Tuesday, February 26, 2013

This Ain't My First Rodeo

RE #4 was a nice silver-haired German fellow who smiled knowingly several times when I quoted him my exact lab numbers from the past several years without once referencing the thick stack of records sitting in my lap (that comprises less than half of my time in the stirrups). FSH, AMH, specific procedure dates. Whaaat? I just like my numbers, Mr. Doctor.  He smiled a little more at my ease with the IF lingo (I swear I wasn't showing off-you all know how it comes naturally after some time) and then when it came time to answer how long we had been TTC, no one could count around the years very accurately, so he decided that 'too long' was the appropriate answer.

Yes, we've been doing this 'too long'. This ain't my first rodeo, buddy. And you know it. There's no deer in the head lights "my God, what have we gotten ourselves into?" look on these faces. We had that look about 7 years ago. Not today. We're now sitting back in our chairs, arms draped over the back like we own the place. We're years past the shell shock (still lingering in sticker shock land, though). No, we're more of a road weary bunch here, fatigued, too familiar with the ropes and wondering when we can get off the ride cause this stuff here, well, it's getting old and we're getting tired.

As I mentioned before, RE#4 is technically RE#2, but he wasn't there when I was doing our IUIs. However he is out of the same office, so it was bizarre to come back and recognize all the faces, faces I was sure I would never see again. But boy am I in a VERY different place than I was the last time I was there. They asked and I told them. Yes, I have a son. He's three. And he's amazing. And being in this spot right here and right now takes me back and makes me that much more grateful, if that's even possible. I remember where I was a little over 4 years ago. It was the last time I sat in that waiting room chair. It had been a year of constant treatment, loss, failure, and heartache. I walked away in pieces. Hope was so much harder to gather. And the more we talked yesterday, the more I recognized how superb lady luck had been to me since then, especially given all that was standing in our way.

And then I laid it out on the line. I made my agenda transparent because obviously that sales pitch I launched a little over a week ago with the OB/GYN didn't work, so I tried straight up honesty. I explained that I was considering both clinics, but in the very least, I was looking for a second opinion. I wanted it straight, from someone who had no incentive to get my patronage (I actually said this). He explained (as I knew) that both clinic's success rates were almost identical and that both were excellent. He, however, was different in that he would receive a paycheck at the end of the day regardless of how many patients he brought in. His honesty was nice and welcomed. So, with the being said, I wondered aloud, am I wasting my time even considering IVF here?

According to RE #4, IVF is not out of the realm of possibility, but it will take A LOT of drugs. My FSH is borderline (while my AMH is hovering around 'fine'). But even 4 years ago I took more stims than you would expect for a 30-year-old. This part was nothing new. He continued and said that for all intents and purposes, I have a 75% implantation rate. 3 of 4 of my embryos stuck around, one as a vanishing twin, one as an early loss, and one for 40+ weeks who is now a living and breathing child. Per this guy, that's better than average. But consider this- I also have virtually the same miscarriage rate as implantation. In fact, he coded our appointment under RPL (recurrent pregnancy loss), which will save us a few bucks, but was eye opening. I mean, it's not like I didn't notice that I've had multiple miscarriages, but hey-that's where the issue mostly lies now-not as much in getting pregnant, but staying pregnant. I hadn't thought of it in that light.

I wondered aloud, have I left any stones unturned? (cue knowing smile from doc again) As RE #3 also noted a few months ago, no. In fact, RE#4 was surprised that I got the full RPL panel after my first miscarriage (I guess I had a better sales pitch back then). Thank God I did! I must have had some foresight. Based on our early testing, no genetic or immunolgical issues were found-nothing was out of the ordinary for either one of us. But still, he wondered, there must be something genetic. Now, genetic issues could have very well been sheer crappy, crappy luck. A big percentage of embryos are chromosomally abnormal, hence the 25% miscarriage rate in all pregnancies. And I fully understand that you could throw test after test at us for years on end and never discover what it is, but I've always felt--always, that there was something more, that MFI didn't explain everything. For once I heard someone say it out loud. (in fact, he didn't think that our MFI was all that significant in explaining our IF-at least from a treatment/miscarriage standpoint. IVF is the great equalizer for that, I suppose.)

He suggested that we consider PGS. Unlike PGD where a known genetic issue is tested, PGS is a general screening for chromosomal abnormalities. We didn't get a chance to talk at length about it, but I've since looked into this. I could write many blogs about my findings and feelings on the matter, but at this point (and based on studies that don't necessarily find the screening to increase live birth rates as well as lower than wonderful accuracy rates), we're leaning away from this for now.

So, we've met with RE#4. He seems like a nice guy, a good doctor, but I felt that he evened the score even more. I could go either way at this point, but I'm feeling like (as he mentioned) continuity of care wins here. So, RE#3, let's have our last go around. Soon, it will be time.


AnotherDreamer said...

Hmm, a lot to consider. Sorry that nothing significant came to you with all this, but hopefully you're in a direction your comfortable with now. Peace of mind can be everything sometimes.

Hilary said...

I am sure you will figure it out... give yourself time and space

Jessah @ Dreaming of Dimples said...

Good luck, Shelby. Our RE recommended PGS and we are moving forward with that also I did have my reservations initially. It is so hard to determine how much to trust your own instincts vs. trusting your doctor's expertise and recommendations. Good luck with your next IVF!