Well, if anything has been anticlimactic, it was today's appointment.
Let me start by saying, once again, that I really like my RE. She started the visit by hugging KG and I several times. She is kind, empathetic, patient, and talks to me like an adult. She is also on a bunch of "Best Doctors" lists, which makes her warmth even more surprising.
This is the gist in bullets (because I love bullets). Don't expect to be blown away by new information.
• They still have no idea why we had zero fertilization with 19 mature eggs and good lookin' sperm.
• They checked for every possible reason including, but not limited to, lab error, culture medium, egg/sperm quality, batch quality issues, etc.
• They see this kind of zero fertilization (with young, healthy eggs and good sperm) a few times per year. It is VERY rare, which is why she didn't mention it as a possibility before retrieval. More often, they see it with MFI, bad eggs, or low ovarian reserve. She said it could be something as intangible as the sperm/eggs not liking the lab environment.
• The embryologist reported NOTHING unusual with our sperm or eggs.
• Sperm did adhere to my eggs, but they did not break through and fertilize. This gives me hope for ICSI next time. Maybe if we can just get those suckers inside my eggs, all will be well.
• They do not do rescue ICSI because there are almost no documented case of it resulting in pregnancy. Eggs have a 24 hour shelf life, and therefore injecting sperm past that time is useless. This Oxford article supports that claim.
• At one time, most clinics did do ICSI on all IVF cases. However, she said currently most clinics (maybe those in New England?) have decided that, unless a couple has pre-existing reasons for ICSI, they want to be as minimally invasive as possible.* Now that we show a reason for its use...
• They will not change my med protocol much because my E2 (estrogen) and follicle development were perfect. I also had no OHSS (THANK GOD). All good things.
• I asked what we would do if we still had zero fertilization after ICSI, and she said that she had no answer for that right now because it has never happened at this clinic. Interesting! If it did happen, it would go to review with her colleagues.
1. Wait for AF (she will probably arrive next week)
2. Call CD1, go back on BCP on day 3.
3. Do at least 3-4 weeks of pills, during which time insurance authorization and potential Lupron start date all get worked out.
4. Keep going for electro-acupuncture to try and fix up my ovaries
5. Go in for pre-Lupron ultrasound to make sure I am not all cyst-y
6. Start. all. the. fuck. over.
By my estimate, that leaves us starting Lupron again in late March, if all goes well.
I know I'm supposed to be comforted by the fact that a zero
fert outcome with ICSI is so rare, but unfortunately I have googled the
crap out of all of this and know that it is possible. But, what else can we do? We can keep moving forward.
In the meantime, I'm thinking some margaritas, pedicures, and frivolous spending is on the agenda.
Have I mentioned I had my first shellac manicure over the weekend? Life changing, I tell you.
*Please don't be offended or think anything is wrong with your clinic if they do ICSI on all cases. I wish my clinic would.