The Stratification of IVF

     A couple of weeks ago I was perusing the interwebz for some infertility blogs and came across something that made me particularly stabby. A blogger (I can't remember who or else I would totally call her out) waxed poetic about how painful infertility has been for her. I totally empathized. In fact, I applauded her candor. She spoke about how she was jealous of pregnant friends, the pain of being the odd woman out, and the desperation she felt. She even went so far as to admit that she sometimes wished her friends would miscarry. It's a horrifying thought, but I applauded her bravery in stating that as I think many of us have had those same thoughts - not because we want anything bad to happen, but because misery loves company and sometimes it's satisfying to see someone else struggle so you aren't the only one. I gave her credit for her openness.

     She totally had me at 'hello.' until I saw that that bitch got knocked up her first fucking cycle of IVF. What the EVERLOVING FUCK does she know about pain?! Hopelessness? Desperation?

     In my opinion - not a damn thing.

     She posted that blog entry a couple of years ago, so I immediately clicked to her home page to get the latest updates. And guess what?! She was pregnant AGAIN on her second cycle. Oh bitch please.

     She knows nothing about the pain of infertility because she hasn't had a failed cycle. Hell, she hasn't had multiple failed cycles. Until you get to that point, you don't really know the horror of infertility. I'm not trying to be a bitch, and I'm certainly not trying to play the pain Olympics because that doesn't get anyone anywhere, but still.

     I've come to realize that for some, IVF is the Golden Ticket. It works all the time, 100% of the time. For others, IVF is the beginning of another long, painful road. And in that realization, I've begun to understand that the pain of infertility is doled out via a stratification system. We can all agree that it sucks badly to get to the point of needing IVF, but I hope we can also agree that it sucks even worse to need three, four, five or more cycles to have a baby compared to those who need one.

     What made this particular blogger worse, is that not only has she gotten knocked the fuck up twice in two transfers, but she has enough frozen embryos left over to start a small country. Fuck her. Try being on IVF #3 with fewer embryos to my name over three cycles than she got in her one damn shot.

     I'm not trying to minimize anyone's pain, I'm just trying to show that it is different, and likely more painful to be walking down my path. I've also come to realize that people who get pregnant on their first cycle of IVF tend to make me angrier than the "normies" who get pregnant the good ol' fashioned way. I think its because I feel so far removed from the normal procreators that their fertility doesn't offend me as much anymore (unless they make stupid comments about infertility, in which case they get a swift mental punch in the throat from me), yet those doing IVF are on a more even playing field than me and their success just highlights my failures even amongst the infertiles. And if you got pregnant by IUI? Good gracious you are pretty much fertile in my mind.

     I was so angry reading that post. I almost felt as if she had no right to feel what she was feeling because she ended up getting what she wanted, and getting it easily. Yet here I am, far deeper down the shit hole than she will ever be, and I haven't gotten my happy ending, and quite frankly, strongly doubt I ever will.

     I know I'm inappropriately minimizing the feelings she had that prompted her to write that blog entry, but for that I am not sorry. She got her happy ending. Now where is mine?

IVF #3: The Conclusion

    
     It was the best of time, it was the worst of times. Yes, my latest IVF cycle can be paralleled with the timeless classic, A Tale of Two Cities. Somehow, some way, this cycle managed to be my worst and best.

     To get straight to the good stuff, on Propofol Day egg retrieval day, we retrieved 12 eggs (!!!) but only fucking 5 were mature. I knew this. I had predicted this shit. My estrogen on the day of trigger was 3100+, which was by FAR my highest yet, but, having been around the block too many times, I knew better than to get excited. Highest highs followed by the lowest lows. That is all IVF is to me.

    Aside from the 5 mature, it looked as if a few more may mature in the lab. Thankfully, two more did. That brought our total to 7. Seven. This is the same number of eggs retrieved for IVF #1 and 2! My ovaries are pre-set apparently.

   The Holy Grail of this cycle came in the form of ICSI. This is the first time we did it and 6 of our 7 eggs fertilized! All 6 were still cookin' by day 3, albeit 4 were good and 2 were crapping out. We decided to press on to blast. That was terrifying! Three were blasts on day 5, and one was able to be frozen that day, with the other two frozen on day 6.

   Now that I am a few weeks out from stims, in my non-hormonal state, I'm thrilled with this cycle. Three blasts!! 3!!! We have never, ever had a blast before! Yet, in my drug-induced stupor I was a mess. It was so hard for me to reconcile that we had 12 eggs but not all 12 were mature. And I was frustrated with our low blast rate, even though it is an absolutely normal and expected number. I was ungrateful, and hormonal, and bitter. Truthfully, I was having a hard time with the reality that I won't ever make it rain eggs. I won't ever be the girl who gets 25 eggs and 19 embryos and winds up with 10 frosties. And I hate that. I was also feeling a ton of pressure to get many embryos because this cycle was to be followed with depot lupron for three months for my wonky endometrium, after which, I may not stim as well for a while.

   On day 6 after retrieval, I got an e-mail from Dr. Wang and he told me the second blast had been frozen but we still had to wait on the third, which, without some growth, wouldn't make the blast cut. I lost my shit. I wrote a long and angry e-mail (not anger directed at him) and he immediately called me. This is why I love him and he's the best ever. He spent thirty minutes talking me off the ledge and, telling me that my cycle went just as expected, explaining why he really felt that depot lupron is the right choice for me and giving me some hope. He made me feel so much better, and I was able to begin to realize how wonderful this cycle went.

    We all agreed not to test the embryos at this juncture. I'm praying that we have at least one baby in there. Please, oh please. It's time. It really is. I hope the HGH did it's job and we have some excellent quality pre-babies in there.

    As for now, I'm slowly settling into a menopausal state and trying to enjoy a well-deserved break from infertility treatments. Hopefully I can take some time to decompress, relax, focus on school and try to get back into shape for a short period of time before my body is (hopefully!) ruined by a baby.
   

Cycle Update: IVF #3

Source

     I started injections for IVF #3 last week so today is day 8. I'm doing a Microdose Lupron Flare (MDLF) protocol and primed with estrogen. Things are off to a bit of a rocky start.

    IVF #1 was new and exciting. I knew I had DOR and would likely not bring in a haul of eggs like many others, but overall, I knew it was a "practice round." This still didn't stop me from leaving most monitoring appointments in tears. IVF #2 was s completely different story. Estrogen priming with patches was so quick and I began stimming during a weekend away in NH. I learned to let the techs know that I didn't want to know my u/s results and I didn't read into the results. Because that cycle did result in a pregnancy, even if only for a moment, I feel pretty good about it.

     Enter IVF #3. I began injections after finding out about my Dr. KK results and that SIRM CT was closing. To top that off, at my baseline monitoring appointment, I only had 3 follicles. THREE.FUCKING.FOLLICLES. As of my next monitoring appointment, I was up to 5 follicles and I'm wondering if almost 4 weeks on estrogen priming (to accomodate batching at SIRM - something I never had to do before) I go in again for monitoring tomorrow. I'm the crazy girl who rolls up into the ultrasound room with my ipod, and tells the doctor that I can't know any information or else I'll lose my shit all day, so please don't mind me laying there, music blaring and eyes closed.

    I started the cycle with 10 units of lupron AM and PM. Then a couple of days later I added in 300 units of Gonal-F in the morning along with the lupron. After my last monitoring appointment last week we added in a vial of menopur at night. I was on Estradiol until yesterday.

     I'm not feeling great about this cycle. It's not starting great and it's looking like it could yield the fewest eggs yet. I know the egg count doesn't necessarily mean much, but I had the highest hopes for this cycle. Stupid me. Worse, if this cycle doesn't get us some embryos, we run the risk of having nothing to transfer at the conclusion of the depot lupron treatment, if needed. That shit stays in your system for months  after the last injection and would effectively kill any stim cycle before it could even start for months to come.

    More uncertainty. More waiting. Less hope. That's where I stand today.

The Day the Music Died. Or, what happens when your fertility clinic is closing!!!

     Fresh off my overwhelming consult with Dr. KK the other day, I was feeling a bit dizzy. Somehow, even though my immune issues were super tame compared to most, and didn't require any sort of heavy machinery to tackle, I wasn't prepared for the realities of managing yet another medical provider, flying back out to Chicago for a blood flow check once I start Lovenox, or for all of the blood work that would be entailed. I had heard warnings about all of these things, but it hadn't really sunk in.

    So, imagine my surprise when that call is almost immediately followed by a call from my RE at 5:30pm telling me he had some bad news. I immediately figured he was calling about my EFT results, and told him I was prepared to hear what he had to offer. I was wrong.

    Apparently SIRM (and, like 70-80% of the fertility clinics in the U.S.) are owned by a company called IntegraMed. In June of 2015, SIRM in NYC (or, IntegraMed) forced Dr. Wang to open the SIRM CT office and direct it. I'm told he didn't want to go, but he did. I'm assuming he had some sort of a contractual obligation. Anyways, he uprooted his life, picked specific staff to accompany him, uprooted their lives, and caused chaos amongst his patients...many of whom weren't able to commute out to CT from NYC, and many who have killed themselves trying.

     And at 5:30pm on this day, Dr. Wang was calling to tell me that SIRM CT was closing...a mere 8 months after opening. Panic ensued. Dr. Wang was so professional and forthcoming about explaining why this was happening, and where he stood in it all. Basically, IntegraMed decided to purchase CT Fertility - a competing clinic that is about 15-20 minutes away from the SIRM CT location, because it's owner is retiring. It's been open since the early 90's and apparently is a very popular clinic with a loyal patient population. It's all dollars and cents, and it will be a much smarter business decision to stick with that established practice instead of keeping SIRM CT open.

     This is where things get sticky. Dr. Wang was offered a position at this new clinic, but isn't sure how he feels about it. He doesn't know their practices or lab, and feels that he cannot decide whether to go there without more information. He was also offered to work at SIRM NYCs satellite location in Westchester, NY - meaning he would see patients there and do some monitoring and minor procedures, but retrievals and transfers would be in NYC. Finally, he may leave SIRM altogether (whaaattt!!!!) for greener pastures (although, they've been fucking with him so much I wouldn't blame him if he shit on Sher's desk before peacing the fuck out), and may visit with his sick mother and mother-in-law in Taiwan for a bit. He gave me all of my options in this scenario, knowing that we were about to embark on a cycle. He wanted me to have control over how this went down, and for that, I'm so grateful. He was so transparent, and being so goes a long way to making this shitty situation much more palatable.

     I managed to hold my shit together for the conversation, which I am quite proud of, and asked some thoughtful questions, like, where the fuck are my embryos going to be living, yo?! CT Fertility will be using the SIRM CT office (since it's shiny and new) for their practice and I'm assuming that our embryos will be chilling there, which isn't something I'm really comfortable with since I know jack shit about this new practice. If Dr. Wang stays at the new practice, then everything will be copacetic and easy. If Dr. Wang goes, my embryos and I want to follow. If he goes to Taiwain, my embryos and I plan to pack our bags and head to SIRM NYC. SIRM NYC is our backup. It's a great clinic and a good lab, and if we are going to travel 2.5 hours to a clinic, we may as well add 45 minutes to the commute and go somewhere fun like NYC. Sorry, Trumbull, CT, you no interesting!

   Basically, Dr. Wangs FB group (yup, I'm a groupie), have banded together to write IntergraMed a letter outlining our demands. First, since almost all of us sought out Dr. Wang and NOT SIRM specifically, we demand that they move our embryos to the clinic/provider of our choosing without cost to us. Second, the wait list at SIRM NYC is cray, especially for Dr. T. So, we decided that since this was a hardship being brought unto us, that IntegraMed must guarantee that any of Dr. Wangs patients who choose to stay with SIRM have expedited appointment times with their new providers, within 1-2 weeks of transferring to the NYC office. I refuse to hop on a 4-month wait list after this bullshit.

    As you can imagine, this was me after hanging up the phone:

   So, now we wait to see what Dr. Wang is going to do. When he puts up his bat signal, myself and the rest of the Wang Gang will follow.