Next Step: Donor Eggs

Today we met with my doctor for what I think of as the obligatory "WTF" appointment. I brought in a list of questions but did not get very far, as he immediately launched into his analysis of why this cycle sucked so bad, why the previous two sucked even more, and what he thinks we should try next. I have to say, even though I am so disappointed in the results, I was overall happy with this clinic, and really do respect and trust this particular doctor. He was clear and informative in his discussion with us today, and honest and sensitive in his manner.

This is what he said: he thinks it's an egg problem. I have impaired function due to my left ovary not working as a result of the endo and/or the endo surgery, and although my AMH is okay, I am a low responder to the drug stimulation. However, I was able to get five mature eggs. But the embryologist reported that of the five eggs, three were just bad. They "degenerated at injection." So, when they injected the sperm using ICSI, the eggs basically collapsed or died. Dr. M believes this is an egg quality problem. The other two that fertilized were okay, but stopped growing, which is why we only had four-cell embryos, so that wasn't good either. The quality of one was bad, and one was pretty good- but only four cell so not ideal.

To sum it up, my eggs are probably bad. We don't know why, but there is something wrong with their quality. He said we could try a 4th round of IVF- he has seen women get pregnant before. But he does not think I have very good chances, and knowing we are paying out of pocket, he did say that donor egg may be the better use of our money.

I agree. I don't have the financial or the emotional strength to go through another difficult cycle. Sadly, I am done with my own eggs. Donor egg it is.

But- this is where the appointment went downhill. This clinic has excellent success rates for donor egg- 68.4% in last year's SART numbers. This is amazing, compared to much lower numbers at most other clinics. BUT the bad news: there is a year and a half wait for a donor. Either this clinic attracts many couples because of it's great success rates, or it has such stringent requirements that it doesn't take too many donors, but either way, we are not waiting a year and a half. I began crying when he said that. I just couldn't help it. I felt... crushed. To go through one surgery, two painful x-rays, and three IVFs, all of which failed, and then to be told I need to wait another two years--- no. Cannot do it. I don't know that I would be sane and not checked into the loony bin if I had to wait that long, suspended in time, waiting for just a chance to become pregnant. Nope, not for us.

But when I got home things started to seem more possible. I called the big clinic in Maryland and they have plenty of donors available. Their success rate is not as good as my current clinic's, but it's not bad, at 50% success per donor egg cycle. No wait needed at all. They are very, very expensive, but we will do what it takes to reach success. They also have refund programs. Because of our not 100% confidence that B's sperm isn't totally the problem, I think we need to do a refund program. It doubles the price, but I just don't think I can handle the stress without a refund option. What if nothing fertilizes, or only a few? Then we'd be out another $15K? No.

We also have an appointment at CC, a local clinic that says they have available donors (and a good success rate of 57.1%), and they have a refund program. Perhaps they will have better prices since they are not next to a large, expensive city. Our appointment is not till the end of next week, so I won't have any more info till then. [UPDATE: CC no longer has a refund program so we are not considering them.]

Another option is to use a private egg donor agency, which is what someone in my support group did. But that gets very expensive. She also mentioned the agencies give you more info about the donors- but that is not a big concern for me. Agencies also allow future contact once the child is 18. I'm not sure how I feel about that, but I don't feel strongly about it. I can't say how a child will feel, but if B's sperm is used and I carry the child, I would hope that a child would feel more connected than, say, traditional adoption. But, I don't know. This is a strange grey area and pretty new. I should think about these issues some more.

Anyway, this woman in my group said if she could do it over again, she would consider using frozen eggs: "If I was to start all over, I think I would go with RBA in Atlanta (Reproductive Biology Associates, I think.)  They are the ones who pioneered egg freezing.  So, their "in house" donor pool isn't the 2 women who volunteer to give their eggs while you are at the top of the waitlist but a huge bank of frozen eggs.  Their success rates are fantastic, they offer a guarantee program and they are supposed to be one of the cheapest options."   So this is something I would like to investigate as well.

So, we have some options. The big clinic in Maryland that has available donors and costs a lot and has decent but not great success rates. The local clinic here that has better success rates and I don't know much else about yet. Using a private agency or the frozen eggs from Atlanta.

Options, options. I am feeling exhausted by it all, but committed. After all we have been through, perhaps this is our answer.

Options After IVF Failure

The last week has been tough.

I'm not even sure how to describe it. I've been really busy with a work-related conference and haven't had time to think over things too much, but when I do, it's not good. Yesterday was Saturday and I think I cried about five times. B and I are getting along fine, and he's been more supportive, but I think he just doesn't know exactly what to do. I'm not real good at telling him, because I don't know what to do myself.

One thing I have been thinking a lot about is next steps. What do you do after three failed IVFs? If I'd had even one great embryo, I might be willing to consider another round, with the third and final protocol available. However, it doesn't seem a wise use of money or time, considering the low yield, poor fertilization, and less than ideal quality of embryos.

So we are left with the following options:

1. Traditional adoption: sometimes I do feel drawn to adopt, and wonder if this is where I really was meant to end up. The physical process of pregnancy has never particularly appealed to me, and I am more interested in being a parent than in being pregnant. However, my concerns about the prenatal environment are strong. I worry about the long term effect of drinking and drug use on a child. Although I know plenty of adopted kids turn out okay, both B and I can list so many cases of adopted kids being messed up, and it often seems separate from their upbringing or other parental influences. Of course, what is nature and what is nurture, and how much is genetics versus the hormonal development in utero? There are no clear answers. But on a practical note, I get shaky inside when I think of doing a homestudy, compiling a website or portfolio about us, and paying $30K for this process. After the trauma of years of infertility and failed IVFs, I don't know how well I can stand up to all of this right now. Being examined and judged? It just turns me off completely, and I feel that my bitterness about the unfairness of life and fertility will be increased through this process. I am just not ready. If someone handed me a child, wonderful. But the rigors of adoption? Not appealing.

2. Using donor eggs: hmmmm. This is probably our first choice at the moment. Using donor eggs is usually an option for older women who cannot conceive using traditional IVF/ICSI. I seem to be an anomaly, being only 32 years old and not having premature ovarian failure. On paper, my AMH and FSH are fine (well, low for a 32 year old but not at all low for a fertility patient). This raises the perpetual question of whether it really is my eggs that are the problem, and not B's sperm that accounts for our poor embryo quality and fertilization rate. For this reason, I am not sure using donor eggs is for us. It is VERY expensive- but it would be amazing if we could get enough embryos for this cycle and for a second child in the future. We are meeting with my doctor tomorrow and I intend to try to see how good of an option he thinks this is for us. Even if he does encourage us to try it, we are only willing to do one of the refund programs. There is no way we are going to spend $22K-ish and have a failure. There are refund program where you can get 70% back if no pregnancy occurs. This seems a reasonable option, though of course I am terrified that we will get great eggs, and then have crappy fertilization. At least then we'd have some answers, I guess. This option does appeal to me in that we can use B's sperm and I would carry the child. We can control the prenatal environment, and we'd both have a biological tie to the child- his would be genetic, and mine wouldn't be genetic, but I would carry the child, and be able to breastfeed. It's so expensive- we would seriously be impacted financially, but we can do it if we are up for the risk.

3. Using donated embryos: a third option, and the cheapest but perhaps the lowest odds of success. Since I wrote about this at length in my March 5th entry, I won't go too into depth again. We are still interested in this option, but we're feeling overwhelmed at the details of actually arranging it. Using the self-match website brings up so many questions about logistics, and my clinic doesn't have any embryos available. The clinic in Cary that advertises "available embryos" actually has a one year wait. We do have an appointment in two weeks at a clinic in Raleigh that also says they have embryos available, but I'm half expecting that to be untrue as well. However, we will go, and see what they say. The low cost is appealing, but we also know the success rates aren't the 60% that donor egg carries. The women will generally be older, so there are lower odds, and they are leftover embryos so not as ideal as fresh ones from a donor who is in her early 20s. Anyway, it's still an option, and probably #2 on our list of most desired paths to take.

Overall, I am feeling very emotional, and I cry often, but I am doing what I can to take care of myself: spending plenty of time alone because I am not yet ready to talk to people about this, eating well, sleeping enough, and getting good exercise. Yesterday we walked in the woods again for over two hours, and today I plan to go to one of my favorite classes at the gym. Later, I'll make one of my favorite meals, tofu broccoli lasagna. All I can do is keep trying to be kinder to myself than I am used to, and being realistic about the fact that I need to keep moving forward.

IVF failure wasn't supposed to happen, not to me, not now. But I hope that one of these three options brings me to peace and brings me a baby. I know I am meant to be a parent and not to live child-free. I just have to keep figuring out how to get there.

This is what a broken heart feels like

On Saturday morning, bright and early, B and I woke up. Normally we'll sleep till 9 on weekends, or sometimes later. But not this morning. We were up and in the bathroom before 7 am.

The test was negative. As I suspected and expected it to be.

We went back to bed but it was hopeless to go back to sleep. All things considering, we had an okay day after that. We took a long walk in the woods, a nap on the couch together, and met friends in Raleigh for dinner. Another friend came over later that night and we shared a bottle of wine.

Sunday was not so good. Sometimes the first day isn't so bad, but then the shock wears off and it becomes more real.. the lack of hope. Sunday I did yardwork and then we went for another long walk. However, we had a horrible fight in the woods. I was asking to mourn the loss of our last opportunity to have a biological child, and he just wanted to try to get me to think more positively about our other options and life in general. He also said he would like more support for the stress he is under at school.

Bullshit. That is such bullshit. This blog is not a forum to complain about my marriage, but I am still very upset with him. I know infertility can cause many couples to become unhappy with each other, and can break apart some marriages even. I know all this, and we've been doing okay over the past two years. But for some reason, this time I really wanted to mourn, and I wanted him to do it with me. And he couldn't, or wouldn't.

This turned into a 7 hour fight. Well, most of that was not actually fighting, it was him hiding upstairs and doing homework, and me crying and being miserable everywhere else. We did make up before bed, kind of.  He did bring home veggies and chocolate to try to make up, but my anger and sadness were overwhelming.

Today didn't start off too much better. Actually, it was awful. I woke up so exhausted from not enough sleep, and went to the gym to try to feel better. Doing Zumba for an hour did help. But then I had to go to the clinic to do the obligatory blood test. I guess I was a little dehydrated, presumably from the Zumba but perhaps also from crying so much yesterday. Anyway, three nurses tried to get a vein, resulting in my being stuck five times. They even sent me away and had me drink water and come back, but nothing. No vein, no blood. At this point I was bawling. I mean, uncontrollable crying, right there in the blood lab. The main nurse finally consulted with the attending, who told me to just go on home. I guess the pee test I did at home is gonna have to suffice.

This experience was torture. My arm is full of pain from the five needles I had in my right vein, and I cried myself hoarse at the clinic, in the car, and when I got home. I called B and told him I'm on the verge of a nervous breakdown and he better damn well stop bickering with me and listen to what I need. I need someone to tell me they know how much I've been through, and that it's been HARD. I do not know anyone else who has been through three IVFs, and I am proud of myself for doing it, and I could use more acknowledgement from him. And when I say I don't need someone trying to cheer me up, but just to listen and try to empathize, that's what I want. I think he gets it now, after calling him at work today and having another little talk.

Overall, I feel that my heart has been broken, stomped on, and broken again. I know some of this is the hormones that are still in my body, and some of it is the lack of sufficient sleep I've had for three nights now. But most of it is just the plain and simple fact:  I will never have a biological child. I am 32 years old and cannot conceive, despite three IVFs with ICSI, costing more than $20,000 and two years of our lives. We will never know if it's my egg quality or his sperm's inability to fertilize, but the combo of me and him will never result in good embryos. We are done with our IVF journey.

Of course, all is not lost. I still intend to pursue embryo adoption, and traditional adoption is that does not work out. One of these days, I will be a parent, and maybe then my heart will begin healing.

4 More Days.. and Plan B

I had a pretty good weekend. A nice date night with B on Friday night where we tried this amazing Singapore style restaurant that we now are wondering how we didn't know about for the past 7 years! As an appetizer we had lettuce wraps that were served DIY- they give you the large lettuce leaves and a filling of tofu and onions and mushrooms, all marinated and delicious, and you get to make the wraps yourself. It was fun and tasty.  On Saturday I hung out with a friend all day- we went to the farmer's market, had a nice brunch in town, went used book shopping, etc. She is trying to get pregnant now and thinks she might already be. I have mixed feelings: of course I would be happy for her, but it's a little painful to watch someone at the beginning of their journey and remember how naiive I was, thinking of course it would be easy. I wish her none of our troubles.

On Sunday a friend came over and we did "fertility yoga." She used to teach it and I think she now trains instructors. In any case, I am not normally a big yoga fan, but it was so good to move my body for the first time in awhile. I've been abstaining from exercise for the past few weeks, to try to help with any possible implantation. But it was great to do some gentle yoga moves, with the sun pouring in and warming us both in my cheerful purple guest room (a.k.a. someday baby's room). Sunday night we had dinner with friends and none of them have kids.

So, I stayed pretty busy all weekend. I did not have time to laze around and feel sorry for myself very much. That is definitely a good thing.

As test date gets closer, I'm prepared for disappointment. I do not have my hopes up too high. Of course it would be the best thing ever if this could work, but I know the chances are not great.

However... we do have a plan B! Of course we will investigate adoption, but we are also starting to learn about embryo adoption. My main fears with adoption are: the birth mother's care of herself while pregnant (as we have heard many, if not almost all, birth mothers are using some amount of drugs or alcohol while pregnant), the massive financial cost (where on earth will we get the money needed?), and the intense process of applying, background checks, home studies (all sound so draining and we are already so weary from 3 IVFs). The lack of genetic connections with an adoptive child is not on my list of concerns. So that's why we are interested in embryo adoption. If we can have me carry the baby, we can control the environment since of course I will take good care of myself. We can avoid the financial toll since from what I read, it's not too much more than the cost of a frozen transfer (a couple of thousand versus $30K). And home studies and background checks are not always required.  I do not feel bad morally if we do not adopt a child that has already been born. A long time ago, or in another country, there was/is a need. But now, with there being years-long waiting lists and more demand than need, it's not like it was.

We still have many, many questions. But it is nice to have another option on the table.

Two Week Wait: Week One

Last time I wrote was Trigger Day. All went fine with triggering, and I had no nausea the way I did the first time. I did have some mild cramping all day Wednesday, but no big deal.

Thursday was retrieval. We got there bright and early, 7:30 am. I was excited and anxious, ready to be done with the monitoring phase of the cycle and eager to hear how many of the possible 7 eggs I would have retrieved.

For some reason, though, I was much more nervous than in the past. The retrieval room was much scarier than my old clinic's. As much as I didn't like my old clinic, they had a great set-up in their IVF suite. They had dim lights, the room was warm, and they played soft music to help calm the patient. At my new clinic, not so much. They started the anti-nausea drip in my IV, which made me extremely dizzy. Not in a bad way, it was almost fun  :)  but it was a little disconcerting. Anyway, the actual room was NOT warm and fuzzy the way my old clinic's room had been. It was bright white, sterile, and COLD. As I got on the table, my knees were knocking like crazy. They also could have waited a minute longer for the amnesia drugs to kick in. They inserted the speculum, which doesn't hurt but is never fun, and that is the last thing I remember.

Apparently I slept for a while afterwards. When I woke up, the nurse told me and B that they had retrieved 6 eggs. I was groggy and tired, but happy enough with that number. We went home and I slept much of that day.

The next day, I got bad news. Out of my 6 eggs, only 5 were mature. Okay, that was fine. But here is the bad part, that even the Fellow warned me I would not like: although we used ICSI, I only had TWO fertilize. TWO. That is really no better than any of my other cycles.
Cycle One: Six eggs retrieved, 1 fertilized normally, 1 fertilized late
Cycle Two: Four eggs retrieved, 2 fertilized with ICSI
Cycle Three: Six eggs retrieved with 5 mature, 2 fertilized with ICSI

ICSI typically should fertilize anywhere between 60-80%. With me, I've now had 50% and this time I had 40%. Pathetic! Why was I pumping myself full of drugs, going through a scary medical procedure, and then having ICSI totally fail me, with no more embryos than I've ever achieved before. So, so disappointing. I don't know how many times I cried on Friday.

But we went in on Sunday as planned. Upon arriving, I did acupuncture. I was told that my two embryos were ready to go. They were both, sadly, only 4 cells. By day three, they should be 6-8 cells. The fragmentation was 75% and 25%. That first number is bad. Low implantation potential. The second number is okay, pretty good, pretty average from what I have read.

I came home Sunday, so sad and disappointed. I had really hoped that a new clinic and a new protocol was going to bring better results. I had to ask for a Valium on Sunday for the transfer, because my nerves were so shot and I was so anxious and sad.

However, upon closer examination of the photos on Sunday, I did start to feel a bit better. My embryos are only 4 cells, but one of them looks much cleaner and crisper, with less fragmentation that any of the other embryos from previous cycles.

So, I'm still sad, and we've decided that we won't try a 4th cycle if this one doesn't work. We just feel that we have a quality/quantity problem and a fertilization problem to boot. Who knows if it's my egg quality that prevents the sperm from coming in, or if there is a serious sperm issue. It doesn't matter, but what it means is that we don't make good embryos. And we've tried two clinics and two protocols, one which all three doctors I interviewed back in October had recommended. I think we are at the end of the rope here.

So, I am hoping that one of these embryos is nestling in, but ultimately I realize that the chances are not very good. I have cried and grieved so many times, and I have to get off this crazy bus.

For that reason, we've talked about adoption, and how we think that is the next step. We don't want to wait too long before pursuing it either. I want a baby, I've already waited over two years, and I want my heart to heal. I do not think remaining childless is going to get any easier.

Life feels so unfair right now. Why am I surrounded by babies, and even my IVF friends have mostly all become pregnant this year too? I am sure my friend B's cycle right now is going to result in pregnancy and I will be happy for her, but I can't deny it will hurt. It's hard not to feel like a double failure: a pregnancy failure, and now a three-times IVF failure.

I have done everything I can do. All I can do is wait and hope now, and temper that hope with realism. March 9th, you will be here soon enough.

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.