Tuesday, February 16, 2010

Wavering heights

In brief: more wavering about treatment.

I briefly ran the second opinion by my regular RE (does that count as a third opinion?). Basically, I picked his brain about I.M.S.I. - and I'm grateful he let me.

First, I.M.S.I. is still an experimental treatment. The handful of studies that have been published in the past may be promising, they're not enough to conclude that it's truly efficient.
In particular, it isn't cut and dried for which group of patients it is suited. Part of the ongoing research is precisely to find out who might benefit.

Prime candidates are couples who have had discouraging results with ICSI. The hope is that I.M.S.I. will help some of these couples to get better results. The working hypothesis is that well-formed spermatozoa will also contain sound DNA, therefor making higher quality embryo's, ...

The thing to remember when reading the study results, is that they show improvements in a group of patients, not individual couples. If the overall figures show improvements with the new treatment, this is because of the success it brings for a subgroup of patients (who were previously perhaps left emptyhanded), not because all the patients have a little better results.

All good to know, but I'm still not sure whether or not to try it. We have had good results with ICSI, good quality embryos every cycle so far (knock on wood), and we've become parents even. There's no reason to assume adding I.M.S.I. to the mix would do anything more for us. That seems to be my RE's viewpoint.

It's a gamble.

My gut feeling is to give it a try, on the assumption that if it doesn't help it won't hurt (note: higher risk of birth defects than with ICSI is unknown).
DH isn't keen, mostly because of the inconvenience of changing clinic. I sympathize only slightly, since he only has to go once in an entire attempt.

I lie, he'd have to go twice. Bigger Clinic demands we go to injection class (where incidentally all paperwork is signed and you get booked in the schedule). Oh yes, and IVF is explained. I'd be amused, if it wasn't during regular office hours, requiring taking time off from work for both of us. 

The good news is that my RE has agreed to do preparatory scans and blood draws locally, just like before.  That takes away most of the inconvenience of switching.

Tuesday, February 09, 2010

Same difference?

We had our consult at Bigger Clinic.

Basically, they agreed that we're getting the right treatment at Local Clinic. At least, they said they would stick to basically the same protocol. They see no compelling reason to transfer to them.

Would anything be different if we did? Yes, but just a few small things.

They use a different freezing technique, which may or may not work better for us.
Interesting, but there's no telling if we would even have something to freeze next time. I'll be glad if we have something to transfer (knock on wood).

A new abbreviation caught my attention though. I.M.S.I. One I hadn't heard of either (yes! another addition for my IF card collection). Basically it's ICSI with a bonus: a spermatozoa beauty pageant.

No, really. They magnify the candidates under a powerful microscope, about 20(?) times higher resolution than with regular ICSI and then select the best looking ones. Supposedly, the good-looking ones also have less problems in the DNA load they carry (less breaks, missing pieces ...), resulting in better cycle outcomes overall.

A quick search on the net revealed that the technique holds promise (in one study at least) but that there is not enough data to conclude whether it is worth it, considering the cost.

So this is now the question for us to answer:  do we transfer to Bigger Clinic just to give I.M.S.I. a shot, at the price of lots of hassle added to cycling. Or do we stay at Local Clinic, which is convenient and familiar.