New All Over Again

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I started drafting this yesterday from the RE’s office. I had quite the wait, so I had some time to kill. I was in for my Antral follicle count, and for ultrasounds (baseline, monitoring, or otherwise) they assign you a day and then it is first come first serve as soon as they open at 7:45. You come in and take a number then wait until your number comes up to actually register with the check in desk. I’d seen this happening on days that I was in for an IUI or appt with Dr. M but never done it myself before. So I got there at 7:45 am sharp. Number 13. Fuck. Apparently people come as early as 7 and just wait until the doors open to get in first. Lesson learned because if/when we end up doing IVF, I’ll get to do this several times a week while on stimulating hormones. Interestingly, there was actually quite a bit of chatter in the normally silent waiting room, because there were so many people. It mostly died down after people started going in, but it was sort of nice to see the camaraderie.

J didn’t come with me this time as it was rather unnecessary, plus he’s swamped being back at work. It was my first time being at the clinic by myself. I know that seems crazy, but so far it’s been important for J to be here (either for the appts with Dr. M or to give his deposits). He’s such a good guy and I’m lucky he’s been able to make it work, as I know a lot of ladies out there just go it alone because schedules don’t mesh. I didn’t like being there alone, it made me feel vulnerable. Plus with the whole numbers fiasco I felt like a newbie to infertility all over again. Also, this was my first ever date with the dildo cam. Again, I know, how did I get so far without that pre requisite meeting? I suppose because my IUIs were unmonitored, there was no need, it’s not until injectables and/or IVF that they bring out the big guns. But they needed to do the pre IVF Antral follicle count, and if/when we do IVF, I’m sure the dildo cam and I will be besties.

So, I finally got called back, to an area I’ve never been before (I didn’t have to walk past the wall of babies this time, bonus!). The nurse showed me to a change room where I was to get undressed, waist down. She asked me if I was on anything besides synthroid and I told her no. She questioned, no folic acid or anything? I gave her the short version that I had suspended all supplements after our last failed IUI but would be back on them as of this cycle. She gave me a bit of a lecture about how it takes 3 months for it to build up in my system. I said, yes I realized that, I was going to be starting them again right away, so she left it alone. She then asked what cycle day I’m on and I told her CD4, she kind of gave me a questioning look and asked if I had a hard time making my ultrasound appt. I said no, but that I hadn’t called until Tuesday because I was out of town. So she tells me that I was supposed to come in on day 1, 2, or 3.

This was news to me as the instructions they gave me specifically said day 2 – 4. I told her this, and she said no, that’s for AFC and then asked if I am there to start injectables? Then I understood her confusion, I told her I was there for the AFC and she had to turf the paper work she had just done. Apparently I was booked for the wrong appt, but I know the girl who left me the voicemail confirming it said it was for AFC so I don’t know where it went wrong. Luckily I was still in the right place, she just had to redo my chart and she told me to carry on, get undressed and go across the hall to the ultrasound room.

So because I have never been to this part of the clinic, or had to have an internal ultrasound I wasn’t really sure what was up. There was a sheet on the chair in the change room (I initially thought it was a gown, but nope just a sheet). So I was kind of confused, like what do I do with this, just wrap up and waddle across the hall? Apparently yes. I also wasn’t sure what to do with my clothes, but the nurse told me just to leave them in the room because I’d be right back after. So I was a bit out of sorts, and just felt unsure of everything. I toddled across the hall (it’s a small hallway, and fortunately I didn’t have to go far with my makeshift sheet/skirt). I get into the room and about 10 seconds later the doctor knocked on the door and came in. This was Dr. T, the 3rd doctor I’ve met now. I don’t think I’ve ever had the same nurse, and now meeting a 3rd doctor. There are a lot of people that work at the clinic. I think the only constant is the surly, young tattooed girl who works reception (and subsequently the one who makes my appts). She doesn’t seem like the most friendly person to work in a fertility clinic, but I suppose that’s neither here nor there.

So, Dr. T tells me she’s going to do my AFC, and doesn’t say much else. Doesn’t explain anything about the wand/probe (what do they call it, surely not just dildo cam?) or give me any advanced warning and just got right to it. Can I just say how not cool it is having a transvaginal ultrasound when you’re on your period. Gross. Anyways, she just starts poking around in there and she too asks me if I’m on any medications or supplements. I tell her not at the moment but will be this cycle and she gave me the lecture about always taking folic acid, yada yada. I told her the same thing I told the nurse and that I was going to be starting them again right away and that we weren’t planning on IVF until August. She still gave me a bit of a chastising, so I just gave her the obligatory mmhmm and left it alone.

She showed me my uterus, and said my lining looks thin (which is to be expected at CD4). She checked out my right ovary, then the left. She paused and made what I interpreted to be a displeased or confused noise on the left but it seemed to be ok, as she didn’t make any mention of a problem. Overall it was not nearly as bad as I thought it would be. I know the ultrasounds are one of the easy peasy parts, but I just didn’t know what to expect. It was just a bit weird and uncomfortable, but ok. My left ovary was 9 follicles, and my right was 15, which apparently is good. I didn’t do any googling research beforehand, so I had no idea what that all meant at the time. Dr. T just said it was good, and that I could go change. I didn’t know if there was anything else, so I asked if I needed to do anything else, or that was it. She kind of chuckled and told me, no that was it. So I went and changed, and started to head out.

After feeling a bit out of sorts, I do have to mention the one really lovely thing that probably helped me stay calm. In the change room there was a white board on the wall, with a marker as well. On the board were all sorts of positive messages and words, from patients come and gone. It made me feel less alone, and it was really lovely. I don’t know how it came about, but I think it is fabulous. I don’t know if the erase it everyday and start new everyday but I’m looking forward to seeing it next time. I was too overwhelmed to think of anything to put on the board, but next time I will make a contribution. I took a picture so I could share with you all.

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On my way out I stopped in to see Tatts (that’s what I’m going to call the receptionist from now on, even though it’s really only one big tattoo on her arm that’s visible) and confirm my next appointment for the saline infusion sonohysterogram. Apparently it’s the same sort of numbers game for the SIS as it was for the ultrasound, but they don’t get as busy for the SIS, and it’s in the afternoon so I don’t have to be up at the crack of dawn. I also spoke to the IVF coordinator about if or when Dr. M was going to be away in the summer. She told me he is away at the end of June, and again in October so it shouldn’t be a problem for our tentative IVF schedule. When I told her we were looking at August for IVF she did advise that a lot of people plan for it in the summer, and they can only take a certain number of patients. So she told me to call ASAP when I start full flow on CD1 as if they get too many people they’ll take first come, first serve (seems to be a recurring theme, eh?). I’m glad I asked, and now I know the plan.

Infertility has a steep learning curve, and once you pass one milestone (whether good or bad) there’s always something new to learn just around the corner. So here’s hoping that no unexpected issues crop up. We seem to be barreling into this head first and I’m sure August will be here before we know it!

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Down the Rabbit Hole

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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.