Quick and dirty

We had another regroup with Dr. S.  It lasted all of 7.5 minutes.  He answered our questions, but didn't offer anything more except to tell us that he thinks we are 'thinking clearly about this".

Here's what he told us:

• He thinks we will lose 1 to the thaw, that would have died anyways when we tried to thaw it for  transfer.  He didn't think we would lose many more on the next thaw, but didn't give us a number. 
• It will take 2 weeks to get the results of the testing. 
• When asked how many of our 10 embryos does he think will be normal?  He said he doesn't know.  He said that the sperm is a question mark here.  (But - let's be honest, the eggs could be questionable too, although admittedly less likely so). On average the donors have 20% abnormal embryos. (That's great news). 
• Should we look at 1 or 2 with CCS?  He still thought we should transfer 2 with my history.  (Interesting). 
• If we transfer 1 normal and we lose it we should start seriously thinking of a gestational carrier.  Ouch.  Okay. 

Someone asked for the ratings of our embryos.  Here's what we have:

10 embryos frozen. Eight were frozen on day 5 and two were frozen on day 6. The grades are: 4AA, 5BB, 4BB, 3BB, 2/3, 4AB, 4BB, 2/3, 6BA and 6BA.

I emailed the nurse and said we're going to go ahead with the CCS.  

Dr. S was the same as he always has been with us, he answered what we wanted to know, but didn't give us anything more.  I find that kind of annoying.   

Dad's here tonight and tomorrow,  so that's all I can write for today.   We're having a good time. 

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?

Meeting

We had a good meeting with Dr. Highrisk today.  We felt like he was much more on his game today.  He was way more talkative and was very helpful. 

He helped us weigh the risks and benefits of the D&C and the fetal chromosome analysis.   He said that he would put us on the operating room waiting list this weekend for the procedure if we wanted.  He told us though that he wanted us to know about some of the things he was thinking about. 

A few of the key things he told us:

• In all likelihood, we would be at the bottom of the OR wait list, because practically every other case would trump ours in terms of urgency.   A long weekend approaching doesn't help our situation much either.  He said there was nothing he could realistically do to change our place on the waiting list.  For example, if a child came in with a burst appendix, they (of course) would go before my case. 
• 50% of miscarriages in his opinion happen with genetically normal fetuses.  He said doctors really just don't know always what causes miscarriage.  (I'm not sure of what CCRM would say on this... have any of you heard anything from your doctors on this?)
• He didn't feel confident that we would be able to capture the fetal tissue that we needed for the sample.  If the fetus stopped growing at 6 weeks, 3 days, and that was three weeks ago, there is probably not a lot of tissue left that would be suitable for the testing.  
• He said he didn't think that the results of the chromosomal testing would substantially change our next step.  Are we going to put in more of the embryos that we have regardless of the result? Yes.   Would it mean our remaining embryos are more or less likely to be normal or abnormal? This would not help give us more reliable information.  
• We asked what if it was a genetically normal result?  He reiterated that 50% of miscarriages might be chromosomally normal. 
• The risks of complications with a D&C are 1-2%.   He explained the procedure and what can go wrong. 
• He explained that he looks at things as risk/reward.  Overall he thought the risks were small, but the benefit of gaining any useful information would also be small. 
• He explained why my first experience with Misoprostal might have been so bad: 
1. It was a twin pregnancy and therefore there was twice the tissue.  
2. I may have taken it orally (I can't remember), and this could cause more gastrointestinal upset (this was a huge problem - I couldn't keep my painkillers down).  That if I take it vaginally it could be easier on my system.
3. That the first time a person's body has contractions for miscarriage (or labour), it is harder for the person's body to adjust to them.  The second time it may be easier for my  body to do what it needs to do.  
4. I could take the painkillers differently (especially earlier than I did the last time).
• If we wanted to do a drug induced miscarriage, he suggested 4(!) Misoprostal tabs vaginally on day 1, and then 4 more 24 hours later.  He gave me an prescription for painkillers too.  I think the last time I took two in total.  He said that misoprostal is one of the most studied reproductive medicine drugs, but the administration of it can be very different depending on your doctor.  
• Most people who are waiting to have an unmedicated miscarriage (from a missed abortion/missed miscarriage) will have it around 12 weeks.  He didn't feel there were risks of waiting. He thought it was a decision to be made mostly based on emotional considerations.  Do we want to wait it out or have it sooner?  I'm in the sooner camp.  Let's get this show on the road so we can move on to better things. 

After we had our meeting, we weighed what Dr. S said and what he said.  We considered trying to do the miscarriage testing kit on our own with a home miscarriage.  

When we picked up the kit we decided that this is definitely not going to happen.   

Natera requires a paternal blood draw for a donor egg pregnancy (which we could work out).  They also require you to try to separate the fetal tissue from the gestational sac with a saline solution.  They give pictures and descriptions on how to do this.  

Attempting to sift through the products of conception to find something the size of a lentil, is not something I want to add to this experience.  Just the pictures alone that came with the kit were hard to look at it.   Not to mention, that the first time I had a miscarriage there seemed to be so much blood! At times it looked like I was "peeing" blood (full stream) from my vagina.  I also had terrible diarrhea from the Misoprostal.  Sorry for the visual.  D and I are definitely not going to be sifting through any of that.    

So, it looks like we've made a u-turn. 

We are going to wait a little while, then try the misoprostal again and hope for the best. 

It's complicated

Written yesterday...

I am so angry. So fucking frustrated.  I hate today too. 

After A LOT of coordinating, we were scheduled to have our ultrasound at 10:30am, and our phone consult with Dr. S in one of our clinic's conference rooms at 11:00am.  It was tight, but we were working around two doctor's limited availabilities, and trying to get answers as soon as possible. 

We had coordinated this appointment day, based on the doctor's availability.  They said the doctor would be in on Thursday, and that day could work for the D&C.   We got permission from Dr. Schoolcraft to move our ultrasound from Thursday to Tuesday for this reason.  

When we arrived, the waiting room was as packed as I have ever seen it.  I told the receptionst about our predicament, about needing our ultrasound results for our 11:00am call.  I told her that our nurse was aware of the situation, and she would just need to know that we had arrived right away. 

I was feeling confident that what the nurse confirmed with me (most recently at 8am that morning!) would acutally work out, we sat back and waited, not so patiently. 

5 minutes later our nurse appeared in the waiting room to call another patient. We made eye contact. 

15 minutes later, at 10:45am, we still had not been called.  

Rage was brewing in a major way.  Why the fuck would they tell me this was possible if it was not? 

We tried to accept that shit happens and maybe they couldn't help it.  Maybe someone else was having an emergency that was more important than confirming my baby was indeed dead.  D tried to calm me by reminding me that in all reality, no new information was going to come from this ultrasound anyways, and that not having it wouldn't likely change our post-consult with Dr. S. 

At 10:50am, we had missed our window for the ultrasound.  I asked the receptionist for the conference room.  5 minutes later, she came back and said they didn't fucking have one.  My anger which was a 9/10 before ballooned.   I'm sure my frustration and disgust were written all over my face.  I said, "I guess I will go out to the car". 

We had the consult.  In typical Dr. S style, we started the meeting off with a big awkward pause, where he probably wanted us to ask him questions.  We wanted him to talk first, but it didn't seem like he had much to say.  Finally, we said, "We know that donor egg isn't perfect and that miscarriages can still happen, but we weren't expecting this.  Do you have any thoughts on what happened?" 

We also asked questions about a lot of things; fetal chromosomal anaylsis (pros/cons/info gained), if our protcol would change as a result of this news, how many embryos he would recommend next time, the pros and cons of doing a D&C this week vs. next.  D wanted to ask if stress could have played a factor in this.  We also questioned what the chances of a miscarriage would be with DE (challenging the 5% number we heard before). We also wanted to know if he thought we should we now CCS test our remaining embryos?

His answers were:

- Yes, he recommends an anyalsis of the fetal chromosomes. If it is abnormal, or male we will have important new information.  If it is normal female, it is possible that the results were from my tissue.  They have a lab that says they have a way of avoiding this problem, we could use that one.  We learned later it is called Natera, and CCRM has just started using them.  It costs $399 plus shipping, which is significantly lower than the Quest lab quote I got for close to $1500. 

- No, it's not to early to have this done. 

- We should regroup afer getting that information back. 

- The risk of the D&C in one week is that the sample may not include all of the products of conception (I hate that term). 

- There isn't probably a change in protocol he'd recommend, because I was already on Lovenox for miscarriage prevention. 

- Next time he would want us to think about transferring two embryos. 
- Stress can affect hormone production in natural cycles.  However because they were controlling my hormones, he didn't think it was a factor.  There was no research to suggest a relationship.   

- There is a small possibilty that the sperm could have contributed to a genetic problem with the embryo, however D's chromosome testing and the donor's were normal. 

- CCS testing the embryos would probably be "overkill". 

-The chance of miscarriage with a 20 year old woman is 20%. (There was obviously a large communication error with Dr. G when we heard 5%. Maybe he thought we were asking something else? I don't know).

We felt satisfied with this conversation.  We ended the call and went back to the clinic to have our ultrasound.  

A different nurse came out and told me that they had come out to get us just after we left. She said they were going to try to squeeze us back in with the doctor.  She made it sound like it was our fault that we left.  

After waiting eons, we finally had an ultrasound. And, yep, the baby was still dead and small. Surprise, surprise. The doc said it had already started to degenerate. He said that by the way it looks he would guess it was a chromosomal abnormality  Off the cuff, he said if it wasn't abnormal, that he would recommend a gestational carrier.  

Then, he dropped a little bomb on us. He said there was no way for him to do the D&C because they don't have a fucking suction machine.  "You'll have to go to an OB" they said. 

Huh?

I had a D&C in that office 2 years ago. 

He says he"ll look into it, maybe they can borrow one. He said he borrowed one so he could do his own wife's D&C. 

He came back, and said no. 

Then the nurse came back in and we discussed it further. She told us it was the surgical manager that said no. I asked if an exception could be made?  If we went somewhere else for care, we doubted that they would rush to get this done for us (unless we fly to CO).  Not to mention that we want a doctor we know and trust because of the risks of scarring. 

I asked if she could check again with the manager.  We were long time patients, we just needed this one thing.  We didn't have another alternative for care.  Could they please, please help us?

She said she would ask again.   She did, and she said the doctor said no this time.  

Thanks a lot, Doc. 

After I thought about it more, I got even more pissed off that they wouldn't help us.  I also however, didn't want a doctor doing the D&C who doesn't do them often.  

Why does this have to be hard too?

Our options for care as I saw them were:
1.  Going to an emergency room for care and getting a random doctor. 
2.  Going back to Dr. Highrisk.  However, he isn't exactly in my good books anymore after not diagnosing a 5 week fetus as a problem in a supposed to be 7 week pregnant woman.
3.  I have another OB, who I haven't visited in over 5 years.  I don't have faith in him because my friend (who is a maternity nurse at the hospital where he works) told me that she wouldn't choose him for her care.  She was trying to be professional and we didn't go into specific issues about him, but she hinted at issues. So, needless to say, I want to stay away from him too. 
4.  I called another RE that I had dealt with in another city a few years ago at a specialty hospital.  The nurse said he doesn't do D&Cs, and that there is a clinic in the hospital that would help me, but it wouldn't be until after the long weekend.

Time is of the essence.  In a week, who knows if there would be anything left to test? Maybe the baby will have degenerated a lot more, or maybe I will start to bleed. 

I feel so frustrated that I just want to give up on this.  I am exhausted, super bitchy and overwhelmed.  I told D I that I was done.  

D said he would take over and make some calls.   

He called a local fertility clinic without any luck.  He also called our family doctor to see if he could help.  He priced out flights to CO to see what that option looked like.  The flights were expensive on such short notice and so close to a holiday. 

If this option ended up costing too much money, we could put that towards testing the embryos.  We wanted to be mindful of that and not to spend too much money. 

D was able to speak with our family doctor.  He reassured us on why he selected Dr. Highrisk for us.  He said that out of all the doctors he could have chosen for his wife's pregnancy, he chose him. That he thought if there was even a 1% chance that he was bad that he wouldn't send us to him because of how precious this pregnancy was to us.  He told us about how everything Dr. Highrisk read from the ultrasound tech's report would have not raised red flags to him.  He said that this doctor was highly sought after by the hospital and that he is well respected across the country.   

While I'm not totally good with everything that happened in our last visit, I agreed to see him again.  

We are running out of options.  We fully trust our family doctor.  We are meeting with Dr. Highrisk first thing tomorrow morning to see if he can help us.   Hopefully he can.  

Menstrual madness and the last couple of days

So... what does cycle day 52 look like for this woman?  It's emotional. Big doses of anger, disappointment, sadness, anxiousness.  This picture above might as well be of me, because it's how I feel.  Except she should have puffy eyes and blotchy skin from crying.  I'm pretty sure if D was being honest, he'd tell you that is the woman he's been looking at the past couple of weeks too.

Yesterday I sent an email to my nurse  to check in.  It reminded them that it was cycle day 51.  That I had waited the 10 days after taking the progesterone.  That I was not seeing any other signs of my period coming despite having slight cramps every day for the past two weeks (it has actually probably been three now that I think of it).  

I asked her what the plan was going forward?  How long will they let me wait for a period?  What medicines/tests are they thinking of?  Etc. I specifically asked for her to check in with all of this with the doctor.  I feel like she doesn't ask him, that she with some help from the other nurses are making too many guesstimates. 

I didn't decide to fly across the continent for this nurse.  I did so for Dr. Schoolcraft, the superstar lab and AND his well trained team.   A package deal, but I need him to be the quarterback, not the supervisor from a distance - which is what I feel like is happening at this point in time.  I'm going to continue to request that the doctor review my file.  

At around 4pm (in my time zone) the CCRM nurse responded.  "This is not typical at all.  Can you get in to your local clinic for blood and ultrasound tomorrow?"  Then a few minutes later I got another email that said Dr. Schoolcraft thinks there will be an answer in your test results on what is going on.

They requested an ultrasound for lining thickness and pattern, hCG, LH, Progesterone, Estrogen.  

If I hadn't followed up with them, I am quite sure that I would not have heard from them to follow up with me.  They had not requested for me to call if I had not got my period.  With the weekend coming it would have likely been Monday or later that they would have possibly even thought of my case. I feel like I'm on their back burner.  This makes me so mad and disappointed.  

D says at least at our local clinic we knew that they were thinking of us every day.  

The CCRM nurse told me she was expecting my lining to be nice and thin at today's ultrasound.  

This morning, I had my ultrasound locally.  Today I had my long time IVF nurse because my new donor nurse I was recently switched to was off unexpectedly.   She asked me how things were going and I had a hard time keeping it together.  I was fighting tears and she just kept saying how she was so sorry and she knew we were going to be good parents one day.  This made me want to cry even more.   She has a kind heart and I am grateful for her. 

She checked my lining.  And it was 6 point something.   Not thin.  And it was triple striped! What the heck?!? They told me over two weeks ago that they through my lining looked luteal.  And not to mention that I've had 10 days of progesterone, and they saw what they thought was a collapsing follicle over 2 weeks ago.   When she took out the vaginal probe she drew my attention to the slight pinkish tinge on the end of the probe.  That was the first pink (etc) I'd seen in well over a month. 

She wondered if it was the lupron doing this to me? I told her the CCRM nurse said that the lupron was just to stop me from ovulating through the estrogen patches that I was supposed to start after my period came.  That the CCRM nurse said it wouldn't stop a period.    My local nurse didn't seem to think that was the case, but I trust CCRM more on this one.  (Any of you have experience with this?)

My CCRM nurse called to say that she received the ultrasound results but not the blood yet. She said it was triple lined, and thick. It was very surprising to her.  She asked if the ultrasound person could have made a mistake?  I said no, that I saw it too, that I had a copy of the ultrasound and I would scan it and send it to her (she said her copy that she received by fax wasn't that clear).  She asked me if I had a lot of discharge with the progesterone, and if they were expired?  I told her I shoved those things in as far as they would go, and yes there was some discharge.  I double checked the progesterone, and no it wasn't even close to expiring. 

Then she told me she got a new job.  And that I was going to have a new nurse as of Monday.  I'm kind of feeling neutral about this.  I think it will depend on how much I like my new nurse.   I hope I like her.  Her name starts with C and she's Schoolcraft's donor nurse.  Do any of you CCRM-ers have her? 

I ended the call by asking her if she could really get as much information as possible from Dr. Schoolcraft, to give us as much as possible to go on.  She said she would. 

......

I just made a call to my local clinic for the blood results.  I couldn't wait for CCRM to call, I wanted to be prepared with some questions for them. 

My levels were:

LH 5.8

Prog 0.6

Est 40

hCG >1

I don't know what that means.  I thought something would jump off the page for me, but it doesn't.

.................

Two other things in my online life have upset me.

Over the last couple of days, I've been following a Resolve.org post.  I don't go to this site often, but there was a time that it was my lifeline.   I stumbled upon a post of a woman who had just experienced a stillbirth after a long journey with infertility.  Reading that post and seeing such raw grief was terrifying.  It has set me back.  I cry for her and all of the other women who wrote in to support of her, sharing similar experiences.   I am so terrified that after our struggle, that this could one day be us.  I don't know that I could pick myself up after that type of loss.

Another blogger, Mara from A Blog About Love, wrote recently about how she and her hubby have decided to end their fertility journey, and that they will not be pursuing adoption because they are out of stamina.  Before infertility, and early in my journey I could never understand how people could give up on their dreams of having children.  Now, after almost 7 years of infertility, I understand.  Knowing that feeling frightens me.  

...................

Oh, and to boot I am having a problem getting my money back from The Donor Source.  After two months of emailing to receive my promised refund I still don't have my money!  They've been telling me that they were "waiting for accounting to sign off" on it FOR THE LAST MONTH.  So yesterday, fed up, I told them if they didn't get back to me by today that I would be taking much more severe measures.  I hadn't totally determined what severe was going to be yet.  I imagined phone calls to senior management, trying to get the credit card payment returned as fraudulent by my credit card company, a letter from my lawyer or something of the sort. 

After getting another "I've done all I can do, it's sitting on the CFO's desk" from my contact person, I called the CFO directly.  

I'm usually very terrible at giving people negative feedback or giving them a piece of my mind.  Except for to D, poor guy.  However today fuelled by my extended PMS and other frustrations, I called the CFO.  

I told her that it was completely unprofessional to withhold a refund for TWO months.  That it affects people's lives to not have this money.  I listened to her apologize (which sounded somewhat genuine but not overly enthusiastic).  She told me the money would be put back on my card today, as she had now signed off on it.  I told her that I wasn't going to belabour the point, but I really needed her to understand just how totally unprofessional this was, and that I was disgusted.   She agreed that it was unprofessional.   I took her private phone number down just in case the money didn't show up today. 

So far, it's not here.  

....................

Ya, so um... that's my rant for the day.  Happy Friday?  Hope yours is going better than mine. 

Don't know where to begin

I've thought about this space every single day since my last post.

So much has happened.  I'm going to try to condense it...  

We went to CCRM for IVF.  They were following 7-8 follicles for the egg retrieval.   I stimmed for 14 days.  I thought that I was going to stim for longer, but my estrogen basically flat lined for 2 days and Dr. Schoolcraft decided to do the trigger.  The largest follicle was 18mm.  The rest were in the mid teens.  

We were still hopeful to have a similar number of eggs as we had at our previous clinic (Recap: It was 14 months ago.  They were following 7-8 follicles then, and we ended up being surprised with 11, 6 x  day 5 embryos resulted.  We did not do CCS).    

This time we only ended up with 4 eggs at retrieval.  We had big heavy lumps in our throats that we tried to swallow.  

We crossed our fingers and toes and hoped that they would fertilize and our embabies would be ok. We reminded ourselves of what Dr. Schoolcraft said in the consult.  In our minds, we were only going for 1 normal embryo.  

2 eggs harvested were immature and they tried to mature them in the lab.  We were thankful for this as they would not have been able to do this at our previous clinic.  

After fertilization and maturation of the eggs, we ended up with 1 embryo (from a mature egg) and 1 embryo from an egg that they matured.   Sadly, the embryo from the immature egg arrested on day 5. 

We debated on what do do with the CCS testing.   The doctor had suggested previously that we consider embryo banking if we got less than 4 embryos to test. 

We felt that the result of the IVF was so poor that we didn't know if we wanted to even do it again.   We wanted to talk to Dr. S again but he was unavailable.   We didn't even know what to ask but felt really lost. 

We decided to test the embryo ($6800 - big ouchie).  We did so because we thought that if the embryo was normal it would change our thinking.   Dr. S ordered the arrested embryo to be tested as well.   However, there was not enough material to test. 

The embryo came back with results 2 weeks later.  It was abnormal.  The irregularity was on the 7th chromosome.  The nurse said that chromosomal errors are almost always (95%) due to the egg because of the way that an embryo forms.  (Coles notes: because the eggs are in the woman's body since birth, and the man's sperm is only been formed approximately 90 days prior to ejaculation they are different.  When an egg is fertilized one pair of the chromosomes are shed by the fertilized egg each from the sperm and egg.  The "glue" that holds the two pairs of chromosomes becomes stuck more easily in the egg and is prone to more irregularities.  This is because it has been in the woman's body since birth.  We didn't know this until the CCS class that week at CCRM.  Admittedly, I'm probably butchering their neat and tidy explanation.).  

We were/are very upset that we only got 1 because we feel that the sample size doesn't allow us to know if it indeed would be possible for us to make normal embryos.   

We were preparing for something bad to come as a result from this IVF.  We were imagining creating 6 or more embryos and getting them tested only to be told that they were all abnormal.    We were told by Dr. Schoolie that we'd have a baby or an answer.   Now we have neither.  Kind of. 

Cue a huge emotional response from me and D.  Exhausted.  Exasperated.  Frustrated.  Pissed off.   In shock.  Mad. 

We had a post consult with Dr. Schoolcraft.  We wanted to know what went wrong?  Was it a fluke?  Why was I triggered when I was?  Would a different protocol help?  Does he think we should even attempt IVF again?  Was it because I didn't take the DHEA or testosterone priming this time?  Should we have waited for a higher pre-antrical follicle count?

D reminds me of what we just did.  We just flew across the country,  spent a year doing the work up and waiting for my body to cooperate, and spent $40,000+.  What do we have to show for it?  A substantially poorer result than our local clinic.  And minimal new information. 

We were rational in the regroup, despite feeling otherwise.  Dr. Schoolcraft told us patiently that he doesn't know why this happened.  That it could have just been a bad month.   That my fertility could have declined that much since my last IVF 14 months ago, that my FSH was that bad.   That we could try another protocol but it was the difference between basically switching from "tylenol to aspirin".  He told me I was on the strongest protocol.   He said if we were to do one more IVF he would give us a 20% of taking home a live baby.  If we did donor egg it would be 80%. 

We have been on this portion of our journey since November 2012.  Now, almost a year later after all of the testing and setbacks of the past year, I just feel like I had a bad month.  That I should have taken the DHEA.   I feel ripped off.   

But somehow amidst this turmoil we have made the decision to move on.  To close this door.   It's not a door that's been wide open for us ever anyways.  Maybe there is enough information now to make a decision.    We're tired of chasing the small odds.  We want to be parents. 

We want to have more than one child (in our wildest dreams).  If we spend so long trying to get baby number 1, will that mean that we won't have the chance to have number 2? 

So, on to egg donor we go.   For me, excitedly, but also anxiously. 

It's a weird feeling.   We are now back into thinking about openness and clinics and whether this will work.  

For D it's different.  He doesn't think it will work.  He's tremendously negative about the chance of success.  He wants to move on to traditional adoption but is doing this for me.  I hate it when he says it  won't work.  It feels like a punch in my gut.  No, a punch in my uterus.   

This has to work, doesn't it?  I understand why he thinks this way.   We haven't been on the positive side of many (any?) fertility odds in the past five years.   But I'm not ready to give up seeing his face in my child, or having the experience of pregnancy.  

So, onwards we go.  

CD2 ultrasound

Yesterday the CCRM nurse faxed the instructions for today's ultrasound.  However there wasn't anything written on it but "rule out cysts".  I thought it was a typo and and oversight.  There was nothing about checking my lining or pre-antricles or blood work.  I was so confused. 

So I called the nurse at CCRM to question it.  It turns out that they were only trying to rule out the cyst.  If it was gone they wanted to start me on the priming again and do some suppression this month if the stims were gone.  

Hold the phone.   

Cue alarm at them not knowing my case.   (I'm not totally surprised at this - but the suppression thing really through me for a loop!)

I told her that we didn't want to do that.  For a few reasons:  

1. That I felt like it was more than a coincidence that I had only ever had cysts while taking the testosterone.   

2. That I read the research and the priming protocol only lead to one more egg on average per retrieval, and I was willing to sacrifice it. 

3.  That D and I were nearing the end of trying and we really just want to get this going (likely the most pressing reason)

4.  That I didn't think the doctor would want to suppress me with lupron or other meds because it would  over suppress me.   

5. That I may still have a cyst and this could all be moot. 

She said she would call the doctor and call me back. 

She promptly returned my call and said the doctor agreed.  She sent me a new requisition that included blood work.  

Today I had that done and yay! No cysts! No cysts! No cysts!!! 

My blood work showed that my estrogen and progesterone were suppressed so I'm good to go!  Starting stims tomorrow! 

I can't believe it! I'm so pumped! 

The infertility scorecard

A group of my out of town girlfriends gather a few times a year.  There are 6 of us, plus kids.  Each has two children, except one who just welcomed her third.   They all know about our infertility. Most of the time when we get together,  we meet at someone's house and all of the kids play together.  Our husbands come too.  It's nice to keep in touch with them all, and I like that our hubbies all get along even though we met most of them after we became friends.

Last year, for the first time in a long time (read: since the first baby was born 7 years ago) we gathered without children.  It was my idea.  It seemed like the majority of the time when we were due for a get together, there was another baby that was born, and we were welcoming it.  There was also the odd adult-only event.  I felt slightly of awkward suggesting no kids, because I'm the one without, but they all happily agreed.  A few months down the road, we planned a weekend of drinks, a little outdoor adventure and a spa day.    

If I kept an emotional scorecard of weekends such as these I would think of them in terms of infertility hits (tolerating one too many gushing parenting stories, the odd offensive comment or watching the one woman pump breast milk every few hours) vs. the overall goodness of the weekend (great conversations, laughs and experiences). The "girls only" weekend had a very positive score.

A few weeks ago, I suggested that we all get together soon.  There is a newborn baby around, and I think it was assumed that we would all gather together with the children, because that's what we usually do.   Someone offered to host, a date was planned (which is fast approaching) and everything was great.

Until I thought about it.

Last year we gathered at the same home with all of the children.   D and I were out of our element with all of the kids around. There were 9 children under the age of 5 and one 7 year old in a confined indoor space.  = I.n.t.e.n.s.e. !   The conversation was 98% child related.   I like to think that some of the women try to make conversation about something other than their children, but invariably, it always goes back to them.  Especially when they are all buzzing around like mosquitos.

Last year, I had some hope.  After an unexpected turn of events, our doctor suggested we attempt our first IVF after four donor FETs had failed.  Hope definitely adds some bonus points to the scorecard.  However, we had experienced some losses too, as had I miscarried our twins a few short months before.  Those losses were hugely negative scorecard points.   While I didn't think in terms of scorecards then, the hope neutralized the negatives, and I thought it would be okay for us to go.

We had a nice day.  At first I thought I had survived unscathed.  Then the baby hangover started to set in.  On the car ride home, I had time to reflect.  Not a good thing. About an hour into our drive, I started to feel kind of sad and depressed.  Then I felt teary, followed by an abundant flow of waterworks  for the next hour of the drive.  For several weeks after, I had a big dark cloud over my head.  The scorecard was negative. It was just too much.

Fast forward to today.   I dropped my sister off at the airport and had some time to kill.  I decided to browse a department store.  I found myself accidentally walking through the baby isle.  Instead of running out, screaming like a banshee, I felt ok.  It made me realize that my scorecard must be positive right now.  I even would say that I felt something I hadn't in a long time... hope!

The hope I have today is very different from the hope I had last year.  It's not the same kind of  blissfully ignorant hope that I had a few years ago, before we accumulated so many infertility scars.  I've learned that it isn't just a matter of time and tries before we walk away with a baby in our arms.  Our hope is now hanging by a very fine strand.  It's hinging on Dr. Schoolcraft, my new protocol, the CCRM lab and the CCS that we have planned.

Right now I'm questioning if I could get through the day with my friends and their children.  I think I would definitely have a baby hangover afterwards, I'm just not quite how severe it would be.  I guess that would largely depend on the conversations we had, and the moments that I share with the children. D has decided he's not interested in going.

Even though I have some hope, and even though I think I could handle it, I've decided I just don't want to.  It's not worth it.  One afternoon of so-called fun and catching up isn't going to be worth risking the little bit of positivity that I've got going on.

So now the question is.... how do I get out of this event that I initiated?  The honest approach?, "I've decided it would be too much for me" or something more discreet "I'm not feeling well?".  Which by the way,  I don't view as a lie, because infertility really does make me not feel well!  Either way, I think I would need to tell my best friend of the bunch because I am babysitting her kids the next day. I don't want her worry about that arrangement.   (For that reason too I need to save some positive points on my scorecard!)

Ordered My Meds

I just placed my meds order.  It cost a gagging $5,365.19.  I will get some coupons for a rebate which will bring the cost down around $5,000.

I was a little nervous about how much to order because the last time I stimmed for a long time.  And it will be more difficult for me to arrange to get more meds because I will be away from home.  The nurse helped me figure out how much to order.  And she said that I can ship to my hotel room, if I need more.

Some of the relatively minor, but trickier things: A) I will need to have a fridge in my hotel room and B) I don't like cutting it close with my meds, given that they might take a few days to come in. C) The drugs are too expensive to order a lot of extra.  D) We many not need any of our extra meds again.  If we don't get any normal embryos this will be it.

I told the nurse I stimmed for a long time the last time.  I asked her if this is likely going to be indicative of this time, given that it's a much different protocol?  She said that people usually stim for 12-13 days in her experience.

Here's my cocktail.

Gonal-F
Cetrotide - new
Clomid - new
Dexo-something-or-other - new
Menopur
Novarelle (HCG)

Another step closer, to "an answer or a baby" as Dr. Schoolie said.  We're banking on it.

A Plan, Stan

I'm happy that our IVF calendar has started.  Yeah for progress!!!

I'm on cycle day 5 right now.  The plan is that I'm going to continue to take DHEA, CoQ10 and estrogen until cycle day 16, at which time I'll add in Endometrin.  On my next cycle, I will start my stim meds.  I'm glad things are progressing!

We have also made tentative plans to go to CCRM for the laparoscopy (and possible tubal ligation) in April.  I was really hoping that it was going to be in March.  However, Dr. Schoolie says that they can't do it right after stimming because my ovaries will be too enlarged.

I thought about having the surgery this month, however I don't want to waste the time I've spent taking DHEA and CoQ10.  A couple doctors have told me that the effectiveness of DHEA is when it is taken for 2-3 months, but not longer.  My naturopath cautioned not to take it for too long.  And, I don't want to piss off my body with a surgery right before I try to make some eggs.

Apparently, 2-4 weeks after the laparoscopy I can do a FET.  I've asked them for clarification on this, I mean which is it? And how do they know? It will mean the difference of one cycle.

Typing this makes me realize that this may not be the step to rush through.  I want  my body to heal and for the best possible circumstances.  If this means patiently waiting for my body to heal for a few more weeks then so be it.

It's disturbing to me that we likely won't be doing a FET until JUNE!?!  Another six months slipping away ?!?! Gah.

In March we will have our CCS report back.  If it isn't good then I will spend the time finalizing an egg donor.  I guess I better start looking into that more soon.

Got my calendar

CCRM calls your schedule of medicines and procedures your calendar.  Dr. Schoolie answered our request for this from his vacation and I got mine the other day.   The nurse took some time to explain to me various components.  I told her that in our last consult, the doctor had previously told us that I would be on the most aggressive protocol that they have.  She agreed and said he was "throwing the book at me".

Hearing this freaks me right the f**k out.  I don't think anyone ever wants to hear that they are on the most aggressive treatment.  That means there's nothing left.  It's another reminder that we're all-in.  I mean don't get me wrong, cognitively this is absolutely no surprise to us.   We've been to 4 RE's, and none of them have been very positive about our chances of bringing home a real live baby.  The only thing that has kept us in the game is has been my age.  I'm 33.   

I take the nurse's comments as a warning.  My body is going to be taxed more than it ever has been before in this IF journey.  I'm scared.  I've been abusing it without much regard for the past year and a half.

Under my bathroom sink I have six filled sharps containers to prove it. There is another super-sized model in the closest, that is also half full.   For whatever reason, I can't bring myself to throw them out.  It's like a little fertility grave yard under my sink.  Each needle represents some weird badge of pain from our IF war.

My naturopathic doctor told me that my kidneys were likely very stressed from all of the drugs I have been taking.  She said in Eastern medicine it is believed that when you are pregnant you give half of your energy to the baby.  She said that this was the case even for a miscarriage.  The fact that I had two in 2012 she said would have really depleted my energy levels.   That moment that she said that made my eyes water.  It was validating in a way that I never thought of before.   A reminder of the pain that I still carry from losing those three tiny babies.

I told her also about the heavy doses of antibiotics for infections for possible (and likely non-existent) infections, steroids supplements and injectable blood thinners.   My body has been kind to tolerate all of them with only mild discomfort.   I secretly just hope it's not storing up the toxins to feed some super disease for down the road. 

In some ways I feel like I know in a small way what it would be like to be addicted to drugs.   I am kind of am right now.  It's just that my substances of choice are Follistim,  Menopur, estrogen and progesterone.   I'm using a substance to attempt to solve and hide an emotional problem.  I wish I could think of it more as taking medicine to cure my disease, but I'm not there. 

Dr. Schoolie, my IF pimp said it was "reasonable" to give this one or two more tries if we had the financial and emotional strength to do one or two more cycles.   Now that things are getting started, I'm realizing that I might have exaggerated when I said we said we did.  

2nd Consult and a guilty conscience

Over the Christmas break we had a consult with Dr. Schoolie.  I was very nervous about it, because it was initiated by the doctor.  I found this to be unsettling considering we had been happily corresponding through the nurses, and I thought everything we had discussed was resolved.

The key issue we were debating was whether or not to a) pursue the laproscopy and tubal ligation b) if it could be done in the country in which I live (because we have socialized medicine) and c) if the opinions of the doctors would be similar enough and therefore yield the same result.

I was worried that there was a new issue that the doctor had found.  Something so bad that the nurse didn't feel comfortable telling me herself.   Thankfully, this wasn't the case.  He just wanted to regroup.  I guess we had asked so many questions that he wanted to speak to us directly.  D thinks he was just tired of the back and forth.

I'm slightly peeved about this because it's not cheap to talk to the doctor each time.  And we felt we had all of our questions answered.  Not to mention the emotional stress of thinking that he had something life altering to tell us.

We didn't waste the opportunity to speak with him though.  We were able to add clarity to the surgical choice we had made to have the procedure.   We also decided where we would have the procedure.  

The doctor we chose at home did not seem overly familiar with requesting the surgery based on the testing we had in our ODWU.   It's kind of ironic now that he was asking us at the time if we trusted him.  Because now I don't really, and that is what this decision has come down to.  We're deep in expenses on this cycle however,  D doesn't think this is the place to try to save money.  There's too much at stake. The tubal ligation will basically depend on a judgement call from the doctor.  I really don't want it if I don't need it.  And the laproscopy could yield important information, that I would rather be viewed by my treating physician.   And a the big one he pointed out, that if things didn't work out and we didn't go with Dr. Schoolie, that we might wonder what-if, effectively ruining our regret management strategy.

It's $4,000 just for the surgery, not including travel.  Boy, I could spend that money in much more fun places.  A trip somewhere warm, a bathroom renovation.  Or, what would be more likely, keep it in the bank for more fertility stuff down the road.

Thinking about the costs of IF treatments have always been uncomfortable.  But now it is really stressing me out. We've slowly flushed the cost of a few vehicles down the drain, and we're about to flush one more.  Instead of flushing used cars we've moved on to flushing the cost of a new SUV.  It's gagging.  Especially as my current vehicle is starting to show it's age with new rattles and noises.

I feel bummed and guilty even complaining about this.  On Resolve.org I've heartbreakingly read about people who can't afford any medical treatment, or much less have the IF testing.  I'm grateful that we are able pursue treatment but it still doesn't take the sting away from paying the bills.  And the absolutely disgusting feeling of knowing the money we are about to flush would provide food to a small orphanage for months.

There's so much guilt tied up in this whole process for me...  Guilt for punishing my body with all of the meds.  Guilt for dragging our families through this.  Guilt for dragging D through this when he was ready to move to adoption a year ago.  Guilt for spending so much money on this.  Guilt for still pursuing a genetic link.  Guilt for wasting so many otherwise good moments on IF.

Regroup

Hmm.  The nurse called just a few hours after our last conversation.  The doctor has reviewed our results.  She said that they usually get instructions for a protocol at this point, but for "whatever reason" he is requesting a regroup.

I don't like the sounds of that.  That means something has changed.  And I don't think it's to call us and tell us that our chances are better than he expected.

The good news is that we won't have to wait long for the appointment because I already had one booked on the 26th to discuss the laparoscopy further.  I was going to cancel it shortly because it seemed unnecessary after conversations with the nurse.

Shit.

Day 3... Results are in!

My results are in,  (drum roll please! haha)...

Estrogen:  35.  They would like it to be below 50.

FSH:  11.9. This is just a bit elevated over the 10 they would like to see - YIPEE!!

LH: 9.1.  She said this should be about 1/2 of the FSH level. (Which obviously it's not). The nurse said that this gives the doctor an idea of what type of protocol to put together.  I'll need to find out more about this later.

I love how without asking the nurse just gives the reference range for a result.  It's awesome.

From here, she will ask the doctor to put a protocol together.  They will determine if they will use this cycle or the next.   Oh my gosh! I didn't even think this cycle would be an option.  Happy dance!!!

She discussed Dr. Dandruffbeard's desire to have a sono-HSG before doing the laproscopy.  The nurse said, "let me just think of the polite way to say this".  I told her "there's no need, you can just tell me what he said".  She told me that Dr. Schoolie thought it was an "idiotic" thing.  She explained further to me, that it would be like having an MRI and seeing you have a tumour, but then saying that you need to look at someone's eyes before doing surgery.  Or, that if you had a mammogram and found a mass, but then wanted to do a breast exam.    She said he thought it would be a waste of time, using a less sophisticated technology and and that it would give us no more information then we had now.

She said if I needed to do the sono-HSG to follow the rules of the Canadian health care system, then to do it.

I asked her if I should be worried about being under his care?  Should I have someone else do the surgery?  Now I'm not so sure.  Ironically, I'm no longer trusting Dr. Dandruff's opinion.  Oh.  And did I mention that Dr. Dandruff is the head of his department at one of the larger hospitals in my area?  Now I can't get the thought of 20 year old equipment and dirty operating rooms out of my head. Yikes.

I might reconsider paying the $3,500 it costs to have the laproscopy procedure done at CCRM.  Maybe they could do it after my egg retrieval if we get that far?.

Dr.  Dandruff had also told me that if there was no hydrosalpinx shown that there would be no way for fluid to be moving in the direction of uterus.  That fluid is pushed out of the tube towards the ovary.  I asked the nurse for Dr. Schoolie's opinion on this.  She said that it is nonsense.  I asked why, she said that some doctors just believe different things.

Trust

During our preoperative consult, Dr. Dandruffbeard explicitly asked me if I trusted him.   He said that it seemed that I preferred the care of the other doctors in America, because I had chosen them for my care.  He said that there were many surgeons that could do the ligation for me in Canada besides him, if it was a trust issue.  He said I should have a surgeon that I trust.   He said this all in a very nice and respectful way.  However, it caught me a bit by surprise! In all of the specialists I've seen over the last five years, this has never come up before.

I told him that no, it wasn't a trust issue.  It is an opinion issue and a timely-care issue, but I didn't go into that.  I told him that geographically it made sense for us to proceed with the other doctor (which he understood).  Also, I reminded him that at the time the only option he gave to us was donor egg, from a known donor.   And since that for us was pretty much out of the question for us, we moved on.

It was his opinion, combined with Dr. Snowflake's that led us to choose embryo adoption.  He told me he was not interested in trying to get eggs from me because of the low probability of success (less than 5% chance).  He told me that twice. Almost 5 years ago, and more recently 3 years ago.

It's painful to think about all of that.  I wonder if he is going to be proven right after all of these years?  If we just stuck with his opinion, and chose other family building options would we have a family now and have avoided a lot of heartache?  Our savings would have certainly taken less of a beating.

I suppose, we've already proven him a little bit wrong.  We did do an IVF and made 11 eggs and 6 embryos, resulting in one pregnancy.  I'm hoping to completely prove him wrong with this IVF in Colorado.  

Later on, I visited his website.  At the bottom of his page was a quote "I thank my patients for their trust.  They know they can count on me 100%.  Interesting.

I'm hoping that maybe we can do the ligation after the IVF cycle.  I've left a message for the nurses to see what the doctor thinks of this idea.  This would allow me to be on a waiting list in Canada for the procedure, without wasting precious time.  Plus, I'm on all of these supplements and restrictions and I want to be finished with them sooner rather than later.   We will know for sure after my day 3 blood work is processed.  We need this before Dr. Schoolie will give his final blessing on any OE IVF cycle.

Update: Yeah - Because we are planning to do a frozen cycle with CCS, we are able to do the laproscopy later.  I'm excited about that news.  Now just awaiting the day 3 blood work.  Please, let it be ok.

Tubal Ligation Preoperative Consult

Well, it seems things are going to get a teeny bit more confusing before they get simplified.

I'm hoping it's like when you spring clean and need to spread things everywhere and make a big mess before putting it away neat and tidy.

I had my preoperative consult with Dr. Dandruffbeard.  Although strangely, today he didn't have any dandruff.  I wanted it to be simple, for him to concur with Dr. Schoolie's opinion, and book the surgery in early January.  The surgery was for what I described here, a laproscopy and possible tubal ligation.

Blah.  But not so fast.  I forgot that this surgery is "optional", and not 100% indicated by my previous tests.  It's just to basically rule a possible problem out, for the best chances of implantation.

Dr. Beard said that in Canada they do a sonohysterogram to determine if there is a hydrosalpinx that requires ligation.  He said they don't go by the x-ray (the HSG) because it is an imperfect test.  The rule in Canada is that if there is no accumulation of fluid shown in a sonosysterogram, they don't do a tubal ligation.

I didn't have a sonohystergram.  But I made a big oopsie and told him I had during my ODWU.  Now things are confusing because my whole consult was based on Dr. Beard reviewing the sono, then talking with Dr. Schoolie briefly, then doing the surgery.

I've messed things up.  :( So now I'm back tracking.

One unexpected perk was that the appointment served as a second opinion on the procedure.  Dr. Beard said that basically if there is no balloon of fluid in the tube aka. hydrosalpinx, that there is no way for fluid to leak back down into my uterus.  And that he doesn't think I have this problem anyways because I've had implantation at "a reasonable rate".  He said the fluid leaking out of the tubes causes an implantation problem, not a miscarriage problem.   He offered though to do what he could to help me.  Hmm, interesting.

Then we had a semi-awkward conversation about trust, that I'll have to write about another time.  I'm off to my exercise class.

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.

Mixed messages

Sometimes I feel like we have taken the most backwards, mixed up path to try to resolve our IF.  One of the first questions Dr. Schoolie asked was to tell us a coles-notes version of our fertility history.  I took a deep breath and summarized the best I could.  Even Dr. Schoolie agreed that we been through things a little backwards.  Although, he politely referred to it as us responding to the “mixed messages” received from our doctors.

Some of the messages we have been given were:

 1.  Dr. Whisper, OBGYN.  A small, kind man who is notoriously soft spoken.  I've heard from a nurse that works with him that when he is delivering a baby that they have to ask him to speak louder so they can hear him. 

Message:    After some very basic testing, he whispers to me that my FSH is within the acceptable range.  He scribbles some calculations on the SA report,  along with the word "sterile".  He might have been talking to me, I don't know.  His voice was low and I think I was in shock.   I go to the parking lot, and bawl my eyes out, wondering how the hell I am going to tell D this news? 

2.  Dr. Ballhacker, Urologist. 

Message:  I like to touch testicles without gloves on, and you will never really know if I wash my hands between patients.  D, you need a biopsy of both testicles.  You won't find out until later, by another more competent urologist that it is a completely unnecessary procedure and will not alter your treatment plan regardless of the outcome.  This is because either way, you will need to use IVF with ICSI to even have a remote chance of conceiving.  Post-operative, you will need to learn to live with stabbing pains in your nuts for the next year or so, especially after intercourse.  

3.  Dr. Nada. Endocrinologist.

Message:  D,  I've got nothing to tell you. Everything looks normal.  Let me send you to a friend from my residency days, Dr. Dandruffbeard. 

    

      4. Dr. Dandruffbeard, RE.  

Message: You are here to see me because you think your hubby’s swimmers are the reason you haven’t gotten pregnant.  Really, I would like to drop the bomb on you that your eggs are actually the deal-breaker here.  Your other FSH test was done on the wrong day, so it really gave you a false sense of security.  It’s 30 minutes after we close, and my wife is waiting for me for dinner.  Please consider donor eggs as your only option.  Oh, and by the way, right now you would need to find your own donor because of the regulation changes in our province.   If you would like to try your own IVF cycle, it would require approval of our ethics board.  Despite your age of 28, your chances of IVF are very slim, less than 5%.  Your eggs and ovaries are yucky, little hideous things and look more like someone who is 45 years old.

5.  Dr. Snowflake, RE.

Message:  I'm sorry.  Yes, your eggs really do suck.  And your sperm aren’t great either.  We would try one IVF cycle with your gametes, but really we would just be taking your money.  For closure, we will however allow you to do this.   Really though, you should look into donor embryos.  (They did not mention of donor eggs.) 

Side note: My sister had a massive stroke on the eve of what we thought would be our egg retrieval.  Our focus turned towards helping her rehabilitate for a year.  When the fog lifts, we decide that we would like to try with donor embryos through the Snowflake program.  We thought that even if we had a one baby through IVF, we likely wouldn’t have two.   We wanted to end our fertility-misery and just become parents.  Numerous mix-ups happen including one particularly upsetting one which resulted in a cancelled cycle.  All because they didn’t notice our donor embryos were day 3 embryos and they let me go to far in my cycle to transfer them.    

6.   Dr. M. Frankenstein, RE.  I call him this because he has a very large, rectangular head, and keeps his black hair short with spikey little bangs.  And, because the first day we met him he had a problem where one of his eyes was completely bloodshot.   

Message: Why didn’t you use donor eggs instead of embryo adoption?  When asked if we could try our own IVF his answer was “we don’t stick needles into people who don’t have eggs”.  He “allowed” us to proceed with the second set of donor embryos.  After the donor embryos were used, suggested we try our own IVF after supplementing with DHEA for a few months.   Bingo-bango, I miraculously made 11 eggs!!!!!  Those 11 eggs turned into 6 viable embryos.   6 months later, all 6 embryos were gone.  For the last two cycles, the doctor suggested Lovenox, Prenisone and Asprin, and some other antibiotic protocols.  Dr. Schoolie later calls this protocol for my situation as “voodoo”.   As a last ditch effort, he tells me to laproscopy and HSG to investigate my uterus, and that they might need to tie your tubes if there is disease in them. 

Side note: Two pregnancies, one from donor embryos and one from our fresh IVF cycle leave us wondering what the real problem is? Embryo quality? My uterus? Something else?

7.  Dr. Schoolie, RE.  

       Message:  You do not need laproscopy or a surrogate.  You may need your tubes tied if there is disease in them. Your embryos are probably mostly abnormal, which is why they aren't surviving very long.  You likely only create one normal embryo from a batch of six.  Unless you do CCS, you will not have any more information about why your cycles keep failing.   Your FSH 3 years ago is what jumps off the page as the biggest deal-breaker.  However, you had a decent result with your last IVF.   Consider OE IVF if you can emotionally and financially afford it, at the end of it you will have a baby or an answer.  Consider DE IVF as well.

 I've said to D before, that if we only knew how many cycles we needed to complete to end our IF journey this would be so much easier.  If only we knew that a positive ending awaited us at the end of this long, winding road, we could withstand it.  But, I guess life just doesn't work that way.   So here we stand, staring at Dr. Schoolie hoping that he know's what he's doing.   Will he "school" the other doctors?