Change Of Plans

istock_000007309956xsmall_crop380wSo after my last post, I was feeling good. I had a plan. I was going to follow that plan, but I didn’t feel attached to the outcome. I felt like our child would come to us in whatever way he or she was meant to.

But what ever goes according to plan? Nothing, you say? That’s right. Nothing.

Warning: this might get long. And boring. Long and boring, yay!

This week we had our two second opinion consults. First up was CCRM. We spoke with Dr. Surrey and he was quite lovely. He had some interesting suggestions. One was that Tim get a next-level sperm test, the name of which escapes me now. Then he suggested I do a double trigger shot. He was thinking that the reason I had half as many mature eggs as follicles both cycles was because they weren’t responding properly to the trigger. He also does not consider someone DOR if they have normal FSH, AMH and antral follicle count. Finally, he said that I might as well transfer our frozen embryo at my current clinic before coming out to Colorado, and send him a thank you note if it works. We liked him. I think CCRM is a great clinic. I think they have amazing labs. Other than the labs, though, I didn’t feel like they had much more to offer us than our current clinic. And the multiple trips to Colorado alone would put us in a bad financial place, not to mention the out-of-network costs for the actual treatment. Case closed.

The next day we spoke with Dr. Braverman. He is a reproductive immunologist. This is a very new field, like so new there are only a couple of these doctors in the country. I first heard about him through my friend over at Spirit Baby Come Home. She has had a lot — way too many — miscarriages. She worked with Dr. Braverman and is now a few weeks away from giving birth. As soon as I heard of him I thought, Hmmm, that guy sounds interesting.

One of his main areas of research is endometriosis, particularly “silent endometriosis,” which is where you have the condition, but experience no symptoms. This piqued my interest because a close relative had this exact thing. She was diagnosed with unexplained infertility and had multiple IVF failures. They accidentally discovered that she had endometriosis during a surgery for something else. They removed it and then her next IVF worked. I’ve asked both of the doctors at each of the clinics I’ve been to if I should be concerned about endometriosis based on my family history. They both said that, no, I shouldn’t be worried. Even if I had endometriosis, the way to work around it is IVF.

Braverman completely disagrees with my doctors’ assessment. Through his reasearch he’s learned that endometriosis negatively impacts egg quality, often making it look like a patient has DOR, when in fact they don’t. He also says that Antiphospholipid Antibody Syndrome typically goes hand in hand with endometriosis.

With every mishap that happened these last few months — miscarrying the genetically normal embryo, getting diagnosed with a blood clotting condition — I started to wonder if I should contact him. But he is a recurrent miscarriage specialist and I’ve “only” had two, so I felt weird about that. Plus, I was comfortable at my clinic (I really do love them!). And finally,  Braverman is beyond expensive.  So I never pulled the trigger. I kept thinking about him, though, and wondering. Then after that last failed IVF and DOR diagnosis, I was like, ok, let me at least talk to the guy.

So I did. I had read a bunch of his articles before we spoke to him, so I was not surprised in the least when five seconds into the phone conversation he was like, BOOM, I think you have endometriosis. He said my family history, combined with my elevated anticardiolipins, combined with my diminished ovarian response, points strongly towards that diagnosis.

Even if what he was saying was true, the fact remained that we couldn’t afford to get treatment with him without sacrificing every penny we had and then some.

But then he told us that he would collaborate with a doctor about 45 minutes from us. This is huge. That means I could be under his care and still in-network with my insurance. Then his financial person got on the phone and said that if I needed surgery to remove endometriosis, the hospital they use is in our network. Meaning the surgery would be fully covered, too. This is even huger. I figured he would be recommending surgery, but I knew there was no way in hell we could swing out-of-network surgery. But it turns out that the only out-of-network things we’d have to pay for would be his initial testing and consulting fees.

Uh, so all of a sudden this doctor that I thought was totally out of reach just became a real possibility. It felt like the Universe had tipped its hat to me and said, “Here you go, wish granted.”

So we’re doing it. We figure the only thing we have to lose is time. The soonest we’d be able to do an IVF going this route would be September. We were just about to start a cycle at our current place in two weeks. That means we would be done with that cycle and, if needed, a frozen transfer and potentially be onto adoption by September. Now everything will get pushed back by several months.

But it feels like we would be doing that next cycle at our clinic just to do it. Which is kind of a yucky feeling. Don’t get me wrong, I don’t think Dr. Braverman is a miracle worker, at least not for everyone, but I do think that immunology is really the only avenue we haven’t explored yet. And, provided that he actually finds an issue, I think we have a better chance with him than our current doctor. How much better, I have no idea. It’s still nowhere near a sure thing, or even on the right side of the odds.

Then there’s always a risk that we do all the immune testing and get the surgery, and he finds absolutely nothing. I think in that case I would feel pretty stupid that my hunch led me nowhere.

In the end of the day, there is no right answer. But I do think it’s worth giving Braverman a shot.

In the meantime we plan to continue researching and saving for adoption. We’re going to try and do as much of the adoption leg work as we can so that if this hail-mary IVF doesn’t work we can jump right into it.

But who knows, maybe it will work. You just never know.

Finding Our Way

which-way-to-goI’m not going to lie, these last few weeks have been rough. Really rough. In some ways, this failed IVF cycle hit me even harder than my last miscarriage. I know that might seem strange, but after our last loss, I still had so much hope. I knew IVF worked for us, and it seemed like maybe it was just a matter of time before we got lucky again. But let’s just say the last cycle and its accompanying diagnosis of DOR was a rude awakening. I’m not saying IVF can’t work for us, but it won’t be easy. Tim and I had to think hard about if we really wanted to fight this uphill battle to have another biological child. Because that’s what it is from here on out–a decidedly uphill battle.

So I did a lot of crying, a lot of feeling sorry for myself and, for lack of a less cheesy term, a lot of soul searching. Tim and I had several long, difficult talks. In the end, here’s what we decided.

There’s a limit to how much my body can deal with–I’m talking about the hormones, the poking and prodding, the minor surgeries, etc. I’m almost at my limit.

There’s a limit to how much our family can handle–the stress of endless appointments, injection timing, days off of work and in general putting our life on hold for treatments. We are almost at that limit.

There’s a limit to how much Tim and I can cope with the emotional roller coaster of hope and sadness, hope and sadness. We are almost at that limit.

We have a deep longing to parent another child. We will do almost anything to get there except ruin our marriage, destroy our financial future or negatively impact our relationship with the child that we already have. Do we have a deep longing to give birth to another child that looks just like Lettie? Nope. We want to parent. We want to share our love for life with a child. We want Lettie to have a sibling. These are the things that matter to us.

To that end, here’s our plan.

Because it is covered by insurance, we will do one more IVF cycle with our current doctor, likely in June. To prepare for that I’m taking DHEA and CoQ10 (both supposed to help with DOR). I’ve always read that you need to take these things for at least three months to make a difference, but my doctor thinks it’s still worth taking in the short term. She says three months is what’s been studied, so that’s why everyone says three months. Less than three hasn’t been studied yet, but that doesn’t mean it won’t help. There will be a new protocol this time, called micro-flare. It’s basically the last-ditch protocol for ailing ovaries. Birth control is typically used, but because of my blood clotting issue, my doctor says no birth control for me ever again. So we’ll do estrogen priming instead. Unless something crazy awesome happens (you never know), that’s likely it for us for fresh IVF cycles.

We will keep our phone consults with CCRM and Dr. Braverman next week. We’ve decided not to pursue CCRM beyond that call, but they might say something interesting that we can take back to our doctor. We may or may not end up traveling to NY to see Dr. Braverman for immune testing, depending on the cost with out of network insurance. We have decided that we will ultimately not pursue treatment with him, but I would still like to know if I have any immune issues (other than the one I already know about), should we decide to continue trying on our own or use donor eggs in the future.

If the fresh IVF in June doesn’t work, we will transfer our one remaining frozen blastocyst.

After that? We are all in for adoption. It’s time for a new chapter. We need to move on, and move forward.

We went to our first adoption support group this week. It was kind of great and kind of terrifying. It really put into perspective how long the process takes, and how much of yourself you need to put into it. It has just as much potential for heartbreak as infertility, but hopefully, at the end there will be another child. It’s not a sure bet–nothing is–but it’s as close as you can get in this world.

So here we are.

Still sad from all that has come to pass, yet steadfastly hopeful for the future, we find ourselves preparing for a whole new journey.

Diminished Ovarian Reserve

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I haven’t posted about this yet because there was just too much going on these last few days with all the will-the-embryos-make-it drama. Plus, I didn’t want to drag the embryos down with my negative diagnosis.

Anyway, after my first IVF, my doctor suspected that that I had “some level of diminished ovarian reserve,” but she didn’t sound convinced. Well, let me tell you, she is convinced now. After this riot of an IVF cycle, I have now officially been diagnosed with diminished ovarian reserve (or DOR as it’s commonly known, because the infertility world hearts their acronyms). This basically means that although I am 37, my ovaries are somewhere in their 40s. I’m thinking maybe like 42 or 43? Here’s the weird thing, though. My DOR is a sneaky B. There are three tests they use to determine if your ovarian reserve is low: FSH, AMH and antral follicle count. The first two are hormones. And the last one is how many follicles you have at the beginning of your cycle. My FSH, AMH and antral follicle count are all normal! So my ovarian reserve should be fine as well, right? But I don’t respond well to the IVF medication, I don’t make a lot of eggs and the ones I do make are poor quality. So, boom — secret diminished ovarian reserve.

What does this all mean? Basically, it’s not good. No infertility diagnosis is good, let me be clear, but this one is extra-special fun because the only way to fix it is to turn back time. Will the 23-year-old Tanya please come forward? I’d like some of her eggs. What’s that? It’s not possible, you say? Ok, fine.

Turns out I lost my time machine, so here are our options:

1. My doctor suggested another fresh IVF cycle with a new protocol. She didn’t seem all that hopeful that it would work, though. We are extremely lucky that we have infertility coverage, so this is financially the best option for us. An exercise in futility? Maybe. Even still, this option is not off the table. We could also check out another doctor in our network, but I already feel that mine is the best in the area. It’s for sure worth looking into again, though.

2. Get second opinions. We are definitely pursuing this. We plan on contacting the following:

Dr. Braverman: He’s a reproductive endocrinologist. I already know I have one immune issue because of my elevated anticardiolipins, and I just have a nagging feeling that there are some other immunologic conditions going on here.

Center for Human Reproduction:  DOR is their specialty.

Colorado Center for Reproductive Medicine: All-around bad-asses in the IVF world.

The one problem with this is that these places, awesome as they may be, are out of network, which means that we likely couldn’t afford them anyway. If we’re going to break the bank, it’s going to be for something that’s more of a sure thing. Even still, I think I’d regret it if I didn’t hear what they had to say.

3. Domestic infant adoption. I haven’t talked about this at all here, but we’ve already been researching this one pretty hard-core. I know it’s not an easy road, at all, but I believe that in the end we would have a sweet baby to love.

Neither adoption or fancy fertility doctors are cheap. We could pretty much do one or the other and that’s it, end of story. What will we do? I have no f*cking clue.

Right now I’m going to cry my eyes out and some drink wine.

Lots and lots of wine.

IVF #2: #GoEmbryos #HopeStreet

You guys, thank you so much to everyone who commented on my post or sent me a message yesterday. I even had one friend drop off some marigolds. It was a rough day, one of the roughest I’ve had in a long time, but you all managed to make me feel so loved. It’s pretty easy to feel isolated and alone on this journey, but you have proven time and again that you walk beside me.

After Lettie went to bed yesterday, Tim and I talked for a long time about what to do. I did end up connecting with my doctor, but she didn’t give us a strong opinion one way or another on whether to go for the day three transfer or hope that the embryo grew to blastocyst. We hashed out every single possibility six times over. We even called a real-life friend who has gone through IVF to bounce ideas off of her. We worried about miscarriages and chemical pregnancies and the possibility of a genetically abnormal embryo implanting. We worried and what-ifed until we were about to pass out from exhaustion.

And then we both just kind of stopped. We simultaneously came to the conclusion that we did not want to make a decision out of fear. Neither one of us wants to live our lives like that. And we certainly don’t want to teach our children to be ruled by fear either. For us, all the reasons to avoid a day three transfer came from a place of fear, not hope. So we decided that if the next day our embryo or embryos looked the same or worse, we would go ahead with the day three transfer. We called the acupuncturist and told her to meet us at the clinic in the morning. Then we went to bed, feeling happy with the decision that we made together. I think we both felt lighter. And dare I say it? Hopeful.

But you know how it is. The best laid plans and all that. This morning the embryologist called bright and early and told us that the decent-looking two-cell guy from yesterday was now a bad-ass, grade-1, 8-cell embryo (these are all good things). And guess what else? One of the two poor-quality embryos from yesterday also looked pretty good! The last one was disintegrating (sorry, buddy. I still love you, though).

Well, eff me. This was not the news we were expecting at all. All of you that told me yesterday not to give up were absolutely right. Your prayers and thoughts and good vibes must have worked because those punks are fighting!

So Tim and I reassessed, and again made a decision from a place of hope. We decided that since the embryos were clearly fighters, we were going to let them fight it out another couple of days. On day five the embryologist will check them again–if any are still going and can be biopsied for testing, they’ll do so at that time. I know there are wildly different theories on this in the infertility world, but both my doctor and the embryologist said that if the embryos were going to make it to day five, they would do so whether in the lab or in my body. I trust them on this one. My clinic has really good labs and that is one of the reasons I chose them. And not only do I trust the professionals, but I have faith in our embryos. I believe they can do it. I’m proud of our scrappy little cells.

And yeah, this means that we might not have a damn thing to transfer in the end, but I think I will ultimately be ok if that happens–very sad, yes, but ok.

Because today, one more time, I choose hope.