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 He said that it's an outdated treatment regimen that he hasn't been using for 15 years.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.