October 27, 2008

Dr. Change

As a first-time infertile all you want is change. Any kind of change might be just the change you've been needing. In the beginning, whatever I could change that might somehow change the outcome of each cycle was worth a shot! There are the changes in position, diet, exercise, mindset, changes into lucky underwear; pretty much almost anything you can think of has been touted by someone as a magic ticket to fertility. After a while I got too frustrated with any sort of magical changes that only led to disappointment but whatever changes my clinic threw at me were still welcome. Injectables? Sure! Up the dosage? OK! Slow the progression? Whatever you say doc, let this be the thing that finally makes it work!

But this time around I'm not so keen on change. It worked last time afterall. Somehow I had forgotten about the excitement of zero fertilization and the depressingly low odds for rescue ICSI. I walked into my clinic last week with half my thoughts devoted to planning Piper's birthday party, another 49% on work, and the remaining 1% split between all manner of various other distractions including the passing thought that hey, I think I'll do IVF again.

Silly me. I sat down in Dr. Chang's office. He says: "So I see you had a very unusual case last time." He's a friendly guy but he says it all serious-like; gets me sort of nervous. Me: Huh? He gently reminds me. Naturally the clinic is very pleased about the pregnancy outcome, but he clearly did not think zero fertilization was good news. I guess I had brushed it off because I assumed we'd just go straight to ICSI next time and it wouldn't be an issue, but it turns out it's not so simple. There are two reasons for zero fertilization: egg prematurity and sperm problems. The sperm always looked fine in analysis but this doesn't mean they can do their job. I had loads of eggs and they were the usual size at trigger, but I stimmed for only 8 days so that could have been the issue.

So onto a new protocol this time around. Lower the doses of stims by 25% aiming to shoot up a little longer like maybe 10 days and possibly have fewer eggs as a result, but better quality, more mature eggs, all of which will then be ICSIed. Any immature eggs will simply hang out a day in the dish until they can be ICSIed. Rescue ICSI was performed on day 2 anyway so this would be essentially the same deal. The fact that all the eggs fertilized after day 2 rescue ICSI is an indication that egg maturity might have been the issue, however the five years of trying before including the year of IUI's would tend to implicate the sperm. It makes for a happier household if we just assume it's both.

I think we've got the right plan. I trust my doctor. And we can always up the dosages or bag the cycle if we don't like the response. I just sort of like the idea of repeating the past because the past worked out for me. As much as I try to prepare myself for the worst and remind myself that I'd have to be ridiculously lucky to get an encore performance on the first try out of our dysfunctional reproductive matter, I secretly hope it all goes down pretty much the same way. I left the office feeling much less cocky but nonetheless ready to start BCPs in December. I definitely feel the slow and ominous upward clicking of the roller coaster.

13 comments:

Jamie said...

I am at the exact same stage. My inital consult is next week and I hate the sound of the roller coaster...

I assume I'll be on BCP in December and start cycling in January. Some days I think I must be insane to do all of this again...

Tinker said...

Oh yes, I was the same: change it up every cycle to see if that is what works. Unfortunately, what worked for our first IUI didn't work for the next three, or the following four in which we did (substantially) change things. It took a whole new procedure (IVF) to make it work again. Then another new one with a FET. It's probably good that I'm done if this one turns out okay, as I'm running out of novel procedures for my body.

My Reality said...

I remember the zero fertilization. I hope the change will keep it from being an issue again.

Sticky Bun said...

I definitely hear you about change. If it ain't broke, right? But, it sounds like they are paying attention to the details and really working to make your chances even more likely.

It's hard to believe that it's all beginning again, though. Your mind must be all over the place when you went back to the office.

No matter what, I hope that you'll get the same happy outcome. Enjoy the holidays and Piper's bday! It's so crazy that it's already been a year!

Sarah said...

You hit the nail on the head. In the begginning any change was welcome, then I got change pissed that there was no magic change, and then I want RE magic. If only there were really magic...
Sometimes the changes make me relax, sometimes they don't. We're going to up my stims (and my cost!), and then back it down if I'm over stimmed...that scary too.
If my cycle cooperates I'll be going a cycle ahead (no bcps for me, they over supress me), if not, we'll be cycle buddies. click click click.

megan said...

i hope you're ridiculously lucky. good luck with piper's party. i hope you will post a picture!
xo
megan

sacredandscarred said...

I hope it works out sans drama this time.

Sara said...

I hear you about the change. It's so funny how superstitious we all get when dealing with IF.

Good luck on the roller coaster!

P.S. I'm sorry about your last living grandparent.

Kate said...

Sarah, there is nothing that I would wish more for you (other than wonderful things you already have) than to be ridiculously lucky again.

Even though it's a new protocol, the major steps are still the same, so I hope that gives you at least some sense of comfort. And I hope you can enjoy the next few months--the birthday, the holidays, without giving too much thought to the rollercoaster. But when the ride begins, I'll be there and I'll sending perfect fertilization thoughts your way!

Furrow said...

Yikes. This is me, sort of. I just assume that an IUI (or four) will work again next time, but what if it doesn't? I was ready to jump on the IVF train last time if the 4th IUI didn't work. Luckily, it did.

Best of luck to you. I'll be watching and reading.

BTW, happy birthday to our girls! WE're partying this Saturday. You?

Hopeful Mother said...

I remember that feeling - and a big change is what I needed on my 3rd IVF and then it worked. But who knows if it was just that our "number finally came up?"

At any rate, I'm hoping you won't have such an unusual case this time. Nice and normal please. :-)

Virginia said...

" It makes for a happier household if we just assume it's both.
". Isn't that the truth? Our clinic has yet to go out on a limb and point to my eggs or his sperm at issue. I'm glad. Keeps the turf and investment equal going forward. Is it nerve wracking waiting until Dec or are you glad for the downtime?

Tam said...

Good luck chicken, I hope this time is just as lucky as the first time!

It's scary to start over again isn't it? We never really know what's going to happen but we hope and pray and trust in our Dr's.

Sending you a big hug xxx