Planning for next time

So I managed to get in to see Dr. G this past Friday. He called me on Tuesday evening, the day I got the beta results. He said that he was very sorry that this cycle didn't work, and suggested that we get together as soon as possible to talk about what we could do differently the next time. He suggested meeting on Friday at 2pm, and of course I readily accepted. What a saint.

He recommended several changes for next time: he thinks we should try to shorten my stim as much as we can, bearing in mind that I'm prone to hyperstimulation. Apparently the vast majority of patients have stim somewhere between 9 and 14 days long. Mine was 20. He wants to see if we can shorten it down to around 10-12. He believes that the long stim MAY have resulted in some of my eggs being post-mature. He thinks that may have contributed to our poor fertilization rate. The plan for next time will be to start me off right away with the highest dose of Follistim that I was on last time - 225ius. He'll watch my E2 level closely, and if it takes off immediately and looks like we're headed for hyperstimulation, then we'll immediately back down the dose. But if all goes well, we'll hit the old ovaries with the higher doses right away and see if we can get them to perform in a shorter time period. The hope is also to get more eggs this time around. Dr. G said 14 was great, but 20 would be better.

All 14 eggs they retrieved this time were mature. He said that was great, and was a sign of good egg quality. Of those 14, only 11 fertilized, and 6 of them fertilized abnormally. I'm sure I learned this in some long forgotten biology class, but when the sperm fertilizes the egg, the newly formed embryo is supposed to "kick out" the extra set of chromosomes. In 6 of our embryos, that didn't happen, and so they had 3 pairs of pro nuclei present. Dr. G explained that this could EITHER be caused by more than one sperm entering the egg, OR it could be an egg quality issue. He thinks it was the latter, in this cycle, but he thinks the quality issue can be attributed to the post-mature state of some of my eggs due to the long stim - NOT an overall age-related egg quality issue. So, his second suggestion, to eliminate any possibility of having more than one sperm enter each egg next time, is to do ICSI (for anyone not familiar, Intra Cytoplasmic Sperm Injection).

His third suggestion is to perform Assisted Hatching on our embryos next time around. He explained that this COULD be the reason that our gorgeous, 8-celled, compacting embryo didn't implant this time around. Perhaps it had a little trouble hatching in time to implant?Interestingly, Dr. G explained that although studies have shown no measurable benefit of performing Assisted Hatching on embryos of couples undergoing their first IVF cycle, the data does show that it helps in subsequent cycles. So, I guess his theory is that we might as well give them as much help as we can, and apparently with their embryologist's sophisticated and practiced techniques, there is little danger of harming the embryos when they "chip" away part of the "shell" or zona pelucida before the transfer.

I think it is really mind blowing - all of these procedures they can perform (ICSI, Assisted Hatching, etc.) on these tiny few-celled embryos. I can't imagine being the embryologist responsible for inserting a single sperm into a single egg cell?!?!?! It's almost like science fiction.

What's even more remarkable, in my opinion, is that "natural" conception and subsequent birth ever happens at all!! Every star and planet has to be aligned and every cell in your body and your partner's has to do EXACTLY what it is supposed to do at exactly the right time in exactly the right way......when you think of all the things that can go wrong, it makes you wonder how we managed not to go extinct before the advent of medical intervention! The deeper my knowledge of fertility issues, the more I'm convinced that every child is indeed a true miracle.

So, anyhoo, now the big freakin' question is how the frick we're going to pay to continue with this shit. We only have about $3,000 worth of insurance coverage left. If you add in all the costs of the "extras" Dr. G recommends next time around, we'd have to cough up about $10K to pay for a single cycle. (Plus, we'd have to pay $2,500 for a subsequent frozen cycle, should we be so lucky as to end up with embryos to freeze, of course.) By contrast, $22K would buy us 6 further attempts and/or a guarantee of our money back. We've been talking about it, and we're leaning toward Shared Risk as the logical choice. But $22K is a significant amount of money - do we finance it with a personal loan? Should we borrow from our 401K plans? Should we borrow against the equity in our home? Honestly?...We don't really want to do any of those things, but at some point we're going to have to make a decision and move forward.....

As luck would have it, Friday when I met with Dr. G also happened to be the day that my period showed up. So, he told me I could go ahead and start the BCPs if I wanted to. No pressure though - he said we could "manipulate" the pills in order to start the Lupron whenever I wanted to. We're going to the beach the second week of September, and there's no way in hell I want to be dealing with either a period or Lupron shots while I'm on vacation. I intend to be blind drunk the entire time. So, at this point I'm thinking we may be ready to start the Lupron around the 3rd week of September. We'll see. I guess it depends on how long it takes us to figure out the financial part of the equation.

Sooooo, I'm still obviously very disappointed that we're not currently pregnant. But, thanks to the upbringing of my two wonderful parents I'm a fairly resilient person. I think I'm over the bulk of rage and bitterness that swept over me for most of last week. It's not the end of the world, for pete's sake. It's just another failed cycle. It sucks, but we'll try again, that's all. The way I figure - if no one is dying, then it's a pretty good goddamn day. Losing a parent to cancer has a way of helping to put life's trials into perspective. This is hard. Really hard. But R and I are still here, still putting one foot in front of the other, still loving and laughing and enjoying each other and dreaming of the future. I keep trying to focus on my innumerable blessings, and that really seems to help.