More Consultations

Cell phone reception was nonexistent in certain parts of the mountains when we were in Denver.  It said “no service” the whole duration driving out of Estes Park.  You can imagine how shocked I was when my phone suddenly rang.  It was a San Francisco number that I didn’t recognize.  I looked at Bob and asked if I should pick it up.  He said of course.  I am so glad that I did.  It was UCSF calling me to let me know that there was an opening on Monday (6/30) for the consultation that was originally scheduled for July 17th.  My first reaction was that I didn’t have access to my work calendar so I couldn’t say for sure if I could take that spot.  I hung up and Bob looked at me funny.  He said, Can’t you just call work and ask?  Duh.  Sometimes my brain doesn’t function.  So I called work and was pleasantly surprised that my schedule was clear for the available time slot at UCSF.  I tried to call the number from the previous caller ID but was being passed around in the automated phone system.  I finally hung up, looked up the reproductive health clinic’s phone number (thank goodness for cell phone reception), and happily connected with the clinic and snatched up the opening.  I was very relieved to have the appointment move up to Monday as Bob didn’t start his new job until Tuesday.  It was nice to have him around when we met the doctor.

So the whole reason why I scheduled a consultation was because I chatted with a lady who also frequents the High FSH forum that I visit.  We talked about six months ago and she shared all of her experiences with me cycling at UCSF.  She has been banking her day 2 embryos for many cycles and recently started transferring.  The cost of each minimal stimulation cycle is about $6500, a lot more affordable than going back to my own RE.  Since UCSF is so close to my work, I figured I should really speak with Dr. No Nonsense before I make a decision.

Yup I am naming this doctor Dr. No Nonsense.  He was gentle and kind, but was also direct and non nonsense.  His intern went over the history with us first and I felt that I was being quizzed.  Good thing I remembered most of the details of our cycles.  Then Dr. No Nonsense went through the history with us again.  He did an ultrasound and found that there was one antral follicle on the right ovary and possibly two antral follicles on the left.  When we finished, we had a talk about the next steps.

He drew a diagram for us.

Given our history of not getting pregnant naturally, IVF is of course the best way to achieve fertilization.  However, given the low egg reserve, we may not encounter a normal egg for quite a few cycles.  The first thing he wrote on the paper was the words “Egg Donation”.  His point was, if we only had a limited amount of money enough just for one thing, he would recommend egg donations.  He looked up and looked me in my eyes.  He said, “I don’t feel that you’re quite done with your own eggs, right?”  He knew that I only had one transfer.  He could sense that I couldn’t really say that I have done everything that I could until I finish doing a few more transfers with my own eggs.  So, if we had some money to spare, then he would support us trying to use my own eggs first.  He drew the graph of number of eggs and age.  We are fighting the battle of trying to find that elusive good egg.

This is the route he’s suggestion:

• Do minimal stimulation cycles
• Use Letrozole (Femara) from CD2 to CD6
• He may add Cetrotide/Ganirelix depending on the cycle
• ICSI all the eggs that we have
• We may get no embryos, one embryo, or two embryo each cycle
• We can decide to transfer each cycle
• We can also decide to bank the embryo(s) at day two or day three
• Banking embryos will allow us not to have the emotional effect of the two-week wait every single cycle
• He doesn’t suggest growing the embryo(s) out to day five or six due to the low number of eggs.  He thinks when we don’t have many to play with, each one counts
• He believes that a good egg can be stressed out too much and not grow to day five in the culture, but can survive in the womb
• Day 2 or day 3 embryos’ thaw rate is over 90%
• He thinks that my uterus should be fine with transfer because the fibroids that I currently have are in the posterior position of my uterus and not in the cavity

Did I tell you that this clinic is three blocks away from work?  So convenience is a huge plus for me.  I received the fee schedule in the last couple of days and found that each cycle of mini-IVF with UCSF IS about $6500, which is a fraction of the cost going to my current RE.  Medication will not be much because of the low dose stimulation.  The only downside is that this is a big clinic so I will not be seeing the same doctor for any of the monitoring ultrasound or egg retrieval.  This clinic has over eight REs.  Dr. No Nonsense will be managing my cycles though as he will be the one making the decisions for me and with me.

I feel very comfortable with this doctor as I felt the compassion and warmth from him.  It’s very different from some of the online reviews I have read about his bedside manner.  I like him and I think I can work with him.

Fast forward to this past Wednesday.  I rushed home to be available for the scheduled 5:30pm phone consultation with Dr. Y down in Southern California.  Phone did not ring once for another 25 minutes.  I called the Li.fe IVF phone number. Fortunately someone picked up.  I was told that Dr. Y was still talking to another patient.  My phone didn’t ring until 6:30, a whole hour after the scheduled appointment.  I don’t know if I should be worried if that is an indication of their future performance, stressing me out with a doctor that does not respect other people’s time.

We were on the phone for half an hour.  I felt that I was driving most of the conversation, as I asked him many questions.  The following are the highlights:

• Given my history of having one embryo or no embryos each cycle as well as a history of endometriosis, he suggested doing natural IVF (no stimulation) or minimally using just half of a pill of Clomid (25mg).
• (A little patch of endometriosis was discovered during my surgery to remove uterine fibroids.  I don’t know if that is enough to say that my endometriosis is messing up my system)
• I asked him why he uses Clomid and not Femara, he said that Clomid has the function of blocking the estrogen receptors.  Somehow that helps with preventing premature ovulation.  He said that Femara doesn’t help with that.
• Since we’ll be banking embryos rather than doing fresh transfers, we don’t have to worry about the effect of Clomid on thinning the lining
• He also doesn’t think using Clomid will make my FSH go higher in subsequent cycles
• He believes in growing embryos to blastocysts.  He doesn’t believe that an embryo that doesn’t grow to day five can survive in the uterus if transferred on day three (an opposite view of Dr. No Nonsense)
• He thinks that at my age, I would need at least 4 blastocysts if not more to have a chance at having a life birth
• He recommends doing PGS on the embryos (which we have decided not to do a long time ago)
• The blastocyst rate at his clinic for patients my age is 50%
• He suggests that I do six cycles
• He said that we can start planning the travel when the follicle(s) reaches 14 to 18 mm
• He doesn’t suggest using Cetrotide/Ganirelix but he does suggest using trigger shot

Those are the points.

So now I have a decision to make.

Egg donation vs. own eggs?

Most likely we’ll try my own eggs first since Bob started his new job and we can start saving up money again for donor egg cycles if my own eggs don’t work in a few months to a year.  My uterus is not going to grow old as fast as my ovaries.  So if my own eggs don’t work, my uterus hopefully is still in good shape.

With my own eggs, SoCal or local?

That’s the biggest question.  I have no gut feeling.  I just feel that there is a huge dilemma in my heart.

In terms of cost, both places are about similar.

In terms of expertise in minimal stimulation, Dr. Y is no doubt the one to go to.  He does this day in and day out with many many many patients.  He’s been doing this for a few years and this is all he does.  Dr. No Nonsense started doing this a couple of years ago and also does IUI as well as conventional IVF.  Dr. Y may know more about how to tweak the protocol for each individual in terms of FSH level, estradiol level, and the state of the ovaries.  Dr. No Nonsense may do a one size fits all model.

In terms of day 2 embryos vs. blastocyst, it appears that there is a higher chance for transfer if we bank day two embryos.  But does having a chance to transfer mean a chance for a baby?  Or is the chance for a baby higher if we can make blastocysts?  For this point, I don’t know which doctor I should believe.

In terms of convenience, UCSF wins.  I cringe every time I think about having to schedule and go to outside monitoring appointments, coordinating with L.ife for their instructions after each scan/blood draw, keeping a watchful eye on my follicles so that I don’t ovulate before the retrieval, timing the travel and booking plane tickets for the right date, booking hotel and car rental, letting clients know last minute that I will be traveling, and traveling/making it to the appointment.  Those are the things we have to do.  And I cringe.

I am at a crossroad.  Can you feel that I have lost my sense of direction?  It’s compounded by cycle day one today, AF showing up, and the feeling of inadequacy as a woman who cannot bring a life into this world in the most natural way.

This is a lonely road.  I know Bob is traveling it with me.  I know that God is there for me.  I know that many of you are out there rooting for me.  But it’s still a lonely and scary road.  I know that once I make a decision, I will be much better.  But at this moment, I am overwhelmed.

Maybe I’ll go hide under a blanket for a little while.