Friday, November 7, 2014

to scratch or not to scratch?

That is the question.

I'd never even heard of the endo scratch until the ladies in my super-secret Facebook group all were talking about theirs. (To be fair, I didn't know what it meant to have a triple-stripe lining, either. So apparently I'm not as up on the world of IF as I thought I was.)

When I went for my ovulation check almost three weeks ago, I asked my Favorite Nurse about getting an endo scratch, which (if you didn't click through the link above) is basically where they insert a catheter into your uterus and gently scratch all four quadrants. The purpose for this is twofold. From

Increase of endometrial white blood cells. It appears that endometrial injury increases the production of white blood cells which secrete so called growth factors which in turn control embryo implantation.
Gene switching within the endometrium. Scientists speculate that sometimes embryos fail to implant due to genetic switching related to endometrial receptivity. That is, genes responsible for implantation of embryos are not switched on during the time when embryos are supposed to implant. Endometrial scratching may increase expression of genes (switching of genes) thought to be responsible for preparation of endometrium for implantation. 

Anyway, I didn't hear back. So I asked again when I went in for a second ovulation check the following week.

Still didn't hear back.

On Monday, I called and asked to switch out generic hcG for Ovidrel, because I found out that the Ovidrel comes premixed and I have such a bitch of a time mixing the generic stuff. The nurse I spoke with said that was fine, but she'd have to run some other med changes I asked about by the doctor (which I'd figured). Lastly, I asked about the endo scratch for the third time.

No response.

Wednesday morning, I left another message about how I needed these answers sooner rather than later, since at that point I was on CD 21, and I was under the impression that I'd be doing the endo scratch during the priming cycle. Also, my cycles can run short; last month, I got my period on CD 23. So I wanted to get my meds ordered ASAP.

Finally heard back from Dr. Smiles on Wednesday night. He'd left a long-ass voice mail message while I was at work, the gist of which was this:

He doesn't think the endo scratch will help, but it won't hurt, either. So, if I want to do it, we can do it. Ditto RE: my med change questions.

Basically, he bounced the ball right back into my court.

So, I asked the women of my super-secret Facebook group. Of the ones who responded, three said that they'd had success during cycles in which they did the endo scratch, vs. lack of success during cycles in which they did not. One said her RE was in the same camp as Dr. Smiles (skeptical of the research) and another said she had an adverse reaction.

I turned to Google for additional information/anecdotal evidence.

Of all of the various communities I dropped into, the majority of the women were in favor of the procedure. Many of them claimed success after having the procedure done. Was it the placebo effect? A combination of factors outside of the scratch? Who knows?

Yesterday, I called to schedule the procedure. I felt confident in this decision. Then the scheduling nurse told me that Dr. Smiles prefers to do them on CD3 of the transfer cycle. Not what I'd been expecting, obviously. I'm supposed to call back on CD1 to schedule.

I turned to Google again.

Now I'm even more confused than ever. It seems that the studies where the scratch proved helpful concerned women equal to or under the age of 37, who were considered good responders with high-quality embryos, yet still have two or more failed IVF cycles. I'm outside of that age range (not by much, but still), a very poor responder, with likely crappy embryo quality (Dr. Smiles did both my transfers on Day 2, one with a 3-cell and one with a 4-cell).

I've also read that if the scratch is done too close to transfer, it can actually lower implantation rates, not boost them.

I'm at least a day or two away from my period, so I have a wee bit of time to decide. And I'm thinking about calling Posh Clinic today and asking why Dr. Smiles does the procedure on CD3 instead of during the previous cycle. I just don't know if I'll get an answer in time.

Thoughts? Advice? I'm floundering here.

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