First Meeting with Dr. No Nonsense re: Donor Cycle

The meeting with Dr. No Nonsense took place bright and early at 7:30am Monday morning.  We even skipped bootcamp for that, although we could’ve gone soaking in our sweat since the clinic is only five-minute driving distance away.  We decided against stinking up Dr. NN’s office.

Dr. NN, like his usual no nonsense self, didn’t say much.  He confirmed with us that the hysteroscopy done at Kai.ser went well, and that we are indeed going to pursue egg donation.  I told him that instead of an in-house donor that we were interested in, we had paid for an agency donor who had donated twice before.  He tried to look it up in the system but couldn’t find any records.  Of course.  Our donor Iris didn’t donate there at my clinic and my nurse probably hadn’t received all the records yet.

From the top of my head, I told Dr. NN Iris’ previous two donations’ results.  First cycle: 8 eggs, 6 fertilized, transferred two embryos and resulted with a pregnancy, but no embryos to freeze.  Second cycle: 25 eggs, 18 fertilized, transferred two with a pregnancy, and 6 embryos were frozen.  He typed all that in without making any comments.

Things that we discussed:

• Number of embryos to transfer: I am really adamant about transferring one embryo.  I know that Bob sometimes dreams of having twins so that we could be done.  But I really do not want to put myself in a situation where two embryos could split into two to become four embryos.  Dr. NN said that the pregnancy rate for multiples with two transferred embryos is 50%.  Uh.  No…. I do not want that chance.
• Controlled cycle: We have to sync up my cycle with my donor’s.  I have been on birth control pills, which I will continue to be on including the sugar pills.  Dr. NN was attempting to draw some diagrams representing my uterine lining and whatnot.  I guess after BCP, I will be on Lup.ron for a little while, and estrogen patches for a few weeks?  I am a little unclear on that one.  I am sure I’ll find out when the time comes.  I was a little worried about my bleeding problems since I had been bleeding even on birth control pills. Dr. NN said that after my uterine fibroid in the cavity was removed, I should stop bleeding like how I had been.  Oh, the big thing:  I will have to use progesterone in oil.  I have been dreading this one day when my butt needs to be stabbed.  I asked if it’s possible to use suppositories. Dr. NN said that since this is a total replacement of the hormones, I should really use PIO instead, at least for the first few weeks.  I turned to Bob and asked, “Are you ready?” He gave me a look and didn’t answer.  I shudder to think about him attempting to jab a needle on my behind… But we have to do what we have to do.
• Endometrial scratch: Dr. NN looked me in my eyes and said, I think it’s better not to touch your uterus.
• The hope is to grow all the embryos to day five and choose the best one to transfer, and then freeze the rest.  No assisted hatching is needed because of Iris’ young age.  Good.  Less money to invest in this.
• ICSI vs. conventional IVF: This makes a difference because it costs a couple more thousand dollars to do ICSI. Dr. NN looked at Bob’s semenalysis results and said that everything is fine, so we don’t need to do ICSI.  We had a big discussion about it.  Bob really wants the most conservative way, which is to make sure that one sperm goes into one egg so that we can ensure most if not all of the eggs fertilize.  Dr. NN thinks said it depends on how we define “conservative”.  To him, the conservative thing to do is not to manipulate the eggs and just let nature do its thing.  But Bob feels better to make sure that everything gets fertilized.  I don’t blame him.  We had only done ICSI so far.  Dr. NN said that the only thing to think about is that we might wonder if the method of fertilization had made a difference if fertilization rate or blastocyst rate is not as good as expected.  We might second guess ourselves.  After a lot of discussion, we had put down ICSI for now, but we can always change our mind later.  Bob really would rather spend the money than regret about it later.
• Blood clots: Dr. NN doesn’t think that some blood clots I had a couple of months ago will affect my implantation.  So he told me not to worry about it.
• I asked why the results of Iris’ first and second cycles were so different.  Dr. NN said that without the records, he really can’t tell.  He will look at her records, do the medical screenings with her, and make sure that she is good to go for a third cycle.  If her antral follicle count is not good, he’ll definitely let me know.

Our meeting was quite short since we couldn’t really talk about treatment plans.  The agency director was going to send Iris’ records to the clinic this week, so Dr. NN said that we would talk again once all the records are in and the donor is done with all of her medical screenings.

I emailed the agency director yesterday.  She confirmed that all the records had been forwarded to my nurse.  She had asked Iris to contact my nurse directly with her recent pap smear results since the agency director is going on an 11-day vacation starting on Thursday.  My nurse later confirmed with me that 1) she had received all the records except for the pap smear results, 2) Dr. NN said it was fine for Iris to start her screening, so my nurse would contact her soon, 3) Iris will also be scheduled for a genetic consult (apparently the previous clinic that Iris cycled at did not require a genetic consult, so we have to pay for one), 4) I will also get an appointment to go over Iris’ genetic consult results, and 5) Bob and I will return to meet with Dr. NN to finalize all the details.  I emailed her back to make sure that we don’t have to pay for the next meeting with Dr. NN since the meeting on Monday was paid for but incomplete.  Nurse told me to just remind her when we schedule the appointment so she would make sure that we don’t have to pay for it again.

So this is it for an update!  We are moving forward, slowly but surely.  Hopefully Iris will pass all the testing with flying colors.  Both Bob and I are excited.  We continue to pray for God’s hand in all of this.   We are hopeful that we are on the path to parenthood.