MicroblogMondays: Chaos and Travels

This blog post is late for about… 14 hours.

I was trying to make a decision this weekend.  This decision was weighing so much on my mind that I didn’t have the mental capacity or time to write a blog post.

We have been scheduled to leave for my home town in Asia and India this coming Sunday.  I didn’t mention about it in my last blog post, but one of my worries of this upcoming trip was the unrest in my home town.  There have been protests for democracy since June there and things have been escalating in the last week.  Still, things seem to be fine if you avoid the usual hot spots for protests… until this weekend.  Extreme violence and large scale damages and vandalism took place over Friday night that the mass transit there had to shut down the whole subway system.  My dad had a difficult time finding public transportation to go home after dinner and he had to rely on my cousin to call him an U.ber.  Some ATMs were smashed so my dad couldn’t get money.  Banks, malls, and supermarkets were closed.  Clashes continued to happen throughout the weekend.  Subway system continued to be shut down due to damages.  Honestly, during those two days, I felt that if we went as originally planned, I didn’t feel that I could protect my children.  My gut was telling me to skip my home town and just transit to India directly and back.  However, emotionally it would be heartbreaking for me to just transit there without entering to see my family.  And I have been so looking forward to my grandmother meeting my kids.  After all, my grandmother is going to be 100 and who knows when we would have the opportunity for my kids to meet her.  I spoke with my best friend and my dad.  Both felt that it would still be safe if we stay home and around the areas of my dad’s house and my grandma’s house.  I wavered with my decision throughout the whole weekend.  Finally, I posted on my college’s parenting group on FB about my quandary.  Some of my fellow alumnae actually live there currently so they gave their perspectives.  I’d say 100% of the people who responded said we should go.  I prayed about it and talked to Bob, and we both agree that seeing family is more important.  And we will exercise caution.  Once the decision has been made, I feel that a weight has been lifted off my shoulder.  I can now continue to pack our stuff for this first international trip/plane ride with our twins.

The Other Shoe Actually Dropped

This is going to be an extremely difficult blog post to write.

My husband is often skeptical when things are going well on our fertility journey.  He often feels that he needs to save up every penny to add to our fertility fund because he is always waiting for the other shoe to drop.  I am often the overly optimistic one who thinks that everything is going to be fine.  On Sunday he told me that he was waiting for the other shoe to drop when we sat down to discuss our finances.

The next day, the other shoe actually dropped.

It is still hard to believe that I am writing this post.

Our donor Serena has been doing extremely well in her stimulation phase of this process.  You know how I had that fear that she wasn’t doing her stims right?  Well, that fear isn’t warranted because she’s growing some crazy follicles.  She returned on Monday (two days ago) for her second follicle check.  I was anticipating an email from Dr. E for an update.  Instead, I received a phone call from her.

We all know that a phone call from your doctor is not a good sign.  Sometimes it’s very bad.  This was one of those very bad ones.

She asked where I was, what I was doing, and if I could find a place to sit down and talk.  I panicked hearing her questions.  So I found a private place.  She went on to tell me the following.

This is a donor that she has worked with twice.  Once in January and once in April this year.  She is really familiar with her.  But Dr. E sometimes throws in a drug screen during donor cycles randomly just for the heck of it.  No rhyme or reason.  So on my donor’s baseline appointment on August 22, Dr. E also ordered a drug screen.  The results didn’t come back until Sunday August 28th.  Dr. E usually doesn’t check lab results on the weekend.  However, she was checking on someone else’s so she thought might as well check on Serena’s.  The results shocked her.  Serena’s test came back positive for cocaine.

Dr. E immediately called Serena on Sunday night and confronted her.  Serena denied using any cocaine.  When Dr. E saw her on Monday August 29 for her third follicle check, she told Serena to tell her the truth.  And Serena still said that she didn’t.  After her scan, Dr. E had to leave to do another procedure, but her physician’s assistant sat Serena down and asked her again.  It was then that she kind of made up a story and said that it could have been from a party that she went to and it could have been second-hand smoke from a cocaine pipe.  Afterwards, Dr. E consulted with a toxicologist at Lab.corp who said that it is nearly impossible to have that level of cocaine in one’s system if it was not ingested or snorted.  So basically she was lying and did not own up to her mistake.

When I heard the news, I was immediately devastated.  Everything had been going so well.  Why do bad things always happen to us?  Has our journey not been crazy and difficult enough?  I thought that because of the positive drug test, we couldn’t use her eggs anymore.  The thought of starting all over yet again and possibly losing our gestational carrier due to a longer wait was paralyzing.  But Dr. E actually said that she doubts that the eggs will be affected.  She thinks that our donor will still make beautiful eggs that will turn into beautiful embryos.  But to her, it is more about the character of the person.  She asked me to talk with Bob and think and pray long and hard about whether or not we wanted to proceed knowing that this person breach our trust and the contract.

Honestly, I was relieved to know that the eggs are still going to be good to use.  But what does one do in this situation?  Do we cancel the cycle and start all over again losing A TON OF MONEY that we had already paid out (agency fees, monitoring fees, legal fees, insurance, medication), or do we move forward knowing this piece of information.  I told Dr. E to call Bob and explain to him what she found out and let him ask questions.

I was standing there not believing what I had heard.  Dr. E said that this had never happened before in her years of practice, that a known donor that she has worked with multiple times would fail a random drug test.  What are the odds?  And here we are, encountering this problem that truly dampens the joy and the excitement at this stage of the game.

Bob spoke with Dr. E for 20 minutes.  After understanding about Dr. E’s take on nature vs. nurture and drug use and drug addiction and moral values, he told me to speak with our attorney (the one who did the donor contract for us) and the agency owner.  I so appreciate him that he was calm.  His calmness helped calm me down as well.  That Monday afternoon Dr. E called me at 1:15 or so.  I was scheduled to see clients at 2, 3, and 4pm.  Since this was an urgent matter (as we had to decide if we would move forward or cancel), I saw my 2pm client, but switched the other two to another day.  My mind was going to all sorts of places during my 2pm appointment and it was so difficult to concentrate.  But I pulled through.  Following that, I called the attorney and the agency owner but couldn’t get a hold of either one of them.  The attorney returned my email.  He basically said that if we had professionals (our RE and the toxicologist) to back the claim of cocaine use, it is a breach of contract.  However, it is often difficult to seek damage from donors who don’t have much financially.  Basically, the so-called contract is a guide and you hope that people with good nature would voluntarily follow through with it.  Unfortunately this is not the case.  We could take her to court.  But do we have the time and energy and the money to do so?

Since I couldn’t get a hold of the agency owner, I decided to leave work and go to the one person that I always turn to when we are faced with tough decisions.  My sister-in-law was once again there to be my sounding board.  Luckily I found her and met her at her house.  We discussed about it and both of us felt that we could still move forward with this donor knowing that Dr. E said that the risks of using her eggs are very minimal at this point.  She prayed for us and promised that she’d continue to pray.  She said that if the Holy Spirit speaks to her in a different way, she’ll let me know.

That evening was very difficult emotionally for me.  There were so many questions that we had to ask ourselves and answer.  Didn’t we have peace when we prayed about this donor and decided to book her?  How could a person be so arrogant and selfish to do this after committing to be drug free during this time?  Are the eggs really going to be fine?  Is my future child going to have a predisposition of addiction?  Is she a habitual user or is it recreational and occasional?  If we decide to move forward with her eggs, will they still be affected by her cocaine use?  Has she been using for a long time?  Am I knowingly putting my future child in danger?  If we don’t proceed with her, how much money are we going to lose?  How much more money do we have to shell out for a new donor?  How are we going to locate a new Asian donor and have a cycle soon so we don’t lose our gestational carrier?

So many questions that we struggled to answer.

But God is good.  I prayed and I prayed and I prayed for peace, wisdom, and discernment.  Although our donor’s cocaine use really disappoints me, I have been leaning towards moving forward.  Sometimes I had the urge the just start all over and cancel her and lose that money.  But most of the time I feel that we should move forward.  Bob has been strongly leaning this way from the get-go.  Once he learned from Dr. E that it is highly unlikely that the egg quality is going to be affected, he doesn’t want to wait any longer and just wants to get this over with.  But at the same time, he is okay with the decision to cancel the cycle if I felt really strongly about it.

I just could not believe that we had to make this decision two days before the trigger shot.

But, my gut tells me that we should proceed and everything will be fine.

I had a terrible night of sleep on Monday night.  I truly could not go to work on Tuesday as I needed that time to process this news and think.  I continuously prayed for peace.  Throughout the day, I spoke with many people whom I trust.  It’s very interesting that 90% of the people that I spoke with said that they’d feel comfortable moving forward knowing that the eggs are probably going to be fine if not still excellent.  Some of my believer friends also felt that way.  My dear friend Elisha spoke a word of encouragement to me.  Basically, this is Satan’s way of distracting us from Jesus.  Jesus is here with us in this storm so look to Him and Him alone.  And if God gave us the peace when we chose this donor and we have peace now, then we should go for it.  My therapist is so wonderful.  I sent her an email asking her to speak to me on the phone for this emergency.  She called me the same day.  She basically said that if my gut tells me to go for it, even if it’s not 100% of the time, trust my gut.  I told her that I was worried that this one piece of information would damage the narrative that we’d build around our future child(ren).  She thinks that we have all the right to build this story with positive things rather than negative.  This piece of information about our donor using hard drugs is one piece of the puzzle.  It does not define our child.  We are the ones who would raise our child the way we want to.  She thinks that once we decide to move forward, we have to work towards an acceptance of this piece of information and continue to find the positive of this story.  She thinks that drug use in the egg donor population is probably quite prevalent.  We just usually don’t know that piece of information.  Now we know it in our situation, what we are going to do with it is the most important.

Yesterday I also spoke with the agency owner who apologized about this situation.  But there aren’t too many options for us.  We either cancel or we move forward.  It’s hard to recover the monetary damage.  If we go to court, the judge would say that the donor has the right to do whatever she wanted to to her body, and she has the right to terminate the contract at anytime.  Agency owner has known this donor and her sister for quite a few years.  She said that it is quite out of the character for the donor to do such a thing.  She also said that she had spoken to the donor prior to our phone call and the donor was still motivated to complete the donation.

Dr. E actually ran a repeat drug screen on Serena on Monday.  She put it down as STAT but was told that she probably wouldn’t get the results back until Friday.  When I spoke with her on the phone yesterday and told her that we were leaning towards continuing, she was very conflicted.  We are like family to her.  And she hates people who lie.  To her, the cocaine is not the problem because she doesn’t believe that the eggs or our future child would be in danger.  Her biggest problem about this is that the donor shows no remorse.  Serena lied about this over and over again.  Dr. E said that her urine sample on Monday came back very low in concentration, which means that Serena probably intoxicated herself with water from the time she got Dr. E’s call on Sunday to her appointment on Monday.  She basically was trying to dilute her urine so that maybe whatever drug in her system would not show.  She wanted to cover up whatever that might be remaining in her system.  Dr. E is sorely disappointed with this person.  She just wanted Serena to admit that she was wrong.  But I told Dr. E, that this journey has been so long and hard for us, and we are so so close to getting embryos, that Bob is willing to gamble and take the risk of having the genes of this person knowing that we will raise our child differently.  Dr. E said that even if the repeat drug screen comes back negative, she does not trust this person anymore.  But her eggs will still be good.  She supports us 100% if we decide to move forward with the cycle.  We had the whole discussion about nature vs. nurture, susceptibility to addiction and what not.  What a heavy duty discussion to have especially when I have never even smoked a cigarette in my life (I know I am an extreme).  It is so hard to fathom doing drugs.  It is also hard to fathom someone who wouldn’t admit their mistake even after being caught.

First our previous donor disappeared. Now this donor breached the contract.  This is why it is very difficult for me to trust young people who are in their 20s.  This is why I’ll never work with a gestational carrier under 30.

My sleep was better last night but still interrupted.  I woke up in the middle of the night with a headache and feeling bugged that this has happened, but at the same time I felt like we were very close to making a firm decision to move forward.  When we woke up at 3, Bob said that we should speak with Annie, our gestational carrier, about this new development and see if she would still be okay with carrying for us.   I had an extremely full day today.  I had to go into work early to see one client, then I had an hour-long presentation in Chinatown to parents of young children.  I had a full afternoon of appointments at work.  I only had time to speak with her at 7:30 when I started driving to work.  I am just so grateful for Annie.  She is such an amazing person.  She picked up the phone, listened to me, and reassured me that she would have no problem carrying for us, and that she’ll provide the best environment possible for our baby to grow in.  We spoke some more and she prayed for us as well as the donor before we hung up.  I am just so full of gratitude that our gestational carrier shares our beliefs and we could speak so openly and honestly about our struggles.

In the morning, Bob and I both felt good to move forward knowing that we’d love our child in the future no matter how the story of his/her creation began.  We love our friend’s adopted son regardless of his birth mother’s alcoholic history.  We know that we will love our child unconditionally.  And since we repeatedly got the confirmation from Dr. E that the egg quality will most likely not be affected (well of course she won’t be able to say 100%), we feel safe to proceed to retrieval.  My presentation went amazingly well.  I sometimes surprise myself that I could turn my personal life off and be very professional without a problem.  Dr. E updated me on the donor.  Her second drug screen came back negative as expected.  I don’t know if she really didn’t have any cocaine in her system on that day or the diluted urine yielded negative results.  But that’s beyond the point now.  Most importantly, we decide to continue with the cycle and her scan today yielded excellent results:

RO: 11.5, 14.5, 10, 20.5, 16, 16, 15.5, 12.5, 11, 17.5, 14.5,  remaining <8

LO: 14.5, 14, 17, 14.5, 18, 15.5, 17, 16.5, 14.5, 23, 13, 10

Of course another fear of mine is that Bob’s sperm won’t perform.  Dr. E reassured me that PICSI is going to help find the best sperm.  We are scheduled to show up at 8am on Friday for the semen collection at the clinic.  We are very close to the finish line of making some embryos.  This afternoon was the first time in a couple of days that I started to feel excited about the prospect of owning embryos again and the hope of having our baby in the very near future.  It IS an exciting time.  I hope that we are still full of hope and joy on Friday when we drive to the clinic.

Isn’t this a crazy twist?  It’s more complicated and surprising than fiction.  I am sure that if I ever wrote a memoir of my journey, nobody is going to believe me.

We don’t know why we are being put in this trial.  And we may never understand why.  But after two agonizing days, I have a new appreciation of us as a couple, how we handle ourselves in an extremely difficult situation, and the loving friends and family that we have.  We are surrounded by love.  I am very sure that no matter who contributed to half of my future child’s genes, our child will be positively influenced by the numerous people that are going to love him/her.  And dependence on God and the guidance of the Holy Spirit is the lesson I have learned here.  This was an extremely difficult decision to make.  One of the most if not THE most difficult decision we ever had to make.  I hope nobody who reads this will have to make this decision in the future.  And I hope that there aren’t any more shoes to be dropped.  However, even if there is more, I am quite sure that we will be able to pull through one way or the other, because we have God and each other.

MicroblogMondays: Maui Is Around The Corner


Our much anticipated 5th wedding anniversary trip to Maui is just around the corner.  Five days from now to be exact.  Back in January when we planned the trip, we were wondering where we would be in our quest of our binky moongee during our Maui trip.  Would we be in our second trimester?  If our February transfer had failed, would we have found a new donor already?  Would we be in the middle of our new cycle?  Despite the unknowns, we decided to forge ahead with our plans for our 5th wedding anniversary trip because living life is as important as waiting for a baby.  I would not have imagined ourselves to be in this uncharted territory: deciding if carrying a baby would be a dangerous choice for my body and my baby.  My therapist was right: it seems like this is a season of uncertainty and we’d better get used to this space.  Bob and I have discussed about the various case scenarios.  We are trying to figure out the right direction for us.  It is no easy task.  How does one go about doing that?  Therefore, we are not forcing ourselves to make a quick decision.  Maybe those eight days in Maui will give us some down time to continue to let the news sink in.  Maybe one path will emerge as the right path for us.  I am grateful that we made a decision to love ourselves and plan a trip.  A very good friend of mine who has been banking embryos finally prioritized an overseas trip over a banking cycle.  She has missed many opportunities for travels in the last year because of her fear of missing a cycle.  I am so proud of her that she has chosen to live life this time.  In this cruel journey, we have to make a choice to be kind to ourselves.  Although this is not the babymoon that we had hoped for, I am still looking forward to sleeping with the sounds of the ocean, sunrise at Haleakala, savoring every bite of fresh fish, enjoying all the fresh fruit Maui has to offer, bathing in the sun on the beach, sporting my brand new swimsuit, and spending some quality time with my dear husband.  Hopefully during the time of our trip God will give us the clarity and maybe a new perspective that we need to move forward in our journey.

MicroblogMondays: Surprising Decision


I was going to write about something light, like how I chopped off six inches of my hair, or Bob’s birthday week fun activities.  But yeah, the agony that I had last week over choosing the next step occupied my mind so much that I have to write about it.

So much went through my head last week.  It was debilitating to not be able to have peace with decision making.  It simply stressed me out so much that my shoulders took the brunt of it.  I constantly felt my shoulders rising up to my ears.  I hadn’t felt so stressed out since we last had to choose a donor.  I think the information that I received from Dr. E and gathering data on cost was just too overwhelming for me.  I was basically on an overthinking overdrive.

What was going on in my mind?  Well, I was weighing the different options of working with my own clinic, working with Dr. E., going to a clinic in San Diego, or going to a clinic in Oregon.  In regards to the cost, it is still the most reasonable to go with my own clinic.  Although the sperm test is extra expensive, the cost of the ERA testing with biopsies on both day four and day five is going to be less expensive than doing one biopsy with Dr. E.  Being a boutique clinic, her fees (except for the sperm test) are higher across the board in comparison to my current clinic.  Cycling with her for a DE cycle is more expensive than at my current clinic.  Since she is an independent doctor not affiliated with any clinics, there is no SART data to support her success rate.  The success rate of my own clinic is similar to those two clinics in Oregon and San Diego.  Then why do I have to spend extra time and money to become a patient at these other clinics?

Why do I have to decide which clinic to go to rather than doing all the testing first?  Well, for the ERA test to assess the receptivity of my lining, the test results will only be relevant when the test transfer protocol for the biopsy is the same as that of the real embryo transfer.  I already know what protocol Dr. NN will put me on and I know that this particular medicated transfer protocol can grow my lining well.  If I go to Dr. E, she may use a different protocol. And if I have her do the ERA testing but don’t go to her for my DE cycle, my real transfer protocol may be different and the ERA testing results would be rendered useless.

My nurse’s calendar for me showed that the biopsies will be done in end of March, which is great timing.  If I wait to make a decision about going to Dr. E, other clinics, or back to my own clinic, then we may have to wait another month to do the ERA test.  That cuts very close to our Maui trip end of April.  If we don’t do it in April, then we do it in end of May.  I would like to get something going with the new DE cycle some time in June, right before my in-laws come in mid-June.

There were some other things that made me uncomfortable about working with Dr. E, which is surprising to myself.  I had never felt uncomfortable with or intimidated by Dr. E when I worked with her in the past.  However, the way she answered my questions this time just made it overwhelming and intimidating to me.  She insisted on seeing my uterus even though I sent her reports and images of my hysteroscopy and my most recent saline sonogram done only two months ago.  The scan clearly showed that my uterine cavity is clear.  She said she wanted to look at it with her own eyes with a simple pelvic scan.  Remember she mentioned about adenomyosis?  My dear friend in this field told me that adenomyosis is usually confirmed only through a pathological report, often after a hysterectomy.  You really can’t see adenomyosis from a pelvic scan because it is in the myometrium, or the middle layer, of the uterus.  She did say that from the pictures of my scans, it did look extremely reassuring, but she would still want to take a look.  I just don’t know what else she could look at.  Doing a scan with her is not cheap.  I pay out of pocket.  So yeah, I don’t know why but I felt very intimidated.  I also felt that one test to check on my receptivity is enough, and two (both the ERA test and the beta-3 integrin test) might be an overkill.

Something else about her also made me feel uncomfortable.  I am interested in a proven donor who worked with another Bay Area doctor and Dr. E for her first two DE cycles.  The first cycle she had 26 eggs.  The second cycle with Dr. E (which is such a coincidence that she had worked with this doctor) yielded 55 eggs.  I don’t know about you but I feel extremely uncomfortable that Dr. E overstimulated this donor so much.  The end results of both cycles were similar: 7 blastocysts and 8 blastocysts respectively, with a successful pregnancy for both.  This piece of information about Dr. E just complicated my feelings.

I emailed my nurse to see if I could do one biopsy instead of two, as well as if Dr. No Nonsense recommends the beta-3 integrin test.  The answer is yes, I can do just one biopsy, but they recommend doing both days 4 and 5 so we could save time.  Dr. NN said that I could do the beta-3 integrin test but he thinks that the ERA test is superior over the other test and he does not recommend it to any of his patients anymore.

My husband got mad at me because of this whole thing.  I had been trying to gather all the information about various tests from the different doctors, nurses, and financial people.  I didn’t want to present this whole thing to him in bits and pieces.  Since I was still trying to wrap my mind around this whole thing, I was waiting for a good chance to talk to him.  Given our busy schedule last Monday and Tuesday, we didn’t get a chance to talk.  When he came home on Tuesday, he saw that I was chatting with a friend online about it.  Wednesday morning, instead of a usual happy man coming home from fitness bootcamp, he came home unhappy.  He felt left out that I asked everyone else for their opinion but him.  I was at first very upset that he didn’t understand why I waited to talk to him.  However, I put myself in his shoes and thought about my behaviors and actions in the previous few days, I started to understand why he felt the way he felt.  So instead of my original plan of going to work early, I took out my little chart that I had drawn for myself to make sense of this whole thing and used 15 minutes to explain to him what had been bugging me.  I am glad that my life partner does not hold grudges in silence but instead voices his frustrations and concerns with me.  I am grateful that we had a chance to smooth things out.

My trusted therapist helped too.  That same evening I had a session with her.  In that session, I learned that I was back to being cerebral with my decision making.  I was over thinking, which drove me to a point where I couldn’t make decisions.  I was afraid of regrets.  She listened to all of my dilemma and asked me deep down what I believed in.  I told her that deep down, I believe that I have a uterus that is good, I will get pregnant with a good embryo, and I will become a mother.  She told me that whatever decision that we make will be the best decision for our path.  She would like me to consider making a decision that stresses me out the least.

That same evening, Bob and I talked about this whole thing at home.  He asked me if I had made a decision about which doctor/clinic to go with.  I have learned to listen to his opinion.  I asked him to tell me first which doctor he would like to work with.  He thought for a few seconds, and told me that he would still like to work with Dr. NN.  I am so glad I asked him because that was my answer too.  I just feel that it is the simplest right now for me and Bob to not worry about starting all over with another clinic again.  Going with Dr. NN again really gives me the peace that I didn’t have in the past week.  What a relief that Bob and I are on the same page.

So yeah, after a lot of prayers for clarity and peace, I will start Lup.ron next week in preparation for two biopsies at the end of March.  I am finally at peace with this decision.  I cherish this sense of peace so much especially after feeling so paralyzed by the inability to decide.  I based my decision on my emotional responses to these doctors.  Sometimes that’s just what we have to go with.

MicroblogMondays: Frozen Donor Eggs (a post not so micro)


This is going to be my third attempt in writing about what has been going on since our donor Iris bailed.  I have been so short on time lately that I just can’t seem to finish a post about it.  I hope you are ready for a not so micro post.

It’s been three weeks since we got the news that Iris had disappeared.  I don’t quite think much about her anymore.  Emotionally I am not affected much by her.  Did she ever return any emails or phone calls to the agency?  The answer is no.  She returned the $200 that the agency sent her for transportation to and from the clinic, without attaching a single note.  Just like that, she disappeared into thin air without a single word or explanation.  On some level, I feel disappointed at myself for choosing a person who would be so irresponsible.  But my therapist told me that I should not take any responsibility because her decision and disappearance had nothing to do with me and Bob personally.

So what has happened in the last three weeks since we found out that we had to start all over again?  It took a few days for my emotions to return to normal.  Then I began to think about the next steps.  Naturally, we started searching for a donor again.  Both the agency database and the in-house clinic database did not have any donors that we could work with immediately.  A proven, repeat donor who is part-Chinese would be our first pick.  Nobody matches that description.  I expanded my search to agencies outside of the Bay Area.  Still, the choices are very limited.  I was discouraged for a few days and was defeated that the chance to have a transfer before Christmas would be very slim.  Why do I want a transfer before Christmas?  I think it has to do with us approaching the end of the 4th year trying for a baby.  Christmas is a season that focuses so much on family and children.  I just want to share the joy with others who have children or who are pregnant.

We have discussed in the past about doing a fresh donor cycle vs. doing a frozen donor egg cycle.  I didn’t really go into details with you guys about the differences.  Basically, the chances of a pregnancy/live birth are higher with a fresh donor cycle because the recipient couple would receive all the eggs in that cycle, hence the chances of making multiple embryos would be quite high.  Many donors would retrieve from 15 to 35 eggs during one cycle (although some may make fewer than 10 eggs).  Many of these eggs would be fertilized and at least a few embryos would/should make it to the day five or day six blastocyst stage.  Often times, a recipient couple transfers one to two blastocysts and has a few other blastocysts to freeze for future use, may it be for a frozen embryo transfer if the first fresh transfer didn’t work, or for a chance at a second child in the future if the first transfer results in a live birth.  The cost of a fresh donor cycle is high.  Compared to that, a frozen donor egg cycle is a lot cheaper.  At my clinic, the difference could be over $10,000.   The eggs are already there, frozen for a recipient couple’s use at any time they are ready.  The advantage is that you don’t have to sync up the donor’s cycle with the recipient, and there is not a risk of the donor not stimming well or actually backing out from the cycle.  The disadvantage is that the clinic guarantees at least six mature eggs.  Compared to a fresh cycle with 15 to 35 eggs, six eggs seems to be a small number.  With fewer eggs, the chances of having multiple embryos are smaller.  Plus, there is a risk of the eggs not thawing well.  So realistically, there could be one or two embryos to work with.  Once the embryos have been transferred, if the cycle doesn’t result in a pregnancy, there may not be any frozen embryos to use for a frozen embryo transfer.  So there is always that risk of exhausting all the embryos quickly and having to do another cycle all over again.

My RE Dr. No Nonsense has always told us to do a fresh donor cycle if we want two of more children because a fresh cycle gives you a lot more eggs.  I do want more than one child.  However, Bob’s position in the last year has been that he only wants one child.  If we get a bonus one (such as having twins), he would be overjoyed.  But he just wants to have one child and be done with this process.  I know that he is very tired of this journey and just wants to move on.  This is coming from a man who had always wanted four children.  It breaks my heart to see him so disappointed and exhausted and just wanting to move on with life.  So in theory, since Bob only wants one child at this point, he shouldn’t care much about fresh donor cycle or frozen DE cycle.  But in reality, he cares a lot because he really wants me to have the best chance at having a live birth and it seems like a fresh cycle will allow us the best chance for that.

You may not remember, but back in May, I wrote about the various choices we had to face when it came to egg donation.  In that post, I mentioned about donor 1.  She is half Chinese half other Asian.  So she is fully Asian.  Back then, I learned that all four of the recipients of her cycles had gotten pregnant.  She had committed to donating for the 5th time for all of her eggs to be frozen.  We did not go with her because only frozen eggs were available.  You can see the above for the reason why we didn’t want to go with frozen eggs.

There is another donor that we also liked.  I mentioned about her in the previous post about egg donation as well.  I described her as donor 3 who only has a bit of Chinese.  I checked with the donor coordinator.  She has just been matched with another couple and will do a cycle in November.  Technically, Bob and I are next in line if she chooses to donate again.  The thing is, I am not so sure if she’d donate again as this is her 3rd donation in a row.  She may or may not want to do it again.  Plus I would still like my future child to have at least a quarter Chinese.  So I am a bit hesitant about waiting for her to be available.

So, out of all the donors on both the agency and in-house clinic databases, the half Chinese/half other Asian donor is still the only donor that we are really interested in.  However, I knew my husband’s position.  I didn’t want to force the issue if he did not want to pursue having a cycle with frozen eggs.  We just had to wait a little bit for a donor to show up that we both like and want to work with.  So realistically, it could be some time in 2016 before we can do a transfer.

And then, Bob had a change of heart.  We were lying in bed one day having our pillow talk.  We were chatting about various things.  Out of the blue, Bob asked if I wanted to consider the frozen eggs from this Chinese/other Asian donor.  I was very surprised at his inquiry.  His reasoning was that 1) this is a young, proven donor with good records, 2) the eggs are all there for us to use, 3) so a donor will never back out from a cycle again (I think he’s a bit traumatized by the incident with Iris and has lost confidence in a future fresh donor), and 4) the cycle is cheaper so if it’s not successful, we still have the money to try another fresh or frozen egg cycle.  We agreed to inquire about the status of the Chinese/other Asian donor.

This is what I learned.  At the time when I wrote the donor coordinator, this donor was about to do a retrieval for her 6th donation.  So we didn’t know how many eggs would be given for each batch.  While we were dealing with our previous donor Iris in the past months, this Chinese/other Asian donor had already completed her 5th donation (and second frozen donation).  That cycle yielded 23 mature eggs which were divided into three batches of 8, 8, and 7 eggs.  All three batches have been matched with various couples but these couples have not done a cycle with these eggs yet.  We would be next in line for the new batch of eggs that results from her 6th donation (and 3rd frozen egg donation).  A transfer had been done with the eggs that came from her very first frozen egg donation but the clinic was still waiting for the pregnancy result.

When I was waiting for the retrieval to see how many eggs would go into each batch, I had asked myself what the most ideal number of eggs would be.  I knew that her first frozen egg donation resulted in 9 mature eggs and 8 mature eggs.  If she has 20 mature eggs, then the cycle would be split into two batches of ten eggs.  If she has 21 eggs, then they would be divided into three batches of 7 eggs.  I was praying that she’d get 20 eggs.

Guess what?  My prayer was answered.  The donor coordinator said that her cycle resulted in two batches of ten eggs each.  They were all deemed mature and were stripped for ICSI (whatever that means).  This would be the best case scenario for someone who is interested in using frozen eggs.  Again, the clinic guarantees at least six mature eggs.  A batch of ten eggs is amazing.

After knowing the answer, I was thrilled at first.  We have ten chances to make a couple of embryos, if not more.  This is a proven donor.  What else is there to think about right?  After praying over the weekend, both Bob and I were saying to each other that we should go for it.  I posted to an online group of DE moms who had experience in frozen egg cycles and many had shared their success stories with me.  Many of them had only 6 eggs and still had a pregnancy and live birth.  I was feeling better and better.  And then, I had a thought.  What if we purchased both batches of eggs?  That’d cost a lot more money but that’d mean that we’d have a chance to have a few more embryos.  Bob still thought that we would only need one batch because he would still want one child.  But he told me to go ahead and ask.

The donor coordinator said this, “We unfortunately do not allow the option to purchase multiple batches of cryo banked eggs because the cornerstone of the program is to offer more recipients an opportunity to match with our more sought after donors.”  

I was at peace with this.  I was actually relieved that a decision was made for us, that we didn’t have to fret about the decision to purchase two batches of eggs.

I was feeling good for a couple of days.  Then I got the latest news.  The donor coordinator told me that the result of the latest transfer with this donor’s frozen eggs was a negative pregnancy and the recipient had one more embryo to try.

Cue panic.  I went from having peace to having fears and doubts.  I was projecting the results of that failed cycle onto my future, wondering if that would happen to me as well.  I seemed to have overlooked the still stellar record of this donor, having a 80% pregnancy rate with her eggs.  I wondered if bad statistics would follow me.  I was fearful that I would be unfortunate enough to have a batch of the worse eggs from the 20 eggs.  I entered into this land of what-ifs.  I could not distinguish my fear from God’s will.  My mind was very noisy and chaotic.

In the back of my mind, I still thought and felt that this was a wonderful opportunity to pursue with a proven donor.  Since we only have to prepare my lining for a transfer, we can possibly transfer before Thanksgiving.  And if this does not work, we still have the money to pursue other opportunities.

But I was scared to death.  I was scared that the first transfer wouldn’t work, and it would be a huge blow to the both of us.  It would mean tens of thousands of dollars down the drain.  It could possibly mean having no frozen embryos to try again and needing to find a new donor.  I have just been so traumatized by this experience that I was so afraid of failure.

My therapist came to the rescue.  A few days ago, a session with her cleared up some of my chaotic thoughts.  Every pregnancy is different.  We don’t know what the failed cycle was like.  We don’t know the sperm quality or the uterine environment.  We do know that the recipient has one more embryo to try.  We also know that other people who used this donor’s eggs have all gotten pregnant.  She told me that things are out of my control.  So I should let go of the what-ifs because no one except for God knows what will happen in the future.  I should focus on my perfect uterus and visualize how welcoming this place will be for my future child.  Instead of putting my energy in thinking that this will never happen to me, I should put some positive energy into believing that this will happen with a perfect uterine environment and a beautiful embryo.  My therapist told me not to rush into a cycle if the reason is that I want to have a transfer before the end of the year.  Go for it if it feels right.  Don’t go for it and wait if it doesn’t feel right.

I was able to get a hold of Dr. NN and asked him a few questions.  He said that this being the donor’s 6th donation does not affect the egg quality.  I also asked him about immune protocol.  He said that I will be on steroids.  He does not recommend any blood thinner like Hepa.rin for me, and he thinks that hCG infusion is not necessary for me.  He thinks that it’s wonderful that we get 10 eggs from this donor.

After talking with him and having Bob’s support, I wrote the donor coordinator and let her know that we’d like to take a batch of ten eggs.  Then came her email.  She told me that there is a change in the guarantee program.  What???

I immediately gave her a call and learned about the details.  Basically, the clinic was evaluating the frozen egg program and wanted to boost the success rate.  According to the coordinator, there was 16 transfers with frozen eggs and 9 resulted in a clinical pregnancy.  So instead of guaranteeing that there would be two viable embryos (could be anywhere from day three to day five) to transfer, the clinic will change its policy to one blastocyst.

I think it is a good change, but I was a bit uneasy with the rate of pregnancy because it is lower than the 70% of transfer with fresh eggs.  I prayed to God for peace and strength as this is such a difficult decision to make.  Bob and I talked and talked.  I let the news sit for a little longer.  I woke up the next morning with peace.

So this is where we are at right now.  We have chosen to proceed with ten frozen eggs from this Chinese/other Asian donor who has had a great record.  I went off birth control pills a few weeks ago because I was bleeding from them.  In order to get ready for the cycle, I will go back on birth control pills when my period comes.  My nurse said the transfer time will be six weeks from the time I go back on birth control pills.  I am expecting my period to come in two to three weeks (I have EWCM lately but I don’t know if I have ovulated yet) so I think transfer time should be somewhere in November.

I can’t help but think that, maybe this is meant to be?  If we had chosen this donor’s frozen eggs in the first place, the eggs that we would get would be very different from the eggs that we are going to get now.  The sperm used for that would be different.  The resulting embryos and child/ren would be different.  Maybe there was a reason why our original donor didn’t work out.  Maybe we are meant to get the ten eggs that we will get?  I don’ t know.  I think we’ll never find out the reason for all these twists and turns until we have a baby in our arms.

I am excited but at the same time scared.  I am grateful for this opportunity but at the same time fearful of the future.  I have been reminded again and again this past week during Bible Study that God has the perfect plan for me.  I believe that this is the right decision.  My hope is that I continue to trust in the Lord and in this process without being doubtful or living in fear.  If you are the praying kind, could you join me in praying that I live daily with trust and faith in the Lord?

Thank you for your support.

What A Crazy Ride

I don’t even know where to begin.

This has gotta be the craziest, weirdest, most unpredictable, and shortest cycle ever.  So what happened?

Well, after last Saturday’s scan with the three follicles and my high progesterone which indicated post ovulation, we returned on Monday for another scan.  My appointment was at 8:15 and Bob got me there miraculously at 8:16.  Unfortunately, that didn’t translate to us being seen on time.  I had a 9am client and couldn’t leave the clinic until 9:05am.  Fortunately the client’s mom is usually very understanding and was okay with me being late.  Anyways, I was seen by Dr. Italian again.  The lining went back up to 10.4mm, but definitely not trilaminar as it was already in the luteal phase.  There were two follicles on the left ovary: 13mm and 11mm.  The right ovary had a little one at 8mm.  I was very confused about this and wondered about what this all meant.  Do I get to transfer if I get some embryos?  Dr. Italian made sure that he would tell Dr. No Nonsense to call me so we could personally connect on the phone to discuss about the cycle.  He did tell me to schedule an appointment for Wednesday to check on the follicles again.  He explained to me that sometimes they try to retrieve in the luteal phase.  It’s unusual, but it happens.

Since I was so rushed in the morning and had a full morning of appointments, I didn’t even check on my phone.  I had it on mute when I was in the clinic and totally forgot to turn the ringer back on.  I would usually have my phone with me in the lunch room but I was avoiding my pregnant coworker so I sat in my office having lunch and being on the computer.  I was oblivious to the fact that the phone was ringing in my purse at 12:51 and Dr. No Nonsense was trying to reach me.  By the time I discovered the phone call and voicemail, it was already 3pm.  All he said was that he wanted to push through the cycle to see if those follicles would grow.  He instructed me to inject 150IU of Meno.pur and one dose of Gani.relix.  After I listened to the message, I was saying to myself, “Huh?”

The thing is… I had ten thousand questions for him.  First of all, how good are the follicles that are made in the luteal phase?  If we move forward with a retrieval, would the follicles yield real eggs?  Eggs that are normal?  Secondly, this is supposed to be a fresh cycle where we would grow eggs, make some fresh embryos, thaw some frozen embryos, and transfer.  If we move forward with the follicles in the luteal phase, it would be a freeze all cycle again without a transfer because the uterine lining would not be the right phase, pattern, and thickness.  I needed to confirm with Dr. NN that this is in fact the case.  A freeze all cycle is only $600 cheaper than a fresh, thaw, and transfer cycle.  If we do a freeze all, the majority of the money that we had paid for this cycle would be gone, and we’ll have to shell out another few thousand for a frozen embryo transfer next cycle or even more money for another fresh cycle.  So this IS about money.  Anyhow, in the voicemail, he said that he would have a nurse call me with the instructions for the injections.

So I called the nurses station and got a hold of somebody.  I discussed with her about the plan.  I said I missed Dr. NN’s phone call and would really love to talk to him about the plan he had in mind.  She explained to me that the plan was to do the injections like what Dr. NN told me on the phone.  I re-emphasize my need to speak to Dr. NN, which she noted and said she would email him and let him know.

I went ahead that night with what I had to do.  I turned off my ringer at around 6:35pm for my bible study.  Dr. NN called at 6:41!  You know, I had bragged to Bob during the holidays that I had never missed one single phone call from Dr. NN in those past few months whenever he called out of the blue.  I couldn’t believe that I missed his phone calls twice in one day!  All he said in the second voicemail was that he agreed with the plan and just moved ahead with it.  Ugh.

I emailed my nurse the next day my availability so Dr. NN could call me again. She forwarded the times to him but told me that he just flew to Arizona and was probably very busy.  Since the two missed calls, I literally had my cell phone stuck on my butt (well, back pocket) all day long.  I called the nurses station again and spoke to the same nurse.  I asked if I was supposed to do the Meno.pur and Gani.relix again.  The nurse confirmed the plan and told me that she spoke to Dr. NN briefly who just told her to tell me to continue with the meds.  I re-emphasized that this is about money as well, since it’d cost us more to do a transfer next cycle.  I just really wanted to talk to him.  She said she would email him again with my concerns.  I didn’t hear from him at all on Tuesday.

Wednesday’s scan showed a 15mm follicle on the left, but the 13mm one was gone.  Instead, there was a 13mm follicle and an 8mm follicle on the right?  What the heck?  Where did that come from?  I was so confused.  The lining had grown to 12mm.  However, I had continued to spot and had been doing so for a few days.  I didn’t know if the mid-cycle spotting had any indication in how good or bad the cycle was going.  Dr. Italian said that the lining had no blood on it.  I told him that I still hadn’t talked to Dr. NN.  He looked at the progress of my follicles.  They had been growing quite slowly.  Just one millimeter or so a day even with injectables.  He was staring at the chart of my follicle growth on the screen and said that maybe we could do better next time.  To me that means that he would cancel this cycle if he were my RE.  But he emphasized that I should discuss this with Dr. NN and come to an agreement with him.

I called the nurses station yet again and spoke to the same nurse.  She said that they do luteal phase retrieval with cancer patients all the time.  I asked her about transfer during the luteal phase.  According to her, it could still be done with the right lining and low progesterone level.  I was listening and not believing what she said.  I don’t think that a transfer in the luteal phase would be optimal, especially for someone like me who has so few embryos to spare.

My phone continued to be with me all day long.  And Dr. NN did not call me until I was lying on the table at acupuncture with needles all over my body.  We both exhaled a sigh of relief that we finally connected.  He kept apologizing for being so busy.  Right off the bat, he told me that if we wanted to do a fresh cycle with a transfer, we’d have to cancel this cycle because we can’t possibly transfer with this lining.  If we wanted to gamble and see if we would get some eggs, then we should proceed and continue with the injections.  He said that there is no way of knowing if there would be any eggs in the follicles or if the egg quality would be different/worse in the luteal phase.  He said that in the cases that they had seen, it didn’t really quite make a difference in the quality.  And to him, my mid-cycle bleeding was irrelevant to the decision.  So basically, what he said was, it was up to me and Bob to make that decision.  If we decide to cancel, then just call the clinic and cancel the ultrasound.

I thanked him and lay on the table with all these needles on me.  I didn’t fall asleep like usual and my mind was going 100 miles per hour.  I was wavering between moving forward with a chance to make an embryo or two and stopping the cycle so that we didn’t have to waste more money.  I was doing math in my head.  I was thinking and worrying about the quality of the eggs.  I was just not at peace.  I didn’t know how we should proceed.  I finally prayed and asked God for clarity, direction, and peace.

Bob came to meet me at acupuncture.  On our way home, we discussed all the various factors into making our decision.  We got home at 7pm.  We had about two hours before we had to do the injections again.  I continued to waver.  Bob said to wait until the next cycle, but said he would be okay with moving forward with this one.  He told me not to worry about the money part because we do have some money to spare.  Do we want to risk having eggs that don’t fertilize, or not even having any eggs at retrieval?  I honestly could not answer that question.  But then I also didn’t want to give up the chance to potentially make an embryo or two.  I was so torn.  At 8:30, I emailed Elisha and asked her to pray for this decision.  (I love you girl.  You came through quickly with a great prayer.  Thank you so much.)  At 9pm, we decided to move forward with the cycle so we did the injections.  Honestly, I was okay with the decision but had a tiny hesitation in the back of my head questioning whether this was the wisest thing to do.  I still wondered about the money.

Well, God made the decision for us.  Last night, my so-called “mid-cycle spotting” got heavier and heavier.  It almost felt like a precursor of my period.  This morning, my basal body temperature dropped to 97.1, which is below cover line.  My bleeding had gotten heavier.  Cycle day 16 had become cycle day one again.  My luteal phase was only seven days long.  This has got to be the shortest luteal phase for me ever.  My cycle was only 15 days, with a 8-day follicular phase.  How messed up is that?  This is the first time that it has ever happened to me.  And this happens to be the cycle we’re supposed to transfer.  So I was wondering if we could still do a retrieval during AF?  I was still hoping that those follicles would grow.  Well, they didn’t.  Today’s scan showed that the 15mm on the left had shrunk to 13mm.  The 13mm and 8mm on the right were 8mm and 8mm.  So the follicles failed to continue to grow.  The lining had gone down to 10mm again.  Dr. Italian and I discussed about maybe taking a break from any meds for one cycle and resume in mid-February.  I thought it was a good idea.  He wrote a note to Dr. NN about today’s scan.

When I left, I was feeling relieved and at peace.  God made a decision for me and I actually feel that a weight has been lifted off my shoulder.  The unknown of the quality of the eggs, if any, would continue to haunt me if the follicles continued to grow.  If we retrieved but didn’t get any eggs, that would have been another blow to our journey and we might regret and question our choice.  I was feeling very good all day long.  I hadn’t felt this good since the beginning of the cycle.  It had not been a good cycle:  humungous cyst, cancelled cycle, resuming the cycle, taking Fem.ara, no follicle growth, high progesterone and temperature indicating extra early ovulation, follicle growth in the luteal phase, having difficulty reaching Dr. NN, doing injections in the luteal phase, mid-cycle spotting, and worrying about the money and quality of the eggs.  All of these made the cycle a bit stressful with all the unknowns and my inability to reach my own RE.  I was mostly zen throughout this whole thing until last night.  God came through and quickly showed us that this is not the right way to go.

I did waste 3 doses of Ganir.elix.  We have three more at home.  It would be a bummer if we need some but don’t have enough next time.  But it’s okay.  We have given our everything for this cycle.  We don’t have regrets that it didn’t move forward.

I am ready for my hormones to go back to normal.  I yearn for a regular cycle where I have a couple of follicles growing, we make some embryos, and have a nice lining to transfer.  I believe that a cycle off would be the right choice.  I am still waiting for Dr. NN to give his opinion, but I doubt that he would suggest doing a cycle immediately because my ovaries still have those follicles that are still shrinking.  I hope that in a month we’ll be back on track so we can just transfer those precious frozen embryos.  I am so ready for this stage to be over, regardless of the outcome.

Well, of course I want a good outcome.  There is still hope.

Thank you all for reading this extremely long post!

Extra Money and Decisions Made

It seems like I haven’t written an update about our treatment cycles for a while.  Where do I begin?

The last time I mentioned about our cycles, we had some decisions to make.  Bob and I talked and prayed about it.  We both feel that we are more comfortable with not taking any birth control pills to hold off my period until end of December.  I don’t see a point of potentially messing up the hormones in my body this late in the game.  In regards to the number of embryos to transfer, we decided that transferring six embryos is just too risky, although it could be wishful thinking that my old eggs would give me more than one normal embryo in a batch of six embryos.  But still, I do not want to take a risk of having multiples.  I have a lot of peace with these decisions.  We are going to transfer four embryos at most.  I emailed Dr. No Nonsense’s nurse to let her and Dr. NN know about our decisions.

My luteal phase is usually 13 to 16 days, mostly 14 days.  Imagine my surprise when AF arrived on day 11 past retrieval.  It had been a wonky cycle and it kept on being wonky all the way til the end.  Thank goodness I always carry some pads in my purse so I didn’t create any embarrassment for myself.  (I have never used tampons and probably never will.)  I guess one good thing about getting my period early is that it’s possible for me to cycle earlier in January after the clinic’s lab closure at the end of December.  I quickly did some math and figured out that since my period came on December 8th, my potential retrieval in December would be December 21.  The lab closes on December 22.  So if we were to do a cycle now, it’d be cutting it very close to the lab closure.  Plus we wanted to do a transfer, so it’s basically impossible to squeeze in a day-two transfer on December 23.  The lab will definitely be closed already.  So yeah, even with an unexpected early arrival of AF, I am still taking a break from cycling in December.

After my email, Dr. NN called me one day unexpectedly.  I feel so lucky that every time he calls me, I am in between clients and am available.  So far I haven’t missed a single unplanned phone call from him.  His main question for me was whether we’d still thaw and transfer embryos if we don’t make any new embryos in January.  That is such a tough question to answer.  I asked if I had to make a decision ahead of time.  He gently said, It’s better to make a decision sooner rather than later.  So I promised that I’d talk it over with Bob and get back to him.  We also talked about whether to go back on estrogen priming for the next cycle.  We both decided to do it.  I hope that it doesn’t over suppress my ovaries this time.

Many of our decision are made based on our financial means.  If we don’t make any embryos next cycle, should we or should we not transfer the frozen embryos?  We don’t know.  We have to look at our funds and see how much we need to leave for donor egg cycles.  Donor egg cycles cost a lot of money.  I don’t know if I’d ever be able to join any of the guarantee programs since I have had an abdominal myomectomy and may not have the kind of “healthy” uterus that some programs require.  How much more money should we put into these cycles with my own eggs?  Bob promised that he would look at our finances and help me make a decision on the weekend.

I knew that we didn’t use up all of the prepaid services for our failed cycle.  We had no embryos to freeze so we’d definitely be credited back the fees for cryopreservation.  I sent an email to the billing person regarding the remaining balance on my account.   A week went by without a response from her.  So I wrote again.  She responded immediately and said she’d look at my account and let me know.  A few more days went by without a response.  So I wrote a third email, to which she responded with a new fees schedule for the next cycle.  I opened the word document and was blown away by the amount that was credited back to us.   Rather than just crediting about $750 to us for the cryopreservation fees, we can carry over $4300 to our new cycle.  So we only have to pay $2700 for our next fresh, thaw, and transfer cycle.  I am sure it was because my little egg failed to fertilize.  However, I am not so sure why they’d credit so much money to me after doing many monitoring ultrasounds and a whole egg retrieval.  She didn’t itemize the services that are being refunded to us so I have no way of knowing, but I’d take it when someone wants to give  me back a substantial amount of money.  This lady’s math is horrible though.  She miscalculated the amount that is due for the next cycle by $40.  This is not the first time I’ve found calculation errors made by her.

So with this new information, our decision making has been a little different.  It leaves us more money than expected.  Bob said that he’s comfortable with not transferring any frozen embryos if this next cycle again doesn’t yield any fresh embryos, because the refund gives us a chance to do another fresh cycle in February.  We’ll give it our all to do two more fresh cycles and see what we can do with my own eggs.  After that, we’ll move full force into donor egg cycles if our effort doesn’t result in a baby for us with my own genetic material.

So that’s the new plan!  I am so happy that we have come to a conclusion and are at peace with the decisions we have made.  It’s been nice not to have to think much about doing a cycle at this moment, although I should start checking my basal body temperature so estrogen priming can begin seven days after ovulation.   Thank you all for commenting the last time and giving us your feedback and thoughts!    I will do a post soon about my thoughts and research on donor egg cycles.

In My Head

Last Wednesday I attended my first therapy session since my senior year in college.  It was a much more pleasant experience than the sessions I had in college.  I had to go back then because I went crazy.  It was the first semester of my last year in college.  I got a B on one of my tests.  This incident caused a lot of anxiety and fear in me because I translated the grade of the test to a bad grade for the class.  This would in turn translate into having a bad g.p.a. and difficulty finding a job after graduation.  I know.  Irrational.  I started crying daily mid-semester.  Then insomnia came.  Everyday I could not fall asleep until 7am and I had to get up at 9am to go to class. I was completely lonely and miserable because many friends didn’t know what to do with me and avoided me.  Finally, I had to go see a therapist to discuss the possible reason(s) behind all the crying and insomnia.  It was such a long time ago that I don’t remember details.  But I remember feeling like it wasn’t helpful.  I was still having a hard time sleeping and was still crying every single day.  I wonder if it had to do with her being a student intern.

With that experience in mind, I didn’t know what to expect this time.  I used a door code to get into the building.  When I got in, I saw a bench and a few chairs with a round glass table in the corner.  There were business cards of all the independent therapists who practice there.  I chose the chair closest to the glass table and read over every single card.  There were two ladies who sat next to me on each side and they were quietly waiting for their appointments.  Down the hallway there were quite a few rooms without any signs or markings.  Down on the floor in front of each room was a white noise machine that was turned on.

My therapist came to greet me.  She looked exactly how I envisioned her since I had seen her online profile picture on her website.  On our phone intake she told me that she just turned 40 last year, so she said she kind of understands how I feel to have reached this milestone.  Somehow I feel better that she is around my age.  I got to say that she looks very good for being 41.  I signed a few consent forms and filled out an infertility questionnaire on which I had to answer yes, no, or maybe for each statement.  Something like… “Infertility is affecting my sex life” or “I feel that I will never be able to get pregnant”.  I went with my first instinct when I answered each question.  Many of them I had “maybe”.  The therapist looked it over and said, “You seem to be doing quite well emotionally.”

We went on to talk about how I have been coping with infertility.  I honestly feel that I am doing better than the first year of trying to conceive.  That was the toughest because we were struggling with not having a clear answer as to why we weren’t getting pregnant, the possible loss of natural conception, and the fear of investing our time, effort, and money in IVF, something that was so foreign to us.  Plus I hadn’t accepted that I was indeed infertile and the best technology may not be able to help us.  I was jealous of others.  I was feeling fearful, lonely, crazy, uncertain, mournful, and sad.  Fast forward to the present time.  I am feeling and doing so much better with my emotions.  So I talked about my daily prayers for peace, calm, wisdom, patience, and submission to God.  It felt a little funny to talk about that to my therapist (assuming that she does not share my belief) but I needed to share about it because God and my prayers to Him really help with my coping.

I had talked to the therapist about the confusion in my head about the next step.  She asked me how I was doing with the decision making.  This is what I told her.  I find myself working on all the pre-cycle prep work for UCSF.  I have not even contacted L.ife IVF to schedule for a financial consultation.  Instead, I have been working to get my lab work done, signing all the necessary forms, scanning and emailing previous blood test and exams to the coordinator, and trying to order this antibiotics that UCSF recommends for the both of us before we cycle there.  But I still haven’t made my final decision yet.  I don’t want to make a decision that I will regret, so I am stalling and trying to make sure that our decision will be the best one for us.  I am stumbling on what IS the best for us.

I think what I get hung up on is whether or not UCSF is the best for my situation.  I still get stressed out when I think about all the logistics I have to deal with if we go the L.ife route.  All the outside monitoring appointments, making sure that the scan and blood work results are faxed over to Irvine before 11am.  Chasing down someone at L.ife to answer any questions I may have.  Getting the doctor’s order a day AFTER the scan because I will be an out-of-town patient.  Buying a plane ticket last minute.  Booking a rental car and hotel last minute.  Canceling clients last minute.  Worrying about premature ovulation prior to egg retrieval.  If we do this once, I think I can handle it.  But we’re talking about banking every month.  I am just not so sure if I really want to do it.   But L.ife does have its perks.  It seems to have a great lab for growing embryos to the blastocyst stage.  Not saying that UCSF does not have a great lab.  Given the conflicting information from Dr. No Nonsense and Dr. Y at L.ife about day 3 embryos vs. blastocysts for women with diminished ovarian reserve, I just don’t know who to believe.

My biggest questions:

1) Am I putting my cycles in jeopardy if I don’t grow my embryo(s) to blastocyst?  On the flip side, am I putting my cycles in jeopardy by growing my embryo(s) to blastocyst?

2) Am I not trying the best that I can if I stay locally for my cycles?  On the flip side, am I doing myself the best service if I put myself through the stress of cycling out of town for months?

3) Will I regret staying locally if the end result is no pregnancy with my own eggs?

My therapist made a few points that became my Ah Ha moments.

She said that it seems like I am someone who is pretty much in my head.  I gather a lot of information in my head.  Sometimes too much information and thinking a lot about it may not be the best.

I said that I see all these people on forums flying to Li.fe and banking embryos one cycle after another.  I feel weak if I don’t go the same route.

She said that after talking to me for an hour, she would not associate me with the word “weak”.  If anything, she thinks that I am strong.  Since I have been taking the more difficult route of cycling with an RE one hour away, maybe this is the time for me to just take it a little bit easy and walk down the street from work.  She said that although it has been proven that stress does not affect pregnancy rate, having a choice to cycle close by definitely will keep my psychological wellbeing in check.  Other women fly to L.ife to bank because they don’t have other choices.  But I do.

She said that human beings are very prone to be hard on themselves.  From what I have told her, she sees that I am being hard on myself.

She also said that it seemed like I might have made a decision already.  I just hadn’t acknowledged it or hadn’t realized it yet.

She asked me if I think about the next step and worry about it throughout the day.  I do, but not when I am very busy at work.  She discussed a technique with me to contain these thoughts to a scheduled time.  She wants me to schedule a time in the evening to think or worry about things related to the next steps.  Throughout the day, if I have thoughts, feelings, or questions about it, I am to do the following acronym STOP:

Stop (Take a step back from what’s happening)

Take a breath (Slow down)

Observe (Observe thoughts and feelings, physical sensations, what’s happening)

Proceed (Let it go, laugh, do something different)

Whatever questions, feelings, or thoughts I have filed away, I bring them back up to surface at my scheduled time at night.

This is to help me to react to a stressful event by having a calm and conscious response rather than an automatic reaction (such as anger, frustration, panic, worry, negative thoughts).  If I worry too much about the past (I should have) or the future (What if…), then I am not living in the present.  She asked if I had any regrets.  I said… Yes.  If I didn’t proceed with my last cycle, then I would have enough  money to do two more mini cycles at UCSF.

She also gave me a self-care plan to cope with this.  It’s a list of ten things.  One thing that stands out is having a calming mantra that works for me.  I am still trying to find one that fits me.  One of them is “I am doing everything I can to become pregnant”.  I  may just use this one.

I enjoyed the hour that I spent with her.  The things I told her were things that I had been telling my husband and my friends.  But having her insight was actually more helpful.  I have to remember not to be too hard on myself, that I am doing everything I can do get pregnant, that I may be thinking too much, and that not going to SoCal to cycle does not equate being weak.

I am going back to see her at the same time on the same day next week.  I think it’ll help me solidify our plan for the next steps.

More Consultations

Cell phone reception was nonexistent in certain parts of the mountains when we were in Denver.  It said “no service” the whole duration driving out of Estes Park.  You can imagine how shocked I was when my phone suddenly rang.  It was a San Francisco number that I didn’t recognize.  I looked at Bob and asked if I should pick it up.  He said of course.  I am so glad that I did.  It was UCSF calling me to let me know that there was an opening on Monday (6/30) for the consultation that was originally scheduled for July 17th.  My first reaction was that I didn’t have access to my work calendar so I couldn’t say for sure if I could take that spot.  I hung up and Bob looked at me funny.  He said, Can’t you just call work and ask?  Duh.  Sometimes my brain doesn’t function.  So I called work and was pleasantly surprised that my schedule was clear for the available time slot at UCSF.  I tried to call the number from the previous caller ID but was being passed around in the automated phone system.  I finally hung up, looked up the reproductive health clinic’s phone number (thank goodness for cell phone reception), and happily connected with the clinic and snatched up the opening.  I was very relieved to have the appointment move up to Monday as Bob didn’t start his new job until Tuesday.  It was nice to have him around when we met the doctor.

So the whole reason why I scheduled a consultation was because I chatted with a lady who also frequents the High FSH forum that I visit.  We talked about six months ago and she shared all of her experiences with me cycling at UCSF.  She has been banking her day 2 embryos for many cycles and recently started transferring.  The cost of each minimal stimulation cycle is about $6500, a lot more affordable than going back to my own RE.  Since UCSF is so close to my work, I figured I should really speak with Dr. No Nonsense before I make a decision.

Yup I am naming this doctor Dr. No Nonsense.  He was gentle and kind, but was also direct and non nonsense.  His intern went over the history with us first and I felt that I was being quizzed.  Good thing I remembered most of the details of our cycles.  Then Dr. No Nonsense went through the history with us again.  He did an ultrasound and found that there was one antral follicle on the right ovary and possibly two antral follicles on the left.  When we finished, we had a talk about the next steps.

He drew a diagram for us.

photo (30)

Given our history of not getting pregnant naturally, IVF is of course the best way to achieve fertilization.  However, given the low egg reserve, we may not encounter a normal egg for quite a few cycles.  The first thing he wrote on the paper was the words “Egg Donation”.  His point was, if we only had a limited amount of money enough just for one thing, he would recommend egg donations.  He looked up and looked me in my eyes.  He said, “I don’t feel that you’re quite done with your own eggs, right?”  He knew that I only had one transfer.  He could sense that I couldn’t really say that I have done everything that I could until I finish doing a few more transfers with my own eggs.  So, if we had some money to spare, then he would support us trying to use my own eggs first.  He drew the graph of number of eggs and age.  We are fighting the battle of trying to find that elusive good egg.

This is the route he’s suggestion:

  • Do minimal stimulation cycles
  • Use Letrozole (Femara) from CD2 to CD6
  • He may add Cetrotide/Ganirelix depending on the cycle
  • ICSI all the eggs that we have
  • We may get no embryos, one embryo, or two embryo each cycle
  • We can decide to transfer each cycle
  • We can also decide to bank the embryo(s) at day two or day three
  • Banking embryos will allow us not to have the emotional effect of the two-week wait every single cycle
  • He doesn’t suggest growing the embryo(s) out to day five or six due to the low number of eggs.  He thinks when we don’t have many to play with, each one counts
  • He believes that a good egg can be stressed out too much and not grow to day five in the culture, but can survive in the womb
  • Day 2 or day 3 embryos’ thaw rate is over 90%
  • He thinks that my uterus should be fine with transfer because the fibroids that I currently have are in the posterior position of my uterus and not in the cavity

Did I tell you that this clinic is three blocks away from work?  So convenience is a huge plus for me.  I received the fee schedule in the last couple of days and found that each cycle of mini-IVF with UCSF IS about $6500, which is a fraction of the cost going to my current RE.  Medication will not be much because of the low dose stimulation.  The only downside is that this is a big clinic so I will not be seeing the same doctor for any of the monitoring ultrasound or egg retrieval.  This clinic has over eight REs.  Dr. No Nonsense will be managing my cycles though as he will be the one making the decisions for me and with me.

I feel very comfortable with this doctor as I felt the compassion and warmth from him.  It’s very different from some of the online reviews I have read about his bedside manner.  I like him and I think I can work with him.

Fast forward to this past Wednesday.  I rushed home to be available for the scheduled 5:30pm phone consultation with Dr. Y down in Southern California.  Phone did not ring once for another 25 minutes.  I called the Li.fe IVF phone number. Fortunately someone picked up.  I was told that Dr. Y was still talking to another patient.  My phone didn’t ring until 6:30, a whole hour after the scheduled appointment.  I don’t know if I should be worried if that is an indication of their future performance, stressing me out with a doctor that does not respect other people’s time.

We were on the phone for half an hour.  I felt that I was driving most of the conversation, as I asked him many questions.  The following are the highlights:

  • Given my history of having one embryo or no embryos each cycle as well as a history of endometriosis, he suggested doing natural IVF (no stimulation) or minimally using just half of a pill of Clomid (25mg).
  • (A little patch of endometriosis was discovered during my surgery to remove uterine fibroids.  I don’t know if that is enough to say that my endometriosis is messing up my system)
  • I asked him why he uses Clomid and not Femara, he said that Clomid has the function of blocking the estrogen receptors.  Somehow that helps with preventing premature ovulation.  He said that Femara doesn’t help with that.
  • Since we’ll be banking embryos rather than doing fresh transfers, we don’t have to worry about the effect of Clomid on thinning the lining
  • He also doesn’t think using Clomid will make my FSH go higher in subsequent cycles
  • He believes in growing embryos to blastocysts.  He doesn’t believe that an embryo that doesn’t grow to day five can survive in the uterus if transferred on day three (an opposite view of Dr. No Nonsense)
  • He thinks that at my age, I would need at least 4 blastocysts if not more to have a chance at having a life birth
  • He recommends doing PGS on the embryos (which we have decided not to do a long time ago)
  • The blastocyst rate at his clinic for patients my age is 50%
  • He suggests that I do six cycles
  • He said that we can start planning the travel when the follicle(s) reaches 14 to 18 mm
  • He doesn’t suggest using Cetrotide/Ganirelix but he does suggest using trigger shot

Those are the points.

So now I have a decision to make.

Egg donation vs. own eggs?

Most likely we’ll try my own eggs first since Bob started his new job and we can start saving up money again for donor egg cycles if my own eggs don’t work in a few months to a year.  My uterus is not going to grow old as fast as my ovaries.  So if my own eggs don’t work, my uterus hopefully is still in good shape.

With my own eggs, SoCal or local?

That’s the biggest question.  I have no gut feeling.  I just feel that there is a huge dilemma in my heart.

In terms of cost, both places are about similar.

In terms of expertise in minimal stimulation, Dr. Y is no doubt the one to go to.  He does this day in and day out with many many many patients.  He’s been doing this for a few years and this is all he does.  Dr. No Nonsense started doing this a couple of years ago and also does IUI as well as conventional IVF.  Dr. Y may know more about how to tweak the protocol for each individual in terms of FSH level, estradiol level, and the state of the ovaries.  Dr. No Nonsense may do a one size fits all model.

In terms of day 2 embryos vs. blastocyst, it appears that there is a higher chance for transfer if we bank day two embryos.  But does having a chance to transfer mean a chance for a baby?  Or is the chance for a baby higher if we can make blastocysts?  For this point, I don’t know which doctor I should believe.

In terms of convenience, UCSF wins.  I cringe every time I think about having to schedule and go to outside monitoring appointments, coordinating with L.ife for their instructions after each scan/blood draw, keeping a watchful eye on my follicles so that I don’t ovulate before the retrieval, timing the travel and booking plane tickets for the right date, booking hotel and car rental, letting clients know last minute that I will be traveling, and traveling/making it to the appointment.  Those are the things we have to do.  And I cringe.

I am at a crossroad.  Can you feel that I have lost my sense of direction?  It’s compounded by cycle day one today, AF showing up, and the feeling of inadequacy as a woman who cannot bring a life into this world in the most natural way.

This is a lonely road.  I know Bob is traveling it with me.  I know that God is there for me.  I know that many of you are out there rooting for me.  But it’s still a lonely and scary road.  I know that once I make a decision, I will be much better.  But at this moment, I am overwhelmed.

Maybe I’ll go hide under a blanket for a little while.

Thumbs up? Or thumbs down?

Bob and I feel that we have grown a whole lot individually and as a couple in the last couple of days.  This has been such a huge emotional roller coaster ride.  I do not wish this upon anyone.  Infertility sucks.

Dr. E called on Friday to let us know that one of the embryos had been growing better than the other two.  In other words, the other two weren’t doing well.  That one good embryo was a grade one, two-cell embryo, which was where it should have been at on day two.  She said she’d update us the morning of transfer on day three.  Needless to say, I was happy that we had one good one but was a bit bumped about the other two.  One thing I helped myself to be sane was NOT to consult with Dr. Google.  I decided to be an ostrich and buried my head in the sand.  I didn’t look up any information online and just proceeded to have a very good rest of the day.

Saturday was supposed to be transfer day.  We were getting ready to go to my pre-transfer acupuncture session at 8:30 when Dr. E called.  Unfortunately my phone had been acting up lately and her phone call went straight to voice mail.  She emailed me for me to give her a call.  It can’t be a good thing when your own RE wants to talk to you right before transfer, right?  When I called her back, she was about to begin a retrieval.  She promised to call us back after the procedure was done.  My heart was pounding so hard.  I was trying to guess what the news would be.  On our way to acupuncture, she called us back and said we have to discuss how the embryos were doing.

Here is the gist of it: the one good grade-one embryo was still a grade-one.  However, it was a four-cell embryo rather than at five- to six-cell.  Dr. E said that she had one patient with a pregnancy resulting from a four-cell embryo with a day-three transfer eight years ago.  In other words, it’s very rare.  It’s not impossible, but rare.  So the pregnancy success rate with a day-three four-cell embryo is low.  What we could also do was to wait until day five and see if the embryo turned into a blastocyst.  If it did, then the implantation and pregnancy rates would increase greatly.  However, since it was only a four-cell embryo on day three, the chances of it becoming a blastocyst would still be low, but not as low as getting pregnant with a four-cell embryo on day three.  Our job was to make a decision two hours before the scheduled transfer and let her know.  She also mentioned that the lab we are using is very good with culture so the embryo being cultured at the lab will be as good as being in my uterus.  She said that letting it grow to day five will give us a lot of diagnostic information for the next round if it doesn’t work for this round.

One of the other two embryos decided to join in the race and turned into a two-cell embryo on day three.  Dr. E said that miracles do happen but we probably wouldn’t think too much about this one embryo.

My first instinct was to let the four-cell embryo grow to day five.  Bob’s first instinct was to put it back and see what happened.  There were so many what-ifs.  We had to go into my acupuncturist’s practice, apologize for being late, talk to her, talk with each other, and go out to pray.  We prayed and talked some more.  It was almost the toughest decision that we had to make when all of our hopes and dreams for this cycle are riding on this one tiny embryo.

I had been trying to be strong in this whole journey since things were going quite well for us.  I finally couldn’t hold my tears and cried like a baby.  Why does it have to be so hard?  Why couldn’t we just have a couple of embryos that looked fine so that we could put them back?  Why did we have to struggle with a decision that could mean baby or no baby?

Bob wanted to give the embryo a chance in my uterus instead of letting it die in the lab.  We decided to go ahead with the transfer.  I went inside to get my acupuncture done while he called Dr. E.  A couple of minutes later, Bob knocked on the door and said that Dr. E wanted to chat with me.

Lying on the acupuncture table, tears streamed down my eyes and soaked my ears.  Dr. E wanted to protect me physically and emotionally for the next two weeks.  If we did the transfer and got a BFN in two weeks, the physical and emotional toll on me would be great.  She called this IVF naivete and that we would make a very different decision if we had done a few rounds of IVF already.  If we still decided to transfer today, she would be 100% supportive of our decision.  Dr. E’s words, expertise, and my trust in her helped us decide to let the embryo grow until day five.

In a matter of days, we went from three embryos to potentially none.

While I was in the acupuncture session, Bob chatted with Dr. E about the embryos and all the implications.  The lab normally doesn’t give an update on the embryos on day four but Dr. E would request for one and let us know how they are doing.

The rest of the day was fine.  Bob and I picked ourselves up, went and enjoyed a very good day together.  Sitting in front of the ocean in our car, we talked about our hopes and dreams, what we had to go through to make a baby, and how to trust that God would provide.  My mind has already gone to plan B, C, and D.  Even the words “donor eggs” came across my mind.

Bob kept on joking that at four-day old, his offspring is already like him, being very slow in growing and taking its sweet time.  Got to appreciate a funny husband at times like these.

With a few more tear drops last night, I went to bed thanking God for giving us a great RE.  I prayed for a healthy embryo and for God’s will to be done.  I woke up this morning feeling refreshed.  Bob usually has his phone on mute.  At 8:45, he went and picked up his phone and just happened to see that a call was coming in.  It was Dr. E calling bright and early in the morning!  When I knew it was her, all my muscles started tensing up and I buried my head in the comforter.  I could hear a bit of what she was saying to Bob.  Once I heard the words “great news”, I jumped up and looked at Bob.  He put the phone on speaker so we both could hear the news.  The four-cell embryo yesterday decided to do a bit of a catch up and it is now a very good looking morula!  Apparently the morula stage is where it is supposed to be on day four right before it turns into a blastocyst on day five!  Wow it went from a four-cell to a morula in a matter of one day?!?  Dr. E said that there is a 95% of chance that it will turn into a blastocyst tomorrow!  Talk about a major turn of events.  We went from a 5% chance of it turning into a blastocyst to 95%!  The other embryo also turned from a two-cell to an eight-cell embryo.   It’s a grade-three so quality isn’t as good.  We don’t know what will happen to it.  We’ll just have to wait and see.

Dr. E told us to get ready for our transfer at 10:15am tomorrow, five days after our egg retrieval.

We went from a high five, to an okay, and now maybe one thumb or two thumbs.  Will it be a thumbs up or thumbs down?  Only God knows.  🙂  I can’t wait to see what the future holds.