Follow-Up Meeting with Dr. No Nonsense re: Frozen Eggs

The last time we saw Dr. No Nonsense, my RE, was July 27th.  We naively thought that since we picked a donor, everything would go according to plan.  That meeting was 2.5 months ago.  How things changed in 2.5 months.

When my nurse scheduled this follow-up appointment for me, I double-checked with her and later on with my billing person at my clinic that we would NOT be billed again for the visit as we had already paid for it back in July.  It’s better to be safe about these things and it doesn’t hurt to make sure so we won’t get any surprises.

Before the appointment, I had the hardest time coming up with questions.  I just felt that since we don’t have to stimulate anyone’s ovaries, it seems pretty straight forward.  I enlisted help from several friends and came up with a list of questions just this afternoon.  I figure that we don’t get a lot of face-to-face time with Dr. NN, so why not make good use of this time to ask him questions.

Bob worked from home so he could come join me for the 4pm appointment at the clinic.  The new clinic apparently has three different waiting areas so we were told to go sit in one of them.  Time kept ticking and there was no Dr. NN.  I only fed the meter until 5:12 and was hoping that he wouldn’t be too delayed.  A nurse walked by and asked if we were waiting for someone.  I told her that we had an appointment at 4pm with Dr. NN, to which she appeared confused and asked if it was a phone appointment instead.  I was more confused than she was.  She looked up and saw Dr. NN. He ensured her that we were his patients.  He greeted us warmly and told us on the way to his office that the nurse had squeezed us in between two other patients.

In his office, Dr. NN checked on the donor’s profile and history for a few minutes, got a piece of paper, and started his show and tell.  Here is what he scribbled:

IMG_5339

Basically, he thinks that with 10 eggs, we should expect 9 to thaw, and 8 to fertilize.  We will transfer on day five.  He believes that in addition to the transfer, we should have embryos to freeze.  He said that it’s realistic to think that we may have three blastocysts to result from this batch of eggs.  He thinks that 10 eggs is a good number for a batch of frozen eggs rather than a batch of 6 or 7 eggs.

I asked him about the difference between frozen and fresh eggs in terms of quality of the embryos.  He said that there should not be any difference, but because a fresh cycle gives you many more eggs to work with, there is bound to be an embryo with AA quality.  For a frozen egg cycle, because the batch has fewer eggs, there could be  embryos anywhere between AA to BB, etc.  He said that right now it is really hard and unfair to compare frozen eggs vs. fresh eggs.  I should just look at the frozen eggs that I have and go from there.  I asked him how they determine which embryo to transfer, he said the best looking one.  I asked if blastocyst rate has to do with sperm or eggs.  He thinks that it doesn’t really have much to do with the sperm.  He explained that this is not exact science though.  They have seen that with the same donor, the blastocyst rate could go from 50% in one cycle, to 30% in the next, to 60% in the following one, then down to 18% in the fourth one.  So really, no one knows.

There is an over 50% of pregnancy rate with transferring one blastocyst.  With fresh, he used to tell me 70%.  But I didn’t ask him about this.  I think at this point, it doesn’t matter.  I just want to transfer and see what happens since we have already chosen frozen eggs at this point.  Anyhow, with twins, there is 10% higher pregnancy rate, but it also means that I could end up with twins.  I asked him what he would recommend.  He said he always goes with one blastocyst as he always aims at a healthy singleton pregnancy.  I asked him in what situations would he recommend transferring two embryos.  He said with donor eggs, he would still go with one.

I asked Bob what he thought, and he did not say much.  I know that he has always wanted to transfer two and be really done with this process.  I don’t think he has thought much about the complications that could be associated with a twin pregnancy.  Plus I really don’t want the embryos to split, which could happen 5% of the time.  However, I brought up this topic again later on because I wanted to make sure that Bob also has a voice in this.  At first he was resistant and said that we didn’t have to talk about it then.  Dr. NN asked why not.  We should talk about it and make a decision.  So we did.  I told Dr. NN to explain to us why he would strive for a singleton pregnancy for his patients.  He said that twin pregnancies have a higher chance of complications and preterm labor.  If he could control it, he would recommend transferring one.  I asked Bob why he wanted to transfer two.  He said that he just wanted us to be pregnant.  And Dr. NN said, yeah I get it, you just want to have a baby.  He told us to go home, talk about it, and let my nurse know.  Bob told him to put down one embryo right now as a place holder.

As for immune protocol, I don’t think Dr. NN believes in it.  He said that for me, there is no indication of that.  I asked about aspirin.  He said that they used to prescribe aspirin to people, until there was a large-scale study that came out that showed that people on it had a higher miscarriage rate.  To him, my problem has always been egg quality.  I know that people who believe in immune protocol may disagree with him.  But he is my doctor and I have to put my trust in him.  As for hCG infusion and endometrial scratches, he thinks that those are indicated for people with multiple failed transfers and need to try other things to make it work.  He does not think that I should worry about doing those.  I asked him what the steroid in my protocol does, and he said that it could suppress any inflammation in my body.  Historically it has been prescribed at this clinic so that’s why it’s there.

I asked Dr. NN to explain to me how this medicated transfer cycle works.  He scribbled on the back of the paper:

IMG_5340

I am already on birth control pills.  I will start Lupron which is to suppress my ovaries.  Then when my withdrawal bleeding comes, I will start my estrogen patches.  Then progesterone should start.  He told me that I can start Lupron any time I want to.  I just have to work with my nurse to figure out the calendar.  He said that we have a say in which day we want to transfer.  Say if we want to transfer on Thanksgiving, then we would work the calendar backwards to see when we will start what.  Honestly, I still don’t understand how we can control the calendar that way.  But it seems like I don’t have to know.  I just have to trust that they know what they are doing.  I was laughing when he said Thanksgiving, because really, do people choose to transfer on Thanksgiving?

There is nothing much I need to do besides to check on the lining.  With a medicated cycle, it’s very likely that the lining will be fine, although sometimes the lining might fail to grow well.  Bob laughed and said that his job is easy.  Just to give a sample and be done.  I was joking with Dr. NN that hopefully this time the room to give a sample would be a little more well stocked.  Last time there was nothing except a DVD and Bob had to rely on his phone to finish the job.  Dr. NN kept on typing away with his eyes on the screen.  But he was laughing and said that the room now has everything and things are streamed (?) so there should not be any problems.  Bob said he’d find out soon.  And I said that I hope he only has to enjoy that well stocked room only once as we are done with this process.  I really don’t want him to have to come back in the future for any more samples.  Bob said that he started to feel hopeful, but still, there is no guarantee.  I am happy that he is starting to feel hopeful again because he has been down about this process for a while now.

At the end of the visit, Dr. NN walked us out of the room and shook our hands.  He said that my nurse would be in touch and we could figure out the timeline.  He told me to let my nurse know that he would like to do the transfer so find a day that he is free to do so.  I was a bit touched that he wanted to do the transfer.

So friends, looks like we will be doing a transfer some time in November.  I will contact my nurse to create a calendar.  I got price quotes for the meds that we need and hopefully will order them next week.  Things are getting real.  I am feeling alright.  Some days I feel very hopeful.  Other days I feel that it’s hard to believe that it could work.  So I maintain my attitude of taking it one day at a time, and pray whenever I feel anxious.  I also tell myself that I am doing everything to make this happen.  The rest is out of my control.

Hopefully this is it!

Advertisements

14 thoughts on “Follow-Up Meeting with Dr. No Nonsense re: Frozen Eggs

  1. A couple of thoughts:
    a) Re blastocyst rate, I know it’s just anecdotal but in our case it was completely related to egg quality. With my own terrible eggs, we only ever had a 25% or less blastocyst rate (1 out of 4 fertilized eggs made it to Day 5). With our donor, that went up to 45% (5 out of 11). I think your previous issues are totally based on egg quality and you’ll see a huge difference and hopefully have something to freeze.
    b) I agonized the same as you guys over transferring one, and I’m so SO glad it’s what I chose. It’s hard because you *think* that transferring two gives you a much better chance at pregnancy, but statistically it doesn’t really increase it that much. What it does increase exponentially is your chance of multiples. Meaning if you’re not going to get pregnant with one, you probably won’t with two but if you ARE going to get pregnant, your chances of twins are huge. IMHO, do a single transfer. At least the first time out. See how your uterus handles a high quality blast for a change. It’s so easy for Bob to just say have twins and be done, but you’re the one who has to carry them and I’ve seen so many bloggers have complications, I just wouldn’t risk it. At least not on your first try with DE. If it fails, and you have two left, then think about it.
    c) I think you get to choose the timing because they can theoretically keep you on estrogen a while and it doesn’t affect anything. It’s once you start the progesterone that the clock starts ticking, since it’s mimicking ovulation and you want to hit that Day 5 window. That’s really cool that Dr. NN wants to be the one to do your transfer.
    d) NOVEMBER BABY!!! SO SOON!!! think I might be more excited than you are. 🙂

    Like

  2. So glad to hear good news and an uplifting feeling about you guys! I agree about transferring one. We transferred two because we just wanted a baby. Well we got two, as you know. I wouldn’t change it for the world but I was blessed with an easy pregnancy, good labor and even no NICU time. So many women don’t have that experience, even with a singleton. If the first run doesn’t work, it sounds like you likely have two or more to transfer a second time, so go for two then.

    Like

  3. You gotta love those scribbled diagrams. I remember getting those in appointments and then coming home and wondering: wtf is this? Anyway
    , it’s exciting that you are so close! Good luck in the next few weeks!

    Like

  4. The notes remind me of my own RE 😉
    I second the suggestion to transfer one. One blast was the plan for us – and then we didn’t get to the blast stage, and suddenly we were in the room for transfer and had to make a decision. Well, you know what happened.
    Hugs and peace for all these decisions.

    Like

  5. I am very excited for you! Transferring two is not going to give you much of any better success rate and we all know that multiple pregnancies are RISKY!!! So excited for a transfer to happen for you!!

    Like

  6. This all sounds so exciting! I really hope you have a good grade blastocyst to transfer and it is great Dr NN thinks you can even get frosties.

    My journey has been very different to yours but looking back I am glad I had a single blast transfer. It’s different for everyone though and I know you and Bob will make the right decision when it comes to it. I’ve everything crossed for you both xx

    Like

  7. Good luck!!! Its really up to you and your comfort with possibly having multiples. I chose to transfer 2 with my FET’s since I a SET with my fresh IVF which failed and that was a AA hatching embryo. I have only been pregnant with singletons so for my next IVF cycle I will do the same.

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s