More Decisions To Make

I have almost gotten over the sadness and the hurtful feeling of the failed cycle.  I have also looked more into the details of donor egg cycles.  This act of research does not mean that I am hopeless about our situation.  I remain hopeful that one of the embryos could be our winner.  However, being a very realistic and pragmatic person, I think it’s good to start looking.  This process is going to be a post in itself.  I will write more about it.

An email from my nurse bright and early on Monday warmed my heart.  This is what she said: “I am sorry about this last cycle and we didn’t get to add to our inventory of embryos for you.  You did so much.”  It was really nice to read those words and to know that my clinic cares as they take the initiative to reach out to me.  And she continued with this: “Dr. No Nonsense has some time at 5:15 today to call you to touch base and go over next steps.  Are you available?”

Oh yes.  If the doctor himself wants to talk to me, I am all for talking to him, on the phone, for free.  I also wanted to discuss with him about the next steps.

I made myself available in the car at 5:15 so I could talk privately.  In the afternoon, I had jotted down some questions.  As usual, the good doctor’s phone call was ten minutes late.  The first thing he said was that he was very bummed about the cycle.  Me too, doctor, me too.  He always talked with the speaker phone on his side, which made it sound like I was talking to somebody in the outer space.  And then there is always an awkward silence before the real discussion comes.  This time it was no different.  His question to me was, “What do you want to do next?”

I told him that from my estimate, my next retrieval will be on Christmas day the earliest, which is right in the middle of the clinic’s lab closure for clean up for the holidays.  So my idea was to take a month off from medications and resume cycling in January.  Then he said, “Or, I could put you on birth control pill until end of December so we can do a retrieval as early as possible in early January.”

HUH?  Birth control pills?  Me?  Someone with diminished ovarian reserve?  I have always been told that I should NOT be put on BCP because it will shut down my ovaries to a point where I won’t respond.  I have this “fact” deep in my head.  This is why Dr. E never prescribed Estrace for me for estrogen priming or BCP because she did not want to over suppress me.

I was very confused.  So I asked him exactly that, if BCP would over suppress me.  He said that for some, yes it will, but for some people with DOR after a wonky cycle, BCP can actually help with rebooting the system.  I was still confused.  So I was like… doesn’t estrogen priming do the same thing and did the estrogen priming over suppress me last time?  He said yes estrogen priming has a similar effect and no, it did not over suppress me last time.  The cycle was weird because the cycle was weird.  He didn’t think that it had anything to do with the estrogen.  So the confused me asked him to explain the effect of BCP for me.  Guys, I still do NOT understand it, but I was embarrassed to ask for an explanation for the third time.  Basically, he believes that it’s worth a try… and the very conservative side of me wants to run away from it.  I told him that I’d have to talk to my husband about it.

Okay.  So here is the kicker of the phone call.  I told him that for financial reasons, the next cycle will be our last retrieval that will also include a fresh and thaw transfer.  Assuming that we’ll have one embryo from the next cycle (fingers crossed!!), we’ll have a total of six embryos.  How many should we transfer for the first time?  His answer almost gave me a heart attack.  He said, “Let’s put all six in there.”  What what what what what?  I almost fainted.  I was hoping that he would say three and three in two different transfers.  Six???  I know that my eggs aren’t good so many of my embryos will not be normal, but six….. I was taken aback from this number.  So Dr. NN said, maybe then we can do two more fresh cycles, transfer 4 for the first time, and try to make more embryos and transfer them all back the second fresh if I don’t get pregnant at the first transfer.  I reminded him that we have funds to do one more fresh and one more frozen embryo transfer, but not two fresh.  Although, I didn’t tell him the truth that my husband said he’d be okay with doing two more fresh cycles.

I asked him again why he suggested all six.  He said that he normally wouldn’t.  But in this situation and this circumstance with my very low reserve and my egg quality, he feels good about putting all six in.

Bob specifically asked two questions: whether or not we should wait it out if we have a wonky cycle again.  Dr. NN said that it depends on the situation.  If we have four follicles in a wonky cycle, he’d want to pursue and grow those four follicles.  Bob also wondered if there is anything we can do to improve egg quality.  Dr. NN said that as long as I am taking all the supplements that are supposed to help (including DHEA and CoQ 10), there is really nothing more we can do.

So friends, here are the decisions that we have to make:

1) Birth control pills or just take a break from medications for a month and wait for a natural cycle in January. (I have never been on BCPs before so I have no idea what effects it will have on me, plus the only advantage it may have is for scheduling convenience and the possibility that it may help reset my system)

2) one more fresh and transfer all of the embryos (could be six of them!!), one more fresh by transferring three to four and one more frozen embryo transfer for the remaining embryos, or two more fresh so we could have our final cycle to make our last embryos

Bob and I discussed about it.  One idea that Bob has is that maybe we can try BCPs and if it gives us something new to work with, then it’s all good. But if it shuts down my ovaries, given that it’s our last cycle, he said just screw it and transfer all of the five frozen embryos and see what happens.

And Bob also said that if we decide to do two more fresh cycles and not regret anything once and for all, he’s okay with it too.

But we both agree that we need to really seek the Lord’s guidance and direction before we make a decision.

Dr. NN is such a great doctor.  He asked me for my decision.  I said I have to talk to Bob about it so once we make a decision, I’ll email my nurse.  He said, “Okay, email the nurse and let her know if you want to talk to me on the phone again.  I will make myself available in the evening.  Sounds like a plan?”  I am so thankful that he’s willing to be available to chat again if we need it.

For those who pray, could you please pray for discernment from the Lord for us?

For those of you who have any insights in the effect of birth control pills on the already fragile ovaries, please enlighten me.

Don’t you feel that there is always a decision to make in this TTC or IF journey???

 

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29 thoughts on “More Decisions To Make

  1. 1) will say a prayer for you tonight
    2) to the best of my knowledge (in the scenario you described) the pill is just a tool to control the timing of your cycle. It’s prolonged use that would be a no no for DOR.
    3) i have never been on the Pill but my RE prescribes it because he suspects I have PCOS and androgens are damaging my egg quality. I don’t love it but, at this point, am used to pumping my body full of all kinds of nonsense. One month isn’t so bad. In my humble opinion if you’re not in a rush, maybe skip it? Not because it’s bad just why do it if there is no time pressure?
    4) Yes, always a drama/decision/worry in this game.

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    • Thanks so much for you prayer and your input. I have never been on BCP so I really don’t know the effect of it on me. And you’re right, that if it’s just for scheduling convenience, maybe I should just wait. Still need to discuss with my husband about it. But thanks for chiming in and sharing your experience!

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  2. Oh wow Isabelle, so much to take in and big decisions! They sound terrifying and exciting all at the same time. I’m not sure I can help you but I am thinking of you and I know you and Bob will come to the right decision. I am a very bad responder to stimulation drugs and I had 3 months with natural cycles before my last IVF then only 7 days of the pill to line me up with their timings and I had a better response than I’d ever had before. Whenever I’ve been on the pill for a long time (or stronger down regulation) the results were bad and my ovaries were slow. Good luck with everything, thinking of you lots xxx

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  3. Hi Isabelle,
    I have been following your journey for a few months. My fingers are crossed for you! I don’t think I have commented before. I will comment today as anonymous as I am not “out of the closet” re infertility.

    BCP – If I had to take this decision, I would not risk it. The potential downside (complete shut down) is just too severe. Certainly, there is a potential upside, but are the odds worth it?

    Transfer – You have commented on this issue a few times. It is a very tough decision to take, especially in light of you not wanting multiples.
    I would like to share my story with you, which might help you make a decision about how many embryos to transfer.

    After TTC for five years, three MCs and no kids, I fell pregnant again at age 39. My husband and I were in full agreement that we would only carry a healthy baby to term. We preferred to live child-free over a life with a child with special needs. Chromosomal testing came back normal and we breathed a sigh of relief. However, later in the pregnancy, a scan revealed potential severe issues with the baby’s brain. We were now faced with the tough decision whether to terminate or not from a practical standpoint. This felt very different from the crystal clear “we would terminate” we had agreed on pre-pregnancy. I had obviously bonded with the baby and was showing.

    To cut a long story short, we decided not to terminate. Fact is – or was at least for me – that suddenly I saw the world in a different light. I could not bring myself to kill an innocent unborn, who had not asked to be conceived in the first place. I was ready to mother a child with special needs with all ifs and buts.

    Hence, maybe the questions you would like to mull over / pray on are the following:
    – How would you feel about “reduction” (let’s not beat around the bush – we are talking abortion here) of one or more healthy embryos during the second semester of your pregnancy? What emotions could you potentially be faced with? How would you choose which embryo to abort? Would this impact the remaining embryo? Your health? How would this work from a practical standpoint?
    – Can reduction of multiples be reconciled with your faith and your belief in God?

    These are very personal questions and can only be answered by yourself and your husband.

    Given my experience, however, I would opt for two fresh cycles and transfer fewer embryos on each try. I understand that you would be in a financial position to do so, which is great. Opting for two fresh cycles implies potentially having to go through a full round of ivf twice. However, it reduces the probability for you needing to make the heartbreaking decision about reduction.

    I hope you find the answers to your questions. I will stay on the sidelines cheering you on!

    … and in case you are wondering: I gave birth to a healthy(!) baby daughter a few months after my 40th birthday.

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    • Aww thanks so much for this very thoughtful and insightful response. And it brought tears to my eyes to know that you finally have a healthy baby girl after so many years of heartache. I agree with you 100% about multiples. As someone who believes in God, I believe that life begins at conception. If I ever got pregnant with multiples, I don’t really think I can bring myself to any sort of reduction (and you’re right, abortion) of any babies. I mean, statistically, I know that my chances of having more than one normal embryo are low. But I am not God, so I really don’t know until I put the embryos back. I agree with you that transferring fewer embryos in two different cycles will be more in line with what I want: a healthy singleton pregnancy. I hope you comment in the future again. I would like to see how you’re doing. Thanks again!

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  4. I read through your post twice before commenting. You are in a position that really only you and your husband can make the final decision. I was on bcp for 7 years continuously and didn’t really have any problems with them. You would be on them for all of 21 days at the most, but probably less if its a timing issue. If you are nervous about the bcp shutting your ovaries down then I would say go Unmedicated for a cycle and pick it back up where you left off. If you choose to go the bcp route and it does shut your ovaries down, you always still have the option of transferring all or most of the eggs. I will be thinking of you and wish you the best of luck

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    • Thanks so much for your comment. What you say makes sense. I am fearful of the pills shutting down my ovaries. And I don’t know if I want to take that risk. I am trying to understand about the mechanism of the pills before I make an informed decision. Thanks again! And I hope you see a wonderful heartbeat tomorrow!

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  5. All I can speak on is life with twins. You’ve watched as I’ve struggled through their first year, and I thank you for your support, but it has been a very difficult road. I love my babies but it took me almost a year to think it was worth it. If you are willing and able to do two transfers, I personally think that’s what you should do, especially if you can fit in another fresh cycle.
    But above all, trust God and listen to him. He gave me my beautiful babies and he’s carried me through the hardest, darkest times of my life. He’ll be there with you through all this too.

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    • Thanks for speaking truth into your situation with your babies. I know that having twins or triplets is no joke. And I see all the complications from different pregnancies. I don’t know if I want to risk that. Maybe I am just being naive that maybe none of my embryos would be normal. But we don’t know that. Only God knows. So yes, Bob and I will continue praying and seeking God’s guidance.

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  6. Wow is this a lot to take in. I know you and your husband will make the right decision. That being said– if it were me, I would do two more fresh cycles and two different transfers. I also have DOR and the cycle I transferred four embryos brought me my healthy son. Best of luck!!

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    • Wow I am so happy for you for your healthy baby! That’s so wonderful! Thanks for your insight. Yeah I think I am leaning towards two transfers. Still have to continue to pray and talk with my husband about it.

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  7. Even if they were the worst quality embryos to ever make it to freeze, I cannot believe he would recommend 6! To me, the risks would be too great! Especially because the transfer is not the expensive part!!! Trust your gut

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    • I think mostly because my embryos are day two embryos. That’s why he feels like I could put them all in. But I really don’t think I want to do that. Thanks for your input!

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  8. Wow, that’s a lot of decisions. There really is never a break!! This is the first I hear about BCP being bad for people with DOR. I was on it for one cycle before my IVF. Perhaps it did shut down the ovaries since as you know I did not respond at all to stims. On the other hand I somehow grew a follicle later. So that could be evidence both that BCP shuts down ovaries and that it “resets” the cycle? I don’t know! I think it’s good that your doctor is at least willing to discuss all these things with you; although that doesn’t mean there’s a clear way to go. I would say go with your instinct; you’ve been through many cycles and have a sense of how your body responds. It’s good to get expert opinion but you are always the expert on yourself.

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    • Oh yeah I remember your cycle and how you got pregnant with your miracle baby! It’s so hard to predict these things, i.e. what the pills would do. The good thing is, my doctor is always receptive to what I have to say so there is a mutual respect there.

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  9. Lots of decisions Isabelle. I say..go with your gut. I’m pretty sure, from how I read it, when your RE suggested transferring all 6 embryos you were floored(as I would be too). What if all 6 took?! I know that it’s very unlikely but it’s still possible. I don’t want to suggest anything to you because ultimately it is you and your hubbies choice and I will support you guys 100% 🙂 So…go with your gut and prayers….prayers are always good…thinking of you!! xoxo

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    • Thanks! Yes I was totally floored. When he said to transfer all five embryos about 1.5 months ago, I was in shock. That’s why we came to a conclusion of four. And now he said six! Thanks for the support and thoughts! I will consult with the Big Guy up there. 🙂

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  10. So…on the BCP issue, I would think you’ll probably be ok. I did BCP before my first two IVF cycles. I was oversuppressed the first time, but that’s because I was also on Lupron. The second time I did BCP and Cetrotide and I got a decent response. I think the BCP is more for timing, and shouldn’t have as much of a “put your ovaries to sleep” effect as Lupron does. Now…transferring 6 embryos? I dunno, Isabelle. That sounds like a lot. Your RE seems comfortable being very aggressive but it’s YOUR uterus. I mean, maybe none of them will work but what if some do? Forgive me if I’m out of line, but I really don’t see you terminating a pregnancy and the idea of putting yourself (and any babies) at risk by carrying high order multiples is just too scary. My vote goes for splitting them up; whether you do it with fresh and frozen or fresh and fresh is a financial decision you guys alone can make. Whatever you do, we support you!

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    • Yeah so I think if I don’t really have to rush for the next cycle, I most likely won’t do BCP. You’re right. Six is shocking. And it IS my uterus. And you’re right. I am not going to terminate any pregnancy and Bob is not willing to do that either. You’re not out of line at all. You know me well. Thanks for your support! And don’t be a slacker when it comes to new posts!!!! 😉

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  11. Making these types of decisions are always so hard!!! However, I am excited for you and this transfer (whenever you decide to do it)! I will be praying for you and I’m sure you will be guided to the right decision 🙂

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  12. I transferred 3 frozen embryos, thinking we could reduce if more than one took. However once we knew we were having twins, we couldn’t go through with it. There is a slight chance that a reduction can harm the remaining fetus. Now we are parents to two special needs kids who were preemies. I love them but would not wish this life on anyone.

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  13. Pingback: Currently #3 | The Parenthood Diaries

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