Based on our initial consultation with Dr. Braverman we have been seeking out information about the potential treatment options available locally. No thanks to our RE we were very fortunate to get a last minute cancellation appointment with an OBGYN who reviewed Dr. B’s findings and suggested treatment with us. Here is what we have learned:

1. Endometriosis Surgery – we will not find a surgeon in this province who will do the surgery based on what Dr. B found.  Here, they rarely do endo surgery at all, so it’s very unlikely they will do it for someone who is not showing any traditional symptoms.  The one local OBGYN who has specialized endo surgeries would be incredibly unlikely to go near me given the complete lack of traditional endo symptoms (i.e. I have pain free periods). It is our understanding that the reason for this approach is not because of the limited resources in a public health care system, but because they work really hard not to do unnecessary surgeries both on the medical oath to not do harm, and due to liability risks of doing a surgery that does not appear as being a necessity.
2. Endometriosis and RPL – Further, based on the prominent literature in Canada, endo is typically viewed as a leading cause of not being able to get pregnant, not a cause of RPL. This means, no local doctors will be influenced to do an endo surgery for us in hopes of improving our changes, as they do not see a link to our RPL situation.
3. It was again reinforced to us that we should start taking it 4 days after ovulation.
4. For a doctor to order IVIG locally, it is very complicated. First, they must have hospital rights. Second, it requires approval from Infectious Disease. Third, the only time IVIG is for pregnant women who contract chicken pocks. It has never, and will likely never be approved by Infectious Disease for our situation.
5. While it is unlikely Dr. B will recommend we use interlipids, we will not be able to get interlipids here. We already knew this based on discussion with our RE and my local immunologist. It is not a product that is utilized here, so we simply cannot get local access to it. In fact, 2 of the 3 doctors have not even heard of interlipds.
6. Absolutely take a low dose prednisone.  Here it is common to use prednisone on someone who has lupus or sever morning sickness.  There is a slight risks of cleft palate, which is correctable should it occur. Therefore, the potential benefits outweigh the risks.
7. Restricted blood flow to my uterus.  Here they don’t do doppler sonograms until 20 weeks, and only for people who have a history of preeclampsia or past low birth weights.  Knowing the blood flow issue, the best approach would be a low dose heparin. There are no guarantees it would make enough of a difference, but it won’t hurt so it would be worth a try. .
8. Poor pre-implantation lining. Estradiol (I think), may help my body develop a better lining prior to implantation. This may be something to consider if we try again. The drawback of this is that an RE will have to monitor my cycles to see what happens.

So, while we continue to wait for the final diagnosis and treatment plan from Dr. B, we have learned a few more things about the treatment that will be available to us locally. Probably the most important things we have learned are that a local endo surgery is completely off the table. Secondly, we will virtually need a miracle to get IVIG locally. Thirdly, we will not get interlipids in our province.

Honestly, we aren’t even upset with all this news. If anything, we are just happy to have more knowledge on our local treatment options. We are no worse off today than we were a week ago. So, really we are not upset by this news as it doesn’t change anything for us. And, if anything, we are relieved to know this now so that we will not get our hopes up, just to have them crushed in a few months.

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