Initial Consult for Cycle #3

I have to say I felt slightly anxious once we got to the waiting room, but on the drive in, Archie and I just talked about normal random things, not even anything related to the appointment. It was great! I know that I have a tendency to get myself really worked up if allowed to, but we didn't even try to focus on something else. Once we got into the waiting room, I found myself drawn to read things that they had on the table about their 2009 rates of pregnancy with different options, eSET (elective single embryo transfer), etc. All it did was fuel my questions, LOL.

I was a tad bit irritated with my doc's apparent 180. After our last cycle being such a flop, he had said he couldn't recommend doing another antagonist cycle again. Then yesterday we are in the office and he is saying that he thinks we could do that cycle again and it would be possible to get different results. He said that he thinks my estrogen was not high enough and that I respond better with an estrogen above 1500 (he said most wouldn't have a problem, but I need it), and that he thinks my eggs were starved for FSH. I honestly want no parts of that antagonist cycle again. He said my first cycle did not get cancelled (although it was threatened a few times!), and we could do the lupron again. I asked if antagonist was something that could be added in if we found that I was overstimming and he said yes, they have done that a few times. I asked if we would expect it to be detrimental to the cycle or to send me back the opposite direction by adding it and he said it was possible, but he hadn't seen it happen before.

We talked about genetic testing and they explained that they would test me first, and if I came back as a carrier for anything, they would then have to test Archie. Archie and I talked about this and to be honest, just because we are carriers for something doesn't mean our child would definitely have the disease or disorder. Secondly, we don't know that we'd really want to have PGD (pre-implantation genetic diagnosis) done on our embryos. We've never had good quality embryos, and I just feel like we shouldn't mess with them more than we have to. We also know that we would have taken Jack regardless of the things he MIGHT have had and just dealt with them as they came.

I did bring up eSET and they really trust the embryology lab at Shady Grove to give us the recommendations they feel have the best chance of working. One of the things that has changed is that instead of where previously we would go in, and Dr. M would call us after our fertilization report and set us up for a day 3 transfer (our first cycle was day 3). Now, they tentatively set you up for a day 3 transfer, but the lab looks at the embryos that morning and decides which ones are declaring themselves. If they think they will continue to go to day 5, they will schedule us for day 5, if they think they might teeter out, they go ahead with the day 3 transfer and as our IVF nurse put it yesterday, "Let them feel the love." Heck, they even said they could go as far as a day 6 transfer-I highly doubt that will be an option for us, and if it is, prepare for me to be a nervous wreck! The 2009 rates showed that in people my age who elected to do eSET, there was a 62% pregnancy rate (it didn't give the live birth rate), and 1.4% rate of twins (embryo splitting). In people my age who were favorable for eSET, but still put back 2 embryos, there was a twin rate of 42%. I saw that and my eyes about popped out of my head! Dr. M says he would probably consider me to be less favorable because we have had a failed cycle, and he showed me the chart they use to make their recommendations, and he said for someone like me, the recommendation would allow for up to two to be put back. Sounds good to me.

I am feeling better about the prospect of twins. It would make things very difficult for a while absolutely. I emailed one of my friends who had a little girl shortly after Jack was born (also an IVF baby, not great quality embryo), and she had done another IVF cycle and put back two fragmented, so-so looking embryos, and is now blessed to have 3 little girls. She told me it is absolutely hard having twins with a toddler running around, and that the first 6 months is rough, but that it gets better as they get older, and I can see where that would be true. She said as far as affording it, there is always hand me downs, consignment stores, etc. And she had her twins when her oldest daughter I believe wasn't even two. I am lucky enough that if that were my situation, Jack would almost be 5. She said her oldest is now more of a helper than she was, and that does help.

Yesterday I left Jack with a good friend who has 1 year old twin boys. She was nice enough to help me, and Jack is really an easy kid, pretty well behaved, and she said she was surprised at how well Jack shared with the babies. She said she doesn't think most preschoolers share too well, but he was great, he helped entertained the boys, and was really very easy to watch. I was so glad to hear that because I felt awful calling her the day before to beg her to watch Jack while we went to our appointment. He loves babies, has to check out babies everytime we go out somewhere, and still asks if I am going to have another one in my tummy.

Today our financial coordinator called to let us know our coverage. We will have a deductible and our copay that will come out of pocket. The deductible I believe is for our ultrasounds, etc. (I was half asleep when she called). The rest of it should be covered. I also found out from her that our insurance covers the freezing of any embryos we might have leftover up to 80% ($1250 to freeze, so we'd be responsible for about $250)! This was great news. We would have to pay for storage ($360/year) ourselves, but when we did our first cycle we were looking at paying alot more for that at our previous clinic. The other problem was that our embies would have to be frozen at our previous clinic and then we'd have to have them shipped or drive them ourselves to Fairfax for storage as they would not be able to store them on-site. It adds up, trust me. I think if we had anything to freeze, we probably would because at that point we wouldn't know if I was pregnant, and if I ended up not getting pregnant, it is a heck of alot cheaper to do a frozen embryo transfer (FET) than a fresh cycle again. What we would do with our frozen embryos if I was pregnant is another story, and it's one alot of people unfortunately have to decide about. Destroying them, embryo adoption, or embryo donation. That's a whole other blog post in itself, and I'm just not there yet to think about it or bother myself with it. I have enough to think about!

I will tell you that I find myself being excited about this next cycle and that scares me. I'm afraid for the giant letdown we may have to face, but I can't help feeling excited. The process is finally starting, and I feel like it could work. I'd rather know that I was positive and excited than dreading it and feel like it could be my fault that something didn't work.

Up next in the process: Wait...go figure. I have to wait for my next period to start, and then call them so that I can get my labwork done. Then 5-10 days after my period arrives I will have another HSG (that miserable the first go around, but it will be fine, at least this time I don't have the fear of the unknown!) to look and see the status of my fallopian tubes and uterus, and to check for any abnormalities. Then when I get my second period from now, we will start on birth control pills and this third IVF cycle will officially be starting. Look for that in early November!!!

Please pray that nothing unforseen will creep up financially for us. I would ideally like to have our copay, deductible, and funds for potentially freezing and storing put aside before we start our cycle in November, and with my luck, that's enough time for something to happen and zap our funds!