It's A....

....BOY!

Which is what we thought it would be, from the sonographer's prediction at 13 weeks, but it was still really good to learn for sure. This makes it much more concrete that this is really, actually happening. My husband was so cute... he is fascinated by the ultrasounds and almost squeals every time the baby would move. As soon as we left and were in the hall, he had his phone out and was texting everyone he knows! His friends, his sisters, his study group from school, everyone! And of course many of them didn't even know I'm pregnant, so there were several confused texts back of "?????" in response to his "It's a boy!"  I had to remind him that we've been very cautious in sharing our news, so he needs to first tell people we're expecting! Anyway, it was cute.

More importantly than the sex, the baby is very active and healthy. Since we did IVF with ICSI, they did an echocardiogram of the heart. It looks fine. My friend's IVF baby was born with his urethra in the wrong place, so of course that risk remains (those are the two things that show up in slightly higher rates than non-IVF/ICSI babies: heart defects and urogenital abnormalities in baby boys). But hopefully all is well.

The sonographer also assured me that he is very active. I'd been getting concerned because I was 20 weeks at the ultrasound and had not felt any movement yet, which is a little on the late side. But just like I am not really showing yet, I guess I was late for that too. We saw the baby kicking and moving a ton, but I felt nothing. However, on Friday evening, I started to feel a strange bubbling in my lower abdomen. I thought maybe it was gas... but no. It has continued consistently now, and seems most noticeable after I eat, and when I am sitting quietly. It is definitely kicks. I have to say, I LOVE feeling this. Between the ultrasound and the kicks, I actually am starting to feel pregnant. Sometimes it has been hard for me to accept that I am pregnant after so many years of failures, so it's really amazing to me to actually be pregnant, and to start realizing I may really have a baby in my life in a few months....

Anyway, telling people has also helped me to feel like this is really happening. My mom has now told all her friends, and I did the dreaded Facebook reveal. I had been resisting for months, but as I talked about before, my husband really did want to tell his friends. He is five years older than me and most of his friends have one if not more children already. I consented, though we ended up posting very different things: he just announced it's a boy, whereas I felt an acknowledgement that it's not easy for everyone was necessary. So this is what I wrote: [my name] is thrilled to share that we're expecting a baby boy in early March. It's been a long, long journey to get here and we couldn't be happier or more excited.

And immediately, I started getting "likes" and congratulatory comments. Nearly half of my total friends on FB actually "liked" it, which I find shocking. I usually get like four likes for typical cat pics (I can't resist! she's so cute!) or shots of what I made for dinner (yes, I am that person- cat and food pics). So this is what I am wondering: do people just like babies, or did anyone read the second part about the long journey?

Oh well, who knows. I just hope I didn't hurt anyone or ruin their day, as so many pregnancy announcements had to me for all those years. Oh, I'm sure I did upset someone, but my wish is that the second line spoke hope to anyone who is still trying or is frustrated with their situation. My pregnancy is still so tied to my infertility that I can't separate the two, nor do I want to. I am grateful every day that this is where I am, and that I was financially and emotionally able to undertake this long and harrowing path. I hope to appreciate my child every day, in ways that I might not have if I hadn't seen a future where this would not have been possible. I am grateful to my donor and to my doctors and my husband every day.

For those still considering donor egg, I can't say enough good things about this decision I made. While I mourn the loss of a genetic child, and I had these slightly sad thoughts as we tried to see the baby's face during the ultrasound, and I think of my donor quite often, this was the best decision I could have made and I don't regret it for a fraction of a second. I thank the universe every day that I live in a time where this was possible.

Today I am 21 weeks and 1 day, and grateful.

Decision Made

We did it. We decided on RBA, and I submitted the initial paperwork last night and this morning.

I feel terrified at the amount of money we are about to pay. We sat down to think of how we can save money but we didn't come up with any good ideas. We already drive old cars, don't eat out too much other than maybe one moderately priced dinner a weekend, and we don't have cable or drink coffee out each morning. We pack lunches and I cook a lot. Anyway, we have the money, it's just scary to let go of 2/3 of our savings from the past five years or so.

But, what's done is done. If we're going to have a child, this is what it takes.

I'm spending hours and hours every day dealing with getting our medical records and updated testing, and organizing it all, and figuring out what needs to be done next. Luckily it's a three day weekend so I am looking forward to relaxing soon too.

Answers to Questions from Last Post

1. How much info do we get about the donor? Atlanta said 20-25 page PDF including genetic info, and baby photos, but what else? If there are future health concerns, can the donor be contacted by the clinic? Answer: I checked with RBA and they said yes, they keep the donors on file and as long as their contact info remains the same, they can contact them if anything were needed in the future. Their contract also points out that laws may change in the future regarding privacy, and recipients may be allowed to find out more info in the future if legal details were to be amended.
2. If we miscarry or have to terminate, does the refund apply? I read somewhere that success is considered a live baby so miscarriage/termination is included, but I can't remember where I read that, or for which clinic. Answer: Yes, both refer to "live birth" so you can try again until then or until you meet the maximum of 5 (RBA) or 6 (Shady Grove) cycles. 
3. I'd like to know the % of 5 day versus 3 day transfers, and twinning rates? Answer: SG has complex charts to show this, but basically, from 2% if you do a SET on day 5 to 46% if you do a double blast transfer on day 5. RBA has about a 45% twin rate but if I did the guarantee program, I would feel less pressured to do a 3 day or a double transfer so I would hopefully be able to avoid twins.
4. I want to compare chances of having frozens left over with a successful cycle? Answer: With the 1:3 program at SG, 52% of participants have frozen embryos left over, with an average number of two embryos. At RBA, about 50% have frozens left over, and I don't know the average number of embryos. 

Other random things learned:

I do not know how many donors are in the database at Shady Grove, but RBA currently has 56 donors (I think Shady Grove has more). But, they are adding a huge backload right now, and expect to have 100 by the end of April or beginning of May. It will likely take us that long to get our screening done and the consult with the physician, so the timing will work out well for us. 

Other facts of concern about Shady Grove: by going with Shady Grove, there is a chance of cancellation that isn't an issue with frozen eggs at RBA. According to their stats, in the 1:3 program, there is a 4% chance of cancellation if you are recipient one, 8% if you are recipient two, and 19% if you are recipient three. I'd likely be number 2 or 3 since I am a newbie, so that 19% is something to be seriously considered. 

And a concern about RBA: the refund program is not as great as I first thought. I was tipped off by this blog. I asked for RBA's contract and sure enough, the refund is not the whole amount, but the total minus $3K per cycle completed. Also, if you only do one cycle, you forfeit a fee of $16,500. It's strange, but it's in writing. So, worst case scenario, we would lose $15K if we did all five cycles, and $6K or $9K if we did two or three cycles. It's not as good as Shady Grove's but I am somewhat reassured by their high success rates that we wouldn't do more than three cycles anyway, for a max loss of $9K.

I hope that we have time to sit together tonight and make a decision, though I think it's pretty clear how I am leaning. The downsides to RBA remain: the need for both of us to travel to Atlanta is more of a pain than DC, the need for me to miss work for a week rather than just three days (not a huge issue- I have plenty of leave), and the refund program is not as good as Shady Grove's. However, the upside of not needing another HSG (which I think Shady Grove requires, and of which I am terrified, having been traumatized by my first one) and having a significantly higher success rate, as well as being able to start any time and not worry about timing and cancellations, all lead me to the important question: WHAT IS MY END GOAL? My end goal is to get pregnant as soon as I can, with a reasonable refund so we can pursue adoption if this doesn't work. To that end, I think RBA will make the most sense. But I will report back soon, once more things are decided and are set in motion.

More Research on Donor Egg Options

Here is a summary of what I have found out. In the past I have not used identifying information for clinics, but at this point I am sharing it, in case this helps anyone else out there:

Shady Grove (in Maryland):

They have four programs for donor egg. You can split one woman's egg between three recipients, two recipients, or keep them all yourself. Their success rates are good, at 46-47%, though the chances of having frozens left over varies depending on the option you choose. Their chart explains it all. Prices are $14K for the 1/3 program for just one cycle, or $30,500 for up to six cycles and a 100% refund if no pregnancy. This is the option we are leaning towards- splitting three ways but paying double to have the six cycles and refund. The 1/2 program is $18K for one cycle, or $39K for the six cycle refund program. The 1/1 option is $29K or $55K for the refund. They guarantee a minimum of 4 mature eggs per cycle. They also offer a frozen cycle through Donor Egg Bank USA. I don't have price info but they say it's similar to the 1/2 cycle cost.  I think if I did frozens I would just go to the place in Atlanta, which has a higher success rate with frozens. 

My Egg Bank (in Atlanta) (part of RBA):

This might be the one I am leaning towards. It's $16,500 for one cycle, but we are interested in their guarantee/refund plan which offers up to 5 cycles or your money back and is $30K. It would mean staying in Atlanta for 5-6 days (they have deals on hotels). Since all the eggs are frozen, you can start anytime you want. They guarantee a minimum of 6 mature eggs per cycle. Their success rates are impressive to me, at 60% for SET and 70% for two embryo transfer. I want to find out the % of people who have frozens left over, in comparison to Shady Grove's numbers. 

Carolina Conceptions (in Raleigh):

They are local which is easier, and have a good success rate between the other two clinics- at 57.1% according to SART figures. They have around 50 donors so a smaller pool, but no wait because many are ready to go. The last weekend of each month they offer a free look at the donor database (check their website). It costs around $15K for 1 cycle split between 2 recipients. It costs $25-29K for a cycle not shared. You get a 3/4 refund if the donor backs out, and $3K back if no embryos are available for transfer due to egg quality issues (the numbers are higher for the non-shared cycle). They do not have a refund program, so we are not going to go with them. 

Duke:

They have great success rates, the best of all options: 68.4% according to SART. But they told me a one and a half year wait. I cannot wait that long so I'm not pursuing this option.

International egg donor options:

Ummm. I have found plenty about going to Cancun and doing it for cheap, but this scares me. I wish I knew someone who had done it. 

Private agency for egg donors:

A friend through the RESOLVE group did this- she worked with a private agency and then did the process all at Duke. I don't know much about this, but she chose it because she wanted a non-anonymous donation- she wanted her potential child to be able to contact the donor when s/he turns 18. I am meeting with her for coffee on Friday and will get more details. She got 11 embryos but is unhappy because only 3 were great quality. She chose to freeze them because she had some other health issues pop up- not sure about the details. She told me if she could do it again, she'd go with the Atlanta place, though I don't know any more than that. Will get more info Friday.

The questions I still want to ask of the two finalists and compare the answers (Shady Grove and Atlanta frozens): 

1. How much info do we get about the donor? Atlanta said 20-25 page PDF including genetic info, and baby photos, but what else? If there are future health concerns, can the donor be contacted by the clinic? Update: I checked with RBA and they said yes, they keep the donors on file and as long as their contact info remains the same, they can contact them if anything were needed in the future. Their contract also points out that laws may change in the future regarding privacy, and recipients may be allowed to find out more info in the future if legal details were to be amended. 
2. If we miscarry or have to terminate, does the refund apply? I read somewhere that success is considered a live baby so miscarriage/termination is included, but I can't remember where I read that, or for which clinic. Update: Yes, both refer to "live birth" so you can try again until then or until you meet the maximum of 5 (RBA) or 6 (Shady Grove) cycles. 
3. I'd like to know the % of 5 day versus 3 day transfers, and twinning rates? Update: SG has complex charts to show this, but basically, from 2% if you do a SET on day 5 to 46% if you do a double blast transfer on day 5. RBA has about a 45% twin rate but if I did the guarantee program, I would feel less pressured to do a 3 day or a double transfer so I would hopefully be able to avoid twins.
4. I want to compare chances of having frozens left over with a successful cycle?

That's the info I have gathered so far. My goal is to make a decision in the next month and be on our way to making a baby by my 33rd birthday at the end of June. Moving ahead! 

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.