Emotional Meeting With Dr. No Nonsense

This morning was my WTF appointment with Dr. No Nonsense, my RE.  I was originally offered a phone consultation by my nurse.  I insisted on an in-person meeting because 1) I hate speaking with Dr. NN on the phone because he uses a speaker phone, 2) for this important meeting, I need to look him in his eyes, and 3) I just need to see his face and find out why he thinks the cycle didn’t work.  Last night, I typed up all my questions on Goo.gle Docs and placed a writing pad and pen in my purse.

Being ten minutes early, I was surprised the nurse called me right away and led me to wait in an exam room across from Dr. NN’s office.  To my greater surprise, Dr. NN came to get me at 10:02.  Practically on time.  A student doctor was introduced to me as someone who would observe the session.

We discussed about why this cycle didn’t work.  Basically, nobody knows.  We commented on how the embryos all fertilized but didn’t grow too well on day three.  Dr. NN said that eggs usually carry the most weight when it comes to fertilization and growth.  The sperm plays a role but it’s very hard to tell what kind of role.  He said that the fertilization and growth for frozen eggs are about equal to fresh eggs.  So it’s an unknown why these eggs didn’t grow well since the sperm and the eggs all looked good.  Dr. NN said that in the future if we need to fertilize eggs again, we could do the DNA fragmentation test.  He said that DNA fragmentation is highly experimental.  It doesn’t really change how we fertilize eggs because ICSI is still the way to go.  But it does provide a different set of criteria to identify which sperm to use.  It basically helps to choose the sperm differently.  Dr. NN told me not to worry about that right now as we should focus our effort on transferring the great embryo that we have.  I asked about the possibility of needing donor sperm if Bob’s sperm is not good.  Dr. NN said that we wouldn’t even go there as it is not necessary.

Early blastoscyst’s success rate is not as high as regular blastocysts.  I thought that Kevin our early blastocyst was from an embryo that had a fragmentation of four on day three because of how it was listed on our embryo report.  Dr. NN clarified that no one knows which day three embryo Kevin came from.  He said that the lab used to grow the eggs separately.  However, it was discovered that embryos grow better together in a petri dish.  So he said that there was no way of knowing which embryo Kevin was originally from since they were all put together in on place.  He said that that piece of information isn’t important anymore.

I made him go through the donor’s previous cycles just to see if they actually grew as poorly.  He spent his time digging up the information on the computer.  Her blastocyst rate for two of her fresh cycles was 50% and 40%.  I don’t know what I was trying to prove, but it really seems like either 1) we got a bad batch of eggs, 2) we have sperm that doesn’t work as well, 3) it’s pure bad luck, 4) it’s my uterine lining.  Nobody knows.

I asked about my lining.  He opts for a medicated embryo transfer because my low reserve means that my ovary may not produce enough estrogen for a good lining.  It is much easier to develop a good lining in a controlled environment with medications.  He does not think that I need any immune protocol.  We have these two new factors: donor eggs and sperm.  He does not want to throw in another factor and mess with my lining with something that may or may not be beneficial to the cycle. He thinks that an 8mm lining is perfectly good for a transfer.  I asked about spotting some blood clots during my menses.  He said that that’s perfectly normal.  It doesn’t mean that I have a blood clotting disorder.

I think around 20 minutes into the meeting, I became increasingly emotional.  I really wanted to remain as calm and composed as possible.  However, with the whole talk about the failure and possibly having to spend more money and time on a brand new donor if Lucy doesn’t work, it was just too much to bear.  I started tearing up thinking that it could happen that we’d never have our baby.   I actually cried in front of Dr. No Nonsense for the first time.  In fact, this was my first time losing my emotional control and crying in an RE’s office.  Period.  I was surprised at my tears, but my fear just surfaced and I couldn’t control myself.  I was telling him that we spent so much money on this, and that other people who used donor eggs got pregnant and have their babies left and right.  I felt like we got the short end of the stick.

Dr. NN was so kind.  His student fetched me tissues.  I apologized for being emotional, and he was very compassionate about it.  He said that you have gone through so much and have done so much treatment.  Of course you are feeling emotional.  He looked me in my eyes and told me that he believes one day I will get pregnant and have a baby.  He went on to tell me about one of his patients.  This poor woman failed a fresh DE transfer, a frozen embryo transfer, and another fresh DE transfer with a different donor.  She finally got pregnant with twins with a frozen embryo transfer.  The fourth time.  It goes to show you that you never know what will happen.  He said that yes, DE success rate is high, with a 70% pregnancy rate. But there is still a whopping 30% of people who don’t get pregnant during each cycle.  We just have to try.  And we have a great embryo waiting for us on ice.  He said that he will do everything in his power to help make it happen for us.  He asked how I would like him to help.

I told him that I just need my uterus to be in the best shape for our frozen.  He told me to get another diagnostic hysteroscopy to make sure that my uterus looks good.  We had one done back in July.  The surgeon back then told me that my uterus looked pristine.  Dr. NN said that it doesn’t hurt to look again so that we have a peace of mind.  Then he said that he’d make sure he is going to be the one doing the transfer.  He will try everything and whatever voodoo he has (whatever that means) to make sure that the embryo gets transferred in the safest way possible.  He said that together we’ll make it happen.

At the end of the session, I had already calmed down.  Dr. NN was finishing up his notes on the computer.  I told him that the embryo was called Lucy.  He actually typed it in and said that we’ll make sure that Lucy makes it home safely.  He told me to wait so that he could give me a hug.  He finished typing, came out from behind his desk, and gave me a huge hug.  He told us to focus on this great embryo that we have during this holiday season and keep ourselves positive on the outlook.

I really appreciate my doctor who gave me over 30 minutes of his undivided attention answering all the questions that I had.  So yeah, we won’t be purchasing any frozen eggs until after we transfer Lucy.  I know that the frozen eggs may be claimed by then. If we get pregnant with Lucy, the baby will not have a fully biological sibling.  I think we are going to be okay with that.   My own OB responded to my request for a hysteroscopy saying that she doesn’t do that in her practice so she has referred me to her colleagues who do.  Just like last time I may have to wait for a while before I could get an appointment.  I went ahead and emailed the surgeon who did my last hysteroscopy and I will see if she can see me earlier, such as some time in the next two weeks.

I like that we have a plan.  I hope that despite what happened this cycle, we will still be full of hope for the possibility of Lucy.  I believe that we will.  We just need time to heal.