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So I’ve been pretty quiet lately as there really just isn’t much to say anymore. I’m in the dreaded waiting phase in between cycles and I’m having a really hard time even feeling interested in this upcoming cycle at all. I know that there are a lot of women out there who need three IVF cycles to get pregnant, but it’s still impossible for me to believe that this cycle could possibly have an outcome that is any different than the previous two.

We’re reaching the end of the “biological children” road and while I’ve said before that I’d be perfectly happy with a non-biological child (and I still stand by that), the thought of it makes me sad nonetheless. And if this cycle doesn’t work, then we’re headed into uncharted waters…not having a plan of what to do next. We discussed our options a couple of weeks ago on our way to Easter, but didn’t really come to any conclusions. While it was good to talk through things and I learned some new information from my husband, I still don’t know what’s going to happen if this doesn’t work. But that’s a different subject for a different day, I guess. For now we’ll just continue to wait and hope for the best.

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If you’ll recall, during my last phone conversation with my nurse, she mentioned that I shouldn’t be discouraged because my RE has lots of tricks up his sleeve. When she said tricks, I was thinking fancy and unconventional protocols (EPP), co-culture, different med combinations, etc. As it turns out, my RE appears to have no tricks up his sleeve for me for our third and final IVF with this clinic.

Our WTF consult started out as it always has in the past, with him saying how he’s so sorry that things didn’t work out. It’s nice that he cares and expresses that emotion, but it kind of feels a bit hollow at this point. Anyway, he went on to say that I stim great, we just need to get some better results with the embryos. Obviously my concerns are that from 19 and 18 eggs retrieved, we’ve only ever ended up with one blast and one morula on day five. He mentioned that on average 4 out of 5 human eggs are “junk,” so my results aren’t too far from the norm. That stat really shocked me because it just doesn’t really mesh with how I see so many other women’s cycles go (not to mention all of the women who get pregnant the first month they try). But I guess it’s irrelevant, it doesn’t really matter what the stats are, just how things go for us.

So given that I had a good response to the last cycle, he plans to do the exact same antagonist protocol again. I was somewhat disappointed when I heard this because in the back of my mind I was hoping that he’d have some special “high quality” protocol that would be just perfect for me. To hear that we’ll be doing the exact same thing that we’ve already done was kind of a letdown.

OK, so no tricks up his sleeves with the protocol. The tricks must be in the details of the cycle. And here’s where I should give you some info on my doctor. He’s super technical and really seems to know his stuff (as he should for what we’re paying him) and he is very opinionated. If you bring up something that he doesn’t believe is useful in treating infertility, he will let you know, and in no uncertain terms, that he thinks it’s all a bunch of hooey. So without further ado, here’s the list of “tricks” that I came up with that were pretty much all shot down by him.

• Three day transfer – this was shot down since they believe that a five day is really the way to go. Never mind that the uterus is really the best place for those embryos to be while they’re trying to grow up nice and strong. But, in all fairness, I can’t really argue with this one too much since they do have a phenomenal pregnancy rate of 61.8% per transfer for my age group and 90% of their transfer are day five.

• Embryo glue – Many people have mentioned this, and it seems that my clinic already uses this, though I was completely unaware that they did. This is another one of those things that my doctor doesn’t really buy into and he even said that they’re going to discontinue using it in the future because it doesn’t really seem to make a difference in success rates.

• Assisted hatching – I remember from our consult many months ago that he said the clinic only does AH on day three embryos, not on blasts. He said once they get to day five most of them are already starting to hatch on their own, and if they aren’t, the blast can actually be damaged by scoring it at that stage. I knew this, but I thougth I’d question him on it again anyway. He stated that the hole that is made during the ICSI process usually works just like AH does. The blast tends to expand out of that hold just like it would if AH had be performed on the embryo. So I asked him if my two blasts had been hatching when they were transferred and he took a quick look at the photos and said that yes, both of them were starting to hatch. I looked, and for the life of me can’t see anywhere on either of the two blasts where they might have been starting to hatch, but I guess he’s the expert, not me.

• Co-culture – Many women have attributed their eventual success to co-culture, so I thought I’d ask if they even offered it at my clinic. He said that yes they did, but again it’s one of those things that he doesn’t believe actually increases pregnancy rates. He actually told me that it’s a pain in the ass and the lab people hate doing it and it’s more hassle than it’s worth. Wow. Just wow.

• Additional testing – I asked about additional testing like antibodies, thyroid, karyotyping, etc. He said we could if we wanted to, but the results are often hard to interpret and even more difficult to treat. Not sure I really understood this one, but he seems to think that the testing we’ve already done is sufficient. Since this is an area that I really don’t know a whole lot about, and because this testing can be really, really expensive, I was willing to take his half-assed response to this line of questioning as is.

So that’s the list of things that he essentially shot down. Here’s my list of consolation prizes…things he was willing to compromise with me on.

• ICSI – When we originally met with this doctor, he stated that it was possible that Mark could have developed anti-sperm antibodies due to two hernia surgeries. He told us that we could test for it, but if the test came back positive, the way to get around it is to just do ICSI. So to save the time and money involved in testing, he suggested just doing ICSI to avoid the whole issue. OK, fine. That’s what we did the first two times. Now I’ve heard experiences from women who have split their batch of eggs in half and done ICSI on half and let the rest fertilize naturally, and the ones that fertilized naturally have developed better than those that were ICSI’ed. I mentioned this to him and he said that he thinks those situations are ones where the ICSI is just not performed well and that’s what causes the embryos to not do as well. Again my clinic has great success rates, so I’m inclined to think that the embryologists are very skilled at what they do, but I’m still curious. I told him that if we were to get a decent number of eggs, I would like to do ICSI on most, but leave a few out to fertilize naturally just to see what happens. Even with his opinion, he was willing to do this, which makes me feel better. Plus, I’d still really like to know if fertilization is our issue, and this would be a great way to find out.

• P4 follow up – This last cycle I was spotting heavily for a few days before my negative beta. Now I’ve always been a chronic spotter, but I really thought that doing PIO would mean that I wouldn’t spot (and this was true with my first IVF). The fact that I was spotting for 3 days before my beta makes me really wonder if my body has issues absorbing the progesterone. He said he didn’t think that was the case because I’m taking so much progesterone. I asked him if I could have my P4 checked 7 days after retrieval just for my peace of mind. He said sure, that they have their local patients come in for a progesterone check mid-lueteal phase. Ummm…what? Why would you have a different protocol for in town patients versus out of town patients? I know it’s very unlikely that there is anything wrong with my P4 levels, but I still want to know.

• Stim dosages – I mentioned that I was concerned that maybe the stim dose was burning out my eggs and that’s why we were having such quality issues. I told him that I would gladly trade a smaller number of eggs for better eggs if he thought that would help. He said that we could definitely do that and thought it might help. As opposed to the 225 Follistim and 150 Repronex daily, he threw out 150 Follistim and 75 Repronex as options. I’m not sure if that will be my final dose once we actually get around to starting the cycle or not, but it’s on the table at least. On one hand I’m really hoping that this will be the key to better quality, and on the other hand, I’m absolutely terrified that the lower dose won’t work at all and I’ll be cancelled again. I guess I just have to suck it up and hope for the best.

• 3 embryo transfer – For fun, not thinking that he would ever agree since my clinic has what I thought was a strict “only two embryos in women under 35” rule, I asked him if, by some miracle, we ended up with three embryos on day five of this next cycle, if we could transfer them all. The words had barely escaped my mouth and he was already replying “absolutely.” I looked over at Mark and he gave a big smile and a thumbs up to me. Of course having the option to transfer three means nothing if we don’t have three to transfer. Past history would indicate that the chances of getting three are not so hot, but I’m still happy to know that we can do it if we have enough embryos.

When we hung up the phone I turned to Mark and said “well that was horseshit.” It’s not that anything went particularly badly, I guess I was just expecting more than “we’re doing the exact same thing” as his plan. The changes that we’re making are because of my doing, not because he thought it would be best. And part of me isn’t satisfied with his answers to some of the questions, but I honestly don’t have the energy or desire to really push the issues. I really just want this next cycle to be over so that we can move on in some way.

So there. That’s probably a lot more reading than you were expecting on a Thursday. In fact, that’s a lot more typing then I had planned to do. But there it is. Accordingly my fertility signs (which no matter how hard I try, I can’t ignore), I am about half way through my “break” cycle now, so I should be starting BCP’s for our final IVF sometime the week of the 20th. Good times.

So yeah, not the best title, but it speaks for itself. Here’s what my life’s been like the past few days:

· Baseline went well on Friday
· I promptly started taking the wrong dosage of my microdose lupron first thing on Saturday
· I didn’t realize that I was taking the wrong dose until Sunday evening, 3 doses later
· I freaked out and didn’t want to call the clinic to tell them for fear of being cancelled
· Mark made me call the clinic
· We were able to change up my protocol by eliminating the lupron altogether and we’ll add Cetrotide later
· Breathe big sigh of relief that we were not cancelled
· Figure out that someone has fraudulently charged $200 in porn to my credit card
· Go for first monitoring appointment this morning at which the nurse only finds two follicles on my left ovary
· Right ovary is missing in action, somehow
· Get a call from my gynecologist saying that my pap a couple of weeks ago came back with abnormal cells
· They want me to go in for a colposcopy to check out the abnormal cells
· Ride home from Iowa takes a stressful and tense 5 hours and 45 minutes instead of the usual four due to a nice snowfall
· After returning to work, find out that Mark is not getting the job that he was the perfect candidate for and would have been a great promotion (and financial relief in paying off our IVF debt)

Anyway, it seems like anything that can go wrong has in the past few days. I’m hoping for a great response on Friday to make up for all of the crappiness that has gone on lately.

I know that I have been nominated for a couple of awards (thank you!) within the past couple of weeks and I need to return some comments also. I will try to get to those real soon, but things are kind of hectic now, so please try to bear with me.

So it occurred to me the other day that I don’t think I ever posted about our WTF phone consult with the RE a few weeks ago. The doctor said immediately that we hit a road bump, but that he doesn’t think that it is any indication of how future cycles will go. He said that I just got over-suppressed, which is what I had imagined had happened. When my nurse called after my suppression check and first E2 draw and told me that I should reduce my Lupron from 10 units to 5 units, that was my very first thought. All of the lovely ladies at Ovusoft told me that it wasn’t a big deal and that most women have their Lupron dropped when they started stims, but I hadn’t started stims yet; I was still five days away from starting stims. Anyway, it came as no surprise to me that the RE was chalking up the cancellation to over-suppression.

So the plan is to take a break cycle, which I’m currently doing, and then start again with my next cycle. This time we will do the micro dose lupron protocol instead of the long lupron in an attempt to avoide over-suppression again. Our RE seems to think that this will make all of the difference, and I certainly hope that he’s correct.

I’m very pleased with how this break cycle is going so far, because I did actually end up ovulating. I have read stories of women online who did not ovulate following a cancelled cycle and ended up waiting weeks for a new cycle, only to have to take progesterone in the end to bring on the next cycle. Fortunately, it seems that my body remembers what it is supposed to do, and in about a week and a half, we should be starting our second attempt at our first IVF.

I am definitely looking forward to getting started again. I am in no means a patient person, and having to go through so much time waiting for our first IVF cycle only to get cancelled has made me anticipate this next cycle all that much more. As crazy as it sounds, I cannot wait to start doing my injections again…I am chomping at the bit!

So last Tuesday we got up bright and early to go to our consultation with the new clinic.  We were really early, so we had some lunch and then went to the mall for a bit before heading over to the clinic.  We registered with the receptionist and were taken back within a few minutes.  The nurse that took us back took my weight and blood pressure and then we met with the RE.  As usual, he started with the whole medical history bit, and went through my records and entered all of my test results into his system.  After that, he went through all of the basic causes of infertility and crossed them off one by one and ultimately came up with the conclusion that we have unexplained infertility (duh).  The only possible explanation that he gave us for our difficulties in conceiving was that that it is possible that Mark may have developed antisperm antibodies as a result of a hernia repair surgery that he had last year.  If that were the case, it would lead to fertilization problems, which could explain why we’re not pregnant yet. 

 

Once he officially gave us his diagnosis, he said that he guessed that we were ready to move on to IVF since most people wouldn’t travel 4+ hours for clomid and IUI’s.  BINGO!  At his clinic, they do ICSI for 90% to 95% of their IVF cycles, and he would recommend that for us too because of the possibility of antisperm antibodies and ICSI would bypass the entire fertilization issue.

 

He seems to think that IVF will do the trick for us, and of course we are hoping that he’s right.  He said that I have responded well to the oral meds in the past and that bodes well for how I will respond to the injectables.  He also thought that we should be able to participate in the shared risk program which will allow us to do three fresh IVF cycles along with any associated frozen cycles for one fixed cost.  The nice part about this particular program is that meds are included in the package price which is a HUGE cost savings.  Comparing my previous clinic’s shared risk program to this new one, we will save somewhere between $6,500 and $17,500 depending on how many tries it takes us to get pregnant. 

 

So before we can move on, he said that I would l need to have another sonohysterogram/mock transfer.  This will be done so that he can determine the curvature of my cervix so that inserting the catheter for the embryo transfer is as easy as possible, and also to determine the shape of my uterus so that he can put the embryos in the “sweet spot” where they will have the best chance to implant.  Mark and I also both had to have blood tests for HIV, Hepatitis, etc, which we did on Thursday. 

 

All that’s left now is to have a phone meeting with the financial advisor and then take the IVF patient education class.  And unfortunately, that seems to be where we’ve hit some stumbling blocks.  He said that he would have the financial coordinator (who also seems to be the person who determines if we can participate in the shared risk program) call us last Wednesday to go over everything.  Well, today is Monday, and we still have not heard from her.  I left her a voicemail and also sent her an e-mail, and still no response.  My mock transfer is scheduled for Thursday and I need to know if we are accepted into the shared risk program before then.  If for some reason we cannot be a part of the shared risk program, then we will likely not go forward with this particular clinic due to the distance.  There is no sense in heading down there for a mock transfer if we won’t be pursuing treatment with them.  So at this point I am beyond frustrated with the lack of communication.

 

Additionally, we need to attend a patient education class before we can start IVF.  It just so happened that they were doing one of these classes on the very same day that we were there for our consult.  We actually asked if we could stay and do it then since it would save us a trip, but the receptionist insisted that we must have all of our pre-testing and financial appointment completed before we can take the class.  We had asked Dr. C if there was any way that we could do both the SHG/mock transfer and the class on the same day, and he said that it would probably be doable.  Well when I called to make my SHG appointment, the receptionist told me that the next class wasn’t until late, late August.  What?!?  Do they only do these classes once a month?  If we had to wait until late August before we could take the class, we would miss a whole other cycle, which is certainly not what we want at this point.

 

So I called on Friday afternoon to see if there was any way that we could pay extra to have a special class just for us.  If not, could we start the birth control pills BEFORE we took the class since you don’t really need a whole lot of education to pop a BCP.  Either of those two options would work out just fine for us (of course we’re hoping that somehow we can arrange a special class just for us on Thursday, which would save us another trip down there), but we still have not heard anything back yet.

 

I’m frustrated because when I initially contacted this clinic, I had asked about doing treatment from out of state.  The coordinator had responded that they just had a client from Wisconsin get pregnant from treatment there the previous week, which made it seem like they were experienced in dealing with patients from out of state and that perhaps they were accommodating to their needs.  So far I have not noticed that to be true, and my frustration with their lack of response is certainly growing with each passing hour with no return phone call.

 

In my heart, I feel like this is the clinic that we need to be at and we will get pregnant from this.  But at this moment, I am so upset and frustrated, I just don’t even know what to do with myself.  I know that frustration is the last thing that I need when we’re going to be starting IVF, so I really hope that the communication improves from here on out.  I have no idea what we will do if it doesn’t.

 

In more positive news, a woman in my real life support group who has been undergoing IUI’s for over a year (her husband is sterile due to cancer treatments) finally got her BFP.  It was so thrilling to hear that it finally worked for her.  I cannot imagine taking 12.5 mg of Femara and doing two IUI’s every month for 15 months.  The stress and emotion of 5 IUI’s was nearly too much for me. 

 

Additionally, two women from my online buddy group are also pregnant, one of which was just about to start IVF for severe male factor infertility.  She thought that the only way they could get pregnant was IVF with ICSI and somehow they got a miracle BFP.  It is exciting to know that it is happening for other women.  On one hand it makes me think that if it can happen for them, then it can happen for me.  On the other hand, of course, it makes me wonder how come they can get pregnant with presumably such major issue, but we can’t with presumably minor or non-existent issues.  It’s a frustrating mixed bag of emotions.  But I am very truly happy for all of them.  I’m just wishing that our time comes soon too.

Our History

Dec 2006 - Started trying to conceive
Summer 2007 - Semen analysis (great), progesterone test (normal)
Dec 2007 - SHG normal
Jan 2008 - 1st RE appointment
Feb - Mar 2008 - Diagnosed with elevated FSH levels, 2 rounds of IUI with 5mg of Femara
Apr - Jun 2008 - Seeing a new RE. 3 rounds of IUI with 12.5mg of Femara, all busts. HSG normal
July 2008 - Moving on to IVF at a new clinic
Aug/Sep 2008 - 1st IVF cycle - cancelled due to poor response
Nov/Dec 2008 - Retry IVF, transferred one blast and one morula, negative beta
Feb/Mar 2009 - 2nd IVF cycle - Antagonist protocol
May 2009 - 3rd and final attempt at IVF - Antagonist protocol
Feb 18th, 2010 - our One Small Wish comes true: Nina Adele is born.

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