Friday, February 6, 2009

Yoga and the flare cycle w/o BCPs

Lately, I never actually go out to a yoga class. I've been practicing yoga for 12 years and teaching for a little over 4 and when we moved to Central New York, I had a hard time locating a yoga studio that I liked...which made me happy, thinking I can finally open my own studio...but then fertility got in the way. Well, today I made a trip out to a yoga class locally at the only studio in town. I generally avoid it b/c if any of you have been to several different yoga studios, you know that some are more open and friendly than others...unfortunatly, contrary to the very basis of yoga itself, some studio owners and teachers approach their work and practice with an air of superiority and snottiness. This particular studio seems nice but you kind of get this feeling from it. But, dammit, I wanted to go to a yoga class where someone else would actually teach ME. So I went, and within the first 5 minutes, regretted it. Oh yes, the teacher was pregnant and at the end of her first trimester. At first I was like, this is going to ruin my practice but then I realized it is an opportunity to learn and to practice some of the philophophy of yoga that I have let slip since I've become obsessed with the whole IF thing. It actually turned out okay. I wasn't crazy about the class itself, but she taught it well, I felt a sense of peace when I left, and I feel very happy for her and her healthy pregnancy:-) Yay, me.

The other thing I wanted to mention was that alot of people have been asking me why I think my former RE kind of screwed me in the baby department. The answer is the flare cycle without BCP's. When I first went to his clinic I was only 32 with no known problems at all. We did 3 chlomid IUI's which were a disaster. He told me to take the chlomid and come in on day whatever for the IUI. Well, on all 3 cycles, about 2 days before I usually ovulate, I felt a sharp ovarian pain (indicating ovulation) and I'd call them to tell them I ovulated and they'd tell me not to worry, I probably didn't, just come in at the regular time. The third time this happened, I actually checked my LH and my LH surged, oh, 4 days before the scheduled IUI...so I wonder why these didn't work....but moving on. We finally moved on to IVF. They immediately told me I have normal ovaries and I could do either a long lupron protocol or a flare protocol. They encouraged the flare. So I did it...they never recommended BCP. it was a miserable failure. Second cycle ended in an ectopic pregnancy. Then cycles 3-5 were all okay, stimulated well, flare protocol with no BCP's (even though I begged to be changed to long lupron) and all BFN's. Then I read an article that SIRM (the number 2 fertility center in the U.S.) doesn't do flare protocols at all...saying in a recent Q & A session, "We do not use “micro-flare protocols” for the same reason. With such protocols, Lupron is started virtually with the gonadotropins. This causes an immediate outpouring of both FSH & LH by the woman’s pituitary gland, While the FSH can improve ovarian response, the LH reduces egg quality and, indirectly (by ovaries), hinders endometrial growth in response to estrogen." (found at http://forums.haveababy.com/lofiversion/index.php?t3579.html ).

Then I received an email form a fellow IFer this morning with an interview with Dr. Schoolcraft in which he says, " we don't use BCP's with an antagonist protocol, but they are essential for micro-dose Lupron flare." (found at http://www.resolve.org/site/PageServer?pagename=cop_ch_poorresponder&JServSessionId_form=login)

Finally, here is a great answer from a fellow IFer on the Fertility Community boards, she posted, "If you take BCP's before the MDL cycle, then you do not ovulate, and you do not have a corpus luteum (ruptured follicle). Everything is ok. But if you skip the 2-3 weeks of BCP's, then you probably did ovulate on the cycle just before starting the MDL protocol. Therefore you still have a corpus luteum present. When you start taking the Lupron, it activates your pituitary gland which "rescues" the corpus luteum and reactives it. This causes you to start making progesterone too early in your cycle. (The corpus luteum is what tells your body to make progesterone in a normal cycle - you ovulate, the egg is released, the corpus luteum triggers the body to make progesterone which prevents your period from starting. If your egg hasn't fertilized and implanted and started to create its own progesterone by the end of the next 2 weeks, your corpus luteum fades, your progesterone level drops and your period starts.) The too-early progesterone messes up the formation of your lining preventing implantation of your transferred embryos." (http://forums.fertilitycommunity.com/vitro-fertilization-ivf/2020175166-anyone-done-lupron-flare-no-bcps.html)

Isn't this shocking? And, after all this, my old RE had the nerve to tell me that my embryos really looked good and I obviously have an implantation problem so I should find a gestational carrier! So, as I go about this cycle half lupron-crazed and concerned that we will fail again, I am realizing that there is a little light at the end of the tunnel. In fact, my prior cycles were very likely destined to fail from the start. I keep forgetting this (or, essentially, deep down, I don't believe it). But, if your RE ever suggests a lupron flare cycle without BCP's tell them NO. It wasted an entire year of my life, made me a way more serious person, strained my friendships, and really hurt me emotionally. Tell them to come up with a better plan!

As a result, I've been angry at my old RE about this (well, more resentful) but I've decided that the past is the past, I am who I am today because of trials in my past and I just have to let it go and move forward with optimism and hope. But, I also wanted to write this post and put the cycle details in the title because I hope that if any woman is googling for info about this protocol, my blog comes up and she reads all of this!

10 comments:

Fashionably Infertile said...

Knowledge is power! I think it is awesome that you posted this. If it helps at least one women out there...then it is worth it. You are fighter and there is such a light at the end of your tunnel. You are in the best hands possible at CCRM. And I am grateful to have buddies like you who are knowledgeable and who are going to help me make right choice. Obviously in the past I didn't and it got me no where.

Sorry the teach was preggo. That sucks. That just as bad as going to highlights and your hairdresser's bump keeps banging into you ;) I am glad to hear you found peace from the class. I am really trying to incorporate it into my daily practice. Or at least make sure I go 1-2 a week. Keep hanging in there hun!!! Glad the link with Dr. S helped.

kayjay said...

You know, what you wrote made a lot of sense! Since the MDL protocol didn't work for me given I ovulated right through the BCP, it makes so much sense now given your explanation. Amazing isn't it how there are so many RE's that have no bloody clue what they're doing yet they're still allowed to practice. You are doing so well otherwise, being on Lupron & all and not storming out of the yoga studio when faced with a baby bump. Hang in there and thanks for the detailed explanation!

JJ said...

I was amazed when Dr Sch told me that BCPs were essential prior to the MDL (which I did in December), because my local RE did MDL and no BCPs before. Ok, so I did better on blast development with my local RE on that protocol, but my fresh transfer went wrong mechanically, so I don't know whether it was the lack of BCPs or the traumatic transfer that caused my BFN with three beautiful blasts..... I'm still very upset about that transfer, so I get your anger comments. Onwards and upwards..... this next one will work for you.

Lost in Space said...

Wow, great information! I wondered why Schoolcraft was so adamant about BCPs for our MDL cycle. This makes much more sense. I can't say it has been great for us so far anyway though.....

I'm sorry you went through cycle after cycle of this with your old clinic. How frustrating!! Thanks so much for sharing all you have learned.

Not Your Aunt Bea said...

First, know that I know nothing about this, but it REALLY PISSES ME OFF that your RE (and another one here in Austin), don't seem to know what the hell they're doing. Don't they realize the gravity of what they do? I don't get why or how they can't know this stuff! It makes me so, so angry.

DAVs said...

Wow, this is crazy stuff.
But...I wonder why SIRM won't do MDL even WITH BCPs? Although CCRM told me in my WTF they wouldn't do MDL again with me...and who knows the logic there. I'm really sorry your old RE sounds like a Micky Mouse doctor, and I'm really glad you moved on. And yay for a good yoga class!

Polly Gamwich said...

I'm so glad you shared this! Not glad you had to go through it - I can't believe you actually found that you O'd 4 days before your IUI with you Clomid cycle - it's like, Hello? ... isn't that stuff crazy making enough?

And I know what it's like to waste a year of your life all b/c the clinic is incompetent ... it's SO frustrating.

But I'm glad you shared, and I hope it will inspire some woman some day - and cause her to challenge her ridiculous RE!

MamaSoon said...

This post was hugely educational.

I did the MDL withOUT BCPs in my last cycle but we KNEW we would not transfer that cycle and go for CGH. It is interested to know that when people say that BCPs have no purpose, that is false, false false. I wonder why this isn't true for other protocols though.

maybe this is why people have been having more success on frozen cycles!!!??

Retro Girl said...

Great information. I'm glad you had a good yoga class and I'm glad you have a new RE!

Jill M. said...

Gosh, I am so sorry that your local RE put you through the emotional/financial wringer! I just don't understand how a practicing RE can miss this critical instruction. You're in good hands now and I just know you're going to get your miracle soon. Hugs