Warning this is going to be a long post filled with IVF jargon and some of my personal views on certain IVF related dilemmas. They are just my opinions as everyone is entitled to their own.
When I first started this blog, I had it in my mind that IUI was going to work. Just as I had the idea when we first started TTC that natural conception was going to work. Our first IUI was a bit of a disaster; we were both super on edge, snappy with eachother and J’s counts were the lowest we had had thus far. As we sat in the hospital cafeteria waiting for the sample to be washed and spun we speculated about the future. We both agreed that we couldn’t imagine doing IVF if we were having this much trouble with IUIs. I said it would take a lot soul searching for me to consider doing IVF. It just seemed like too much; too much money, too much stress, just more than we could handle.
Fast forward to our 3rd (and final) IUI and at that point I was rather certain that IUI wasn’t going to work after all. I was already pondering the thing that I thought I wouldn’t do, but as you go forward with treatment, you realise just how far you are willing to go. With infertility, everytime you open a door and step through, it shuts behind you and you can only go forward. Decide to start TTC (natural conception), we’ve made the decision, the door shuts behind us (not that we realised it at the time), we are officially “trying”. Twelve months later, still nothing, see a fertility specialist, diagnosed infertile. The natural conception door shuts behind us as we move onto IUIs. After that fails, we were left standing on the other side of the door, wondering how we got here and where we go next. Although we can’t go backwards, there is more than one choice going forward, we just have to decide.
Before we even went in to our appointment I was fairly certain we were going to have to go forward with IVF + ICSI but definitely wanted to hear the Dr out, see what he had to say, although I know ultimately it is our decision. So here’s how it all shook out.
Dr. M sits down with us, and apologizes that it’s not going to be as easy as we had hoped. He looks over our file and J’s SA results, as well as counts from the IUIs. He says that J’s numbers are just bordering on average, that if 15 is a pass, then J is at 15.2 (just made up numbers as a “for example”). This is pretty much the case for motility, counts and morphology. His analysis does also depend on what averages he is using. J’s morphology on his first SA was 0%, and the second one 4%. Now 4% is generally the lowest they want to see, but even still that is pretty low (and by some standards considered below average). Plus his counts over our IUIs were much worse than his initial SA of around 45 million. We averaged somewhere between 15 – 20 million per IUI at about 50% motility. Say, based on 20 million if you figure that 4% of those are normal forms that’s only 800,000 and if only 50% are motile, cut that number in half. That seems like pretty shitty odds if you ask me (I know it’s not that cut and dry, but just to paint you a picture).
So anyways, that is the past and it didn’t work, so obviously it doesn’t really matter. It bugged me a little bit though, as he called us unexplained infertility. He did say that based on the fact that I responded very well to the clomid, and my progesterone was good after ovulation, and J’s numbers are so so that it would stand to reason that MFI was our problem, but he still left it at unexplained.
He told us we basically have two options; to do 3 more IUIs with injectables and monitoring, or just go straight to IVF with ICSI (I’m so glad he automatically suggested we do ICSI, because I wasn’t sure what our best option would be). He said we don’t have to do ICSI, but because of J’s numbers it would probably be in our best interest. He did advise that there are some higher risks associated with ICSI, just so we can make an informed decision. I asked him what he thought our best option might be, and he said if it were not for the cost of IVF he would take IUI off the table completely.
That is sort of what I figured his opinion might be (and am happy to have my thoughts validated). Based on the research and reading I have done after 3 IUIs the likelihood of it working drops (based on success rate %). So in my mind, why would we not move onto IVF? Obviously money is a factor, in that we have to pay for it ourselves, but if that is the only reason against jumping straight into it then it is not really a consideration for me. We will find the money.
Dr. M could tell from my questions and thoughts that our minds were pretty much already made up. I sort of verbalized my thought process to him, and he agreed and said that I was taking the logical route and not basing my decision on emotion or money (I am a very analytical person, so he hit the nail on the head with that comment). He had a short power point on his computer just going over the process for an IVF cycle (which I pretty much already knew from all you brave IVF ladies who have gone before me). He gave me a requisition for a SHG (sonohysterogram), an AFC (antral follicle count) and for me to redo my day 3 bloodwork. After all that is done, we are good to go (so long as they don’t find any problems).
When he was reviewing our file he noted that he had J listed as a smoker, and questioned whether that was still the case which J guiltily admitted it was. Dr. M strongly advised that he quit smoking and we give it 3 months for the nicotine to get out of his system as it can reduce the success of IVF by up to 25%. That seemed really high to me, but he said if he were in our shoes he wouldn’t be gambling that kind of money on subpar sperm, and I tend to agree. Even before our IUIs I told J I wouldn’t do it until he quit smoking, which he did, for a very short period of time. But this time, it is all or nothing. I’m not messing around. For all I’ll have to go through, he can throw out his gawd damn cancer sticks. His smoking is a rather sore subject with me, and everytime we see Dr. M he shames J for it, which I know J hates (good!). So we think he might need to take Champix or something, because he needs to try harder. The annoying thing is, when I first met him he was a regular smoker, and after about 4 months of us dating he quit, cold turkey, and stayed that way for over 4 years. So I know he can do it yet he won’t give it his best effort for probably the most important thing in our lives.
J and I talked, or rather I talked at him telling how it makes me feel as though he doesn’t care as much as I do because he won’t quit smoking. I told him I know that’s not the case, but it’s perception that I have and it really hurts my feelings. He gets sort of defensive about smoking and I could tell when we were in Dr. M’s office that he was getting uncomfortable/annoyed. At home tonight he said that he didn’t want to question Dr. M but how do so many smokers have babies? Again, just sounds like he’s trying to make excuses for his smoking but I told him that obviously smokers can have babies but in our case because we are already at a disadvantage his smoking just made it worse. And I’m not willing to fork out several thousand dollars on nicotine filled sperm. I told him he needs to do something that will work. I suggested we put a calendar on the fridge and cross days off. That way he’s more accountable to me (without me nagging) but can also see his success. Plus some sort of smoking cessation aid is in order.
So after all of this discussion, it looks as though our soonest IVF cycle would be August, to give J’s swimmers a chance to recuperate from nicotine, and get him back on some supplements. Which is ok, I suppose as we’re not quite ready to jump into this head first. The only thing that I slightly dislike about this is our tentative due date if all goes well, but obviously I am getting way ahead of myself, and at this point beggars can’t be choosers.
I also had questions about fresh vs frozen cycles, keeping remaining embryos, twins, ect. Dr. M gave us the stats that fresh cycles for women under 35 yrs old was 64.2% positive pregnancy, and 54.1% live birth rate, vs 70.5% positive pregnancy from a frozen cycle, and 53.7% live birth rate. So overall, I guess they shake out the same, because I don’t care about just getting pregnant, but getting our take home baby. There are some risks that come with using ICSI, such as higher rates of birth defects and genetic imprinting disorders (still very low, like 0.9% with ICSI as opposed to 0.3% with natural conception, which is minimal but 3 times higher than natural). I think I would still go ahead with ICSI just because I can’t take the thought of doing IVF without ICSI and not getting anything.
Dr. M said that more than likely I would over stimulate, and that he would rather have that than under stimulate. He said if I did over stimulate then they would do a freeze all and wait to transfer the frozen embies on the next cycle. He also said that the clinics frozen success rate has continued to increase and eventually he would like to stop doing fresh transfers at all, so it would give time to recover from retrieval and build the lining back up. That was very surprising to me, but I trust him and and I know he will do what’s best. Plus, overall with an overstimulation it would stand to reason we would end up with more eggs.
Dr. M did also suggest that they generally transfer 2 embryos which I am opposed to (depending on the quality, I suppose). Again, ultimately it is our choice, but he is the professional and I respect his opinion. He gives us full control of what we do, he said he likes us to be informed. Not like the days before the internet when a Drs word was gospel (I mean it’s still held with high esteem, but we all know there are Drs out there that don’t know their head from their ass). He wants us to be active participants, and ultimately we are in charge. He tells us that we’re the boss. I would really have to wait and see the quality of the embryos before making this call as I am very opposed to carrying/having twins. I think after having suffered through infertility, all of the sudden having two babies might be just too much. I don’t even necessarily know if I want more than one child. Plus with all the risks associated with twins, I would really just like to have a simple, uncomplicated singleton pregnancy. I know this is not the opinion of everyone and some of my fellow bloggers are currently pregnant with twins (hello instant family!) but it is not for me.
I also questioned him on what would happen if we did a successful cycle, and ended up with extra embryos on ice. He said it is a couple hundred dollars a year to keep them in the cryobank and then if we want to use them for another child in the future we can. He also said, if we decide not to use them we can donate them to science, donate them to another couple, or have them destroyed (he didn’t say it that way, but essentially that’s what would happen).
Now, in theory I am pro-choice, I don’t necessarily believe in life beginning at conception (settle down, I’m not trying to get into an abortion argument). However, if it were mine and J’s genetic material that we worked so hard to create, I would have a difficult time just letting them “expire” (that’s what Dr. M called it). On the other hand, I am not so comfortable donating to another couple, as much as I would like to help someone out of infertility. If I were in the case of not being able to use our own genetics I don’t know what I would do. But then again, you never know until you are put in that position.
I voiced this to Dr. M and he agreed that he is of the same belief (pro-choice), but put in our shoes he doesn’t know how he would make that decision either. He said, once you create these children from your embryos, the remaining ones could have just as easily ended up as a baby and then it’s not so black and white.
All in all, I feel good about what was discussed. J stayed pretty silent the whole time (as usual at our appointments). The one thing that made me want to scream is that just before we were leaving Dr. M said because we are “unexplained” we could be one of those couples that just goes on holidays and gets pregnant. Not that he suggesting that would happen necessarily, but just that it was possible because according to him there is no good reason why we haven’t had any success. I replied that I almost hope that doesn’t happen because then I will just perpetuate the stereotype of “just relax”.
J and I discussed everything over dinner and we’ve decided we are going to plan for IVF in August, but still continue to pursue a job transfer with J’s company. If nothing happens before August then we just let it go, and move forward with IVF. If we do get a transfer, then we put IVF on hold for the time being. It makes me feel a lot better having some sort of a timeline, instead of just floating in limbo. It feels good to have a plan, and a goal. Some thing to move forward to. Now I don’t even know what I want more, a transfer or IVF! We’ll most likely get both eventually, so I should be thankful for that.
If you made it all the way to the end of this post, congrats, gold star! I’m sure if we head down the IVF path I will be looking to the wise IVF veterans for advice. Until then, we are going to enjoy life with out fertility treatments, before we possibly have to bring out the big guns.