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12/18/2003

Confusing the issue

You know, doctors can be a slick lot, especially reproductive endocrinologists.  They have to be, I guess, if they're going to manage to convince you to hand over considerable sums in exchange for absolutely no guarantee.  Usually it annoys me — the refusal to commit to a position, the mincing of words — but on Tuesday it entertained me.  I loved watching the doctor furrow his brow as he read my chart, and hearing him finally settle on a non-actionable way to ask, "What the hell did they do with you?"

What he said at last was this: "I'm seeing certain things here that confuse me."  (I can just see myself telling anyone who will listen, "You know, they're supposed to be really good at Cornell, but I don't know — this guy just kept saying how confused he was.")

The doctor we spoke to was adamantly opposed to the notion that we should even consider donor eggs at this stage.  Given my age (almost 33) and my FSH (6.7), he said there was no reason to believe my eggs are unsalvageable.  When I asked him about the notations in my chart, which indicate that many of my eggs seem to have defects beyond the whole weak zona question, he paused to frame his words, then said, "There are so many human factors that influence the IVF process.  I would look to those, rather than to biological ones" to explain the problems I've had so far.

Slick.

And on the whole weak zona question, he communicated the same thing.  His theory was that I'd been triggered too late, that the eggs that ruptured were post-mature, on their way to degrading when the ICSI process finished them off.  They tend to trigger earlier at Cornell, with daily monitoring near the end of the cycle.

I asked him if he'd ever seen a patient with a persistent weak zona — a problem that manifested itself over repeated cycles.  He said they'd had one patient who never made any zona, a problem so rare that "we wrote a journal article about her," but no one with intrinsically flawed zonae.  He repeated his comment about the human factor.

Interesting.

He also said he would recommend decreasing the medication as the cycle progresses, and would opt for a pure FSH protocol rather than combined FSH/LH as I've had in the past.  But he didn't recommend anything arcane, and seemed to think a simple approach could work for us.

And I am beginning to think so, too.

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