We had our follow-up consult with our RE earlier this week. It went pretty much as I expected, with one exception. I’ll get to that in a moment.
First, the expected: My eggs are old. Really? I hope that makes the evening news. RE said that he and the embryologist were very surprised that only one of my 5 mature eggs fertilized normally (3 didn’t fertilize at all and they all underwent ICSI), but that they really don’t have an explanation other than my age and presumed aneuploidy. Again, very helpful, thanks. No change to the protocol if we do this again.
The RE also said that he didn’t think the Lupron or the Puregon could have caused any quality issues with egg or embryo and commented on the studies I’d read saying they used “the wrong technology” to measure the effects on chromosomes of eggs and embryos with varying levels of stimulation and more recent studies show that even maximum doses of stims don’t affect egg or embryo quality chromosomally. I have a few questions about that, none of which I raised at the time because I was in shut-down mode after hearing he’d just repeat the same protocol except I could use another drug instead of Lupron that did the same thing since the Lupron was a nasty bit of business for me.
Question #1: Where are these newer studies?
Question #2: This doc knows I have a background in reading medical literature so why he didn’t voluntarily direct me to or provide us with those studies? [side note: Bless the OB who was supposed to do my first D&C for getting my email after learning what I did for a living and sending me a bunch of studies that were really encouraging after I lost baby #1 – sometimes doctors really do act human and get it right].
Question #3: How are these studies conducted and are any of them done on women whose eggs are over 40? Because let’s face it, if they’re all done on women who are 27-35 they have little application to my case and many others in my shoes.
Question #4: Not all negative effects need be chromosomal. Do these newer studies test for fragmentation and other “errors” that can arise in the cell-duplication process? Surely “quality” of embryos and eggs is not simply a matter of chromosomes?
Finally, we discussed my chance of a pregnancy if we repeat this performance. He gave us a 10% chance next time using the same protocol and knowing what we know now. That’s not chance of live birth, only a positive beta at 11dp3dt or 9dp5dt. Big deal. I’ve had a half dozen of those who’ve never made it into my arms. $10K for another potential miscarriage… um. Maybe not so fast.
Enter the IUI discussion. To my surprise, the RE did not discourage us. He did not comment enthusiastically or even give us odds of success, but he politely answered my questions about how much it cost ($800 – less than 10% of the IVF, excluding meds in both cases), when I could start (as soon as next week when my next natural cycle is scheduled to begin), if I could use the same stims (yes), if I would not have to take BCP or Lupron (yes to both – don’t take either) and how much time I’d have to spend away from home, at the clinic for monitoring (7-10 days, like with the IVF). We said “let’s do it”.
Well, truth be told, I asked the LP if he wanted to start that and he nodded as he paced the room – these calls make us both sick to our stomach and I’d just finished a long discussion with the RE about how it would work if we decided to use frozen donor eggs at their clinic (fresh is not an option, we don’t know anyone we’d hit up for eggs and we live in a land where fresh donor cycles other than with someone you know personally are illegal), which long discussion probably added to the LP’s nausea and general distress. I am still in awe at how emotionally traumatizing our fertility challenges and in particular the IVF process have been and are for the LP. My heart aches a little for him. I’m glad he’s at least letting me know… and it does help us trauma-bond, I suppose, in a macabre sort of way.
Back to the IUI discussion. I got a call from one of the nurses at the clinic who I really liked yesterday and she sent me the consent forms and a package of information spelling out the superovulation and IUI process in detail (Yay – nothing I love more than new reading material!). I am going to get the LP to sign above his dotted line today and fire those back to the clinic. Then I just have to call on cycle day one and decide if that’s going to be next week or next month.
That decision is entirely dependent on my work schedule and which day actually ends up being cycle day one. I can’t leave town for 3 days in late February as I’m in a course that my work has paid several thousand dollars for me to attend after I spent several hours making a business case for it and pitching it to my practice group leader. Plus, I want to go to the course.
That said, I also want to bring our little spirit baby home. So somehow we will make this work, either this month or next.
And on the magical front inspired by my hypnotherapy… I’m still hoping maybe all of this will be unnecessary. You never know. And it doesn’t hurt to dream. Well, sometimes it does ache a fair bit, but I’m up for it.
Wish us luck, friends. Please.