FET#1: Cancelled

Oh yes, that word that is heard far too often in the Land of IF: "Cancelled".

Our poor little 6-celled embryo did not survive the thaw.

When the clinic rang this morning, I could tell by the tone of her voice that it wasn't good news. Then she confirmed this by saying "I am afraid that I don't have good news". I knew that we had a 40% chance of cancellation, as we only had one embryo to defrost. So this was not entirely unexpected.

But then she surprised me. She said that I had to have a meeting with The Professor before we started our next fresh cycle. I told her that, no, we just had a meeting with The Professor, and we had agreed on a new protocol for the fresh cycle. She told me, no, my file said that I had to have another meeting first. I told her that wasn't necessary. She told me it was. Fine, I said, and asked her when the next appointment was available.

December 23
That's seven weeks from now. I have to wait seven weeks to have a 10 minute conversation in which The Professor tells us what we already know. Look, I enjoy talking with The Professor as he is quite knowledgeable and can answer some of our questions. But I am not willing to wait seven weeks for the privilege. Last time we had the appointment, he had already reviewed our chart and determined a protocol. Nothing that we said changed this protocol. It was a reassuring meeting, but hardly medically necessary.

I am thinking of sending the clinic an email like this:

On September 23 we met with [The Professor] to discuss our treatment options. He told us that there was a 40% chance that our upcoming FET cycle would be cancelled due to the embryo failing to survive the thaw. We discussed our treatment options for the next fresh cycle if the FET cycle was unsuccessful. [The Professor] recommended an injectable GnRH-agonist instead of nasal buserelin, and the use of recombinant Gonal-F instead of urine-derived Menopur.

Today we learned that our FET cycle was cancelled because the embryo did not survive the thaw. However, I was told that we were required to wait another seven weeks for another meeting with [The Professor] before we can begin our next fresh cycle.

I understand that [Fertility Clinic] is a large and busy practise that deals with hundreds of patients every month. [The Professor] works many hours as an academic, a researcher, and a clinician. We appreciate the fact that he is very willing to take the time to meet with all of his patients one-on-one, and we understand that he meets with a large number of patients.

However, we do not feel that this appointment is strictly necessary, and we would love to be able to begin another fresh cycle as soon as possible. Is there any way that we could commence the next cycle earlier without having this appointment first? Or if a consultation appointment is essential, could we meet with another doctor in the clinic if they have an earlier slot available? We are also open to consultations via email or telephone.

What do you think? Am I over-reacting to a seven week wait? And how do I tell them that I don't want to wait for a consultation appointment, but I do want to ask them to add estrogen and sildenafil to my next cycle?

FET#1: CD14

No more injections! We trigger tonight.

Right ovary: follicle 16.1 mm
Left ovary: nothing big here
Endometrium: disappointing 6.7 mm

Transfer is scheduled for Friday.

FET#1: CD11

Lining: 5.9 mm
Right ovary: 12.1 mm
Left ovary: 9.5 mm

So it looks like I am progressing very similarly to my last IUI, not surprisingly because I am on the same Menopur dose. If things go the same way, I will probably trigger on CD13 (Sunday), ovulate on CD14 (Monday), and transfer on CD17 (Thursday).

We asked the Professor about the chance of multiples, as we are stimulating ovulation as well as transferring an embryo. He said that it is theoretically possible, but they have never seen it in practise. He also said that animal studies have shown that simply the act of intercourse before embryo transfer can increase the rates of pregnancy.

Feeling much better today. I need to remind myself that the best cure, for me, is just to knuckle down and attack all the work that is stressing me out.

The sun is shining over the soft falling leaves. This might be our last autumn as a family of two (plus two furballs). This is a time to celebrate our love for each other, for cherishing all the wonderful joys already in our life together.

FET#1: CD8

I am participating in a clinical trial for this FET, which involves me injecting half a vial of menopur each night, much like I did for my last IUI. This means that they are monitoring my follicles too, even though we have a little embryo that we prepared earlier.

Stats:
Lining 4.7 mm
Right ovary: One large follicle at 9.7 mm
Left ovary: One large follicle at 8.4 mm

Perhaps another week until trigger? Next check-up on Friday.

Things that are currently stressing me out:
* The hours of sunlight are decreasing, so I am waking up in the dark every morning
* More people are catching the metro, so I now have to stand for 30 minutes to get to work
* My boss is off sick, so I am doing the work of two people
* All projects need to be completed by the end of the year, so we are extra busy
* My mother is coming to stay for a whole week
* I am putting on weight
* Blood tests in the morning, waiting for phone call during the day, injections in the evening

Things that I should be doing to decrease this stress:
* Working hard at work
* Cleaning the house
* Going to the gym
* Eating lots of fruit and vegetables

Things that I am actually doing instead:
* Spending hours on the web looking at pictures of cute animals
* Napping
* Eating chocolate and biscuits
* Worrying
* Feeling guilty

Argh.

FET#1: CD2

I don't know what's wrong with me.

We were at a dinner party over the weekend, filled with strangers. I had my first inkling that there could be a problem when the hostess said to me "I hope you like children, because there will be plenty of them here tonight". I blink and suddenly the house is full of them, running and playing and babbling and crawling. Then one of the fathers comes over to me and says loudly "Are kids in your future? You can have our two if you want!".

I get a sudden sinking feeling when I realise that I am going to burst into tears, right in the middle of the party. I walk away from the father, leaving my husband to reply, and stumble into the first room that I find. Luckily it was the bathroom, and I let myself have a few big sobs before trying to pull myself together. I was so mortified that someone would see my swollen eyes and I would ruin the evening.

I manage to make it through the rest of the party with the help of a few glasses of wine, and just ignoring anyone who probed into our childlessness. I even offered mock sympathy to one woman who said to me "It's been so long since I could drink wine, unfortunately I got pregnant with our second child as soon as I stopped breastfeeding our first".

~~~

When we first went to our fertility clinic, they told us that they had psychologists on staff if we ever needed counselling. I smiled at them, thinking that I wasn't one of "those" women with the Baby Crazies. I knew how lucky I was already and I wasn't going to let a short delay in procreation ruin my day.

My life is wonderful. I have so much for which to be thankful.

Yet I just burst into tears in public.

Is there something wrong with me?

IVF#1: Post-failure consultation

We had a fabulous consultation yesterday. We left the appointment feeling like our clinic has a great understanding of IVF and is really tweaking out next cycle to give us the best chance of success. These are some of the answers to our questions:

FET cycle
• How fragmented was our 6-cell embryo at freeze?
They gave it a score of 2 (with 0 best and 6 worst). The symmetry was 1 (with 0 best and 2 worst)
• What are the chances that this embryo will survive the thaw?

There is a 60% chance that it will survive the thaw, and then a 10% chance it will result in a live birth. By law, I must use up all my frozen embryos if I want my next fresh cycle to be funded by health insurance. They quickly signed me up for a clinical trial of Menopur-versus-no stimulation for my FET cycle. I am in the Menopur arm, but I can opt-out and just go the no stimulation with monitoring route instead. I am not sure which option I will take.

Next fresh cycle
• Given my poor response, and that no embryo reached the 8-cell stage, what are our chances of success in future fresh cycles?

At my clinic, 9 eggs is not a poor response - they only aim for 10 eggs retrieved. I guess as 6 fresh cycles are funded, they prefer to have fewer patients with OHSS. They said 6-cell and 7-cell is not that far off from 8-cell, and that we have a very good chance of success in future fresh cycles, especially with a change of drug regime (see below).
o Does our history of a chemical pregnancy and miscarriage influence this?

One chemical and one miscarriage, sadly, falls within the 'normal' range and doesn't tell us anything.
• Will I be on a different drug regime next time around?
Absolutely. My LH was too high throughout the whole cycle, indicating that I was not properly suppressed. He even asked me if I had trouble using the nasal spray. So instead of Suprefact nasal spray for suppression, I will be taking an injectable lupron-like drug instead. Then, instead of urine-derived Menopur I will be taking the recombinant Gonal-F. He said that in order to reduce costs, they put first-time IVFers on the cheaper Menopur, but then after that keep them on Gonal-F, which has a better quality control and is easier for the patient to use.

• How many eggs should we transfer next time?

By law I am now permitted to transfer two embryos, but I am leaning towards elective single embryo transfer. The increased risks associated with twins makes me uncomfortable.

• Can we squeeze in another fresh cycle before New Year's?

Probably. I need to ask them if they want me to have a break cycle after my Menopur-FET.

Donor embryos
• Can you tell us about your frozen embryo program?

They were very unwilling to talk with us about this program. They said that they usually suggest it as a last resort, and no on has ever asked so early on in the process. The process is completely closed, even if the child turns 18, and even if the child requires a bone-marrow transfer.
o Does the six month waiting period apply for every frozen donor embryo transfer?

No. It takes six months for the psychological tests, and after that, we are permitted a 'virtually unlimited' number of donor embryos.
o What criteria do you use to match couples with embryos?

I couldn't get much information on this. From the web, it appears that no matching is conducted (I'm not sure about blood-type).
• Can we sign up for donor embryos now while still attempting our own cycles?

Not yet. They suggest we try a few more time with our own gametes first.

• Will they transfer in donor embryos shipped from abroad?

This question really confused the guy. To clarify, I said, if we had a frozen embryo shipped from the Czech Republic (thinking of Reprofit's bank of cheapish embryos), would you conduct the transfer? He then looked really confused, asking me if I wanted a Czech baby? I laughed, and said, no, we just want one good embryo. We don't care where from. My husband said that we'd even be happy to take a baby if they have any of those laying around. The poor guy just looked more confused and I had to tell him that my husband was joking.

So that's that. Most of my questions answered, and a shiny new drug regime waiting for me for our next fresh IVF cycle. I feel hopeful and happy.

Now it's off to the UK for a week!