Wednesday, February 8, 2012

Tell me something good...the WTF appt

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.

Sooooo...

The Plan
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.

34 comments:

  1. I know SEVERAL girls that have had rescue ICSI performed and have babies or frozen embryos or are currently pregnant. While it might not be the "norm" it can and should ATLEAST be tried.. I was shocked when I read your post... The sperm didn't penetrate your eggs, because it seems the shell might be harder on your eggs (in which case ICSI WOULD fix that problem) sn: I ALWAYS make my clinic do ICSI, even when I was young, because I never wanted to risk of zero fertilization..BEST OF LUCK TO YOU, I will be following along with your journey.

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    1. All I know is what I was told. I agree, I wish it had been tried. I didn't realize zero fert was a risk before this happened. Oh well.

      Thanks for following my blog!

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  2. Fingers super crossed for you for #2. One foot in front of the other. I'm still shellshocked. I hope you are doing well. You know you can talk to me about this any time. HUG HUG HUG HUG.

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  3. I am so hopeful that, with your amazing response to the medicines, everything will be perfect next time. How frustrating, though, to have no real answers!

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  4. Well, at least there were no surprises from this visit (seriously, an "oops we did this wrong" would have really jeopardized your confidence with this clinic). In addition, it sounds like you have an excellent RE. The fact that she spent time walking you through everything and helping you understand what happened and where you would go from here is huge. I'm still keeping you in my thoughts during this time. Try not to drive yourself too crazy with Dr. Google. I did that and wish I hadn't.

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  5. I honestly think you had worse case happen already. It can only get better from here. My doctor is doing icsi on us but not on all eggs. He said some of the best quality comes from .natural fertilization. I really really think that you will have fertilized eggs this next go around. Your doctor sounds amazing. You are in best hands. As always I am wishing you luck and hoping time goes by quickly.

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  6. I think you are doing wonderfully after all this fiasco. My clinic doesn't do ICSI on all cases either, unless there is a reason. We didn't do it for my IVF. I really do think that you'll have better results this next time when they accomplish ICSI, I have hope.
    You are asking all the right questions and it sounds like you are in good hands with this RE, so it is only a matter of time.

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    1. Well, it sounds like you had a thorough visits with actual answers. We've done ICSI on all 3 batches, and even with my old eggs with cement walls, we still get a pretty good fertilization rate.

      I do like your agenda...I am addicted to Shellac, although it will weaken your nails. But I love it and get it done every 2-3 weeks anyhow. Have fun on the frivolous spending!

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  7. For our first IVF cycle we had 0% Fertilization rate as well (out of 9 good eggs). It was such devestating news.

    The second IVF ICSI was performed. We made some good looking embryos (one of whom turned into a pregnancy, and is sitting next to me right now).

    Don't give up hope - I have a good feeling that ICSI is the answer for you as it was for us.
    Caroline

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    1. Thanks for replying! It is really helpful to hear your story.

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  8. That sounds like a very promising appointment with lots of good information. It seems they really did their homework to give you all the answers that they could. I think your next cycle is going to go very well with ICSI. Hoping for the very best for you!

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  9. You said it best yourself, what else can you do but soldier on forward. Your specialist sounds good. I guess just trust with her and run with it.

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  10. Somebody (on some blog or board at some point :)) told me that if you trust your RE and the clinic has good success rates - then stay put. That made me feel better. It sounds like you are in good hands, and if there's anything good to come of this (awesome consolation I know) it might give you some insight into why things haven't worked on your own. Which means....next one will be it.

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  11. Somebody up there already said it...hopefully the worst is over! It's onward nd upward from here.

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  12. This must be so mysterious and confounding. I'm sorry it didn't work out, and then this odd unusual outcome. The thing that happened with my IVFs was that they seemed to learn from the one before to get better results. (((Hugs))) It's a tough thing to go through.

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  13. I sincerely hope that ICSI will work out for you! It simply has to. Fingers crossed!

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  14. I think this sounds like a good appointment overall, although one with a crappy outcome. And I'm really glad that you have so many margaritas and pedicures on the schedule!

    As a fellow New Englander (though I don't think we're at the same clinic) I agree that they aren't very pushy on ICSI around here. My RE said that he preferred to avoid interventions where possible, although I do remember him telling me at the initial consult that it was possible I could have 0% fertilization if we chose to go au naturel. I do wonder if it's a regional thing since there can't be that many REs in the area and I'm sure they all know each other - have you checked out the statistics at http://apps.nccd.cdc.gov/art/Apps/FertilityClinicReport.aspx?

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    1. Yeah I did check out the reports for my clinic (and the others near Boston) and they have excellent stats, which is reassuring. :)

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  15. We will be doing everything together again in March!
    Granted, I'm not doing another IVF -- I feel just as depressed as if I were.

    Maybe we can be cycle buddies again!? :P

    Love to you! <3

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  16. Your doc sounds wonderful. I'm really sorry you didn't get any clear-cut answers but am hoping & praying that ICSI is the magic bullet.

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  17. stay strong and keep trying. Hugs to you and your DH. :-)

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  18. I'm glad that you have a good doctor. It sounds like she really cares, and she'll do everything she can to work with you and to make this work. My thoughts are with you.

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  19. I wish I could give you a giant hug. And then, we could go get another shellac mani, I'm due. Aren't they amazing?

    Big hugs.

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  20. I'm keeping hope that this cycle in March/April will be the one for you. Good luck!

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  21. What a great appointment- so much information and a plan. I'm sorry you have to start over again but here's to hoping this is IT!

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  22. Dr. Google is evil. Pure evil.

    Sorry you have to go through all that again, hopefully there will be a much happier outcome!

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  23. Just catching up with this terrible news. I am so so sorry.

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  24. Well OK! Good news, although not exactly what you wanted to hear. Isn't it crazy how modern science can do so much, but at the same time can fail to explain them. You are doing great and I am so proud of you. I love you!

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  25. I am so glad your Dr is so great! Sounds like you have a plan and I am keeping everything crossed and hoping and praying so hard that you have a bunch of little embies this time!

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  26. Oh babe, I don't know how I missed this post. I blame my hormonal daze and crazy travel schedule. I can't believe you had a zero fert rate! I do think that your doctor sounds fantastic and that you are on the path to success. Never-the-less, set backs such big time. I'm keeping good cyst-free thoughts for you so you can get this show on the road.

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  27. I'd like to respond directly to the silly spending portion of the blog, and tell you that I am here for you for that ;) Also, depending on what my doctor says tomorrow I can start cardio later this week, and I think dancing is in order. Love you.

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