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.

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.

I listed the questions I have for DrH when we meet with her on 9/23.

I prefer to have my answers earlier but they do not have emails. They do not do phone consultations also. So instead, I plan to mail this list to them or drop them off at their clinic next time I am around their area.

Some of the questions are really hypothetical but I want to ask them anyway as it would be indicative of their situational response.

Reframing our case:
1. Which among our previous IF factors are still at play in our case that we are up against?
2. What is your IUI statistics for couples with similar diagnosis? (How many women our diagnosis (my age and condition) have success for multiple IUI cycles (in your clinic)?)
What are your IVF statistics for couples with similar diagnosis?
Is there value in doing another IUI cycle in our case?
3. What can be gleaned from our IUI - possibilities on why it failed and what could be done differently?
4. What was my first Follistim cycle’s high response indicate? (in terms of quantity and quality of eggs? in terms of how I will respond to the planned protocol? is there a cumulative effect of the drug?)

If we are going for an IVF:
5. How much Follistim are you planning to put in my protocol - like the 1st cycle or 2nd cycle or in between or even more the 1st?
6. If I responded similar to my first Follistim cycle (that we needed to cancel because of impeding OHSS) with the pre-IVF stimulation, is this a reason for cancellation?
7. What are typical reasons for IVF cancellation and how can they be avoided?
8. What kind of monitoring is going to be done while on the suppression stage with Lupron?
9. What will be the deciding factor for D3 embryo or d5 blast ET? What are the typical scenarios for cases similar to ours?
10. Is the progesterone going to be a suppository or IM injection?

Egg/embryo freezing:
11. If we have a lot of retrieved eggs, do you have a way of selecting better eggs than others? Is your facility have the ability to freeze eggs?
12. What is the correlation of “better eggs” to fertilization rate? to 8-cell embryo development (at Day 3)?
13. Assuming we have eggs or embryos to freeze, what is the storage rate?
14. If we want to fertilize 3 or 4 eggs only and transfer all fertilized embryos, would you honor that?
15. What do you do with embryo and blasts that are not transferred and you think will not survive freezing?

Others:
16. What is your view on alternative treatments (acupuncture, TCM, vitamins)?
17. If IVF fails to produce a positive, where do you see us moving next?
18. How do all these meds affect my breast cysts?
19. The last cycle (when we had IUI), I had to call the clinic 15 minutes before closing to know my beta results (instead of the clinic calling me). Is it typical to get beta results late in the afternoon?

Are there other things that I should be asking?

Do you have experiences regarding my questions? Would you share your experience and thoughts? Please leave your comments - I appreciate it!

Also, if you have the advanced maternal age factor, can you sound off too? I know a couple of you already. I would like to see real life examples of those who have come out of the trenches, too.

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?

In-Vitro Fertilization - I never thought we’d get this far.

I knew IVF was a possibility for us even we started TTC’in in 2004. Of course, I placed it in the backburner because there were still many protocols “below” (less invasive, less costly) that we could try before we needed it. By that time that we need it, I thought it would be straightforward to move forward with it since we would have been prepared by the previous protocols.

I’m finding now that DrH has recommended IVF as our next step, that it is not as easy for me to move forward with it. When K from the clinic told me that, I was downtrodden. We were sort of hoping, it would be another IUI round. I think I was in shock that I could not drill more questions any harder - as if my mind went blank. Blind-sided.

Perhaps because at first we thought we are going to have a child naturally (don’t we all?). Nope!
Then ok, maybe with clomid. Nope again!
Then, ok, maybe this time with injectables and IUI…

And we were really hopeful on the first IUI last month because:

• Now, my ovarian cysts are gone, gone, gone
• IUI will be more “precise” than doing it naturally.
• We have conceived naturally in the past

But Nope! Negative! Denied one more time.

Although, we have not decided on what the next steps are for us. I was more ready to give IUI another round because of:

• 2 reasons above (cysts are gone and we have conceived in the past)
• SA was low on the first day IUI (when I think the egg had the most chances of being fertilized)
• My research showed that IVF at my age was about 11-25% vs the 20-25% that DrH mentioned for IUI (of course, she mentioned the usual disclaimer “it depends upon the egg quality”).
• Much less cost than IVF

So there I was not knowing what to think, not knowing what to do next. I just knew that in about an hour, I had an appointment with the ladies from the church for a dinner at a nice restaurant.

What I Don’t Like About IVF
I was rebelling against the thought of IVF. I was marinating, stewing, boiling even… So much money for something that is not going to guarantee success! So much money for something that does not have a more significant chance for success! Hmpph! So I thought…

I was thinking already that we only have a budget for 1 IVF. What if it fails?

Then we will be eating up our Emergency Fund. What if the 2nd IVF fails?

Then we will be tapping into our retirement and investment money. What if a 3rd IVF fails?

Assuming we even have the emotional fortitude to go through 3 IVF cycles, I am thinking that at that point, we should stop.

Researching the Stats AGAIN
It’s amazing how after sulking, pouring out and surrendering to the Lord all my concerns, issues, questions, pleas - He gives peace and clarity.

I was prompted to research the IUI stats again and guess what? I saw what I was blind to see earlier. The limited self-published IUI data from a couple of clinics were 6-12% (for a 35 yo woman).

It was NOT 20-25%. Somehow that number which DrH mentioned during the IUI cycle stuck in my mind. So even if I was reading the same reports last Wednesday, the other numbers of 6-12% were not registering. This is a real case of “I was blind, but now I see”.

Conclusion: IVF is about 2x more successful than IUI.

So this all boils down to my conjectured reasons and money.

All that Anxiety for Naught….
I did all the research, all the math, all the fist shaking. And all I needed was a clear and peaceful mind that comes only from the Lord. He showed me once again that “Who of you by worrying can add a single hour to his of life?” is so very true. It’s a lesson that He’s constantly teaching me specially on this saga of becoming fruitful, this infertility journey.

So, what is the worst case scenario? If we don’t have a child of our own blood by the 3rd IVF, then we would have $45K less (which could have been used for “better” use), be another year older and be potentially a lot more pounds heavier.

I look at this now and it does not look too bad, actually.

Ask me again tomorrow.

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.

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!