Finally a Followup

The doctor had called me the Thursday night of the unfulfilled transfer date to say she hadn't forgotten about us and that she was going to meet with the embryologist to go over my case.  She asked me how I was doing.  I responded that "it is what it is".  She said, "oh, honey" - like we are so close.  I hung up with her and I broke down crying.  Four days later, after the initial hurt has waned a bit, I finally received the follow up call from the doctor.  Not the quick turn around I might expect, but at this point, I'm no longer surprised.

She called me at work at the end of a very long Monday.  She mentioned that her car was warming up in the parking lot due to the nasty winter weather today.  Weather chit chat ensured.  Then, the long story short: I was given too few drugs (M2) for IVF #1 and given too many drugs (M4) for IVF #2.  Recommendation with IVF #3 is a happy medium (M3).

Apparently, I am not one of those women who respond perfectly to any combo and timing of drugs that are thrown at my ovaries.  I have sensitive, finicky, picky ovaries.  Lucky me.  I have to have the perfect cocktail to illicit the ovarian response needed to make nice embryos. I asked her if it was an "egg quality" issue that had more to do with the natural state of my eggs than the drugs.  She said no.  The quality of eggs that we got were directly related to the dosage of drugs.  With IVF #1, we went too long with the drugs and the eggs were exhausted.  But the embryos ended up progressing better and were of better quality than IVF #2, which were too 'slammed' with the M4 and the response was "lopsided".

I asked if we would consider changing up the Femara/Menopur combination to something else.  She said no.  She thinks that another type of FSH would stimulate my ovaries too much and the bigger problem would be the whole new learning curve of another protocol.  We have to get the exact right dose.  IVF is so individual and differs so much from person to person.  It is "not an exact science" and involves "guessing", "artistry", and "wiggle room".  All her words.  Not mine.

I also asked if the clinic really doesn't look at the embryos on Day 4.  She said that was true.  There are "delicate changes" that occur between Day 3 and Day 5.  It is better to leave them in the incubator undisturbed with as little extra environmental exposure as possible.  This is why they couldn't let us know about the cancelled transfer until pretty much right before the transfer.  Also, I know that her theory on Day 3 transfers is that if the embryo wouldn't make it to Day 5, it wouldn't end up in a BFP even if we transferred on Day 3.  So I didn't bother asking again.

So, here we are.  Here are my thoughts:

1.) Financially, we need to wait for all of these current IVF charges to go through insurance, etc. to see if we could possibly afford another round of IVF this year or if we should wait until next year, which we both really don't want to do.  It is only January!

2.) We are taking a trip to Lake Tahoe and Reno in early March, so we probably won't do anything until after that trip.  (We definitely need a vacation now).  Also, I am so sick of winter driving.  So waiting until spring/summer is here is obvious.

3.) We may consider a 2nd opinion.  This would be to mostly to see if RE #1 is full of crap or if she is on the right page now that she's been able to play around with my dosages (and fail) two times.  We don't know if we would make a permanent switch or not.  Even with all of the customer service issues, moving to a new RE would be like starting all over.  The new RE would have to "get to know" me and my cycles.  What if it takes two IVF cycles for them to figure me out, too?  The new RE's office is still an hour and a half drive away (in the opposite direction), so I wouldn't save much driving time in any case. 

We have some decisions to make.  But not this second.