Response From My RE About Implantation Failure Questions

So after emailing my RE with my list of factors I wanted to discuss at my appointment regarding implantation failure (see my last post), to my surprise, he emailed back his responses and suggested that I move my appointment to later in my cycle (or not at all- keep reading for the explanation on this one!).

First let me say that the one he took the most seriously is the one I think is probably the most realistic and hopefully the most promising for me at this point.  This was the first one I brought up- endometrial injury during the cycle preceding transfer via hysteroscopy, biopsy/scratching.  This is why he suggested moving my appointment, as it seems like most of the studies have done this during the luteal phase (although there is a lot of variation on when during the cycle and how many times it has been done during published studies from once up to 4 times).  So, this seems like a step in the right direction!  Doing something different, that has a decent amount of supporting evidence- rather than just randomly adding a week to my estrogen patch time… I feel better about this!

As far as the ERA testing, he basically said he can’t do it here and I don’t meet the number of failed implantations to be a candidate according to the test developers website (above the age of 35 with 2 failed embryo transfers in case you are wondering).  I’m not surprised he wasn’t into doing this one, I know there are only a few clinics in my area that do it and many REs don’t feel that it is worthwhile.

He is still adamant about the thrombophilia tests not being appropriate for someone until they have multiple pregnancy losses.  He said he is not the person who would prescribe, instruct, and manage the heparin medications (it would be a high-risk OB), and he thought it unlikely that they would prescribe it for me.  He did say he could have me meet with one of these people to discuss it though.  Again, not really surprised, although I tried to emphasize research suggesting these factors are thought to influence implantation failure in addition to repeated losses.

As far as the immune/autoimmune issues, he basically said he wouldn’t know what to do with test results suggesting I had these issues and could send me articles supporting his rationale (skepticism over the treatments).  Again, this is what he’s said all along, so not really a surprise.

He was open to me doing other sorts of tests again (vitamin D, iron etc.)

Now we get to the surprising part- he suggested I get a second opinion or even get another RE to do my next transfer.  Now, he is possibly just trying to be supportive of my interest in seeking tests and treatments that are not part of his repertoire by making this suggestion, but I have to say, it also kind of feels like he’s saying, ‘peace out, I don’t want to deal with you anymore!’  This feels a little like he is abandoning me in my time of greatest need!  We stayed with Kaiser insurance specifically so we could get bits and pieces of insurance coverage for this infertility journey, and we are locked in for the year.  I don’t even really know what switching REs would entail at this point with our embryos frozen in storage and I don’t think any of the other REs at that clinic would be any more open to exploring these other treatments than he was.  So, unless I was going to switch clinics and figure out embryo transportation etc. I don’t really think this is an option, and I have no idea what costs would look like.  He did say he understands our desire to be proactive because we have so much riding on our next/last transfer.

So now I’m left with a lot of questions… should we carry on as planned and schedule the endometrial biopsy during the luteal phase, stick with everything else pretty much the same- assuming I can’t get any of the other factors tested, and go forth with the FET after we get back from Mexico?  If so, if my cycle starts while I’m in Mexico and I take birth control pills for a few days until we get back and start the estrogen is that adding an unnecessary risk factor?

Or should we be looking for another RE and finishing this guessing game with someone else?

What day of the luteal phase would be best to do the biopsy?  I’ve seen dates mentioned between day 21 and 26 in the literature, my RE suggested somewhere between day 19 and 28.  Have any of you reading done this sort of procedure for the purpose of improving implantation in the next cycle?

So many questions- so few answers!