I was so shell-shocked yesterday that I just spewed what I was thinking onto the computer screen and hit post. Today I'm still shell-shocked so it's probably not going to get much better, but I want to at least answer some of the questions and try to organize my thoughts.
1. My clinic does not do any monitoring until the 9th day of stims, and then they do one ultrasound to check on follicles, and one follow-up ultrasound if things need more time. And that's the total monitoring for an IVF cycle for everyone. No bloodwork at all. This is their standard operating procedure and they do not personalize it, at least for IVF #1. Since it is a package deal, extra monitoring would cost them money.
2. We have to decide what to do on Sunday, when we go in for the next ultrasound. Maybe our choice will be clear - we'll have a few more follicles (the dr. didn't think so), or a few less. Having five is sort of crappy, because it's borderline.
3. Everyone in blogland seems worried about multiples, while my husband and I are actually pretty convinced that the only realistic result of an IUI is a BFN. Given our two years of trying with four prior medicated cycles and never a hint of a BFP, I sincerely doubt that our chances of high-order multiples are anything other than 0.000000001%. I don't think our chances of even a singleton pregnancy are much higher than that.
4. The doctor has pretty much offered us our money back if we switch to an IUI. If we do the IVF, I don't know if we can switch our payment option from the 2-cycle option to the 1-cycle option. Even if we can, and we do IVF and then leave this clinic after this fiasco, we'll be spending about $11,000 for an IVF cycle that could have possibly been saved if the RE had just monitored me a few days earlier.
5. We're going to Italy for Christmas, which means we won't be able to start a new IVF cycle until at least January. Given that we already put this cycle off for several months until after knee surgery, that really sucks. I am 31, which isn't THAT old, but I'm not getting any younger.
6. One thing I don't like about my clinic is that for IVF, they get everyone on the same calendar and run the whole thing like an assembly line. They like to talk about how everything is personalized, but the further I go, the more I realize that it's actually very standardized, and it's standardized to make it easy for them, not to benefit the patients. I'm not ok with that.
7. ICSI - apparently, the doctor had decided that since we don't know what's wrong and why we can't "achieve pregnancy", it would be a good idea to ICSI half of my eggs and let the other half fertilize naturally to see if the problem lies with fertilization. It would have been nice for her to tell us about it before we were instructed about paying for it, yes. Now that we only have 5 eggs, if we do go ahead with IVF, I'm not sure if it would be a good idea to throw more money at this situation and do ICSI anyway. Would it be throwing good money after bad? Or would it be paying a fee to raise our chances enough to make the whole thing worthwhile? It would make our total cost for this cycle, including ICSI and meds, about $12,500.
8. There are other clinics in the area, especially in Sacramento where I work, but not in the town where we live. Which means my husband will have to take a lot of time off work for appointments instead of me, and it's a lot easier for me to take time off. Also, I'm no longer sure about how to choose a good clinic. And at this point, I want to feel confident in my clinic.
9. I've been dreading PIO, but I always thought it was worth it to have a good chance at getting pregnant. I'm not so sure it's worth it just for a shot-in-the-dark hail Mary. If we do IUI, I skip the PIO completely and if we get pregnant, that's a lot of injections I don't have to do. On the other hand, if we do IVF and we don't make it to transfer, I at least don't have to keep taking the shots, and if we do make it to transfer, then it might be worth it in the long run.
10. We paid for a package deal - one IVF, up to six FETs until frozen embies are gone, and then another IVF (in that order). If we continue with this, we probably won't have any frozen embies, and we'll have to move straight into IVF #2. If THAT doesn't work, we'll be paying for future FETs, which seems stupid. The package deal seems great if you have a good response during the first cycle and you just fall on the wrong side of statistics with a BFN, because then you have plenty of back-up options. If you have a poor response during the first cycle, the back-ups aren't really back-ups anymore - you've just wasted a lot of money.
11. Since we have so few follicles/eggs, does that mean that our eggs are probably of higher quality? I don't know. Should I ask the RE? Should I trust her answer?
Here are my thoughts now:
IUI - In my opinion, the most likely outcome is a BFN, but we'll get our $14,400 (minus the IUI fees). We'll have had a learning experience, and we have time to look for another clinic. I'm really not worried about high-order multiples. I'll also spare myself the PIO completely, including if a mircale happens and I do get PG. It would be nice to spend a first trimester without a daily shot in the ass.
IVF - We'll spend a lot of money and our chances are still pretty low. I'll have to do PIO, but see #9 above - if we get to transfer, it'll be worth it, if we don't I can stop. We might learn something about our infertility - then again, we might not. We might end up with nothing at all (no eggs, or no fertilized eggs, or no embryos) and wonder if an IUI might have worked out after all.
Clinics - I think we'll switch clinics after this, no matter what. It's just a matter of how to salvage this cycle at this point.
This is torture. I can't believe I'm in this situation. I can't believe it's been almost two years since we started ttc and we are in the same damn place, except now we're older and we've been through a lot of shit and we have nothing to show for it. I can't believe this is happening. I hope I wake up tomorrow morning and it was all a big joke.