On to IVF

We have completed, unsuccessfully, our fourth IUI attempt, and so we will begin IVF shortly after the new year. We started with an initial round of tests and an IVF class at the new clinic. My blood tests had better results than back in February. There's no good explanation for that, but it does suggest that I should respond well to the IVF drugs. More interesting is that we had our third semen analysis, under more rigorous (and more reliable) criteria. The result was a normal morphology of 6%. Using these criteria, >15% is considered fertile, while <5% is considered infertile and not eligible for IUI. (It would have been nice if either previous clinic had run this test. We probably still would have been advised by the docs/required by insurance to try IUI, but our expectations would have been even more realistic.)

What this means for IVF is that we are currently scheduled for "traditional IVF," where the sperm and the eggs are combined in a petri dish to do their thing. But if day-of results are <5%, we will be converted to ICSI, a procedure in which a single sperm is injected into a single egg. Wild!

When is day of? Early March. I will start the first round of drugs (including one the infertiles on the interwebs call Loopyron for its tendency to induce irrational rages - fun!) in about four weeks. They will completely shut down my reproductive system for a month. Then, if all goes well, we'll begin stimulation drugs to grow eggs, hopefully 10-20. I will have minor surgery to retrieve them, around March 1, followed by embryo transfer (we hope!) 5 days later. And in the meantime, of course, I'll be teaching 5 days a week.

The IVF class was our first real exposure to our new clinic. We were pleased that we were very comfortable with the nurse and embryologist. Not surprisingly, we were the most informed couple there. (We were also the only ones who laughed at the jokes. Apparently other people have trouble seeing the humor in the infertility. But that meant we were a favorite of the nurse, which we always like.) We are also very blessed to have my continuing insurance; we were the only couple not paying a lump sum $12,000 out of pocket. (We are paying $12,000 to the insurance company, but in $500 bites, which is manageable. And if IVF #1 doesn't work, any more attempts in 2010 will essentially be free instead of an additional $12,000.)

I will call the clinic tomorrow to get on the schedule officially!

Just waiting

We're expecting lots of action in early-to-mid December: our final IUI, some additional tests for IVF, and our IVF class, where they'll tell us everything we already know and teach us how to give even more painful shots with even bigger needles. But for now, for the first time in 20 months, all things reproductive are quiet. I don't mind the break.

Another laugh

I had a consult with the second clinic in town last week; I'll post more about it soon. But my favorite part was when the doc said that there was probably nothing wrong with me; it's just the morphology issue. It's not what Brent wanted to hear, I'm sure, but it made me feel better! And coincidentally, Mo & Will's latest Hallmark reject is perfect for the occasion!

Isn't it ironic?

I'm actually feeling better, saner, happier in the last 10 days since going public and admitting that I'm *not* doing so well with all of this. Thanks for reading!

On the dark side

I caught Barbara Ehrenreich on Jon Stewart the other night, talking about her new book, Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America. I haven't actually read the book, so what follows is based on the Jon Stewart interview and the press release from her publisher. The book stemmed from Ehrenreich's breast cancer diagnosis and treatment, a period in which people told her to stay positive, visualize the cancer shrinking, repeat affirmations about her strength and health. Her theory is that "the relentless push for patients to maintain a positive attitude is often psychologically devastating."

I couldn't agree more, especially with regard to infertility. The bane of every IF's existence is someone saying "just relax." First, it's impossible, what with the constant monitoring, timing sex, giving up wine for two weeks out of the month, waiting to test, waiting to test again after the first BFN each cycle, popping pills or injecting shots, early morning trips to the doctor for ultrasounds that could reveal good or devastating news. There's nothing relaxing about any of it. Second, it doesn't work. Relaxing is not going to get me pregnant. Yes, we've all heard the stories about women who adopt a baby, only to discover they're pregnant and end up with Irish twins or women who, after multiple rounds of IVF finally produce a baby, suddenly get pregnant on their own. But in truth, it happens quite rarely. (And I suspect that the latter -- post-IVF surprise pregnancies -- result from the IVF finally shocking our systems into submission, an actual biological change, not from relaxation).

But is the "just relax" mantra (along with saying positive affirmations about my womb being a warm and welcoming place and visualizing the swimmers and eggies doing what they're supposed to do) actually, as Ehrenreich posits, "psychologically devastating"? Yes. Infertililty is a dark and lonely place. Despite knowing so many other women going through this right now, I often feel very alone. All the happy pregnancy announcements and adorable baby photos on Facebook crowd out the knowledge that there are others just like me. And when we are told to "just relax" and be positive, it feels like a denial of our reality, which is, frankly, "dark and twisty." It's okay that we are desperate and depressed. We feel betrayed by our own bodies; the one thing we are supposed to be able to do, we can't. Meet us where we are.

I think the positive thinking approach is really for the benefit of the "friend," not the patient. By telling us to remain positive and think good thoughts, the "friend" gets to avoid the dark and twisty. That's only more isolating for the patient. We're made to feel like we're wrong for feeling like we do.

But if you want to say affirmations and visualize for us, that's okay! I don't know if prayer works, in the sense that G-d hears our prayers and then intervenes in our lives. But I do know that circles of prayer -- as well as circles of affirmation and positive visualization -- can make us feel loved and supported. So feel free to pray or affirm or visualize for us; we'll draw on that strength. But don't expect us to do the same, and be willing to listen and accept it when we can't.

A tentative plan

It's amazing how helpful typing out the options is! Within hours of yesterday's post, we had a plan. We've got an appointment for a second opinion at the other clinic in town in two weeks. The biggest question we've got for both clinics is whether they would do the local bloodwork and ultrasound monitoring if we do a cycle at CCRM in Denver. That may well be the deciding factor, more than the stats of the respective clinics here. We're tentatively planning to do an initial IVF cycle here in town in February/March. If it doesn't work, we'll head to CCRM in May and cycle there over the summer, taking advantage of the flexibility that comes with our professorial schedules. In the meantime, we'll probably spend some time this winter thinking about our "Dear Birth Mother" letter to submit to adoption agencies. I can't imagine a more daunting task than writing a letter to convince a woman to let us raise her baby.

Choosing a clinic

Assuming our last round of IUI (whenever that happens) doesn't work, we'll need to choose an IVF clinic. We have four options:
*Our current clinic at the University. We really like the staff and find it to be a calming place that offers personalized attention. But it's a relatively new program.
*The other clinic in the city. It's a much bigger and older program, which means less personalized service but more experience.
*Colorado Center for Reproductive Medicine. It's the number one clinic in the country, according to Parents Magazine. I have a friend who had great success there. It's the place that all the IF bloggers go when all else fails. But it's out of network, which means meeting my deductible and huge co-pays.
*Presbyterian Hospital in Dallas. It used to be the number seven clinic, though the personnel has changed. And it's out of network. So this one seems easy to eliminate.

In patients under 35, all four clinics have roughly equal success rates: 57-65 percent. But in the 35-37 age range, the numbers vary wildly: our clinic had a 38 percent success rate in 2007; the other clinic in the city 51 percent; and CCRM 58 percent.

Technically, we have time for two IVF cycles before I move from the under 35 group to the 35-37 group. But my FSH levels suggest my eggs are old, so I wonder if I should just assume I'm going to behave like the 35-37 age group, which probably means switching clinics.