Monday, November 27, 2006

Addendum

Some of you were surprised about the anonymous-only policy regarding donors at my clinic.

This is due to clinic policy, not legislation. The reason is that they consider known donor too 'messy'. Sure, you're best friends/sisters/cousins now, but what about later? They seem to feel that the risk of boundary issues between the donor and the recipients is too great.
That, and the hospital has Christian roots, which makes it a tad conservative. For instance, they only treat hetero couples (married or living together, surprisingly).

They have a sperm bank they work with. They don't provide egg donors, you have to find your own. Anonymity is ensured by doing cross donorship. Couple A finds donor A. Couple B finds donor B. Couple A uses B's eggs, couple B uses A's eggs.

Another Big Clinic does accept known donors, though they're not keen either.
They also do egg-sharing, which my clinic doesn't.

As far as I know anonymous really means anonymous. I'm sure they register the identities of all donors, but they never ever give the child access. None of the clinics want to change this, because this would lead to a serious shortage in (sperm) donors.

I've never heard of voluntary identity-release schemes either, where the donor would give permission to release his identity when the child reaches a certain age.

At this point, I don't know how I feel about all of this. There are so many issues to consider. Right now, I'm making a conscious effort not to dwell on the donor route.
My reasons are pragmatic, I need to let it all rest.

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A clothes-on consult

We had our post-IVF - or more acurately IVZero - consult. We were happy to get it over and done with, and we suspect so was the doctor, though he was kind and generous with his time as ever. DH reckons he was expecting a tearful production and was relieved when I just peppered him with questions as per usual. (This might be my husband projecting his own relief though.) At one point the doctor did remark we were down-to-earth people before delving deeper into one issue or other. I'll take that as a complement.

I really appreciated that the doctor remembered one of my main concerns: is it an egg or a sperm issue? In preparing for the consult he called the embryologist that worked on our case to find out. Read on for the answer.


This is what we learned in question - answer format. Any similarity with our actual conversation is accidental.


How many eggs did we have?

12

Egg quality?
Good, 10 were mature, which is a good rate.
The polar bodies in some looked wonky, but they can't say that this means anything. It's just one of those observations embryologists like to put in their reports.

Sperm quality?
Scored normal in all aspects: count, morphology, motility. No indication at all that ICSI was necessary.

So, what went wrong?
The problem seems to be the binding between sperm and zona pellucida. Normally, one would expect to see a swarm of sperm around each egg, all trying to get in. In this case, the embryologist saw the sperm swimming about cluelessly in all directions.

Is it the sperm or is it the egg?
We can't say for sure. The egg may not be sending the right 'come hither' signal to the sperm. The sperm may just be too clueless to respond to the signal.

Are we just incompatible?
There's no practicable* test available.

-- Well, what did you expect, that he was going to tell you each to have an affair and see who procreates first? --

What now?
With ICSI you should have a good chance of creating embryos.

Is our condition hereditary?
Well, you've been tested for know genetic causes of infertility (Y-deletion, fragile X, balanced translocations, CF) and you have none of these.
Of course, there must be a gene somewhere that is the root of this problem, and the odds are you would pass it on, but we don't know what gene. Nor do we know whether the trait is dominant, but that is unlikely since it's such a rare condition.

What if the same happens again?
Then we'll have exhausted all our treatments options ...

... with our own genetic material.
Correct.

What kind of donor options does the clinic offer?
Anonymous donation of sperm or eggs is a possibility, any form of known donorship is not.

Really?
Yes.

-- Perhaps an affair is not such a bad idea after all. --


Moving back to matters at hand, how soon can I start again?
After one rest cycle. The cycle after that you can start with BCPs again in preparation of the next attempt.

Protocol changes?
Actually, yes. This time you can use G0nal-F, the synthetic drug, instead of Men0pur, a human derivative.

Why the change?
G0nal-F being synthetic has the advantage that we can accurately measure the dosage. In Men0pur, the vials all supposedly contain 75 IU, but in reality it ranges from 60 to 90 IU.

Don't some doctors claim Men0pur works better because it contains trace amounts of LH?
Yes, but those claims haven't been adequately substantiated. Your body will produce some LH throughout your cycle. We monitor this and can influence it by altering the Supre.fact dose.


What could have come up, but didn't:


*So, there are unpracticable tests?
Why yes, I'm so glad you asked.
In theory, after TFF, you could pipette the eggs into a fresh petri-dish, leaving behind all dh's sperm and add a fertile donor's sperm. Now mind you, no embryo's would form, because the eggs past their sell-by-date. But the zona pellucida is still fully functional for a while, and if the new sperm did make it through ...
Likewise, we could take some of dh's sperm and put it in a petri-dish with someone else's leftover eggs, and see if they can get in there. Of course, 'leftover eggs' are a rarity in practice. In future, we hope to mass produce artificial zona pellucida, so we can test sperm for their ability to hack it, so to speak.
Nice, swinging it in a petri-dish!


If any of the issues in this post have affected you, please don't call me, check out these great resources:

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Wednesday, November 22, 2006

Dreams

I'm at the clinic where the nurse has given me an odd shaped HPT.
It looks like a thin syringe.

Lo and behold, two pink lines appear.
Shock! Joy! Fear!

Well it doesn't mean anything till I've had two good beta's.
Still, I'm happy.

I realize we never made it to transfer.
This is impossible.

I'm dreaming.
Wake up disappointed.

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Saturday, November 18, 2006

Resonance

"In physics, resonance is the tendency of a system to oscillate with high amplitude when excited by energy at a certain frequency. This frequency is known as the system's natural frequency of vibration , resonant frequency, or eigenfrequency." ( Wikipedia)

Clever scientists want to use resonance to create wireless electricity .

What about resonance among humans? You all know what I'm talking about. There I am, minding my own business - or rather not - reading some blogs, when BAM! one of those posts hits me right between the eyes. Another setback, another BFN, another heartbreak, ... Ouch! The weird thing is, I keep coming back for more.
At times the intensity of this community can be overwhelming. Kath ( Inhospitable) calls it the tender trap. I call it empathy overload, repetitive strain injury of the soul.

Of course it isn't all gloom and doom in our community. Many of us find a way out of this quagmire, and it makes me happy when they do.
To be perfectly honest, the happy news doesn't resonate as strongly with me as the negative, nor is the impact as long lasting. I think the reason is pretty simple, I can relate more directly to the negative experiences, especially when they echo my own, than to the happy ones.

Right now, I can't imagine a happy outcome for us anymore, or perhaps I don't dare. Lucky for me, you're imagining one for me, so I can let it rest for a while. Thanks, it makes the bouts of empathy overload worthwhile.

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Tuesday, November 14, 2006

Explanations

Thank you all for your support, it means more to me than I can say.


Yesterday I was in shock, but not paralyzed. I plucked up the courage to call my doctor's office, firstly to move up our follow-up appointment, but also to ask about our situation.

Dr. A was willing to take my call, even though I'm sure he was with a patient.
He took a few minutes to explain what the embryology lab thinks is our issue. At one point in fertilization the egg and sperm must fuse by a chemical reaction. In our case this isn't happening. This is an uncommon cause for infertility, but we're not alone with this. He's confident that by using ICSI we have a good chance of success.

The feelings of panic and despair fell off me. This is not the end of the road yet.

Panic and despair came back at night though, while I was lying awake in bed. Am I clutching at straws? What if ICSI doesn't work either? Do I need to start thinking about donor gametes? Why don't we just quit now?

Its nothing out of the ordinary to feel this way. I need to keep reminding myself that we're not done yet. And if the worst comes to pass in the next cycle, I'll deal with it then.

My follow-up appointment is in the beginning of December. Before we can try again, I have to wait through a rest cycle. When my period next arrives, in two weeks probably, I can start BCPs again. I'm hoping this is in preparation of the next attempt.

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Monday, November 13, 2006

Zero

The results are in: we have zero embryos.

The eggs looked good, the sperm looked good, but nothing happened. The lab was very much surprised. No ICSI was tried, it was too late.

Needless to say, I'm in shock.

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Sunday, November 12, 2006

Retrieval

The retrieval is over and it went swimmingly. The twilight sedation worked like a charm, what must have taken half an hour seemed to last only minutes. I was too sleepy to follow the action on the screen, though I managed to keep my eyes open long enough to see one follicle be sucked up.

I kept quiet during the procedure, no babbling and no questions, apart from my name and date of birth.

There's some confusion exactly how many eggs were retrieved. I distinctly remember being told 12 just as the RE finished. I even asked whether that meant two follicles were empty. My husband says he was told 14 by the RE just a little later. We'll know more tomorrow, when we get the fertilization report. I'm content with 12.

So far, I haven't suffered too much pain. We'll see if it gets worse tomorrow.

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Friday, November 10, 2006

It's a date!

This morning's wanding revealed a dozen almost mature follicles (and some stragglers). Everything looked ready, according to the dr, and the bloodwork confirmed it. Retrieval is set for this Sunday.

Upon my doctor's advice, I will be knocked out for the procedure. Normally they give a local anaesthetic, but with my oddly placed LO, that would probably be too painful. It won't be a real general anaesthetic, but a short working kind that leaves you half conscious and able to blab away uncontrollably. I'll just have to trust the doctor and nurses not to interrogate me ... or that letter might come in handy sooner than I thought!

I asked when transfer would be, day 3 or day 5. To my surprise he said day 3 was most likely, if we have a lot of embryo's.
From reading your blogs, I was under the impression that it was generally the other way around. The idea being that if there are a reasonable number of embryo's, you can afford to wait until day 5 and risk losing some along the way. I didn't ask any further, the morning wanding is supposed to go swiftly and other ladies were waiting for their turn. It's not like I get to decide anyway.

I'm excited that we've made it this far and a little bit nervous about what is to come. I do feel a bit hopeful, but not that it will work the first time, only that it *might* work eventually.

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Wednesday, November 08, 2006

You were right

On occasion, I've been called to give a**vice about reproductive matters.
On those occasions I spew a nugget of information I've picked up along the way, from books, websites or you guys.

Q: IUI are likely to work, right?*
A: 15% a pop.

Q: An IUI and 3 negative HPTs, but my period is late. I could be PG, right?*
A: Highly unlikely, I'm sorry, it's the progester0ne.

Giving out bad news is no fun and I hate it when I'm right. I'm sure you know the feeling


Which is why I'm very pleased to report that you were right, MORE HAVE APPEARED! The doctor now measured 14 follicles in total, ranging between 13-15mm.

Retrieval is now estimated for Monday, the delay is somehow caused by the fact that my dose was increased. Somewhat counterintuitive, but this is perhaps to let the latecomers catch up?

I'm very pleased with this development and feeling much more hopeful. My rational
side is still skeptical, but some things never change. A spoonful of hope makes the medicine go down.


Thanks for all the pep-talks on my previous posts. You said what I needed to hear.
I realize that my whining about 9 follicles might have hit a sore spot with some of you. (And now the universe rewards me with MORE?** For goodness sake) I apologize if I hurt anyone's feelings.
That being said, IF blog reading can be risky business, not all of it is avoidable. I'm not going to plaster on a fake smile here, because otherwise what's the point of blogging?


* Questions from an offline IF. Didn't know they still made those!

** No I don't actually believe there is any meaning or intended purpose behind IF, no punishment, no rewards, just cause and effect.

NOTE: Echo! Echo! Echo! This post might appear twice, since I attempted to post it by mail - unsuccessfully - then added it manually.

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Monday, November 06, 2006

Slow and steady

After my last u/s, my dr decided to adjust my medication a little, a little less Supre.fact and 3 in stead of 2 vials of Men0pur. Apart from a little discomfort in my abdomen, I'm not feeling many adverse effects of the treatment.

Fast forward to today, next u/s and blood draw. The 9 follicles we saw last time are still there, no more but also no less. They're growing rather slowly, average size is now 13 mm, with one at 15 mm. (They ranged between 7-11 mm 3 days ago). Perhaps I'm just being impatient. The good news is that - for now - they all seem to be keeping up. Endometrium is preparing itself as it should too. Excellent!

The dr was happy and said everything was going nicely. That was good to hear, but I'm still feeling despondent, or maybe just blue. I could really use one of those hope highs right about now. It's crazy to feel this way, I know, there is no drama here (yet). Unless you count the whole needing-to-resort-to-IVF thing. Really, they should put a warning on the box: IVF - hope not included. No worries, I'm blaming my blues on the medication. I'm entitled to a side-effect just like the next person.

Retrieval will be on Friday at the earliest, more likely over the weekend. It seems so far off and I don't know if I can face work for another 5 days. I don't want to see anyone, answer any phones or e-mails. I'd take some time off, but I'm saving it for the aftermath.

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Friday, November 03, 2006

Average

The stimming has been uneventful, thanks to all the needle training I've done the past 6 months. I haven't felt any side-effects of note.

Today's u/s showed 9 follicles in total, ranging from 7-11 mm. 5 on RO, 4 on LO (no hiding today).

That result is nothing to frown at, but my greedy new-to-IVF self isn't satisfied. My 'you're still young' ovaries produce 9?
This is my supposedly PCO-tic - should be well responders - ovaries we're talking about?
The doctor aims for between 5 and 15 follicles. 9 is just below average. Great, a C+. Or is that a B- this days?

Yes, yes, I need some perspective. But I'm giving myself permission to feel a little disappointed, just for 1 day.

My husband's response: "it only takes 1". Sweet of him to try, but ... sigh. Nearly 3 years of trying with 1 hasn't really worked for us, has it. And it's a numbers game, how many will they retrieve, how many mature, ...

Tomorrow, I'm going to realize that average isn't that bad in IVF land. The average IVF patient takes home a baby, eventually.
I'm also going to remember that lots of follicles at once is pretty painful and increases the risk of OHSS.
Finally, I'll start hoping that it's quality over quantity, and that all of this batch makes it to pick-up.

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