Lilypie - Pregnancy

Friday, October 23, 2009

Follow-up

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.

15 comments:

  1. After reading this post, I think most people will agree that switching clinics is a good idea. It doesn't sound like they are really working in the best interest of the patient - you! Definitely look for a place that does more monitoring and earlier than day 8 or 9 of stims as well as bloodwork with it. I wasn't worried about HOM either so if we would have had 5 follicles, I probably would have done an IUI (although my dr. wouldn't let us). Good luck on Sunday! I hope the ultrasound gives you enough to make a decision.

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  2. After everything you've laid out here, it seems like switching to and IUI makes sense. That way, if you do get a BFN, you'll at least have the option to switch to another clinic without losing so much money. I'm so sorry it isn't going as smoothly as you hoped :(. Hopefully Sunday's u/s will make it clearer what decision you need to make!

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  3. Hey babe, haven't commented for a while but am still lurking.

    The IUI option is jumping out at me to be honest. Because at least, then you have a shot at SOMETHING and you get your money back. Then you get to choose another clinic.
    Don't rule out IUI as not working - I know that it hasn't worked out for you in the past but it might this time. Never say never, stranger things have happened. I know a blogger who did an IUI after several IVF's and didn't think it would work and now has twins. It can happen.

    If you go ahead with the IVF, there is no guarantee that those 5 eggs will all be good quality. There is usually a percentage that die off, whether you get 30 eggs or 3. But I think the only good thing about going ahead with the IVF will be to see if you do have any egg quality issues. They may all be excellent, again, you never know.

    I'm sorry that you're in this shitty position babes. I hope that you can come to a decision that you are both happy with!
    Sue xx

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  4. Such decisions to make! I am on the IUI side and switch clinics if a BFN.....but on the positive side, this last cycle I had five follies....intitially pregnant with twins but lost one to disappearing twin, and am currently almost 23 weeks witha little girl....so 5 worked for me :)

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  5. Sorry to hear this is so hard! I understand how you feel about the IUIs being BFN. We have done 5 and all were BFN, so I would be hesitant about it too. With that being said, you never know. However, it sounds like a new clinic with more attention and personalization is needed. At least, with IUI you would be able to take that money back and put it where they were going to really look after you. I know it is a hard decision. Good luck on Sunday.

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  6. Totally understand the shell-shocked postings. This isn't a fun or easy process. Like the others, I would lean towards the IUI. Of course, whatever you decide will be what is best for you. Thinking of you.

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  7. Oh hon... First and foremost, sending you lots of ((hugs)). I wish there was a magic wand that could make all of this stress and nonsense away.

    After reading this post, I agree that it looks like IUI is the best option at this point. It still give you a shot at a bfp, but you get most of your money back if it doesn't. Then run screaming away from that clinic! Seriously, most doctors have somewhere online that you can post a review of their service... I would put your experience out there so that future patients can be equipped with the most info possible.

    I hope that your u/s on sunday will make your decision easier.

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  8. So sorry for all this frustration. If you are serious about changing clinics after this cycle, then I would go for hte IUI and get most of your money back. If this IVF is not successful, you're going to feel obligated to continue with this clinic b/c you bought the package deal. That will just lead to more frustration.

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  9. I'm on the IUI side as well. I had 5 follicles last month for my IUI and I got a BFN. I was very worried about the possibilities of multiples because the impact of more than twins is pretty huge, but figured that when you look at the stats, it wasn't that big of a risk. Good luck with whatever you decide.

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  10. Hi, I found your site on cyclesista, and just wanted to say your situation is my worry for our IVF prospects. (we are giving IUI a couple more shots first) but then we will go to IVF. I have been following your story and think you definitely need to switch clinics, these people sound like they aren't taking your concerns seriously and aren't customizing your care. If there is one thing about IF we all know is that no ones cycles are the same... I would do an IUI and then get a refund for the IVF, and enjoy yourself in Italy!

    I have nominated you for Kreativ Blog Award, please see my post at http://conceptionallyspeaking.wordpress.com/.

    Best of luck in your decision, I hope you can have some one on one time with your doctor.

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  11. Oh, I'm so sorry it's working out this way. I'm shocked they do so little monitoring! I think you should go with the IUI. Get your money back, and find a new clinic.

    Although I wish they would've discussed it with you first, I like the idea of half ICSI and half natural fertilization. It would be nice to have those answers.

    Let us know what you decide!

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  12. To help choose a better cycle, check their statistics on sart.org or on the cdc site.

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  13. ugh! i'm just catching up on what has been going on with you. i am so sorry. i know 5 follies seems very disappointing, but i have read many blogs of ladies who are upset by a low number of eggs and end up pregnant. i'm guessing you were only going to transfer 2 or 3? however, i totally understand not wanting to take a $14000 risk on 5 eggs. moving on to an IUI seems like a reasonable option, especially since you are feeling negative vibes from the whole experience with this clinic.

    whatever you decide, i hope it works out. we in blogland are all hoping for you!

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  14. My opinion is to switch to IUI and take your money and run. While I agree that IVF will probably lead to more conclusions about what the problem actually is...it doesn't sound like this clinic is the place for you. And, what that in mind, they may not even give you an answer that you can understand or live with. I received the same info from 2 clinics - at one place, it made me want to jump off a bridge. At the 2nd place, while, it still broke my heart, it was communicated in such a way that we could live with. Does that make sense?

    I'm so sorry that you are having to go through this. I'll still pray for a BFP no matter what you choose!

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  15. I'm sorry I'm late to your post and I'm sorry to hear that they want to convert your cycle to an IUI. That EXACT scenario happened to me, except I only had 3 follicles. And it was IUI#4 for me too and I scoffed when they gave me the speech about multiples. But don't count yourself out yet. Injectables are different than clomid. You have 5 eggs vs. 1-2. Your body has been controlled by drugs and will continue to be (most likely they'll tell you to go on progesterone suppositories and if not then ask them for it). You just don't know what will happen. IVF#0.5/IUI#4 turned out to be the biggest surprise of my life. Don't lose hope!

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Thanks for sharing your thoughts!