Decision

As of last Thursday, I was feeling okay about ARC. Not wonderful, but okay. I liked the doctor and liked her intention to try a different protocol, but the drive is kind of a pain. A lot of time on the highway. Their prices are higher than other clinics, and it bothers me a little bit that the place was so empty. I worry a little about a place that is so new and untested, yet charges so much more than well-established places. I went into the next two consults with curiosity and a bit of nervousness that one of them, or both, would tell me not to waste my time. However, that was not the case.

My consult with Duke was first. I was prepared to not like them, and to not want another big university-based experience. However, I was totally impressed by both the clinic and the doctor. The clinic is near Southpoint and therefore pretty convenient- not as close as my old clinic of course, but I can get there in 20 minutes with no traffic. It's in a free-standing building with plenty of parking right out front, which is also nice and different from my previous experience of having to pay for parking and walk quite a bit (not really something you always want to do after procedures). It wasn't as fancy as ARC, but certainly didn't have the public hospital, slightly grungy feel of my old clinic. I also liked the tea machine  :)

Anyway, I spent only half an hour with the doctor but he answered all of my questions with confidence and with as much certainty as you can possibly expect or hope to hear. He agreed that there is no guarantee, but that it's likely the birth control and Lupron were over-suppressing me. In fact, he scoffed at the fact that I did two cycles on Lupron. He said Lupron is considered good for endometriosis patients, but that with a low responder like me, it's a bad idea. He said that it's an outdated treatment regimen that he hasn't been using for 15 years. He also disapproved of my having the endo surgery, and indicated that it may have caused more harm than good to my fertility. While I don't know, since he didn't see all my surgery records, that was upsetting to hear. He think it is worth one or two more tries, with my age and my great AMH. He predicts I will do at least as well in quantity, but what he really wants to focus on is quality.  He told me that is his goal for me. He will not let me go too long, but trigger much earlier, and he won't have me on such high drug levels. He doesn't need lots of eggs or big follicles, but good ones. I left feeling reassured. He advised me to quit the birth control and come back at the end of next cycle for AMH and FSH testing, and a baseline ultrasound and a water sonogram. We'll see how many antral follicles I have and plan for January. I left feeling calm and hopeful.

The next day, I spoke with the doctor from SG. It's funny, because I expected to not like Duke and to like SG, and it was the total opposite. Whereas I trusted the Duke doctor and felt that he fully and respectfully explained each part of his thinking to me, the SG doctor completely turned me off. He didn't seem to review my records personally, and would not give me the details I politely requested from him. I wanted exact medication recommendations, but he just kept saying, "We'll double what you were on." Huh? I was already nearly maxed out on allowable/beneficial amounts. He recommended another sperm analysis, but I don't see the point since we're doing ICSI regardless. A test won't change our treatment, so why bother? When I politely argued this, he then agreed. But what most upset me was his insistence on a repeat HSG. I had a traumatic first HSG and he said we can do sedation, but that is likely to run me thousands of dollars. I guess Maryland patients have the insurance for this, but I do not. Unless I have a clear and logical explanation for why this is helpful, why would I agree? He would not clearly explain the necessity. Something about leakage from my tubes post surgery could affect implantation... while this makes some vague sense, he did not bother to explain it to me. He didn't seem to want to explain anything to me, but just for me to blindly follow all recommendations. I have come too far and am too experienced to take this attitude, and I am done following doctors without understanding or agreeing. The whole consult made me uncomfortable and upset me, and I was very late to work due to my crying.

Some of why I was crying is not his fault. All three doctors seem to agree that Lupron was not the protocol for me, especially after an unsuccessful first cycle. They all think the surgery may have irreparably harmed my fertility. I am confused by what this all means, and how I may have wasted so much time and emotions and money on what turns out to not have been the best treatments for me. I am upset that I didn't do my research well and went to a clinic with such low success rates compared to the other clinics in my area. I have been through so much heartbreak and stress and anxiety, and it has affected my relationships, my work, my self-esteem, and my friendships. It sucks.

And now I have these large, looming doubts about the HSG. I wonder if it would tell us something, but my guess is that it would not. And even if it showed some obstacle to implantation, would that really change anything? We would still try IVF again, because nothing is ever certain, and we would hope that with increased quality, we'd have a better outcome. Furthermore, I don't think I have it in me to go through all this with SG, without B being with me for a week or more. My mom and dad are great, but being home in my bed, with my kitty and my husband- that's what I need when going through IVF.

I did ask the nurse at Duke to ask the doctor there about an HSG and he reiterated that a water sonogram is what he will do. I would like to ask him about this again, and about implantation factors, when I see him in about a month for the next consult. I know he and the ARC doctor believe it is probably the quality that has prevented implantation, and I keep reminding myself that the HSG is probably not going to change our decision tree anyway. I will try not to dwell on it anymore. K loved her experience at Duke, and that means a lot, and their outcomes are as high, even a slight bit higher, than SG.

Another thing I have decided, in addition to going to Duke, is to buy just one round at a time. Though I intend to try IVF twice more, I do want to see how the first time goes. If it's really lousy or if by some miracle it works, maybe I will be glad I didn't pre-pay for two cycles. Also, if I hate it, I could always try a different clinic. I do not think I'd have the energy to try a third place, but it's always an option. A friend of a friend mentioned the Colorado Clinics. Their outcomes are amazing, like in the 70% success range (versus Duke's 50-ish% and my old clinic's 38%) but so are their prices, and again, there's the issue of being away from home, and even worse, without my family. No, with B's school and work, it's just not an option.


I should get back to work now, but I wanted to give an update. For now, I got my period yesterday, and I'm just supposed to complete a regular, unmedicated cycle. Then I go back to Duke and do the testing, and prepare for a January start. Maybe it's the consults and the upsetting SG talk, or the fact that I got my period , or that B is always busy with school and so I'm alone again a lot, but the past few days have been really hard for me. Although Duke gave me hope, and really all three of them had hopeful outlooks, I do feel pretty pessimistic. I feel that we're going to spend a ton of money and time and emotional output on two more cycles, only to be child-less, poorer, and bitter (in my case, not sure about B). But, I also am not ready to give up. It's a tough place to be in and I am just glad for the break, for Ecuador in December, and for K's unending support and companionship throughout all this. I can't believe that she is moving and I will have to do this on my own in January, but that's another problem to dwell on another day.

First New Consult

The last week and a half have been really busy. I was away for work and to see my dad, and then caught a terrible cold. I came home last Thursday night, really sick, and then had my first consult on Friday afternoon. I was in a bit of a daze due to the head cold, but still went to the appointment of course.

I really liked ARC- I'll just use initials here, but you can probably figure it out if you wanted to. It's a brand new clinic, located in the Brier Creek area. It feels like a spa, all bamboo floors and frosted panes and very calming, and the attention was very personalized and friendly. I liked Dr. C a lot, and the staff (with the exception of the bitchy and confusing financial lady). Downside: it is not cheap. And a real pain to drive to from my house. And untested, as it's new, although both doctors come from Duke and are highly regarded. 

The doctor confirmed that I have a fabulous AMH, equivalent to a 30 year old's, but that in practice my eggs suck. Both in quantity and quality. At least we think they do- I have had such small sample sizes, that it's hard to judge anything much. But the quantity problem is obvious, and the fragmentation is a problem she identified. I am a good candidate for egg donation, as my old doctor was pushing, but this doctor also said she has no reason to recommend against trying the antagonist protocol or flare. I have only ever done Lupron downregulation and that sure didn't work. 

I am officially a "low responder" and limited by my one functioning ovary, so I'm probably just going to waste a ton of money and emotional energy on this, but since when was fertility treatment a rational thing???  I do feel unresolved. As the doctor pointed out, I will walk away after all this with either a baby or the thought that I tried everything I could. She recommends doing an antral follicle count and then choosing which of the two protocols, and taking some time off the pill before beginning in January. She referred to the antagonist protocol as "gentler" and I do have to say I am glad to not have to do Lupron again. She also mentioned human growth hormone, and I want to ask her about assisted hatching, if I do go with ARC.

Anyway, I have not made any decision, and have a consult at Duke on Thursday and a phone consult with Shady Grove on Friday. I am curious as to whether they agree with Dr. C at ARC, or agree with my previous doctor who told me to give it up and try donor eggs. My husband is completely consumed with the business school program he started last month and pretty much absent from this whole process. K has actually been coming with to appointments, which is strange but perhaps the nicest thing anyone not related to me has done. I'm kind of puzzled but grateful to have the support. 

So. I'm doing shitty on paper, but I'm actually not feeling depressed or weepy at all. Amazing what being off the hormones will do for ya. Also we are going to Ecuador for the holidays, just me and B, so I have something fun to look forward to! Then I get to come home and deal with whatever I have chosen to do in January. 

New Strategy

Today I spoke with a friend of a friend, who did IVF. She also sent an email about how she chose her clinic, and a different friend of a friend sent a similar email.

I realize how I wasn't as smart about picking a clinic as I could have been. I went with mine because it was so geographically convenient, and because I knew the doctor there and felt comfortable, and because I naively thought that I'd get lucky without too much work, being young and relatively healthy and all that.

This time, I am doing all the research the two friends recommended, and that I should have done right from the start.

The best numbers come from Duke and Shady Grove. I compared 5 clinics including my own. I was foolish not to have done this before. I let the convenience and comfort of going somewhere I knew let me waste my time and money. I am going into this with a different attitude now.

I will call UNC on Monday and get my medical records. I will call both clinics on Monday, and also the new one that was started by the Duke physicians that my friend liked (and whose work contributed to Duke's high success rates in the past). I will go to all three and show them my medical records, along with a concise summary of what meds I took, what dosages, my follicle count each day, and my estrogen. I will ask what they would have done differently and what they would do if I came to their clinic. I will very carefully ask what their honest thoughts are on my past two cycles and my prognosis and chances of success if I do two more. I will take very careful notes, ask all my questions, and not get intimated.

For now, I will still consider adoption but temporarily put it on the back burner. If my dad's  adoption attorney friend can meet with us, great, but I think I have plenty of work interviewing the three clinics already. I am looking forward to hearing from the adoption foundation people at Tuesday's support group meeting. But I just don't feel at peace with stopping the IVF. 

This is a lot to think about, but although I obsessed about all this last time, I don't think I asked the right questions all the time. I hope I'm on a better path now. 

Not Willing to Let Go

I always thought I'd know when to quit. Logically, it makes sense to stop the hamster wheel, get off this train, whatever. I had two lackluster cycles and we're out about $10K already on treatment and medications. It's drained us emotionally, physically has been tough, and has affected me at work. B is entering a really stressful next two years as he starts business school. We're worried about money all the time due to his tuition. It probably makes sense to take our limited funds and spend them on a sure bet, adoption, rather than continue on a very unsure bet, more IVF.

Yet.

I cannot force myself to feel that I am done with IVF. I only had two tries, and I have never felt good about my clinic's care. I also feel that if I gave my left ovary some more time, perhaps it would play ball, as the doctor says.

I see that it's about $10K for two tries at NCCRM. They have better outcomes than my clinic. I always wished I'd started there instead.

I know that I was feeling okay about adoption, but I'm not really. I'm just not.

I think that I should meet with Dr. F one last time (appointment is scheduled for next Friday) and also have a consult at NCCRM. Bring my records and ask them what they would do differently. What my chances are like, with two more tries. Ask them if I were their daughter or if they were me, would they keep fighting this seemingly uphill battle, or would they put their funds towards adoption instead.

I should call NCCRM. I should just do it. I know B is not in favor of this, but he is not totally opposed either. And perhaps I could use my own savings a bit. I know it's supposed to be there for an emergency, but this seems like one.

Or should I just let.... go?

Torture. Plain and simple. Torture.

Most Depressing Post Ever

This morning I found out that I am not pregnant. 

I thought today couldn't get any worse, but suddenly, everything has. 

We have been kicked out of the Attain program. We get $9000 back.

B has announced that he is done with medical intervention and the doctors, tests, treatments, and drugs. If we want to continue another round of IVF, we'll have to use our whole $9000 refund plus a lot more for a single cycle and drugs and ICSI, and then only have a 50/50 chance anyway. With the not so good outcomes of both of my cycles so far (low egg count, low fertilization even with ICSI, and nothing to freeze either time, never even made it to day 3 transfer, etc.), he says it's wiser to take the $9000 refund and put it towards adoption, which is a safer bet than another $10,000 plus on a 50/50 chance at best. 

I think, logically, he is correct. But I am in shock. I had forgotten Attain could kick us out, and never really considered what it would mean.

I am not sure how someone processes these thoughts, so I have decided to do nothing for the time being. I just never considered how it would feel to Stop. Like, I will never, ever get "accidentally" pregnant when we stop "trying" because I am going back on the pill and never coming off of it, which is what my doctor recommends due to my endometriosis. So, this is it, perhaps.

Not sure there is anything that can be said, but I guess the adoption people coming to our Tuesday RESOLVE meeting could not have picked better timing when it comes to me.

Worst. Day. Ever.