Thursday, August 12, 2010

What a difference an appointment makes

I have so much to tell you, I don't know where to begin or if I will remember everything. And I apologize in advance for how long this is. But let me just start by saying how humbled I am by the grace of our RE AND our God...

Our follow up appointment with our RE began somber. I was tense and emotional, and as he began by saying how sorry he was, how hard he knows all of this is, and how hopeful he still is for us I fought back tears.

He said from a medical standpoint, he sees no reason to stop treatments. He pointed out (for the 100th time in the last year) that I am "young and healthy." He even joked that he knows he has said that to us a lot, so if we get annoyed we can tell him to stop. But who doesn't like to hear how young and healthy they are (even if you start to wonder if it even matters after three IVF BFNs...)? Testing wise, he wants another SA since we haven't done one in awhile, and we discussed a possible laparatomy to remove a fibroid that he has been on the fence about. However, he ended up doing an extensive ultrasound and said he really does not think it is effecting the uterine lining at all, and does not recommend surgery.

I asked about many of the tests you ladies suggested.
  • S.perm DNA Fragmentation: In his opinion, this is a useful test if we would consider donor s.perm if the results came back poor, although more recent studies have shown that even men who had very poor test results still fathered children through IVF (although at a lower rate). He also pointed out that the only potential "treatments" for this are a varicocele repair surgery (which we have already done), a testicular biopsy to extract "less fragmented" s.perm (but he says this is very invasive, painful, and controversial), and an antioxidant vitamin therapy. He suggested that DH simply start taking the vitamins "in case" it would help, and gave us a list of vitamins to include.
  • Immunological testing: Our RE was very opinionated about this. :) He said it is a very controversial topic in the medical field, but he has done extensive research on it and does not believe it really effects the outcome of IVF cycles. He also said the testing is expensive, and often times women will test negative but will be told to still do the medications that treat the immunological issues "just in case." He showed me three articles on the topic (one of which he wrote), and told me if I am ever at another practice and they want to do the testing, to ask if I could just take the medicine without the testing. :)
  • RPL blood work & endometrial biopsy: He does not see these as necessary in my case.
The bottom line is he says his hands are "a little tied" by the fact that we are limiting fertilization, and we just can't know which eggs are the best. He specifically described our last fresh cycle, and how he and the embryologist teamed up to try to determine the "best" eggs. Normally he simply retrieves all of them in no special order, but in our case he picked the three largest follicles and had the embryologist examine those. Once they determined there were eggs in those follicles, he had her set those aside to be the ones fertilized. However, as they retrieved the rest the embryologist discovered that some of the smaller ones actually looked like better quality eggs. It was interesting to hear, and I think the point of the story was that they were trying to do what they can to "pick" the best, but they really can't tell by looking at the eggs or follicles which ones those will be.

We knew this going into our IVF cycles, and we knew we were limiting the potential success somewhat by fertilizing only a few eggs. But I think discussing it in this way reminded us that it *may* just take a few more tries to find the golden egg and s.perm combo. There is no way of knowing that, but at least we felt a little encouraged in our efforts to try again.

Our RE then asked us what we are thinking about future attempts. He said he knows this is emotionally difficult and very expensive, and he wants to do what he can to work with us. We told him we had enough saved for one more cycle - and we had imagined this would be a fresh cycle - and then we would be done.

And this is where I was floored. And amazed. And left wondering if this was God's provision - God opening a door?

The RE said that he is going to seriously work with us to reduce the cost of this cycle. No ICSI charge. Reduced lab fees. No doctor's fee. A nurse will see how much Follistim she can track down for us. And he said he wants to work with us either until we have a baby or we are emotionally ready to stop trying, even if that means free IVF. Probably some of you reading this do not believe that what I just wrote is true - I know it is crazy. And I honestly don't know if that was a figure of speech to express how extensively he will work with us, but all I know is that DH and I felt so incredibly humbled that he would do this for us. We have done nothing at all to deserve such a gift...in fact, we almost feel like we don't deserve it more than an average couple because we are actually making his job HARDER by limiting fertilization. It would be perfectly reasonable to us if he charged us full price (his prices are fair to begin with and we can't expect a discount), or, worst case, he decided he couldn't work with us anymore. But, instead, he is offering to work with the resources we have to do what he can to help us get pregnant. DH & I both felt incredibly thankful, and inadequately attempted to express our appreciation.

He said, "I know it sounds Pollyanna, but I have established my practice. At this point in my career, I just want to get as many people pregnant as possible."

The plan for next cycle: Same protocol (Antagonist). Full stim to retrieve as many eggs as possible for freezing. Start stims for sure on cycle day 2. Possibly fertilize 4 eggs this time (DH & I still need to prayerfully consider this - but with our history we feel the possibility of all 4 fertilizing/ developing/ becoming babies is low, and the RE said even if all 4 did he would be willing to transfer them). If we fertilize 4, do a 5 day transfer.

As we waited for the RE to do the ultrasound, DH looked at me and started laughing. He said I looked so happy now, and it was quite a contrast to the last week and a half. I almost felt guilty for feeling happy - I do not want to place my hope or emotional state on the roller coaster of IF treatments or the encouragements of a doctor. But I was happy. Ironically, DH felt more angst after the appointment. I think he wants to see this as a black and white issue in our lives (3 cycles and we're done), but suddenly it is becoming much more fluid (already it's 3 fresh cycles PLUS a frozen...and now the RE is alleviating our financial concerns....could there be more cycles?).

As we drove home, DH was very quiet. Eventually he said he has been praying, and that, for now, he thinks we should move forward with one more fresh cycle as per the original plan. But he said as he thought about "the plan," he knew the line was indeed determined by finances....so perhaps if that is taken out of the equation he doesn't necessarily know when we will stop. We don't know exactly how the money part of this next cycle (or two? or three?) will work out, but he said that once we spend the money we have left and the RE does not want to "work with us," we will be done. This seems reasonable.

Of course, we are hoping there will only be ONE more attempt, and all of these questions about money and where the end point is will be a moot point. As difficult as it was to face the end of IF treatments, it is also strangely difficult that the ending has become so blurry (especially for DH). Will we have a point when when we simply "know" we are done? Will God lead us to a new and different path to build our family even if we *could* do another IVF? I feel like there is a slightly different dimension of trusting God in our new position. And I have honestly {and happily} been shaken up by this new development....God knew we would have 3 failures. God also knew we would have this conversation with the RE. I have wondered - if God wanted us to conceive, why didn't he do it within the parameter of three fresh cycles that we had prayerfully decided? If God doesn't want us to conceive, why is opening this door to potentially try more times than expected? I am humbled and amazed at how this has reminded me that God is working. Even if we don't conceive, he has clearly created this unusual path for us for a purpose. This journey has become one that I would have never guessed or imagined, making it all the more apparent that God is leading it.

22 comments:

Andrea said...

Your RE sounds like a man with morals and convictions who takes his job of creating life very seriously. I believe he respects your stance on limited fertilization and sees it as being very responsible and committed to your faith. And, he wants to help you :)

I'm so happy that you got some reassurance and peace of mind. We will all be rallying you on and praying like mad for you.

Do you believe that God sends us signs? I've become a strong believer in that if we ask "him" to send us a sign he will. I see your sign in your Dr. offering to help you at reduced fees. Very few Dr's would do this and I'm happy you are in the hands of someone special :)

Many HUGS

Heather said...

Hillary-

I have been faithfully following your blog for awhile and aching right along with you. My DH and I are in your same situation, we are getting our eggs harvested Saturday morning, and we also are limiting the fertilization numbers. Please never back down from your convictions. I belieive that the Lord WILL honor our respect for human life. And not to create 28 embryos just so we have a better "number". I admire what you guys are doing, and am so excited to follow along in your journey. We are almost in the EXACT same situation. We also have had THREE BFNs from IVF, devastating each time. But I hav efaith that with all these tries, we both will hold our miracles one day.

Please know I am praying for you and excited to see what God really has in store for you and your hubby. I would appreciate prayers for me and my Sweetness as well and we embark on making our babies on Saturday.

Much love to you!!!
-Heather
http://sweetnessandme.blogspot.com

Mellow said...

What a wonderful blessing. :) God has this RE in your life for a reason. I pray that reason is a baby in your life very soon. I can see the hope in your post, it's nice to see that.

Melis.sa said...

wow! Your RE sounds amazing. I pray to God you guys get your BFP soon and all of these worries will come to a close.

Amanda said...

Your RE sounds awesome!!!!!!!

Why don't they fertilize all of the eggs they retrieve? I must have missed something here. I dont get it?

Rach said...

What an amazing appointment. I'm glad your RE is so willing to do what ever it takes. Very excited for your next cycle!

Amanda said...

I love your doctor.

andreajennine said...

What a wonderful report of a stunningly good appointment! It brings to mind the verse that says God is able to do more than we ask or imagine. Praying, praying, praying that you do get the desired result soon. And oh, I wish my leftover IVF meds weren't all expired! I'll double-check just in case...

Heather said...

I honestly believe God is opening this door for you and your husband to continue your TTC journey. I think that God will NEVER give you more than you can handle, and He has a plan and purpose for you guys! I honestly believe you and your DH will know when its time to stop treatments, you will find a peace and another door may open then.
Stay strong!!! You are meant to be a mother and it will happen!!! Contiinue to keep faith and confidence and God will guide your path...

Lindsey Is Waiting said...

That is so good! What a great reminder of how our God works in ways we never expect! I will be praying for you and your future baby(ies)!

Sara said...

First of all, your strength is amazing. You just look infertility in the face and take it head on.
Second, I am just amazed about your RE saying he would work on getting costs down, possibly a free IVF, etc. It is sooo refreshing to hear that there are still purely good people out there. Wow, he is freaking amazing. The fact that he admitted to you that he has already established his practice and just wants to get as many people pregnant as he can just proves that he is a person who really is concerned with bringing joy to people's lives. God certainly has blessed you and your husband with a special doctor.

Britney said...

Your optimism and joy just floats off the page. Just keep seeking God's face and He will guide your path. I'm so happy for you!

nobabyruth said...

Wow! What an amazing RE you have found!! He seems to really understand your wishes and his honesty is so wonderful. I wish you guys the best of luck and hope that you don't have to go beyond this next cycle!

Betty Rubble said...

HOW AMAZING!!!

ceecee867 said...

Your RE is "paying if forward".... I have this "gut" feeling that you and DH are gonna be Mom and Dad in 2011.... :)

Jessica R said...

Hillary - I have been reading for a long time now - I just had to post on this one :) What an incredible blessing from your RE. That man is an angel. I got tears in my eyes reading! I often wonder the same things you mentioned, for myself and for all of my sweet friends who are going through this. I feel that God has told me both in prayer and in action that He is working on me, and that He has a plan. Right now He is still forming me into the mother He wants me to be, and when He knows I'm ready, that's when it will happen. (Of course, I think I'm ready now!) You and I both know that when we wait on His timing, we find out after the fact that it was the best thing - but to say that waiting is nearly impossible is an understatement! Thank you for your incredible example of submitting to His will - trust me when I say that your story has made me want to be a better person!

cowgirltn said...

I don't know gods plan for your family or your path to parenthood but I do believe he saw your sadness. So he offered you an amazing amount of grace. He placed you with an RE that truly understands your struggles and wants you to have a family. I believe christ was sitting there in the US room as you smiled and he delighted in your joy. Keep having faith he will reveal your plan soon.

kdactyl said...

Awesome appointment. I love your RE!!!!! I can hear hope and optimism in your post and I know this alleviation of the looming "last chance" can only have good results for you.
kd

Leah said...

Sounds like a wonderful appointment and that you found the RE just right for you, and that must be such a gift.

Thinking of you as you move forward. :)

the baby baker said...

that's so awesome! lightness shines though darkness. i heart your RE. wishing you all the luck in the world this next cycle. hugs.

Hannah said...

So glad the appointment was so encouraging! Praying for you guys!
Hugs!

addingtothepack said...

Wow -- amazing RE! I wonder if he is encourage/inspired by your situation to try and improve the clinic's techniques for limited fertilization patients such as yourselves and that is part of the reason that he is interested in continuing to work with you despite any financial considerations? That would be such a blessing for you as well as other couples in your situation!