Questions to ask the RE about IVF with Endo

By mrswin Mar 18, 2014

I have a WTF appointment with my RE this afternoon which is really going to be a chance to talk about moving onto IVF. I have a bunch of general questions about the procedure, costs, etc.

I am wondering what questions I should ask specifically about IVF with diagnosed endometriosis (had a lap a year ago) and lower than normal ovarian reserve?

I would appreciate advise from any of you wonderful ladies that have already gone through this :happy:

ETA: Are there any additional tests that your RE suggested before moving onto IVF?

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10 comments

Shutterbug
grapefruit / 4703 posts

Mar 18, 2014

I don't have experience with endo or DOR, but at my IVF consult he basically went over the steps involved with IVF, explained the protocol he thought would work and why, and we discussed whether or not we wanted to do an eSET. I'd ask about the different protocols available and what he would recommend given your lower than normal ovarian reserve... specifically about suppression (BCP or Lupron). The only additional tests I needed were for insurance - my CD 3 testing was outdated (more than a year old) so I had to re-do that. I also had to make sure I had an updated physical and pap smear (within a year or so). Good luck!
spaniellove
honeydew / 7916 posts

Mar 18, 2014

I don't have much advice about endo (my RE said I most likely had it but it probably wasn't doing much) but can talk about DOR. How low are we talking?
Jenn23
persimmon / 1085 posts

Mar 18, 2014

I have mild endo, DOR, but I had to do IVF for tubal reasons. But since I have DOR, my RE took the most aggressive approach to get as many eggs as possible. Let me know if you have any questions. Good luck!!
spaniellove
honeydew / 7916 posts

Mar 18, 2014

I'm realizing that you've already told me about your numbers, so...I agree with @Shutterbug: about probably not wanting to do traditional Lupron/BCP suppression. You might want to find out about an antagonist or estrogen priming protocol. My first RE just put me on an antagonist protocol because my cycles were so regular but it turned out that estrogen priming was really really important for me (and actually all I needed), which is why it's worth asking. I'd also ask how your RE feels about high-stim vs low-stim, because some REs who have experience with DOR believe high-stim protocols ruin egg quality. I did a high-stim cycle and got fewer follicles than an IUI w/ injectibles cycle and a BFN, and my next RE (who treats mostly DOR and over-40 patients) absolutely recommended low-stim.
Jenn23
persimmon / 1085 posts

Mar 18, 2014

@spaniellove: Interesting. My RE never mentioned high stimming being bad for egg quality and out of the 13 eggs I had, 8 fertilized and all 8 made it to day 5. And he had said that he used this protocol with most of his DOR patients. I never heard that before. I will bring that up next week when we meet with him (we are considering doing IVF again soon). I'm going to go research this now. Edit: Oh, but yes I did the antagonist without BCP or Lupron, too.
spaniellove
honeydew / 7916 posts

Mar 18, 2014

@Jenn23: How high was your dosage? I did 450-525iu and only ended up with 5 eggs...4 fertilized and all 4 made it to day 4 transfer but I think they knew we wouldn't have any blasts. But I also started with a cyst and they never addressed that...which wouldn't have happened if they'd just done estrogen priming! Don't know if my DOR is more severe - my AMH is almost undetectable and by the time I got pregnant with our sticky one my FSH was 17.

ETA: Oh and the second RE I saw is a bit nontraditional...if you look around at DOR stuff you'll come across his name eventually! I went to Cooper/Dr. Check.
Jenn23
persimmon / 1085 posts

Mar 18, 2014

@spaniellove: I think I took 600 of Bravelle. I believe it was the highest stim amount you can take. My AMH a few months before IVF was .6 but my FSH was below 10. An 8 or 9 (can't remember!) I have seen Dr. Cooper's name mentioned in all my previous IVF research!

Edit: My AFC was low too. Only about 4 follicles each IVF Cycle. (First one cancelled half way thru due to high progesterone), so that is another reason we were so surprised to get 13 eggs.
septca
GOLD / pomegranate / 3688 posts

Mar 18, 2014

@mrswin: I think your DOR will drive your protocol more than your endo. Because I was only dealing with endo, my doctor recommended a standard IVF protocol, although told me that I could try natural cycle IVF if I wanted because endo-only diagnosis usually respond very well to IVF (according to her).
mrswin
nectarine / 2433 posts

Mar 18, 2014

@Shutterbug: @spaniellove: @Jenn23: @septca: Thanks for the suggestions ladies! I'm sorry I wasn't able to respond earlier but I was in back to back meetings right up until I left for my appointment.

I got some of my basic questions answered but she wants me to do a Hysteroscopy and then when we get back from our trip at the end of May we will have a follow up to discuss protocol and timeline for a June/July IVF cycle
Jenn23
persimmon / 1085 posts

Mar 19, 2014

@mrswin: Good luck with everything! I just had my 2nd hysteroscopy last fall (hopefully doing IVF again soon) and they aren't too bad. Definitely take advil beforehand and get a valium script if your doctor gives them. I used the combo with advil and valium both times.

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