Overwhelmed

I'm stuck. I'm unable to make a decision. Unable to plan our next steps. I want nothing more than to have a plan. I want nothing more than to move forward. I want progress. I'm assuming you want the same things from me because you're oh so very tired of listening to me weigh the options. "Pick already, " I hear you scream! Don't worry; I'm screaming it at myself. I really thought Monday's appointments would make things easier, but if anything, I feel less resolved than ever.

I wish I could move forward with confidence. I wish I could say this is the clinic for me, commit, and be done with it. We will never know how much money we need until we commit to a clinic. We will never have a plan for achieving/earning/raising/borrowing this giant sum of money until we know how much we need. This is the pivotal decision that everything hinges on, and I can't seem to make the decision. The decision to eliminate. The decision to explore. The decision to commit. I can't make any of them.

I thought making a wish list might help… a "these are the five things I want out of my IVF clinic/doctor/experience" type list. So I did it; I made a list:

1. high success rates- if we're only doing one fresh cycle, I want to know we're giving it our very best shot
2. reasonable cost- I started to say low cost, but decided I really meant reasonable. I've decided reasonable means this: clinics with national average success rates get to charge national average fees, below has to charge below, above can charge above. Therefore, CCRM gets to charge an arm and a leg, but The Center for Reproductive Health in Nashville does not (15%! really?)
3. patient-doctor contact- I know this about myself: I will be a FREAKING basket case if I never talk to my doctor. The more opportunity to see my doctor leading up to the biggest, most expensive moment ever, the better, in my opinion.
4. location- obviously convenience of clinic lowers stress and seriously helps out the husband as he cannot get off of work very easily
5. embryo success- everyone has assured me that I'll have gobs of embryos. If by some miracle this is true,  I want to know that I'm giving these precious babies the best possible chance at life... the more I think on it, I'm wondering if this isn't THE most important criteria of all

I thought this list would help me decide, help me eliminate, help me make the best decision, help me do SOMETHING. Unfortunately, I'm simply more confused now than ever. So I decided to do what I always do... more research. I started reading articles about how to pick the right clinic, about the top clinics and what they have in common, about choosing doctors, etc. The theme seemed to be that while statistics often don't tell the whole story, we should take statistics seriously. In Georgia, the data available from SART places all of the clinics pretty close together... approximately a 10% spread just at or below the national average. Thus, I always assumed that this was true of the ENTIRE country. I started hearing crazy talk about CCRM and their wild rates as I had more and more friends go there, but I assumed they were the exception; everywhere else must be like Georgia. So I literally looked up EVERY. SINGLE. CLINIC listed on SART. You guys, not all IVF clinics were created equal! If you life in or west of Colorado, omg, the success is overwhelming. And the northeast... Rocking! However, if you live in the southeast, well bad news for you, but you'll be lucky if you have ONE clinic that beats the national average in your state. And poor mid-westerners. I'm so sorry, but your chances are slim. Like crazy slim. I found SO MANY clinics with less than 20% chances of success... that's like paying for IVF with the same chances most places give for IUI... huh?!? But on the flip side, there were TONS of clinics with great success rates... pages in fact... I filled SIX pages with clinics that met my criteria (above national average success and more than 100 total cycles in a year).

Six pages of clinics that do more than 100 cycles a
year and have at or better than 42% odds of success

All of this research really made me mad. As if infertility isn't unfair enough. As if needing IVF to solve infertility isn't unfair enough. As if having no insurance coverage for infertility treatments isn't unfair enough, I basically live in the armpit of infertility treatment centers. I already unloaded on Suzanne (she gets it, if I'm in one armpit, she's in the other), so thank her for taking the brunt of my angst, but you guys, this is just frustrating.  Georgia only has two clinics (based on the most current data) that fits my criteria, California has twenty-one, Colorado has three (of the best), Texas has eleven. I think I'm starting to understand Resolve's infertility scorecard a bit more... but I don't think 44 out of 51 really captures the difference between Georgia and Massachusetts (number 1). That's just ranking the states, but really if Massachusetts gets a 100, Georgia gets a 12 (in my opinion). So frustrating.

I just don't know where to go from here. IVF is already THE MOST EXPENSIVE THING EVER, so we really don't have the money to look at traveling to Pennsylvania, or California for treatment. But I feel like I'm settling by staying in Georgia, I feel like I'm saying my future maybe baby isn't worth it. And the Lord knows I would go to the moon and back for my child, no distance, no cost would be too high, but this doesn't feel the same... should it?

I'm just feeling really discouraged. I can't comprehend how everyone else chooses a clinic so easily. This feels MONUMENTAL. I suddenly feel the weight of IVF, the pure gravity of such a decision, the immense responsibility I have for these lives that we will attempt to create. I feel the pressure to get this decision right, not simply because we want to be successful, or because it's a lot of money, but because these doctors, these clinics will literally hold our children in their hands. And so I'm stuck, unable to decide, to choose, to move, to veto. In a word, I'm overwhelmed.

Anybody want to choose for me?

Ruffled Feathers

First of all, let me take a moment to say thank you! Y'all are so sweet to care about our appointments. Thanks for the love and the prayers yesterday... even Sam was feeling the love, so THANKS!

Unfortunately, yesterday was kind of a frustrating day. Don't get me wrong, at this point, I'm a firm believer that all information is good information... it may not be what I want to hear, but it's good information to have. However, with that said, yesterday was a lot of what I didn't want to hear. You may remember that we decided to go in with a BUNCH of questions to our two consultations. Our first consult was with Dr. Massey at Servy Massey Fertility Institute. This appointment, overall, went better than I expected, but I didn't go in with very high hopes. Dr. Massey was really nice. He answered ALL of my questions very thoroughly. He did call me "subfertile" rather than infertile, so I kind of wanted to punch him in the face, (my new biggest pet peeve!) but he meant it as a "thumbs-up" kind of thing, not a "are you two sure you know what you're doing?" kind of thing, so I resisted. He also called me "needy" and "high maintenance" and had a good chuckle with Sam over that, but I'm the first to admit this, so I let that slide. Particularly because in reference to question number six, "What will my level of contact be with the office? Will I have a direct way to speak with someone?", he simply rattled off his personal cell phone number. This scored him some MEGA points! He did try to convince me that I didn't want to freeze sub-par embryos, but when I pushed, he said he'd allow me to freeze whatever I wanted. The biggest thing that I liked about him and the office was that I would see him; I would have direct interaction with him at each monitoring appointment, and of course the cost savings is pretty huge. The greatest deterrents were:

1. location-both the main office (it took right at 2 hours to get to the appointment, even at 10am) AND the retrieval and transfer office (Augusta) require a good bit of travel
2. frozen embryos- there is an additional charge to freeze more than 8 embryos, and the FET success rates are moderate

In between our morning and afternoon appointments, we had time to swing by IKEA and to have a yummy lunch at Vini Vidi Vici. It's one of Sam's favorite restaurants, but it's in Atlanta and kind of pricey, so we never go. Sam had his favorite pasta and I had a yummy panini. In the midst of the business people of Atlanta discussing uber important things like real estate purchases and business mergers, we discussed my uterus and things like that. Good times.

The appointment at RBA was kind of blah. I don't really know what I was hoping for, maybe an offer for free IVF?!? Essentially, he didn't have a reason why IUI #4 failed, but when pushed, he said that at this point, he assumes we have either an egg quality issue or an embryo quality issue. Sad face times a million. He's hopeful that it could still be a fertilization problem (that ICSI would solve), but he doesn't really think that's it. I asked about the falling success rates and he suggested that it was probably due to the number of DOR patients they have been seeing in the last few years. He suggested that RBA is one of the top clinics and that women turn to them when they either fail at other clinics or when they are turned away by other clinics. This was one of those moments when my feathers kind of got ruffled. In my opinion (and in my experience) CCRM is the ULTIMATE collector of these types of patients. In fact, I currently have three blog friends who are cycling there and one more who intends to if her current cycle fails (fingers crossed). My point is this: CCRM takes them all, the non-existent AMH, the rejected, the repeat fails, and yet, they have a 65% success rate. I don't think a few additional DOR patients really explains a 10% decrease in success rates. In my opinion, CCRM has the right to charge $13,080 for IVF for 65% success rates, but RBA doesn't have the right to charge $13,500 for 34% success rates... see where I'm coming from? Needless to say, his reasoning kind of ruffled my feathers. However, he made a really strong case for them in regards to future children. In his opinion, going through RBA is like securing a sibling. He's pretty darn confident that we will have success and that we will have frozen embryos. The question then becomes who do I entrust with these embryos? He argued that they have one of the most sophisticated labs and freezing techniques, and they have the stats to back it up. They do significantly more FETs that most clinics and have a 50% success rate for each transfer. This is pretty huge to me.
That along with the convenience of the Gwinnett office are the two biggest perks. The things I don't love are:

1. cost (obviously)
2. contact with the clinic- it's apparently completely plausible that I could complete my ENTIRE IVF cycle and never see Dr. Slayden. He doesn't do monitoring appointments and transfer and retrieval will be by whoever is on call. I find this odd, and immensely frustrating.

I really hoped that after yesterday's two appointments I would be coming here to yell you guys our plan. Unfortunately, I'm not. Shocking, I know. The Greavu's are nothing if not thorough (err, slow) at making decisions. The good news is that we left both appointments on the same page (miracle), so we won't have to wrestle for the right to decide (I'd obviously win).  If you've hung with us this long, thanks, I promise some day we'll decide on something and actually move forward. Until then...

Almost There

We are one week away from two consultations. To refresh your memory, we're meeting with two Reproductive Endocrinologists in the Atlanta area next Monday. These two guys and their clinics are basically polar opposites. One clinic (our current clinic) is big, flashy, and touts the highest number of IVFs each year in Georgia. They have doctors consistently listed as the best doctors in Atlanta and the clinic itself is constantly in the news. Dr. Slayden (my current doctor) is younger, extremely nice, very optimistic and generally my favorite doctor. However, this clinic is the most expensive in Georgia and all of the surrounding states, and their success rates took a tumble from 2011 to 2012. So with than it mind, we are looking into Servy-Massey Fertility Institute and meeting with Dr. Massey as well. This clinic's claim to fame is low cost, and by low cost I mean literally half of the cost at RBA. We're not sure exactly what we'd be sacrificing though. We know the practice is much smaller, the office is much less state-of-the-art, they perform a tenth of the number of IVF procedures annually, etc, but we don't know exactly how much any of that will affect success. So we are meeting with both. I'm going in with the attitude of "woo me", meaning I'm looking for each of them to convince us why we should shell out thousands and thousands of dollars and give them the honor of impregnating me.

I'm also looking at this as a fact finding mission. I have lots and lots of questions: moral questions, ethical questions, health questions, patient contact questions, long-term questions, short-term questions... I have lots of questions!

I put this out there before and Suzanne came through in a big way, so I'm probably pretty set. But I thought I'd put my current question list on the blog and see if anyone can think of anything else we should ask.

1. SART data- Can you explain your SART data? Why are _____ clinics so much lower/higher than others? Do you limit IVF candidates by AMH levels or BMI? 
2. Under what circumstances would you cancel an IVF cycle?
3. Are there any additional tests we should run before IVF? Beta-3 integrin biopsy? Natural killer cells? Autoimmune disease? Why/why not? 
4. Which protocol would you recommend?
5. Do you recommend ICSI, Assisted Hatching, or other means of improving our odds? Why/why not?
6. What will my contact be with the office? Will I have a direct way to speak with someone? Email? Cell phone?
7. Do you do Day3 transfers? Why? Under what circumstances?
8. Do you do Day5 transfers? Why? Under what circumstances?
9. What are your post-transfer instructions? Do you advocate bed rest?
10. Do you encourage acupuncture? 
11. What medicines can I expect to be on?
12. Do you perform doppler ultrasounds to determine uterine blood flow?
13. What supplements do you recommend in preparation for IVF? Why?
14. How many mature eggs do you think we can retrieve?
15. Do you think we should “pay as we go” or invest in a “refund program”?
16. How do you determine recommendations for embryo transfers? How much say do we have?
17. Does your clinic facilitate embryo donation?
18. Will you allow us to transfer any embryo? Any quality?
19. How do you/ your embryologist determine what to freeze and what to discard?
20. What is your thaw success rate
21. Are there any practices Sam or I should put in place NOW while we wait? Is there anything we can do in the months leading up to improve our chances?
22. Would you recommend a mini IVF? Why or why not?

After meeting with these two doctors, our plan is to discuss and see if one of them clearly won us over. If we feel really, really good about one, we'll begin making our plan of action, looking at the financial situation (still bleak, but have you noticed it's growing?!), and checking out the calendar. If however, neither doctor effectively woos us, we will discuss setting up some additional consultations. Front runners on the list currently are ACRM (slightly lower cost, higher success rates, local), FIRM (significantly lower cost, good success rates, large clinic) and PREG (low cost, great success rates). Hopefully, we can set these up fairly quickly, within a month or so. Then we'll go from there. I'm really, really hoping I get a warm and fuzzy feeling, or some kind of sign that this is the clinic for us. Most days I feel the exact opposite of the way I felt the day before. Today, I think this is all a waste of time and money and we should just move forward with RBA because we're happy there. Yesterday, the cost was so overwhelming and their success rates so underwhelming, that I was thinking about scratching RBA all together. It's safe to say that I have not made up my mind... at all.

So leave me a message if you've got any great questions or advice and wish us luck next Monday!