The Saga of Becoming Fruitful

Archive for the ‘Conversation’ Category

Where is Wisdom Found?

DH and I are currently leading the Experiencing God study with a small group composed of MIL, FIL, BIL, SIL1, SIL2 and a couple friend, F1 and F2. In one of our previous lessons, we learned that God could speak through the church, so we “coveted” their prayers so they may be able to guide us based on what the Lord may impress in their hearts.

So 2 weeks ago, DH and I decided to ask them to specifically pray with us as we make decision regarding IVF although we know that they were already praying for us to have a baby.

DH was the one who spoke about it. He gave an overview of the what we are faced with. Their reactions were not what I expected.

MIL asked rhetorically why we had to go through IVF . SIL1 echoed a statement from our study “What I believe about God will determine what I do.” . Reading those statements now looks like they are harmless. However, what I perceived in their voice tones and body language were lacking grace. What I perceived was - we are not trusting God.

BIL and F1 had more open stances. BIL said that maybe in the future, IVF will be treated like the treatment of vaccines - initially, there were many, many questions. Now, it is a common practice void of any no moral and ethical questions. F1 only suggested that we might want to consult with a bioethicist so we can have any of our questions clarified.

I felt that with the little overview we gave them, we were immediately judged. So I had to interject and say that the reason why we are sharing this is to request for their prayers since as a church, the Lord deals with each one of us. I added that we are not asking for their approval and permission.

I have to say I was disappointed with what I saw in their reactions - specially the ladies.

Someone watching the discourse might think that I am overreacting to their reactions. DH did say he could understand their reactions since they did not know a lot about IVF and perhaps were operating under many misconceptions.

Which is exactly why I was disappointed in their reaction. Had they been in my position, I would be more graceful in inquiring.

The Lord pulled me aside though and later gave me this verse: “Pride only breeds quarrel, but wisdom is found in those who take advice.”

I realized I was being prideful because I had researched this IVF topic extensively and here they are just getting less than 20 sentences in description and they are able to make a conclusion about it and about us in less than a few minutes. I thought that was being arrogant and judgmental. And of course, my pride was hurt!

Nevertheless, we did ask for their prayers in the hopes that the Lord speak through them as well on this IVF thing that we have been praying for some time. So I, we ought to be humble and ready as well to receive what they get from the Lord.

SIGH….

National Infertility Awareness Week

Oct 19-25, 2008 is the National Infertility Awareness Week. Most, if not all, people who visit this blog are struggling or have struggled through infertility, and thus we are the best spokespeople for infertility and raising awareness to it.

Some of us are pretty open about the process we are going through in our quest for a baby - we talk and write about it to friends and family and we let them know of our blogs so that they can visit it on their own conveniences.

Some of us are going through this journey to baby secretly, with a lot of friends and relatives not aware of what we have to go through.

Some of us are somewhat in the middle. I think I fall under this category. I answer to queries about us having children but most of the time though, I do not volunteer information about our “saga of becoming fruitful”.

I have an answer to people who really want to know what is going on and who I trust to hold those answers confidentially. I also try to weigh how much I share since not everyone is interested in the whole nine yards.

I have a different answer to people who I am not comfortable with - those who think they know it all on how to make babies, those whose personalities treat stuff lightly or those who just want to know but cannot hold their tongues (use the information to share to others who have no business of knowing).

I (We) have spent a lot of time culling information about our diagnosis, treatments and of our fellow infertiles’ experiences. Maybe even too much information, TMI in infertili-tese. We can probably teach lessons on this now.

My simple mind tells me that there are 4 types of people we are interacting with in our everyday infertile lives:
1. Tactful people who know about infertility - We like them because they “understand”.
2. Tactful people who do not know about infertility - Potentially, these are the people who are open to be educated more about infertility and become our friends, allies and advocates.
3. Tactless people who know about infertility - These ones I would avoid because they do not have a compassionate heart for our sufferings (that they already know of).
4. Tactless people who do not know about infertility - They may still have hope

So there really is an opportunity and value in having an Infertility Awareness Week (Why not a month?) and making people more aware about infertility…

So what am I going to do in connection with National Infertility Awareness Week? Well, I just wrote a piece in my personal blog about it in the hopes that friends and family become more aware of this thing called infertility.

How about you? How are you going to make the people in your circle of influence more aware of infertility?

Consultation re IVF - REFRAMING (Part 1)

We had our consult with DrH and she was very accomodating. She answered all our questions - I didn’t necessarily like all her responses, but it is good that she didn’t sugar coat it. She said that she would have discussed most of the topics anyway but appreciated the questions I sent in because it gave her an idea where we were coming from.

She said that she wished there were more couples who were more concerned on what would be done to their embryo.  She just gave me some more additional things to dig more on too…

Anyway, I wrote all that I could remember from our consult … yes I forgot the recorder… and writing it down resulted into a very long post, so I am broke it into 3 parts.

OUR INFERTILITY FACTORS
The factors we are facing are Advanced maternal age, PCOS/Anovulation and Low sperm morphology:
- PCOS/Anovulation can be “tricked” by controlled ovarian hyperstimulation (COH).
- Low sperm morphology effect would be minimized with IVF.
- So, the only factor that we cannot do anything about is the advanced maternal age - that determines the egg quality. (I got the usual talk about “women are born with all the eggs for their whole lifetime. As the woman ages, the quality of the eggs “deteriorate”.” In essence, my eggs are old… my raw materials have deteriorated.

Re my 3.5 FSH - DrH said that what it means is that for a 40-year old woman, that was good. However, it still does not compare to a 25-year old woman’s eggs who tests as 3.5 FSH. My eggs are still 15 years older!

WHAT OUR IVF WOULD LOOK LIKE
Since I am a good responder to the gonadotropin, DrH expects to be able to harvest a lot of eggs if I undergo COH in preparation for IVF.  However, she said that fertilization and viability of embryos from eggs of someone my age may not be very good, so just fertilizing a few eggs will not make sense and that the procedure will not be worth it. She also recommends to transfer back 3-4 embryos since the implantation of embryos for someone of my age may not be very good as well. (So that means the “fate” of embryos that are not transferred is a real key question.)

As for typical reasons for IVF cancellation, DrH mentioned 3:
- low stimulation
- overstimulation (typically for younger women)
- ovulated early (or early LH surge)

What to expect with Lupron?
- Before starting, ultrasound to make sure there are no cysts
- Start Lupron. Attend IVF Orientation
- Expect period
- Baseline ultrasound

DrH said that the Follistim dosage she would use for IVF would be at the same level as our 1st Follistim stimulation (that was cancelled) which showed I was a good responder. So instead of the $3K medicine cost estimate, she thinks I would only be using $1.5K worth of meds.

Progesterone is going to be intramuscular (IM) injection…on the butt? on the thigh???. (I was hoping it was just suppository even if it was a bit messier.) Uuuggghhh…

Consultation re IVF - STICKING POINTS (Part 2)

These topics are really the ones that have a lot of sticking points for me…

EGG/EMBRYO FREEZING
DrH also said that egg quality cannot be predicted and since I have old eggs, there is no point in egg freezing. They are able to assess the quality of the embryo through morphology to determine which will be transferred.

I don’t know if I picked up correctly on the discussion on Day 3 vs Day 5 transfer…

If there are only a few good Day 3 embryos, transfer is usually done on Day 3.  If there are more than a few good Day 3 embryos, those can tested for PGD (preimplantation genetic diagnosis) or embryo screening.

DrH clarified that PGD is taken on the Day 3 embryo and results will be in for a Day 5 transfer. (So I am just realizing it now that if PGD is desired, that would automatically mean that it would be a Day 5 transfer - unless there is only a few good Day 3 embryo which forces a Day 3 transfer???)

On what is done to embryo and blasts that are not transferred - they are either frozen or discarded.  They will freeze only those that are judged to have a high chance to survive the freeze/thaw.  They give the blast up to Day 7 (which I suppose would be enough time/chance for the rest of the “lesser” blasts to survive before arresting) and will discard them.

Not sure if I captured that last statement accurately but that sounded a bit harsh… If I may quote from their clinic’s literature - “Only embryos that have fertilized abnormally, stopped dividing or have completely fragmented are discarded.” “Each embryo in our IVF laboratory is treated with the utmost care and respect…” DrH also mentioned that they are actually lean more leniently in judging the embryos to be frozen.

PGD OR EMBRYO SCREENING
DrH said that through PGD, they are able to determine if there are chromosomal abnormality (for 9 chromosome pairs only, not the 23 pairs) in all the embryos. This will isolate which embryos that have normal chromosomes from embryos that have abnormal chromosomes which lead to miscarriage. DrH also said that although PGD reduces the probability of miscarriage, it does not increase the pregnancy/live birth success rates.

The PGD is able to determine the gender of the embryo even at that point. (I read somewhere that there are some who practice gender selection using this method.)

DrH also said that as PGD will not be able to screen all chromosomes and I am of advanced maternal age, she recommends that if I do get pregnant, to have an amniocentesis for all the chromosomes since they cannot screen for Trisomy 21 (causes Downs syndrome) or Trisomy 17 and the like. (I don’t think I will do that since however the baby will be, I will accept. I will not terminate.)

I need to dig more into these.  Please pray for wisdom and discernment that we make a decision that is according to God’s will.

Consultation re IVF - STATS AND RECOMMENDATIONS (Part 3)

STATISTICS
DrH said that normal (fertile) couples chances of getting pregnant are 20% in 1 month, 50% in 3 months, 75% in 6 months.

She said that an infertile couples chance of getting pregnant is still even less than that with IUI - which I have seen different numbers from various websites ranging for 6-17%.

DrH showed us national stats on live births, miscarriages, own vs donor egg  - all by age ranges. She believes though that 40 year old stats are closer to the next age range of 41-42 (than with 38 where it is in the same age range).

She said that their clinic’s stats are generally much higher than the national stats, except for the advanced maternal age where they are still higher than national stats but not much higher.

(I’ve actually seen their stats from SART so I knew what she meant when she made relative comparisons of their stats to the national stats.  Their clinic is by no means the highest in the US though…)

IT TAKES ONE GOOD EMBRYO
DrH mentioned 2 successful advanced maternal age cases.
- One was 45 years old with 20 retrieved eggs that resulted to 19 fertilized embryos. PGD on all embryos showed that only 1/19 was normal and that was transferred. Now that patient has a daughter.
- One was 40 years old who had 1 failed IVF (without PGD). She went for a second IVF and out of the retrieved eggs and fertilized embryos, there was one lone embryo that tested well in PGD and was transferred. The lady’s beta is now being monitored.

OTHERS
DrH echoed back that some studies showed acupuncture to help but she would stay away from herbs.

She said that the meds would have no effect on my breast cysts.  (I still am not 100% on that.)

POSTMORTEM ON RECENT IUI
DrH said that our recent IUI (second Follistim stimulation) was perfect according to her - but it still did not succeed.

Regarding the first Follistim stimulation which got cancelled due to OHSS (did not push through for IUI)… DrH said that it could not be converted into an IVF anymore since that decision should have been made in Day 8 so that antagonists are prescribed in order to convert into IVF. We were already past Day 8 when the impending OHSS was suspected.

DrH also clarified that they make calls until 6pm (only their incoming phones are turned off at 4pm so that they can do their housekeeping and return calls within 4-6pm). So I would have received a call re my results by 6pm.

She also said that she typically has post-mortems after failed cycles.

RECOMMENDED NEXT STEPS
I am on Day 50, so DrH said that when we are ready…. She would give me
- Provera to induce a period
- Skip the usual birth control pills (since I have irregular periods)
- Start me with Lupron
- Then proceed stimulate.

If IVF failed despite high fertilization rate, DrH said that she would not not recommend another cycle of IVF.
If IVF failed and there was low fertilization rate, she would say 2 things - 1) go for PGD or 2) go for donor eggs.

DrH recommended that we go through the IVF Seminar which is scheduled on Oct 8.

LASTLY…
DrH hugged me! I did not expect that but it felt good that she had no qualms on hugging.
DH thinks that mentioning the hug in this post is sooo trivial.  Man, are men clueless…

Well … that’s a lot for now… more data, getting a clearer picture, still need to dig more on specific topics.

Then need to digest info, step back, reflect and weigh, pray and decide.

IVF Indecision is a Decision

I don’t even know if that title makes sense…. but it has been almost a 7-week break…

We have our consultation appointment with DrH on Tue. I hope she received the set of questions and I hope she has read them.

Meanwhile, I have a new friend (who turns out to be a fellow infertile) and she said that sometimes, less options are better.  In our confusion and indecisiveness, I could relate to that because our choices are now boiled down to these 3 -
1. IVF
2. Adoption
3. Child-free

Narrowed down. And yes, there are still 3 options.

I heard something from someone that the “cure to confusion is action. Do something and fail. Or do something and succeed. It removes the ambiguity. Whether you fail or succeed, you are moving forward since you are eliminating alternatives.”

Should we do IVF for the increased probability (still a probability, still not a guarantee) of having our own biological child?

Should we go through what is humanly possible before we accept that our “only hopes” are to either adopt or to be childfree?

Should we make the decision to be child-free NOW (without trying IVF)? And save ourselves from heartbreak and the heavy financial burden? Should I resign myself to the “death of a dream” now?

My biggest fear for the last option is that I will regret not knowing whether we could have had our own child had we tried IVF.  The many “what-ifs”….

We have decisions to make and we are vaccilating up to the last minute.

Every Month Counts for the Infertile

A week ago, M from the IVF clinic mentioned that for a woman my age, “every month counts”. Well, for us not to “waste” 1 month, I should have had my baseline ultrasound last Friday 9:15am and started with BCP last Saturday (CD3)….

But how could we go last Friday when we only had one night (less than 12 hrs inclusive of 8 hrs of sleep) to prayerfully think through an IVF decision? We needed more time, of course!

For me, it was a process for us, albeit, a 2-day process. There was denial first (why won’t another IUI work?), then there was frustration (why didn’t the IUI work?), skepticism (will IVF chances be really better?) and then clarity (I can see clearly now that IVF has 2x higher chances!).

Although statistically, we call it “chance” or “probability”, it is my belief that it is the Lord who creates the child within our wombs. Or not. This I believe and accept. The acceptance does not make it less joyful or painful when it happens. But then, I know in the end, I know He has plans for me, “to give me a hope and future, plans to prosper me and not to harm me.”

So by Saturday night after all that struggle and acceptance, I told myself “I am ready for an IVF”. I have already planned in my mind to call clinic last Monday if we can still start this month despite it being CD5 already so that this month can still be “saved”.

When DH and I talked on Saturday evening though, he raised some questions that he believes we need to answer first. Aside from needing more information on how IVF works, the more important questions were of the ethical kind. We agreed that we want to be honoring God on our decision and thus need to look into our hearts for our motives and to look to God for guidance.

I realized that I was so on the go-go-go mode already (reminds me of Amy’s post as a rocket builder) and I have not even thought about those questions. There I go again, leading the way when I should be patiently yet joyfully be talking it out with the Lord for his guidance in the decision making. Perhaps that is why I have DH - to complement me in that aspect.

So, we are basically in the hold mode now. No decision yet but I am looking forward to the conversations towards and to the decision.

How about you? What were your considerations, concerns and fears? How did you go about your decision making whether or not to move forward with IVF?

Conversation with DH on Pathforwards

Last Thurday, I was reading LifeSlurper’s blog for the first time after she left me a comment. My tears were falling silently when I came to the Stiching Up the IVF Game post.

That’s when DH arrived from work. Came into the bedroom, saw me in bed with the laptop open and asked me how I was, how my day was, etc. Then he noticed that I was crying.

I told him that DrH recommended that our next cycle be IVF, instead of IUI. That’s when the dam broke even further. Waaahhhh … I could not contain myself. So there I was a crying and sobbing mess. And my DH just hugged me.

Why God?
When I was a bit more pacified, I told him that I was asking God, “Why can’t we not conceive naturally?” “Why did that first IUI cycle not work?” “Why can’t we have another IUI cycle?” Why? Why? Why?

“Can we not conceive with ‘just’ IUI instead of IVF?” Please, please, please?

Money Matters
I also told him that I was so averse and repelled to the idea of having IVF and pay a lot of money for something that was not guaranteed and had no significant edge over the much cheaper IUI.

Will You Still Love Me?
I asked him if he will still love me even if we don’t have a baby? He said, YES! And that as children of the Lord, we are different from the world as they view and react to this situation.

He said what would comfort me deeply - “You are my baby.”

I Want a MiniMe
But I said, “I want a minime, a miniyou.”

And he said “Don’t ask from me what I am not able to give. It is the Lord who gives us a child.”

“So what do we do?”, I ask.

“That’s simple.”, he says, “We pray to God to give us wisdom and guidance to make the right decisions and do the right things.”

WOW. I can’t help but feel so blessed to have him. I just praise God for giving me a beautiful husband who loves me, comforts me and helps me keep my perspective. I can’t ask for more in a husband (aside from wiping the toilet bowl, separating his colored vs white clothes, bringing in his lunch boxes, taking the trash out - all without reminders) No, really. I’m so very glad he is whom I married.

Yet, I feel sad that I can’t produce us an heir who we can raise to be beautiful as well. So I still keep on asking God.

CD1: Phone Consult on Infertility Treatment Pathforwards

Ms Flo arrived yesterday with a lot of aches on my lower back and the back of my legs.

So on Thurday morning, I called in to the clinic as instructed and actually get to talk to a live person! Woo hoo! J used to be the one calling me up on updates - I have met her face to face already, so that’s good. This is a cleaned up and shortened version of what transpired (or at least this is my recollection):

Arpee: I’m having a weak flow but that it may be CD1 already since I was passing clots. Remember that the last 2 periods that I had were similarly weak and clot-passing, and that is why I think this is my real flow and this is CD1.

J: Alright. So what cycle are we doing next?

Arpee: I don’t know. (intentionally remained silent.)

J: I don’t have your chart with me right now, but are you looking to maybe another clomid cycle or injectables cycle? (Gets chart, I think) Oh yeah, you are in injectables now. So you’re looking into whether another cycle of IUI or move to IVF.

Arpee: Yes and I was hoping we could have a talk with DrH so that we can discuss it. Can we have a phone consult with her?

J: Unfortunately, she doesn’t do phone consults. What we could do is to schedule you a consult with her on the 28th. Or we could schedule you in for a baseline ultrasound … I would need to squeeze you in tomorrow since DrH is out on the weekend… and then you can talk to her after that.

Arpee: Wow, the 28th…that’s a long time from now.

J: Well, you can come in tomorrow but I would hate for you to pay for the ultrasound if you didn’t need to if you are not proceeding yet to an assisted cycle.

Arpee: Yeah, me too. I just want to know if she has a recommendation on next steps.

J: How about I write her a note and I’ll get back to you within the day?

Arpee: That would be great. Can ask her also what she thinks could be learned and further improved based on our previous cycle?

J: Alright, will call back later.

So I went off with my day, mostly in front of the computer… until I got a call back from the clinic later in the afternoon. This time I got K who is currently the one giving me updates - I’ve met her face-to-face as well (but she is also the one who should have called me regarding my recent beta-hCG results)

K: Hi. I talked to DrH and she said that she recommends IVF.

Arpee: Did she elaborate on why she recommends IVF to be the next step?

K: No, but I think it is because of your age and the past cycles. Would you like to talk to the IVF Nurse? I can transfer you to A so that she can let you know what to expect.

Arpee: Sure, why not. (Transfers me to the IVF nurse and I will write another post on that.)

Meanwhile, I just realized that although I did not get a phone consult directly with DrH, I did get an indrect phone consult through the nurses as the middleman. It wasn’t the best way to do it since they cannot sufficiently answer the questions I asked such as:
- What could be learned and further improved based on our previous cycle?
- Why is IVF being recommended as the next step for my case.

Although I understand the generic answer of “because of your age”, I thought I needed more convincing on why another IUI is not a good idea. I am thinking that a even just a phone consult with DrH would have been more spot-on. (Thinking now…. DrS in Boise, ID (whom I mentioned somewhere in this blog as being not aggressive enough and not keen on explaining things) earns a point for having a phone consults.)

What was your experience with the clinic and your RE (or FS) after a failed cycle? Did you get a call from your RE (or FS) directly? Did the clinic initiate the call regarding next steps? Did they seem to be on top of your case when you have a conversation?

For those of you who will kindly share their experiences, can you please add if your clinic is a big or a small. (I know, “big” and “small” are subjective. For this post though, let’s just say, if it is a single practice (not a partnership), let’s call it small.)

July 2008 Cycle (7/7-8/7): 31 days
June 2008 cycle (6/2 - 7/6): 34 days

What’s Next?

Yesterday after getting the beta-hCG result, my headache went into full blast. Torture to the MAX! (Typically, I just sleep a headache off, but this one needed tylenol!)

Could it be hormones crashing? Or perhaps thermal cycling going in and out of the car into the heat and then into the airconditioned stores? Or perhaps 4 hours without food? Anyhow, it made me indulge in some self-pity…

I was thinking I was tired of trying
…of having to take the injection shots
…of having to ride the stirrups and probed
…of having to induce Miss Flo with provera
…of having to look up the clock to see if it is time to take a BBT, to take the levothyroxin, to take the shots, to take the prenatal vitamins
…of wondering will I ovulate? will we get pregnant this time? if I am pregnant? are these pregnancy symptoms?

Many questions. No answers. I’m tired.

Well …the wonders of rest and sleep is that it can give you back perspective. DH woke me up when he got home from work and I told him of the results. Cuddle. Comfort. Wow. What a great husband I have. Thank you, Lord!

DH saw the book on our bed - “When the Cradle Is Empty“. And he read to me the following excerpt from the When Is It Time To Move On chapter:

Don’t make a hasty decision. Infertility testing and treatment involve a long, intensive, expensive process that’s bound to produce anxiety and frustration. Understanding this and preparing yourselves for it can help you avoid the “early dropout syndrome”. If you quit before you’ve really made an honest and thorough attempt to achieve a successful pregnancy, the two of you may regret it for the rest of your lives. (Emphasis is mine.)

That made me realize that this is “just” our first IUI and that there are many women who’ve had multiple IUIs and even moved on to IVF. I could not say with all honesty that we’ve had a “thorough” attempt already. So that encouraged me.

Meanwhile prior to the actual IUI, DH and I discussed a bit on Plan B. I suggested that we do Follistim cycle #3 with BD, instead of IUI. He said though that he’d rather have another IUI since the probability is supposedly higher. I thought that was mighty brave of him considering he had some technical difficulty in herding the boys!

Today, we’re not sure if that is the best next thing to do.

Anyway, we will meet with DrH when Miss Flo arrives to do baseline and at the same time discuss our next steps. Sounds like it is either another IUI or move on to IVF. I will have to do some additional research on the probabilities on either options.

The challenge with these probability information is that there is very litle IUI data that is published. But will make do with what is available and will surely share what I learn from them.

Meanwhile, maybe some of you can share what your thoughts were in making a decision on whether to try another IUI or to go forward with IVF. Appreciate it much!!!

Waiting for Ms Flo
Maybe I should get a job… instead of blogging my thoughts away!