10 June 2009

plan is just a four letter word

I totally agree with Grade A and IF Optimist in their kind and concerned comments on my last post-- to decide ahead of time what you are doing (IUI vs IVF) before you even know what you have to work with feels backwards. I agree- it does.

it seems somewhat realistic to plan for an IUI based on my lack of optimal response in two cycles
and it makes sense based on my so far consistently low number of antral follicles
and on our prior success with this very thing last time
...so in these ways it is not entirely crazy.

And one of the things it also does is take the pressure off of me to succeed/fail at IVF. I do not have to worry about the heartbreak of conversion and feeling like I failed. That really sucked.

And cynical/realistiKate says it also takes me out of the stats for the clinic -- If I am not a declared IVF cycle, then my probable IUI does not impact the stats as an IVF cancellation. And I asked, if I stim well I can possibly upgrade.

So, let's say I have 8 antral follicles like my first cycle, and let's say by some miracle I stim well and all 8 develop and maybe bring along some friends-- I asked, if I do well can I convert to an IVF? And the answer is Yes if the schedule allows. This is the other reality-- so much of this treatment stuff has to do with clinic schedule-- we take birth control for some of these cycles for two reasons-- to suppress but also to schedule, right? If I stim beautifully and we do not get to do IVF simply due to scheduling reasons, I will most definitely be bummed out/pissed off since I know it is our highest chance of success. So I can only hope that if this scenario happens, it will work out schedule-wise, and it will work out in every other way too.

In reality, I will know more at my baseline ultrasound-- my last one I had only 4 antral follicles and that was all that we ever had to work with that cycle, and one 6 week embryo and one empty sac said at least two of those resulted in eggs that fertilized and embryos that implanted. So I like thinking that could happen again (only better!).

So yes, I agree-- On the one hand, I do not like deciding which way we are going before we need to. But I also get why we are calling it this, and I also get that, with luck, if I do something amazing, we can call it something else.
Like, say, a baby.

Where does CCRM fall into this? My period is due any second-- seriously, I feel like a highly irritated water balloon with cramps and a headache and my temperature dropped precipitously this morning. And I want to move ahead NOW, I do not want to sit out a cycle. My talk with CCRM is not until next tuesday-- and if I get CD1 tomorrow, I may even be stimming by then. So, this is a cover-my-ass, hope-for-the-best cycle. I still absolutely want to know what they say and what they think, and if this cycle fails, we will take what they suggest into account as we look ahead as best we can emotionally/financially/logistically. Even if they say something inspiring, and we decide we can afford it, the next step is to schedule a one day workup in Colorado early in one of my next cycles. So this is about not waiting.

I welcome your opinions folks, I always do. This is the only IVF/fertilty clinic I've attended, and the only doc I have worked with, so my experience is limited. So please, feel free to share experiences, concerns and ideas. I am not offended at all since I know you are pulling for my success too.

One of the things I've learned so far on this IF journey is that a plan is just a plan-- reality may be (and so far, has always been) something entirely different. And who knows, maybe this will just work. Wouldn't that be cool?


sprogblogger said...

Hey Kate - I am all for optimism and planning for the worst. Sounds like you are, too. Going ahead with an IUI to convert to IVF sounds like a good plan - bummer about your clinic's scheduling stuff, though. That's one nice thing about going to one of the big guns - they're simply not going to cancel or delay your treatment because of scheduling issues.

And yeah - at this point in the game, I think CCRM is a fantastic next step. I've heard that some of the reasons for their outstanding success rates are that they push women our age toward DE, but I've also heard that if there's a way - realistically - for you to walk away with a baby, then you will.

I hope that this cycle works out for you, but if it doesn't, then I hope CCRM is ready, willing, & eager to make this happen.

White slacks work wonders for me...

Nic said...

IUI convert to IVf if poss sounds like a good plan. I love a plan! Really hope that scheduling does not get in the way if this can happen.
We are all hoping that this works for you. Will be with you all the way
Nic x

onwardandsideways said...

Okay. I've been kind of holding off on saying what I'm about to say because I'm trying to be supportive. But I also think that it's important not to cross over into the realm of blowing sunshine. And as I just read that you've only worked with one clinic so far, I really feel like I need to speak up. Please know that what I’m about to say is meant to be supportive. I really hope I do not piss you off, scare you or depress you. I just hate to see you spend another second in Infertility Hell. If I do piss you off, feel free to tell me to stuff it and I will understand.

We started TTC when I was 38. Not sure if you're aware, but I'm now 44 and will deliver when I am 45 (I have a birthday in July.)

If I understood then what I understand now about conceiving in your 40s with your own eggs, and the chances of success (even with ART) at 40+ with your own eggs... I would have turned to DE much, much sooner.

Giving up one's genetic connection is a process and everyone comes to that decision in their own way. I'm not telling you what to do, by any means. But I think you need to -- if you can -- sit down and really look at the facts and stats. I'm kind of surprised that your current clinic, given your age, is allowing you to do another IUI. The clinics I was at at that age were much firmer and clearer that my chances of success were so unbelievably low that it just wasn't worth it, nor was IVF. I don’t know if your IUIs are covered or not, but hopefully they are. Otherwise, I question the ethics of clinic that would take money from a 42-year doing an IUI with her own eggs, especially given your follicle counts. Yours are about what mine were, fyi, and I responded about the same to meds. Has anyone discussed with you that fact that response tends to get worse on every cycle with women who have antre-follicle counts in our range?

I think you should seriously consider the fact that if you pursue a baby with your own eggs, the chance of having another miscarriage or blighted ovum or something of that nature are high. Or a child with Down's. Or a Trisomy. I don't mean to scare you or depress you, these are just the facts. Personally, the thought of doing another D&C was enough to push me over the line and make the decision to go with DE. I would really, really hate to see you end up in that camp again.

I hated the first doctor who told me that DE was my best chance. I hated the second and third doctors who told me that too. When we got pregnant on our own after our last IVF, I was so looking forward to sending them a birth announcement so I could wave it in their faces and prove them wrong.

I don’t hate those docs any more, and I understand that they were only trying to help me. I sincerely wish I’d listened to the first one. But as I said, it’s a process.

I think you should consider DE sooner rather than later. It’s no guarantee either, but if you really want a baby, you’ll get there a lot faster with DE. Miracles happen all the time and people do beat the odds... but not as often as you might think.

So that’s my assvice. Take it or leave it. I wish you much courage, strength and SUCCESS, no matter what decision you make.

onwardandsideways said...

Also, @sprogblogger: I once felt 'pushed' by IVF clinics to do DE. Especially when I was still 'only' 38, 39. I now feel very differently about that. Those docs new exactly what they were talking about and no one was pushing me. They were trying to help me.

Having been to CCRM, I can tell that I sincerely doubt they 'push' anyone to DE. They were very open to discussing any possibilities of why I couldn't conceive on my own, any testing we could do to figure that out... every rock we turned over came up the same thing: my eggs were just busted and it was time to move on.

They are known for taking 'difficult' cases, I know of at least one women who falls in that category and is now the happy mother of twins.

So... just so Kate knows, they won't push her to anything. But they will definitely give you just the facts and if you're a DE candidate, you'll know right away. And if they tell you you are, I wouldn't question them.

Michele said...

Kate, I dont think it is dumb to think out your plan in advance. We decided even before beginning treatment that we would only do IUI and that, if it didnt work, we would accept that and not do IVF (IVF is against our religious beliefs, so we always knew that wouldnt be an option for us). Going into it with a plan and with research, I think, makes what happens in the cycles, a tad easier to handle since you become very aware of each little thing that you are going through.

All in all, I think that, whatever you do, you follow you heart. That, to me, is the most important thing. Follow your heart, wherever it takes you. Regardless, I will be praying that your dreams come true.

IF Optimist, then... said...

You are so amazing to open up this very personal part of your journey to us all. I didn't want to start a fire or anything. I just felt like "Mama Dragon" for a sec when I read your IUI post. I said to myself "GRRROWWWWERRRR, must use giant claws and gnash pointy teeth to protect the fair maiden Kate." I was 95% certain that there were logical, medical circumstances that brought you and your RE to the decision...but my 5% part just wanted to make sure. I appreciate your understanding.

The good news is that you DID get pregnant with 2/4 of the eggs. I find that to be a positive sign. It's great to know that IVF is an "upgrade" possibility. Wishing you the best for your CCRM consult.

Now put on those white capris and go out somewhere in public far, far away from home. Oh and don't bring any AF supplies in your purse. The bitch is certain to come.

Maredsous said...

One of the things that frustrated me the most was the timing of my clinic. Looking back I realize I was really jerked around completely by them. I had to wait two months because of holidays and their national meeting. I realize from others blogs that I was fortunate that I wasn't part of the cattle herd that went exquisitely by their schedule, but by the same token they robbed me of several months. If you are limited by the clinic's availability then that sucks. But I really think a stimulation IUI with a potential upgrade is a great possibility. You had great success with your IUI. Believe that it is a great sign.

Wishing you all the best in your next cycle. You are Kate, hear you ROAR!!!!