CD14 Ramblings about IVF

I now have egg white CF, so hopefully I'll be getting a positive OPK in the next few days. Yay!

Anyway, I never did write about our IVF consult last Monday, so here it goes.

We met with Dr G. He's the one I see the least often, but the one who did our original consult. Therefore, S trusts him quite a bit. Actually, I don't think that S has ever actually met Dr A or Dr W, but they're the ones who usually do my ultrasounds or IUIs.

So, Dr G told us that he thought that it was good that we had tried the IUIs, because there is no way to know up-front whether sperm with poor morphology will be able to fertilize eggs or not, and it was worth a try. He still hopes that maybe this month (Clomid/IUI) will get me pregnant. But he agrees that IVF with ICSI is a reasonable next step.

I had a whole list of questions, and he answered pretty much all of them. In brief:

- No, he hasn't heard of metformin and/or Clomid raising people's basal body temperature. (Mine has jumped by about 0.3F since the very first day I started Clomid).

- He is satisfied with my 1-2 eggs per cycle and lining with Clomid.

- Yes, I should still take vaginal progesterone after this upcoming IUI. If I want, I can take a different formulation. In the end, he agreed that I can decrease the dose to 2 per day. (But I'm not going to use it at all; see my post dated Friday 2/1/08).

- He told S that "less is better" in terms of alcohol consumption. S is not a heavy drinker by any means, but he does often have a 2 drinks on 2-3 days of the weekend. If you google "sperm count and alcohol" or anything like that, it is really scary. But I wanted S to hear it from Dr G, not me, so I put it on the list of questions.

- He thinks our chances are about 60% for success with IVF/ICSI. This is high enough that he would not recommend the financing plan in which you pay for 3 fresh cycles + 3 frozens, and get a partial refund if you don't get pregnant by the end of all of that. In our situation, he instead would recommend paying for one cycle at a time. At this practice, you also get a "free" 3rd cycle if you are not successful with 2 fresh cycles and transfer of all frozen embryos. The catch is, this does not include meds, and you have to do everything within 18 months.

- If we get good embryos with IVF, he would recommend transferring only one. Otherwise, there is a 40% risk of twins. I emphasized that we would prefer twins to no baby at all, but we'd prefer a singleton to twins. I think we're concerned about the the prospect of dealing with two babies at once and giving them the TLC and attention that they need, but even more importantly, we're worried about the risks of a twin pregnancy (prematurity etc etc). Still, I'd take twins any day over this current situation.

- I asked about S's pre-wash counts during our IUIs. At first, Dr G said, "32 million and 33 million." I was thinking that was a total count, which made sense as S's previous counts were 100 million in June, and 25 million in October. But, it turns out that those were actually the concentrations (32-33 million per mL)! To boot, S had mega volumes of over 6 mL each time. So, his actual count was more than 180 million each time! Good job!! However, then I got to thinking...jeez, with 180 million sperm, how come our post-wash count was only 11 million?? That doesn't seem very efficient...

Afterwards, S had to run back to the office, and I met with the nurse, followed by the financial counselor. I do not particularly like the financial counselor, but I suppose I can work with her. She said that the cycle costs about $17,000. Well, it is actually less than that because she is not accounting for the fact that we have already done mosts of the preliminary testing (FSH, estradiol, semen analysis, HSG, sonohystogram, infectious disease screen, etc). Also, the meds can range from $3000 to $5000, depending on the doses required. The IVF is $8100, plus $1750 for the ICSI and $550 for anesthesia. I'm going to think of it as $15,000 including all meds, freezing embryos, etc. Still, yikes!!!

As for IVF,
The informed consent paperwork assumes that you will have embryos to freeze. Then, it makes you think about all sorts of unpleasant scenarios, such as:

"What would you want to happen to any frozen embryos in the event of:
- death of one partner?
- death of both partners?
- separation / divorce?

Our answers were:
- made available to the other partner if he/she wishes.
- donated to another person or couple.
- made available to the partner if he/she wishes.

But ugh, it was painful to even think about or discuss those scenarios. It made me tear up just to talk about it.

We also need a few more tests before we can proceed. Namely:

- One of us has to be tested to see if we're a carrier for cystic fibrosis. If not, we can proceed. If so, the other one of us will also need to be tested. I can only assume that in the unlikely event that we are both carriers, they will require preimplantion genetic diagnosis (PGD) on any IVF embryos. Cost = $147.50. I think my insurance might cover this, but that would mean that I need to talk to my dumb gynecologist again. Ugh.

- S needs to submit a semen sample for culture. If this is important, I don't know why we haven't already done it. If not, why do it now? Cost = $35.00.

- Sometime before or early in the IVF cycle, I'll need to undergo a trial transfer. This helps them decide which catheter to use for the embryo transfer, how far in it needs to go, etc. Cost = $125.00.

So, it looks like we'll finish up this current cycle, and if not pregnant, we'll probably do one more unmedicated IUI cycle while I have a stressful work on an inpatient team during the month of March. I found out that the IVF will start with 10-21 days of birth control pills, so that the cycle can be adjusted a bit to fit the clinic's schedule as well as my own. So, we'd probably be looking at starting the pills in mid-March, and starting injectable IVF meds sometime in early April.

All I can say is that I can't believe that this is really happening to me. Last summer, when we found out about the morphology problem, it seemed surreal. Now it's becoming a reality. I wish it weren't, but at the same time I am thankful that this is 2008, not 1975, and that the technology is available to at least keep trying.

I still have more to say about other matters, but I've blabbed on long enough... Maybe later!