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!

To Try, or Not to Try

Confession time: I haven't really been trying to get pregnant. Gasp! I know! What kind of infertile am I? The IUI kind of spoiled me. I'm sure it sounds strange to most people, but on some level, an IUI is a break from the monotony that is timed intercourse. It takes some of the stress out of the picture. It doesn't matter whether he feels like it, or if I'm into it, it just happens. There's no need for candles, or mood music. It's as close to a guarantee as you can get. I mean not a guarantee of success, but a guarantee that sperm an egg will have a fighting change.

I guess the failure of the IUI, the failure of my body to do what it was supposed to (again) even with four (maybe five) beautiful, plump follicles and an extremely lush lining has made me question what the heck I think I'm doing every month with all this timed intercourse and charting and ovulation testing. But if I'm being really honest, this started before the IUI. During my April cycle I was given strict orders NOT to get pregnant because of the laparoscopy. And it was lovely. I still kept my BBT chart that month, but I didn't test with OPK's and we didn't time intercourse... it was refreshing.

May's cycle started and we spent much of June preparing and hoping for a successful IUI. And while I won't say that IUI's are stress free (see here for evidence of my stress level), IUI's do remove the stress and the obligation to get it all right. The monitoring gave me confidence that we wouldn't miss ovulation and the actual IUI procedure allowed us to kind of chill in the baby dancing arena... again, refreshing.

So after two months of just not fooling with timed intercourse and all the stress, the next month kind of just happened. I didn't test for ovulation, I didn't worry with timing intercourse. And while you can imagine my shock when I wasn't pregnant, I kind of just didn't care enough to put in the effort throughout the month. I'm terrible, I know. I whine all day about wanting a baby soooo badly, but when it comes to putting in the time, I'm not interested. Pathetic. This month has happened almost identically. I'm charting (sort of), but I haven't tested for ovulation and I haven't worried about timed intercourse... I'm pretty confident in the outcome of this cycle already. In fact, I think I've taken like 5 prenatal vitamins in the last two months. I have religiously taken prenatal vitamins for two years, and now, I just can't seem to work up the energy. How much energy does it require to take a vitamin, you ask? Umm, effectively none. The bottles sit on my nightstand. There is also always a beverage of some kind on my nightstand. It is all of an arm's length away. And yet, every night I think, "what's the point?", and my arm just can't seem to bridge the great expanse of space between bed and table.

I'm not really sure what this says about my psyche at the moment. Is this a faith thing? A "if He wants me to be pregnant, He'll make it happen" thing? Or is this an "if IUI doesn't work, nothing I do will work either" kind of thing? Because that's the other option. We've been at this for two years now. And for the vast majority of that, we've been trying hard, really, really hard, to get pregnant. We've done six medicated cycles, four of those were IUI's, and yet all have been an absolute bust. So you can see why the thought is there... if two years of timed intercourse and fours cycles of IUI didn't work, our only hope is IVF. And if that's true, then shouldn't we just live? Just enjoy? We are already living under such heavy restrictions in other areas of our lives as we prepare for IVF, so shouldn't we give ourselves a break here, where our efforts seem fruitless?

What do you think? If it was you, would you take a break from the charting, testing, and baby dancing? Would you put your baby dreams on hold until IVF? Or would you go the exact opposite direction? Would you get fired up to give it everything you've got before handing over that GIANT chunk of change? To try or not to try, that is the question.