First Email to new RE

Subject: Cancelled Cycle Follow Up

Dr. Q -

I'm not sure if you remember me or not since you have had so many new patients thrown at you all at once and are mid-cycle, but I was a long time patient of Dr. N's and my latest cycle attempt (modified estrogen priming/6 weeks, 4 amps Gonal F, IUI) was cancelled Wednesday due to non-response. Since this is my second cycle in a row cancelled for non-response, I know this does not bode well for having another genetic child, but I am not ready to give up yet. I would be interested in knowing how you think I should proceed for another attempt with my own eggs in an effort to get these ovaries to go back to being a poor responder, instead of their current completely non-responsive state. I would be particularly interested in hearing more about ovary sensitization (?) that you briefly mentioned during the u/s. I have an idea of how I would like to proceed, but would like to get your opinion. Let me know if you would prefer me to set up a consult to review/discuss instead of doing it through email. I have also set up a consult with Dr. A for later in the month to get his opinion before I make a final decision. I have attached an excel cycle history chart that I maintain for myself that summarizes my ttc attempts in 2 pages that you may find helpful. I have copied it below in case you don't have excel, but it reads/lines up/prints better from excel.

On another note, you said something that I found quite hurtful after the exam on Wednesday that I just wanted to mention for awareness. I truly know that it wasn't intended as such, but when you mentioned that you know many women who would give anything to be in my position (or something like that) because of my son, it really stung especially because with 2 cancelled cycles in a row for no response, after 6 weeks of estrogen priming which was probably my best shot at having another genetic child, the reality is that likely no matter what I try next my ovaries are done. Studies have shown that secondary infertility can be just as emotional and stressful as primary infertility. The whole process is just so hard and regardless if someone is struggling to have their first child, a second child, or a fifth child to make/complete their family it is still exceedingly difficult when it doesn't work. I actually agree with you that many women still trying to have their first do feel that way, not understanding that it isn't any easier (and in some ways can actually be harder and more stressful) after successfully having a child if you so desire to have another. Because I have been in their shoes (Max truly was a miracles child if you look at the cycle he was conceived), I am very conscious of when and how I talk about my son to my many friends who are still trying unsuccessfully to have their first or who have decided, at least for now, to live child free. My ideal family size, in a perfect world, would be 3 children. I weaned my son early and have been trying for a second child for over 9 months now in an attempt to build my family before it was too late and getting cancelled on Wednesday means my dream for my family will probably never happen and future attempt are more to get me emotionally ready to move on. Comparing my pain or situation to anyone at that time seemed to invalidate my feelings, especially on top of the loss of Dr. N who was just so special to me, when I was trying (had personally vowed) not to cry during the visit even if I was cancelled as I feared I would be. Again, I truly know that is not how you intended it and that you are under extreme stress right now, but I wanted to mention it. I hold no grudge and am letting it go now that I have told you how the comment made be feel. I look forward to working with you again soon.

Deb Cycle History Summary Chart

Cycle 1 Date: April 2004
Cycle Day 10 13 15 17 18
Right 8 12 17 19 10
Left 9, 7 13, 13, 9 18, 16, 7 18, 15, 9 23, 20
Lining 9.8 9.7 10.1 9.9
Protocol Clomid, No Trigger
Procedure IUI cd 17, IUI cd18
Result Negative

Cycle 2 Date: June 2004
Cycle Day 9 13 15
Right 12 18 ?
Left 10, 8 14, 12 ?
Lining 5 9.6 ?
Protocol Clomid, with Trigger
Procedure IUI cd 15
Result Pregnant, M/C

< August 2004 Myomectomy>

Cycle 3 Date: September 2004
Cycle Day 9 11 13
Right 13, 11 15
Left 16, 10, 9 20, 14 23, 18
Lining 8.14 9.1 9.3
Protocol 2 amps Repronex/Pergonal, Viagra, with Trigger
Procedure IUI cd 13
Result Negative

Cycle 4 Date: December 2004
Cycle Day 9 11
Right
Left 24, 16, 13, 12, 10 27, 16
Lining 8.44 ?
Protocol L5
Procedure IVF Cxl, Converted to IUI cd11
Result Pregnant, Max

Cycle 5 Date: April 2006
Cycle Day 5 7 9
Right
Left 12, 11, 8 17, 13, 10 21, 10
Lining 5 9.6 10.2
Protocol Natural, with Trigger
Procedure IUI cd 12
Result Negative

Cycle 6 Date: May 2006
Cycle Day 8 11 13 16
Right
Left 13. 8, 8 18,12, 11, 9, 7 22, 15, 12, 12, 10, 9 30, 20, 16, 16, 14
Lining 9 11.1 12.2
Protocol 2 amps Gonal F, 1 amp Repronex
Procedure IUI cd 16
Result Pregnant, M/C

Cycle 7 Date: July 2006
Cycle Day 2 5 9 10 12
Right 6 preantral 9
Left 6 preantral 11, 7, 6 18, 13, 8 20, 16, 10 25, 17
Lining 2.4 ? 9.5 11 11.3
Protocol A8 Follistim/Repronex
Procedure IVF Cxl, Converted to IUI cd12
Result Negative

Cycle 8 Date: September 2006
Cycle Day 2 9
Right
Left
Lining
Protocol ? 4 amps Gonal F, alt 1 amp Repronex @ day 3 every other day; ? dex
Procedure IUI, cd 9 CANCELLED NO RESPONSE
Result n/a

< October 2006 Lap, remove gallbladder, appendix, small cyst on left ovary drained>

Cycle 9 Date: September 2006
Cycle Day 2 9
Right
Left
Lining
Protocol modified estrogen priming; 4 amps Gonal F, alt 1 amp Menopur @ day 3 every other day; dex
Procedure IUI, cd 9 CANCELLED NO RESPONSE
Result n/a


Hormones/Tests:
FSH - cd 2/3, 5.5 - 6.5
Inhibin B - 7
Progesterone - 7 dpo, 7 - 12 with 400 mg sups
Immunity Testing - Fine
Fluid u/s - Fibroids