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:
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:
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!