Мили момичета,
ДОБРО УТРО
"Приставти себе", проф Кахраман дето и писах вчера взе че отговори. Нещо май подбно на каквото казва горе МЕЦАНИ за смяна на протокола и тн.. Мецани, ако не си по принцип доктор, може би си вече полу!
В духа на пълната откровенност, "публикувам" въпроса и отговора (само махайки името за съвсем малко анонимност). До края на деня ще мацна и превода..че изкам да го поизпипам (да не се излагаме...).
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ПИСМО ДО МЕМОРИЪЛ/КАХРАМАН
Dear Prof. Kahraman,
I am writing to you on the recommendation of a few friends as a specialist in the difficult in-vitro cases. You may not know but it turns out you have quite of a fame here in Bulgaria.
I am a 39 years old “girl”, with trouble conceiving. I have limited previous experience with IVF here in Bulgaria. The first stimulation was in October and was cut off after the 5th day on GonalF/150 as seemingly my follicles were not growing sufficiently. I had produced only 1 dominant and 3 smaller size follicles. Second stimulation was abandoned on account of the presence of an old follicle that had not fallen down with my menstruation. I am now on contraceptives and was asked to go again the beginning of January for a 3ple GonalF dose (at 450/daily). I am desperate for a child (for a few - truth be told!) and my husband, who is 49, does not get any younger either.
The challenges here are multiple –
a) I have never had a child (married late), and neither has my husband. We are both at “advanced age” and 0 time for waste.
b) We were both smokers. I have now given up smoking but my system, I would assume, is still clogged to a degree.
c) Additionally, whilst I would not say I am obese, I certainly am overweight (80kg). I can reduce the weight at a lower calories diet, but I have variously been advised not to put the system in for a shock at the moment.
My current basic hormonal tests and FBC are as in the attached. They are in latin. My husband sperm is bad, but I was told that for ICSI there is sufficient material. Therefore I am the problem. My tubes are OK/navigable, but that may not be materially important now.
Prof. Kahraman, would the scenario as in the attached be acceptable challenge for you? We are not able to get funded by the Bulgarian State Fund for our try, and we only have 1 chance left for a considerable amount of time, as we do not have savings for 2 tries. You can understand our dilemma – we only have X amount to spend and we don’t know where to go. One can not be more desperate than that.
I so much look forward to hearing from you; and remain with
Warm regards,
CONSTANT DREAMER..
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ОТГОВОР
Dear CONSTANT DREAMER,
Thank you very much for your detailed email. I have also checked your test results. Your AMH level is low, together with your age AMH is the most important criteria for the success. In your case I would prefer to use low dose hormones than what you mentioned in your email, 450 IU is extremely high, and does not increase the chance of having more oocytes but increases the risk of chromosomal abnormality of your eggs. Please make contact to Elis Ceylan (you will find her email adress above) who will assist you regarding your inital visit to our hospital , and I also need a recent hysterosalpingram.
Best regards
Prof. Semra Kahraman M.D.
Director of Istanbul Memorial Hospital
ART and Reproductive Genetics Unit
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