The Big Reveal

Today is a day I will remember forever. I saw my sweet, little baby's heart beating for the first time and it was an amazing site to see.

I was so anxious going in to my appt. and my clinic never makes you wait long and of course this morning we waited FOREVER! At one point Sean joked that he was going to hit the lights and get started without Dr. P. This made me crack up!

Dr. P finally came in and we got started. I am not sure I was even breathing. He turned the monitor towards him and right away he said, "It's good news! We have a heartbeat! There's only one!" Then, he turned the monitor towards us so we could take it all in. The baby is soooooo small, just a 1/2 cm, but the flicker of the heartbeat was very clear. Sean & I just stared in awe at the screen. Dr. P did not see anything that he thinks would have caused the bleeding, but did say I have a pocket of old blood that I could likely pass. At least I can be on the look out now.

After the u/s, Dr. P had us meet with him in his office where he told us the baby is measuring right on. He confirmed our EDD as Christmas Eve, said he was cautiously optimistic for a positive outcome, thanked us for helping his statistics :), gave us a few instructions and told us we would be "graduating" to our OB today. No more appts at the clinic. This caught me TOTALLY off guard. I definitely need to plan a visit in the next few weeks to see the girls that were off today and bring everyone a token of our appreciation.

Sean & I are both overjoyed, but I do have to say that neither one of had the big outpouring of emotion that I thought we would have. We were both very quiet during the u/s and during our meeting with Dr. P. We went out to lunch afterwards and we talked about how there is still a lot of unknown and leaving the security of the clinic has us feeling a little unsettled. They really cared for us and handled us with kid gloves and I just do not have that relationship with my OB. I know seeing a heartbeat is a huge milestone and I am overwhelmed by all my emotions right now. We were both a little sad that Jack & Diane did not hang in there together and yet relieved that we will not face the risks of a multiple pregnancy at this point. As my mom said, we can always work up to that :)

So, without further ado, I present Baby Saucy or "Ralphie" if you prefer!

Now I need to start working on a new blog title!!!

A Plan

I know it has been a little bit since I had anything worth while to say. I have been doing ok, I guess. I am not in the Christmas spirit, not even a little bit. We did not even decorate the house this year. We had very little shopping to do, which was good. I am going to make homemade candy this weekend and I did do holiday cards, but that is about it. My kids are finished with exams and I am finished tutoring until January and am looking forward to the little break. We head up to Bu.ffalo on Tuesday.

I had my WTF appt on Monday with Sh.ady Grove and while it was somewhat informative, I found myself walking away feeling frustrated. Dr. M was compassionate and asked us to keep trying. He agreed that the Ganirelix protocol did not do what we were hoping (more eggs) and that we would go back to a long Lupron if we ever did another fresh. He seemed kind of stuck on the fact that we are "new patients" to him and we "only" had one failed cycle with him and we were hoping he would look more at the big picture. He totally dismissed immune issues, beta 3 integrin (sticky glue), and basically did not see the need for anymore testing. Overall, he suspects a chromosome problem and said we are more prone to one because of the severe male factor. However, he doesn't think we are candidates for any type of genetic testing at this point. He said we don't make enough embryos to risk sending them out. He is not a big fan of PGD and said that they are still in the learning stage of CGH. They will be offering eventually, but no time soon and in his opinion, we are not making blasts, so no CGH for us. This is where I was getting frustrated because I felt he wasn't offering us anything new to get us over the hump. His overall plan:

1. Join their shared risk program - $22K 6 fresh cycles, unlimited FET, 100% refund.
2. Bring our 6 frozens over and include them in shared risk.
3. Try to thaw all embies and grow to blast.

That's it. He wasn't very optimistic about an FET - puts it around 20-25%. I was frustrated. I felt like he was kind of dismissing our frosties and putting more emphasis on shared risk and more fresh cycles.

Our consult at our old clinic with Dr. P was really, really great. Everyone was so happy to see us - it is so warm and friendly. We got hugs from the nurses and receptionists and billing and everyone was sorry to hear we had another failed cycle. I thought I was over needing the warm and fuzzy, but it felt so good to feel so cared for.

Dr. P was completely understanding about us seeking a 2nd opinion and doing IVF elsewhere. I was nervous about that and he put my mind at ease. We talked about the failed cycle and he also said no more anatagonist protocol for me. For another fresh he said long lupron or possibly microdose. He said he was going to pretend that all three cycles failed with him and treat us accordingly, which made us happy because any way you slice it, we have still had 3 failed IVFs. He thinks we are still very good candidates for IVF and have a good prognosis. He also feels that we have some great frosties and is much more optimistic than Dr. M about it. He is excited about doing an FET because he thinks I might just be one of those people who responds well to an FET.

Dr. P is a little concerned why I am so prone to polyps and is wondering if it indicates a possible lining issue. He agrees there could be chromosome issues, but is hesitant to jump right to genetic testing. He said PGD is a very flawed science. It misses a lot of abnormalities, there are a lot of false positives and false negatives and PGD has not been found to increase pregnancy rates in IVF patients. He thinks it has its place if there is a known genetic issue that they are screening for. He admitted to not knowing much about CGH, but would be open to genetic testing under the right circumstances. He thinks we need to focus on getting some blasts before we worry about that though. He also dismissed immune issues/testing and beta 3 integrin. Dr. P doesn't believe there is good science or data to justify testing or treating either. Supposedly, after more than a decade of research on both, there is no increase in PG rates for those undergoing immune therapies or Depot Lupron for Beta3. He also feels there is a huge conflict of interest that only one lab in the country does the beta 3 screenings and they also publish all the studies. He discussed how results can vary wildly cycle to cycle and he believes if it worked and truly increased success rates, every RE in the country would screen for these 2 things. He doesn't believe in testing for the sake of testing or "going fishing" as he put it. I just don't know what to believe in this department as there are so many varying opinions in the field.

Anyway, without further ado, his plan:

1. Repeat SIS on Tuesday to check lining. B/W to screen for insulin resistance and check my prolactin.
2. Order a DNA karotyping for me. Revisit genetic testing pending results.
3. Do a mock cycle before my FET. This means prepping my lining for an FET using Estrace and Endometrium, but instead of doing a transfer, he will do an endometrial biopsy instead to check my lining. I am not sure exactly what he is looking for, but he said "abnormalities" and to see how my lining responds to meds. It always looks great on u/s, but he wants to see it under the microscope. He said tweaks can then be made and if there are abnormalities, they are treatable. I have never really heard of this before, but if it means learning more, then I am all for it.
4. Do an FET cycle after mock cycle. Thaw all 6, culture to blast, transfer 2 or 3 blasts. He feels confident we will get some blasts. Fingers crossed.

Overall, we walked away feeling much more confident about Dr. P's plan. He seems more thorough and more optimistic about the success of this FET. Plus, I feel good knowing my embryos were created there, frozen there, and were the result of 2 good cycles. I walked out feeling like my questions were answered and like the weight of the world had been lifted from my shoulders.

I have b/w and SIS on Tuesday and I will do my mock cycle in Jan. FET in Feb pending results all the testing.

I feel like my mood has improved slightly since meeting with him and as I have said before, I do best when I have a plan. Now, I hope we get some answers!

Whew, that was loooooooooong. The end.

Decisions, Decisions...

After many tears, a great deal of soul searching, and many conversations with each other, friends and family, I *think* we have come to some conclusions about what our next steps might be.

We are very lucky to have 6 frozen embryos from our 1st two cycles. For whatever reason, our old clinic did things kind of backwards and if you had any good looking embryos on day 3, they froze them with the thinking that they can be grown to blast when they are thawed. Here is what we have in the freezer: (scale 1-4 with 4 being the best)

1 @ 10 cell grade 3+
1 @ 9 cell grade 3+
1 @ 8 cell grade 3+ - fragmented
1 @ 8 cell grade 3+
1 @ 7 cell grade 3+
1 @ 6 cell grade 3+

Not bad, right? So, we are going back to our old clinic where these embryos were created and have a consult on 12/17. Our ideal plan (which has been proposed by my docs before) is to thaw all 6, hopefully get a few to grow to blast and transfer the best ones. We have no guarantees that anything will make it to blast at all, but we feel strongly about giving these embryos a chance to grow and thrive. I feel great that some of these embies are from the batch that created a blast or two from the crappiest among them.I also learned they can be refrozen if they look good! FCOM's FET success rates for 2007 were 42%, which is certainly enough to be hopeful about!

Now, I know this plan is not perfect. I know we run the risk of wasting time, energy and resources on something that may never work, but isn't that true of all ART cycles? I am not convinced that there aren't possible immune issues, chromosome issues and maybe even a lab issue, but I am willing to give it a shot regardless. What if it is none of the above? What if it has just been bad luck? What if I am one of those people whose body hates stims, but does much better with an FET?

We feel committed to using these embryos that we created. If it works, not regrets, obviously. If it doesn't, no regrets then either because we will still have options and even more answers.

For now, phone consults with CCRM and SIRM have been postponed indefinitely. If this FET is a bust, we will take that step, but for now, we are trying to muster the energy to give this FET the best shot possible. Honestly, another fresh cycle with all the anxiety and stress that accompanies it, is not appealing to me at all right now. It is not easy and I am not ready for that. I wouldn't cycle again locally and traveling for one day work ups and for almost 2 weeks for stims and ER adds a whole other element of stress to the mix and I want to be 100% sure of my decisions before taking that on. I need to walk through this door first and see where it leads me...

I know I mentioned the possibility of FET with PGD and I think that is off the table for now, unless our dr. feels strongly about it. That is money we don't want to have to spend and would rather hold onto if CCRM or SIRM end up being in the cards. We also decided not to move the embryos to Shady Grove. We think that it is a little risky to move them and they were created at FCOM and did really well in their lab, so why take a chance. Besides missing my polyp, I was very happy with my care at FCOM and to be honest, if feels a little like coming home.

We are not in a big rush, it has been a long year. We may opt for January or February for an FET. We are going to *try* to enjoy the holidays as much as we can handle and try to rest and heal. I am still having a tough time, I am feeling very raw and emotional and broken. I do best when I have a plan though and we are well on our way to one!

In other news, you should head on over to my dear friend, Jill's blog , and celebrate with her! She FINALLY got a BFP on IVF #3! Go wish her congratulations.