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December 4, 2003
We had our follow-up post-IVF (and m/c) appointment yesterday.
I wish I could spend time with Dr. Hottie every day. That guy always makes me feel so at peace. I swear the effect he has on people is amazing...
Anyway, the appointment started with my smart ass husband telling Dr. H that he "got hosed on his office" because it's so much smaller than the other RE's. Dr. H of course laughed and explained why he prefers this office (better view, uh ok, and he hates the other desk. Plus his office is smaller and cozier—the patients are closer to him blah blah blah).
He then asked if I wanted to go first or if he should. I voted for him since I figured he would answer a lot of my questions anyway (yup).
First he was so kind about the m/c--which of course made me almost cry. He should NOT be so nice! :)
Then he jumped in...
He thinks I have recurrent implantation failure rather than an issue with recurrent m/c. Based on this we have two options--repeat the sonohysterogram to make sure my uterus is free from obstructions (my appt is next Wed!) and if that's fine then he wants to
review my data with the lab to see if there is anything they've missed. He also thinks the EFT (endometrial function test) is a good idea (he was laughing that I knew all about it and wondered how--poor Chris was so lost by now). If you’re lost too, this document explains it well http://info.med.yale.edu/obgyn/kliman/resources/AIA%20vF.pdf
The deal with EFT is that I can't do it this cycle (the m/c would skew the results) and Yale (where the results are sent) is closed when I could do it next cycle...so between that wait and my clinic’s downtime I probably couldn't do another IVF cycle until March!!! So it's up to us if we want to wait that long or jump back in and hope for the best. The good news is that our INS reset and we get 3 more paid IVF attempts.
The “benefits” of EFT are that it might lead them to do a laparoscopy if they detect endo in the samples (I’ve had 4 REs tell me I don’t need a lap done so if I end up needing one now I will be pissed!), or determine that I need a different estrogen/progesterone balance, or the worst case scenario that I will never be able to carry a PG to term. I asked if they could change my E/P ratio now without the test and he said that would potentially really screw up my lining (it's one of those things where if there isn't a problem and they treat it they will then create a worse problem). Ah well I tried. ;) He also said that he's seen reports that indicate a couple would need a surrogate and yet said patients got PG and carried to term. So the results aren't 100% meaningful in that regard (but I'd like to know!).
The other thing he wants us to consider is PGD (pre-implantation genetics diagnosis. This is where they take a cell from each embryo to test for genetic soundness). He's not sure we're there yet as far as its need, but if it's not an implantation issue then it's probably an embryo one. Of course PGD is $5000 out-of-pocket (EFT is only $500) so I really think I'd rather do one more cycle without it. I know that seems pretty silly since it would give us more answers and maybe lead to a viable PG sooner, but that's a lot of money if we don't NEED to spend it...He offered to just put back more embies next time (argh, I knew putting 2 back instead of 3 last time would come back to haunt me!)
Dr. H asked Chris if he had any concerns (as usual I did most of the gabbing) and
Chris (of course) replied nope his job is easy. So Dr. H said (and I nearly fell on the floor) "Yeah, you just harpoon her." HAHAHAHA Chris said “yup, just give me a cup” and Dr. H followed with “and a cozy room, with soft lighting.” OH MY GOD, how can you not love this guy?!?
Since I'm not exactly a great responder, he'd change my protocol a bit for IVF #3. This time it would be Gonal-F, antagon, and HCG each day (instead of LH--it's given in small doses prior to ER. It's stopped then to avoid hyper-stimulation.)
In short, he thinks we still should be able to get and stay PG, but there is something subtly wrong with me that they haven't found yet (no kidding, how long did I beg my last RE to investigate possible lining issues only to be fluffed off and patted on the head?!?). I told Dr. H. how happy I am there and how much better I think the quality of care is (he said he had just mentioned this to the other RE in the practice and they both feel they're doing a good job in that regard). After 1.5 years of no one listening to me it feels so GREAT to have a doctor who DOES.
As usual we'll know more next week (my next beta is Monday and my level has to be at 0 before they can do the sonohysterogram).
There were other funny moments like when Chris asked what EFT was and I explained they take a chunk of the uterine lining for testing...well Dr. H said I wouldn't make a good Dr. using that kind of description. ;) Of course he later was impressed by my proper use of abbreviations (PIO, LPD etc.). I guess I get a gold star anyway...
Ok, one more thing, I asked if I needed a Rhogam shot (being RH-) and he wasn't sure so he thought about it and decided it couldn't hurt. The poor nurse couldn't load the shot (it came in some weird protective plastic case) and it took forever. Then she "admired"
my PIO battle wounds (the hives are gone, but I have HUGE purple swollen blotches all over my butt). I'm a mess I tell ya.
Anyway, it does pay to be informed (Dr. H. agreed with that!!!).
Jen
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