about it, so I will just casually list off the ridiculousness and incompetences that we’ve had to deal with:

1. Nonsense: When DW went in for her monitoring last cycle, they kept insisting that I had to come in to update my bloodwork since she hadn’t been active for almost a year. I suspect that this must be protocol for heterosexual couples, but we’re a same-sex couple, and my blood work has nothing to do with DW’s FET or the status of our embryos. Plus, the nurses know who I am (I mean, 3 years, 4IUI’s, 2IVF’s, 5 transfers, and 50 grand later, they better know who we are!), so logically, why do they need my blood? We argued with them for a while, and all they said was that they needed updated bloodwork because the embryos came from me (still doesn’t make sense!). Anyways, we just keep ignoring their requests because I ain’t getting poked to satisfy their stupidity and inability to critically think.

2. Inconsistencies: So on her last cycle and during this cycle, DW had elevated prolactin on her both of her day 3 blood draws. They told her that anything over 30 (don’t remember the units) was elevated and then made her repeat her prolactin bloodwork the next day while fasting (in fact her day 3s were also done fasting coincidentally), and her repeat levels were normal (29) for her monitoring cycle and 39 for her treatment cycle. They then said that the normal range was 40 or less, and that her prolactin values were fine. WTF? How did the normal range change from 30 to 40? This nurse has made major mistakes in the past and I’ve argued incessantly with her but it just makes her even more unwilling to check her facts. Also, I know that high prolactin can affect implantation, and have read that other RE’s consider normal as 25 or less, and ladies with anything higher are put on bromocriptine or Dostinex to bring it down before transfer. Sadly, there’s nothing we can do about this because this nurse is not very open to other opinions and the RE is very uninvolved in checking levels it seems. 

3. Incompetences: so my endocrinologist (who is awesome, and I trust very much) says that TSH should be less than 2 preconception, and when I was trying to get pregnant, she vigilantly had my blood TSH, T3 and T4 levels checked monthly to keep me under 2. Last cycle, DW’s TSH was 3.8, and the damn fertility clinic seemed to think this was fine. I argued with them about it, and apparently my RE seems to believe that a TSH under 4 is acceptable. I’m so upset about this because for our 4IUI’s with me, my TSH was around 3.9 and my endocrinologist (looking back at old bloodwork print offs that I demanded from the fertility clinic) thought it was unacceptably high. I’m frustrated that the fertility clinic doesn’t seem to prioritize optimal hormonal levels, but instead is just happy with us trying under suboptimal conditions, wasting sperm, wasting embryos, wasting time and money. I feel so strongly about this that after her day 3 bloodwork last cycle, we “unofficially” started DW on 25mcg of Synthroid from my stash. In one month, that brought her TSH down from 3.8 to 2.8, so we added another 12.5mcg daily = 27.5 mcg daily to hopefully bring it down a touch more. Frustratingly, the fertility clinic only checks her TSH once in a cycle, so we have to just keep our fingers crossed that her levels are hovering around 2 or less. I’m also a big stressed because I’m still taking Synthroid and my stash of pills isn’t large enough to be supplying both of us until my next refill is eligible. But my priority is giving her body enough thyroid hormone to support a pregnancy. It just sucks to have to be so clandestine about it. We’re also doing the same thing with her and prednisone. 

I know I’m a bit over analytical about all of this baby-making, but DW has suffered 2 miscarriages of 4 of our best day 5 blastocysts. Despite their “investigations” the clinic has not been able to identify any reason for her losses. They have demonstrated inconsistencies, incompetencies, and don’t seem to critically think about our unique circumstances, but rather treat everyone with the same “cookie cutter” approach. Changing clinics at this point is pointless, since most clinics around here function very similarly (what’s the incentive in improving when you’ve got a 3-6 month wait list of patients?). So basically, our approach is to just go ahead with the transfer, hoping that by lowering her TSH her prolactin might balance out too, and that the autoimmune meds help deal with the unexplained RPL. As I mentioned before, this is DW’s last go at it. She took a year off after her last loss to be ready to face this juncture again. We hope that it works, because I can’t even imagine the heartbreak if it doesn’t. 

If you have any experience with prolactin or TSH levels, I’d love to hear from you. 

As usual, your support is invaluable to us. 

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