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Thursday, February 03, 2011

Reconsidering

I'm having second thoughts.

Not about whether we'll cycle again. No no. Not at all.

But about whether NOW is the right moment. And the reasons I'm having these thoughts are plenty.
  • When we got our calendar, the RE who prepared it didn't consult with the RE who'd do the transfer (Dr. Tan) or the urologist who will need to do Hubby's surgery (Dr. Chan).
  • He also didn't factor in any bloodwork that needs to be done.
  • And nowhere is anything about the cyst included; "we'll deal with it when we need to" was the answer.
Ugh.

Okay, so let me be clear: I have total faith in Dr. Tan and the process that worked for us last time. But any modification from the protocol that we had last time might be cause for concern.

Last time, I had been preparing for YEARS to do IVF. I was taking vitamins, folic acid, exercising regularly, etc. While I'm back at the gym, I'm certainly not a 'regular' there yet and the vitamins and folic acid? Um... no. *hangs head sheepishly*

Anyway, the third time I called the clinic to ask about the fact that we were prescribed three months worth of vitamins but our cycle was in less than one month, I got Dr. Tan himself on the phone. He looked at my file, and realized that he didn't even HAVE a copy of the calendar that was given to me! I had to put the phone down and go fax him a copy so he could see the dates himself! Sheesh!

First problem: Dr. Tan isn't going to be in the country during the week of our retrieval/transfer. So that won't work. Solution: He advised stepping up the cycle, having me take the BCPs and overlap that with the Buserelin (aka Suprefact) injections and move the entire cycle up so that we'd finish retrieval/transfer by the first week of March.

Honestly, that seems a little wonky to me. Again, if I deviate from the standard protocol, I might just be wasting my money. I'd rather take the time and in a couple of months, do it right. Assuming they can fit me into their calendar that is.

Second problem: Dr. Tan asked (via e-mail) that I start taking DHEA, but didn't prescribe a dose/frequency for me. While I can get it, I need to get more details from him so the pharmacy can make up the correct dosage.

Third problem: Dr. Tan recommended a relatively new procedure for us. It's called CGH array (similar to PGD). They would ship embryos to New Jersey to the testing facility so that they could ensure they only transfer chromosomally normal embryos back into me at transfer time. However, I'm guessing that means a FET rather than a fresh cycle and I'm not so keen on doing that. The first baby born using this procedure was born to a 41-year old UK woman who had 13 failed IVF procedures and then they used CGH for the last one. Her baby boy, Oliver, was born in September 2009. The cost is $4000 for the shipping, biopsy and testing for all embryos we produce. Using CGH can improve chances up to 50%, and can be useful for women of an advanced age. (When he told me about this process, I immediately thought of a few blogging friends who might be interested in giving this a try!)

So Hubby and I have talked about this. I really don't think we'll be doing this for a few reasons. Yes, my eggs are two years older than last time, so we do have to consider that. However, my FSH is still really good. My bloodwork is all normal. Last time, we only produced six embryos, three of which made good quality transfers, but fertilization rates were high, dividing rates were really good, and quality on visual examination was quite good for those three. If we had multiple IVF failures, then I would probably go for this. Yes. And as I said, it would likely mean a FET rather than a fresh cycle.

Fourth problem: I am on CD3 today, and I still don't have all the vitamins that I was supposed to take (for three months, remember) leading up to BCPs and suppression injections, followed by stim injections. I'm working on getting them all, but some aren't available easily in Ottawa; I expect I'll have to order them online. One in particular is from a Quebec company and is new on the market; pharmacies in Ottawa don't carry it and can't get it. Hmm, maybe I can drive across the river this weekend to Quebec and find a pharmacy there? There's a plan... So yeah, I'd like to get going with the vitamins, folic acid, all that good stuff leading me up to the proper cycle dates and medications as are laid out in the regular IVF calendar.

Fifth problem: This is one that CAN be overlooked, but when combined with the others, it makes sense to consider it...

Hubby's schedule.

If we do the IVF right now, this month, and assuming it works, we would have a newborn on or around Christmas this year. And that means that the first four months of the baby's life, Hubby is tied up in school, trying to study and get good marks. But of course, he'll be wanting to help out and bond with the baby. It just makes more sense to delay for a few months to let me get these vitamins going, and that way, Hubby will be closer to being finished his course of study for practical nursing and we won't have the time issues and considerations.

So, with all that said, I'm on CD3. I had picked up the BCPs and took the first one before looking at all the details. Sure, doing it this month would let us just get going and not have to think about it too much. But it is only because I stopped to think about all the little things that aren't adding up, that I figured out we couldn't stick to the calendar they'd given us. So in this case, thinking about it is a good thing. I'll be sending an e-mail to the docs to let them know that we'd like to hold off for the three months so we can do this the right way. That'll give us a better shot. And it would save me from the "what ifs" when and if this doesn't go well. Honestly, if there's one thing I've learned, that peace of mind is bloody crucial.

Still hanging in there, and starting prep work for our IVF cycle. So stay tuned. More fun and games will be forthcoming. I promise! For those counting, Tuesday, Feb. 1 was CD 1 (clockwork I tell ya, even with a mere 4.0 lining on CD 23!) and all seems normal. We've started looking for and taking the various vitamins required. Here we go again!

5 comments:

Kakunaa said...

I think the decision to postpone a few months makes a lot of sense given the list you've made. Definitely want to give yourself the best odds!

Good luck!

My Reality said...

If you aren't ready, don't do it yet. There is no reason you can't put it off a few months. Or maybe you will decide next month is the month you want to cycle. And that is ok, too.

BTW - my DHEA dosage has always been 25mg 3 times a day.

Nearlydawn said...

Can I just say this? That schedule sounded TOUGH to me, and confusing, and not well planned. I don't like it when things aren't aligning for me - it usually signals a problem somewhere. I don't presume to have a "vote", but I'd wait until all those ducks are better lined up and I could see from A to Z how we'll get there.

Just my 2c - take it for what it's worth!

ultimatejourney said...

It really sounds like it makes sense to wait. I know it's tough to do that when you were mentally ready to start cycling but you want to give the cycle the best chance of success. And, I couldn't agree more that we need to focus on making decisions that will ultimately give us peace of mind. That tenet has completely guided us for the past several months.

Hugs and sorry for the delay.

PiccolaPineCone said...

it's hard isn't it? the balance between wanting to go now now now and logistical/medical factors that whisper "maybe you should wait...". i find it really hard to suppress the NOW NOW NOW urge but sometimes it is just necessary.
on a completely different topic but pertaining to something you said several posts back...i am using the same clinic as you right now. the first time i went, the doctor called someone's name repeatedly until the receptionist said "she's across the hall because she has children". the doctor went across the hall and came back with a woman and baby. i have never found this mysterious "with children" waiting room. never heard it mentioned again and there are often parents with children in the main waiting room. now i wonder if i imagined the whole thing. i really wonder what the deal is now but am strangely shy to ask about it. it's just curiosity on my part... no opinion on the topic implied.