Going for the kill?

Overkill... that was Dr. Schoolie's word for whether we should consider CCS for our remaining 10 embryos when we asked him a couple of weeks ago.

We were satisfied with his answer at the time, but I've had some time to think about it and now I'm not so sure.

I believe that knowing how many normals we have left will dramatically change how we proceed.

Scenario 1: No CCS, The original plan. 

• If I miscarried again, we wouldn't know if it was because of an abnormal.  
• It would be more difficult to determine when it would be time to retire my ute. 
• I don't think I have enough stamina left in me to go through any more losses.  Especially if the loss was due to an abnormal embryo, that never would have most likely never had a chance of making it.  
• I could have a baby on the very next shot, and save ourselves the cost of CCS.  Oh, to dream!  (10 embryos is $6,875 + $1,000 because they were previously frozen = freaking gag me.)  
• I would be seriously considering transferring 2 embryos at a time, at Dr. S's recommendation.   Having multiples and the complications and loss that could happen because of this scares the crap out of me. 
• My clock is ticking.  I can't stand the thought of doing this all for many more years.  Six years has been enough.  Miscarriages and FETs take time.  My body seems to get pregnant even when the embryos are abnormal.  Of course, I don't know this for sure.  Especially for our last cycle.  I am quite confident that my first two miscarriages (from our own IVF and the donor embryos) were because of abnormal embryos.   In all reality, to do 5 transfers with our 10 embryos would take over a year.  If more miscarriages or cancelled cycles were thrown into the mix, it would probably be double that. 

Scenario 2: CCS reveals all DE embryos are abnormal:

• This could happen.  This is us after all.  And Dr. S says there is a small chance of this because D has wonky sperm. 
• We would be devastated.  I don't even want to imagine this. We would have flushed a lot of money down the toilet on this DE escapade.   However, knowing this information would prevent us from:
• Throwing good money after bad.  Meds, lost wages, travel costs and FET costs.
• Emotionally, it would be less painful to get one big dose of bad information than have it spread out over many BFNs or miscarriages.
• Knowing this would save us a lot of time.  

Scenario 3:  CCS reveals some normals:  

• Dr. S said 3-4 normal embryos would be a realistic expectation when we started the DE process based on how many embryos we have.  
• We would know what we were working with.  How many transfers to possibly expect. 
• We would only transfer one at a time.  Less risk to me and babies. 
• We wouldn't have to transfer the other 7 abnormal embryos. 
• Less emotional heartache, especially if there was one or more miscarriages. 
• Financially, we could avoid the meds, travel, lost wages and FET costs for (maybe) 3 transfers? 
• Math: If we transferred 2 at a time, assuming all survived the thaw, we would be doing at 3 extra/unnecessary transfers.  FET is $5,005 costs, say $2,500 for meds (Lovenox is expensive), and $1,000 for travel.  These are low estimates that do not include testing that would need to be updated.  The grand total is $25,515 vs. the $7,875 cost of CCS.  
• Physically,  I would not have to take the drugs or have the side effects for those transfers.  Amen. 
• If I knew that I miscarried a normal embryo. 
• It is very important information to know, but not the complete picture.  I now know that 50% of early miscarriages are with normal embryos. 
• Knowing this information would be more difficult for me emotionally because of the implications using my uterus.  
• If I put all of the normals into my body and they don't work, I will have to face the music that I've done all I can do with my body and it's time to move on to something else.
• We could transfer a normal embryo and have a baby straight away.  (I'm ready for this, universe! Pretty please?)
• If we had a child from these embryos, we would know exactly what we had left (if anything) in the freezer.  If we didn't have anything left, but had one child, we might make the decision to end this journey hell trip there. If we had 2 embryos left, and we transferred them, I would of course have my hopes up for another child.   Knowing how many normals we have would give me a big reality check through the rest of this process if we were lucky enough to have one baby.  
• If we try some normals, and have one or more miscarriages, we may be able to transfer our last normal(s) into a gestational carrier (if someone I know will do it - don't think we can spring for the $100k for a GC). 
• Okay, you can have a good laugh here, because I am.  But if we had several extra embryos (ha!), we plan to donate them to another couple.  This is because we were recipients of donor embryos and we would like to pay this generous gift forward.  If I knew that I had say, only one normal embryo left, no matter how many kids I had I would just transfer it.  If we didn't CCS and had say, 4 remaining embryos, after our family was complete (again, I laugh at myself that I'm even writing this), I would probably be thinking of donating them.   Those last 4 could be all abnormals.  I don't want to give another couple abnormal embryos.  And, I don't want to be involved with donating any embryos if I can avoid it.  (PS- Did you know that to have the option of donating the embryos CCRM charges approximately an extra $750 in blood work - that was a nasty little surprise.)

Risks to the embryos:

• We are waiting to hear this from Dr. S during our second regroup on Wednesday. 
• Some of our normals might not freeze well a second time, or survive thaw at transfer time.  We could harm an otherwise normal embryo.

We have a lot of hope still tied up into these 10 little embabies.

We'll see what Dr. S has to say about all of this Wednesday.  I wonder if he'll change his tune?

What do you think? What have I missed?

Courage or stupidity

D's near or at the end of his rope with all of our IF treatments.  I'm not quite there yet, but I am approaching.  Debating our end point has me thinking about what the two ways our story could be told.

You hear or read stories about people who persevered through crazy, intense, and heart wrenching scenarios.  One that comes to mind is that of Mo and Will, who navigated their way through tremendous obstacles (cancer, and seven miscarriages among many other things).  They now have a beautiful baby in their arms.   I put them well into the courageous category, and I know I would do this regardless of whether their most recent efforts made them parents or not.   It's because they handled the journey with intelligence, strength and grace.

I'm finding as we wade through deeper waters of IF, I'm starting to judge myself more harshly.  I'm wondering if I'm no longer making smart choices. Two, three and four years into this seemed like we were fighting the good fight.  We were young and had time on our side.  Year five I felt like we had new information and were on to something new and more promising with CCRM.

As we approach year six, I wonder if we've done something terribly wrong.   Especially as D reminds me of a couple that was in our adoption course who now has a toddler because they chose traditional adoption.  That could have been us.

I wonder if I am in denial? With all of what we know (and don't know) maybe chances of success are  too slim?  Maybe the cost of pursuing treatment are now too high? I feel time running short, we are emotionally drained and financially tired, not to mention the opportunity costs of IF.

D is going to be 37 soon.  I'm going to be 34 this year and according to every doctor I've met, my ovaries are a decade older than they should be.   If we want to pursue adoption it will be a lot harder (I think) if we are a few years older.

I feel like if the next procedure worked for us, I would look back and think about what an incredible story it would be.  "It was all worth it" is what people say when they end up with what they wanted.   Nobody questions your decisions any longer.  We would say that we triumphed after a long hard fight.  That we were beaten down but we got back up again and again, and again.  That we figured things out.  We made our dreams come true.

There's another part of me that sees how this story could be told in a much different light.  Perhaps as we enter six years in, we are entering a new territory.  I think I would question whether we made intelligent decisions from this point on.   Even possibly decisions about DE IVF if it didn't work either.

 

Bridesmaid

I was asked to be a bridesmaid in a wedding this July.  The offer completely caught me off guard to say the least.  I had met her all of three times before she asked me.   I'm not a good surprise-reactor under the best of situations, let alone this one where I hadn't even had time to process what I thought about it all.  D was also asked to be in the wedding party.

So, I hugged her and said a mostly enthusiastic, "sure!"

A month or so later it came out, that I was actually being asked to stand up for her fiancé, which made a little more sense.  He is D's long time friend, and he has hung out at our house a lot.  We've helped him get through some tough times in his past.

It's interesting. But, oh well I thought.  It will save me sitting at a table full of significant others who I don't know.  And maybe D & I will get a nice picture all dolled up together.  :)

The bride has been changing her mind (a few times) on the styles of bridesmaid dresses that she would like.   While other bridesmaids were growing slightly annoyed by the decision making process, I couldn't care less.  For one, I don't care what I'm wearing, it's her day, and I'm happy to wear a paper bag if that is what she wants.  It would be a plus if I liked the dress,  but it doesn't really matter.   The bride had many other people chiming in to give her advice, so I just sat back and relaxed.

After much deliberation over the course of a few months, the bride selected the bridesmaid dresses. She also let us know that they are on sale right now.  So, the good bridesmaid that I am, I called the store and ordered my dress.

There is only one problem though.  What size to order?   At first I thought I would just order my size and an extra bit of material.  You know, in case I was actually pregnant next July.

But I wasn't sure if this was the best option.  Maybe I should just order a larger dress?  That might be a weird conversation.  Umm, I'm planning on getting fatter, what size should I order?  So, I confided in the clerk my hopes of becoming pregnant, and asked her what I should do about sizing.  Deep down, I silly even saying it his to her.  Of course she doesn't know my history, but I've been through this before.  Thoughts of maybe by next Christmas or at my next birthday?  Should I buy that new winter coat? This sweater is great, because I could also wear it as a maternity sweater, I've told myself more than a few times.

It's such a hard thing to figure out.
a) If I'll be pregnant (please, please, please universe!), and
b) what size of a preggo I would be? (I think I'll be a nice plump one if I ever get the chance) , or
c) Will it be a pregnancy from our first CCRM IVF resulting in third trimester baby bump?
d) Will we (still holding my breath for a miracle) have more embies to transfer in a frozen cycle if the first transfer doesn't work?  Might I be pregnant, but only in the first or second trimester?
e) Will we have finally closed the door on OE, and moved on to DE and be in the early stages of a DE pregnancy? or
f) be where we are now, childless and not pregnant with one super-sized teal coloured bridesmaid dress?  Correct that, I mean as the bride would say, "malibu" coloured dress.

I decided to error on the side of optimism.  I ordered the dress two sizes larger than I am now.   They told me they could take it in if they needed to, and that it shouldn't be too hard with the style of dress.   But if things don't work out, I'm going to have a yucky little reminder in the early summer when I go in have my alterations done.

Here's to hoping I won't need those alterations.

Gearing up

Gah, I want to post something just so I don't have to look at the last pic anymore.  Bad call on the beard pic, and it doesn't even have any dandruff in it.  I don't hate beards, but ew!

The exercise class has been going well.  As I write this my face is attempting to return to it's normal colour, down from the beet reddish-purple that it is right now.  I've never been a person who sweats much, and I think my body tries to compensate by turning colour.  I can remember in elementary school when I was running cross country, people used to ask me if I was ok because of it.

I'm emotionally putting on my armour, and gearing myself up for Christmas. This will be my last family Christmas (on my side) that will be child free.  This baby will be my parents first grandchild. The truth is that I've enjoyed the fact that I could escape our IF when I was with my family.  I have 2 younger brothers and 2 younger sisters, and baby making and child rearing have never been a part of our conversations.   That's about to change, with my brother's girlfriend expecting this January.

Of course I am jealous.  However, I am cutting myself some slack because I think it's not surprising that I'm feeling this way.  Who wouldn't if they were in our shoes?  5 years of IF hell and your brother's girlfriend gets pregnant by accident while on the pill?  Uh.   The IFers know the drill all too well.   It just hadn't infiltrated my family yet.  It was one of my remaining safe places from IF.

The only good thing about her pregnancy is that she isn't super pumped about it.  I know that sounds terrible and that this fact would make a lot of people upset, given how much they want a baby.  But I'm ok with it.  I get it.  She wasn't ready.  If I wasn't ready (say 10 years ago), I would probably feel the same way too.  I'm trying to see it as a small blessing.  She's not flaunting her pregnancy around me, letting me know when the baby has gone from the size of a plum to a medium apple to a turnip.

I'm hoping for my day 3 FSH today.  This is the last piece of the pre- IVF work that needs to be complete.   I'm hoping for sky-high or low.  No middle iffy number.    I want to make a final decision about this IVF, DE or OE and move forward.

Surgery it is

 *image from goivf.com

It took a few phone calls and a couple of days, but I've made a decision to have the surgery.  Checking another thing off the list.

After pressing for more information, Dr. Schoolie says that it is only a three day recovery and that without it he would reduce our chance of a normal embryo implanting by 50%, to only 25%.

While I'm not looking forward to having the surgery (who would?), I feel good that I got the information I needed to make the decision with confidence.

Dr. Schoolie says that it is a pretty basic surgery and he would be comfortable with me having another surgeon do it.  So, I am going to try to have the surgery in Canada to avoid the cost by traveling to Colorado and to avoid paying for this procedure (I suppose I guess I do pay via my tax dollars, but I digress).  I would also like to recover in the comfort of my own home.  I'll be traveling only 2 hours away and under the care of Dr. Dandruffbeard.

By some fluke of the Canadian medical system, on Friday afternoon I was able to get a Monday morning appointment for the surgery consult!   I appreciate socialized medicine for many things, but wait times for specialists is not one of them.  I'm considering this a mini-miracle.   The receptionist said that if the doctor agrees to preform the surgery that I could be looking at a January surgery date.  Perfect!

Dr. Dandruffbeard did request a letter from Dr. Schoolie, and the CCRM nurses amazingly emailed me one within an hour of my phone request.  The letter said:

"...During her testing she had an HSG that revealed delayed spillage and questionable hydrosalpinx in her left tube.  It is our recommendation that she needs to have a laparoscopy to evaluate her tube and if there is a hydrosalpinx noted, she needs to have her left tube ligated."

The letter makes things sound simple.  Getting to this point of understanding about this procedure has not been that simple.  I'm realizing that CCRM isn't perfect either.  I am however still very appreciative of their care.

I'm trying not to think (several times a day) about the possibility of this not working.  My mind just goes there, so it's difficult.  I'm also second guessing our decision to do OE IVF vs. donor, but not enough to change my mind I think.

JS

PS)  The exercising has been gratifying but... ouch! Muscles that were happily withering away are now mad at me in droves.   And I'm happy that today I discovered a warm, sweet drink that I can have sans-caffeine.  It's warmed milk with a little (or a lot) of my favourite french vanilla creamer.   I'm semi-lactose intolerant, so I'll have to do this in small doses.

Ready, set...

It seems things are mostly in order for January to start treatment.

• All of our medical records have been received including copies of physical and mammogram - check
• One day work up (ODWU) at CCRM complete - check
• Day 3 blood work shipped - check
• Extra blood work completed for the coagulation panel - check
• Decision made to try OE IVF - check
• Consents signed - check
• Decision on which local satellite clinic to use - check
• Naturopath visit completed, and supplements purchased and organized - check.
• Arrangements for the sperm samples being shipped to CCRM as a back up plan - check. 
• Chromatin assay test results from ODWU - still waiting. 
• Decision on tubal ligation and laproscopy.  Still awaiting more information from the doctor before making a decision. - Follow up in progress.  

I'm glad that everything that is waiting on me is mostly done.  And that it is done before the holidays.  Phew!

Right now I'm just working on walking that fine line between being an annoying patient and a proactive, organized patient to get the remaining information.  My unfiltered-self would like call the clinic frequently saying: "Hi, it's me again. Do you have those results yet? No? Ok. Can you call me later today with an update. Thank you".  Rinse and repeat. 

It's funny it seems almost foreign to me now that some people just go out for a nice dinner, have a glass of wine and roll in the hay and wake up two weeks later to a positive HPT.   Or hump a their pimp drug dealer and make a baby or ten.  But that's another post for another time.  

All in

It seems I'm coming down from the emotional high that I had when leaving Colorado.   I kind of feel lame writing that - as if going to a fertility clinic could ever be a high, but, I guess I'll take what I can get.

I got my period yesterday, so it seems that the countdown is officially on.  I'm hoping to have all of my paperwork compete to attempt an IVF stimulation cycle in January, and a FET (hopefully) in February.  There's been a lot of tears (all mine) since November in getting to this point.  I'm scared of flushing a big wad of money down the toilet and coping with the emotional fall out if there are more negative results.

As I put it to D the other night while on a walk, this is it.  We are now all in as it relates to having a genetic child.  If this doesn't work (we're giving ourselves two IVF cycles depending on the results of the first CCS screening), this door will officially be closed for us.

Saying we are all in kind of makes me gag a little in side.  And I think I know why.  I've always been a procrastinator.  After some life coaching afforded to me in a previous career made me realize that my procrastination stems from wanting perfection.  Basically, it goes like this.  Something is hard or outside of my comfort zone.  If I procrastinate long enough, and don't have enough time that I am saving myself from disappointment if things don't work out.  There's always the thought that "I could have done better if I... had more time/tried harder", etc.

That's not the case for IVF.  I can't say that we've really procrastinated on a lot of things.  We've been chugging along this path for five years now.  Always in line for more tests, more procedures, more results.

These will be our last attempts at OE IVF.  And it makes me very emotional to think about it.  We are flying across the continent, to go all in.  This is it.  I've never felt this way before because there's always been more embryos, more chances left, more options out there.  God, please help us.

I've been following a blog for several months (http://lifeandloveinthepetridish.blogspot.ca) which I've grown to love.  She's a woman who persevered through much more than I think I could with all of this. She's survived cancer, seven IVFs and six, yes, six miscarriages.   One of the things the author has talked about is regret management.  I like the idea of this.  Hers involved a lot of very interesting things.  Mine are more basic.

1)  I've started exercising.  Today was my first day, and I joined a boot camp style fitness class.  I'm doing this to help stabilize my mood and to feel better about myself.  Because if this is all a bust, I'm going to need all of the help I can get.  It's been long enough that I've been making excuses (fertility treatments work great).  I will be stopping when I'm stimming, but until then it's a go.   At least I'm hoping to keep even with the house over the holidays.

2) I'm starting acupuncture. This is for overall health and to try to increase blood flow to my uterus.  At CCRM, during my one day work up they told me that I have "reverse flow" with the main arteries around my uterus.  They would like the flow to be under a 3.0 but my results were 3.62 and 3.5 left and right respectively.   When I go back to CCRM I'm going to have another doppler ultrasound to see if any of these things have changed my blood flow.

3) I've given up caffeine, even decaffeinated drinks and chocolate. When I had my doppler ultrasound, I wasn't allowed to have caffeine for three days prior because it reduces uterine blood flow.  Man, oh man. This has been hard for me.  I love sweets.  And it's Christmas.   I cheated once last Saturday and had a decaffeinated coffee, but other than that I've been caffeine free since November 29th.  I love a warm creamy drink (I'm drooling right now just thinking of a tall white chocolate mocha or coffee with french vanilla sweetener, literally).  This is difficult for me.  

4) I'm continuing with my supplements.  DHEA (3 x 75mg per day), CoQ10 (3 x 200mg per day).  1000 units of vitamin D (CCRM tested and I am slightly deficient).  And a prenatal vitamin with DHA.  This may slightly change when I see the naturopathic doctor today.

5) I'm going to continue to eat mostly home cooked meals with lots of veggies and lean proteins.  For my morning smoothie I'm going to start adding more greens.  Right now it's frozen raspberries, a banana, a frozen spinach puck, orange/veggie juice and greek yogurt.  I'm experimenting with adding celery and cucumber and kale.

As for drinking wheat grass or any other disgusting concoction, I just don't think I can handle any more changes.

This is it.  This is me.  I'm all in.  And it's scary as hell.

What IF

Oops, I just realized that this didn't get posted.... it's from a couple of weeks ago.

In my mind, one of the more annoying side effects of infertility (IF), are the 'what ifs' of IF.

Truthfully, I'm a person who could drive herself crazy just on normal life decisions, let alone making big ones with huge pieces of missing information.  I like to think, then over-think each decision.  Then rehash it after I've made the decision.  I even annoy myself doing it, it's a miracle D can stand it too.   I think one of the things that attracted me to him was this ability to analyze the situation, and make a quick decision.  When things don't go his way, he usually doesn't feel regret about them, he just changes directions, and moves on.  It's a lovely way to live.

Of course our biggest what if is about if there will be little feet around our home sooner or way-later?  We're already 5 years into this journey.  I wonder what our lives will look like in 5 more years.
(Side note - I'm a moment of relative positivity about our infertility, and so I'm feeling like it's not a matter of if we are going to become parents but when.  Tomorrow I will probably post something precisely the opposite because that's how I roll.)

There are so many choices that D and I would like to make. 

One big one is related to our home.  Specifically, what city we will live in. The cities we are choosing between aren't close, they are about 5 hours apart.  And, basically it boils down to his family or mine.   We live close to his right now, and have for our entire relationship.  We both went to university nearby.  We've got some good friends here and his family which is basically just his parents and Grandma.   My family is larger, and is expanding as my cousins begin the years where most of them will marry (and I'm assuming procreate easily...ah... why does my mind always go in that direction...but anyways).   

My heart is where my family is.  Before we married I told him that I may want to move back home.  He told me he was ok with that.  8 years later that little itch I had before to move is turning into a full-blown case of the chicken pox. 

Once we decide where to live, there will be the choice about how large of a home to buy.  How many bedrooms. 

The second biggest choice right now is that D would like to go back to school to do a PhD.  Lately we've been discussing which schools would be good for him, and finances, etc.  It's a big commitment on many levels including to a geographic area.  And it would also mean that I would go back to work, at least until we start our family.   I never imagined parenting with him as a student.  We would be going from the most flexible lifestyle (he's self employed with a lot of freedom), to something with a pretty demanding schedule, and him working on the side.  

I feel like there is an added level of 'if' built into every decision we make, or don't make for that matter.

Post-consult

I'm back. 

Colorado was great.  It was everything we hoped it would be.  I kind of felt like it was a fertility-wonderland, complete with a waterfall.  The staff were very professional and we felt that we got some new information.  I'm happy that we went.   

We still haven't made a decision on donor egg vs. trying our own egg.  Honestly, I'm still on the fence.  If money weren't an issue, I would 100% give an IVF with CCS a go for two cycles.  But, being real, money is an issue.  If we spend $60,000 (the rough cost of trying two IVFs) and don't end up with a baby I'll be feeling really depressed and kind of stupid.  The only reason why I prefer own-egg is because in many ways it just feels simpler.  No explaining one day of where they came from and no issues of loss for the child.   I suppose I just don't feel very confident in my parenting skills, because I haven't got the chance to practice them yet. 

It's funny to me how we are back to (almost) the same decisions that we were making over years ago when we decided to adopt the embryos.  

It's very frustrating and difficult to make these decisions. I just want to be done with this part of my life and move on to the part where I am a mommy. 

Some of the things I really liked about CCRM:

- They are organized.  Check in at the desk, have a test, check in again, have another.  We had back to back appointments all morning and things went very smoothly. 

- I felt Dr. Schoolie was kind and was honest with us about our options. 

- The staff seemed to be really well trained and experienced.  I liked that many of the technicians really took time to explain the procedure they were doing, and what they were hoping to see.  

Some of the things I don't like:

- They messed up on drawing enough blood for a thrombosis panel.  I had 16 vials of blood taken, and that still wasn't enough.   16 vials tops my previous record of having 13 drawn at once.  I wonder what my fertility-lifetime total would be? 

- They called me back and said that they doctor isn't sure about whether to recommend a laprosopy and tubal ligation for my left side.  It seems that my HCG showed some hydrosalpinx (sp?), but there was some spill (which means that there is no blockage) however they weren't 100% sure if there is a blockage or not.  Basically the doctor said it was my call on how to proceed with this.  After a few days of marinating on the topic, I've decided that this isn't enough information to make the decision.  I need a doctor's recommendation.  Isn't that what I'm paying  for?!?  I'm honestly a little flabbergasted that they haven't given me more information on this to make the decision.  Oh well.  I guess no clinic is perfect.  That's why I've called back for more information. 

I'll write more later.  I just wanted to break the silence, and get some of my thoughts out. :)