Is DHEA making me fat?…Why my ovaries are like dogs…And other stories.

Has anybody else put on weight while on DHEA? I’m up ~4 pounds since midsummer (and ~7 since 15 months ago when I was pregnant, but I can’t really blame DHEA for those extra 3 lbs…) DHEA is an anabolic steroid, and anabolic steroids cause weight gain, so I think it’s possible. The other reason I’m inclined to blame the DHEA is because of where the weight has been going. Not to my hips, thighs and butt (like usual), but straight to my belly. I have a beer gut. And now that I have to start dressing professionally again, all my work clothes are either unflattering, uncomfortable, or both. Ugh.

So, as you all know, we had our phone consultation with Dr. Schoolcraft on Monday. Overall, it went pretty well. (You can find his answers to my long list of questions here.)

Here are some other tidbits from our conversation with Dr. Schoolcraft that didn’t directly pertain to our questions:

  • Dr. Schoolcraft was late. He called us almost 40 minutes after our scheduled time. This wasn’t so much a problem in itself (the nurse had warned us that it was often the case), but – ever the healthcare practitioner – C pointed out that if he was that far behind schedule (it was 5:40pm his time), he almost certainly didn’t stop to look over our file before he called.
  •  Judging by the conversation, Dr. Schoolcraft almost certainly hadn’t reviewed our file. Again, this might have been fine in itself. (His answers were thorough, and he didn’t make us feel like he was in any rush.) But we found it annoying that we went to so much trouble to get our records, and to fill out an annoyingly detailed (and poorly designed) health history form online, if he wasn’t even going to read it. And, we now have one more question…which wouldn’t bother us if we felt like he had actually read our file before calling. (Specifically, we spent a lot of time with him talking about low-stim versus high-stim, the underlying assumption being that we had only tried low-stim and don’t know what would happen if we increased the dose…somehow we all forgot to consider the fact that we in fact tried IUI with pretty high doses of Menopur – 5 vials per day – and only got 2 follicles developing. I know that IUIs are different – I couldn’t take stims for as many days because I wasn’t taking anything to suppress ovulation – but still, the scientist in me is frustrated to think that we neglected an important piece of data!)
  • Dr. Schoolcraft thinks I have a “poor prognosis”. He just sort of let that slip out in the context of some comments about comparing SART stats between clinics. Not that it came as any big surprise, but it was more direct than Dr. Y has ever been (though not as bad as when Dr. L said I would go through menopause before 40…) I think it’s a good sign; it’s consistent with what I’ve heard from other patients (who described him as “direct” and someone who “doesn’t mince words”) and the last thing I want is a doctor who’s going to blow smoke up my ass…but it still stung.
  • I thought Dr. Schoolcraft’s advice for comparing SART stats was very interesting. He mentioned (and I’d heard before) that some clinics manage to inflate their stats by refusing to take patients with a poor prognosis (especially older patients). His advice, therefore, is to compare the ‘% of cycles resulting in live birth’ specifically for women under 35 (where there will have been the least selection bias). If you want to compare the quality of different embryology labs, then look at the success rates for donor cycles. It’s not perfect, but I thought it was an interesting way to get around some of the stat manipulation.
  • Naturally, the first thing C and I did after getting off the phone with Dr. Schoolcraft was to compare the SART stats for our local clinic to those for CCRM in the categories of women under 35 and donor cycles…and while CCRM was better on both counts, there really wasn’t a huge difference. So our lab really does seem to be quite good. But we also considered Dr. Schoolcraft’s point that CCRM sees mostly out-of-state patients who have already failed one or more IVF cycles. In other words, they see a disproportionate number of ‘hard’ cases. And yet, their stats (in just about every age group and diagnosis) are higher than anybody else’s I’ve found. This seems to back up Dr. Schoolcraft’s claim about having the best lab.

So, despite our mild annoyance, and “poor prognosis”, C and I decided that we should at least make the appointment and do the one-day workup. It’s not cheap, but it’s thorough, and after getting the results, we’ll be able to have a better sense of whether it’s worth our time to continue with my eggs…

C made the point that every month to my ovaries is like years to a normal set of ovaries. (My ovaries are like dogs, apparently.) And also reasoned, “We’ll probably spend money on a lot stupider things.”

I’m not feeling very optimistic about our chances of getting pregnant – even at CCRM, but it feels like something we have to do to feel like we’ve done everything we can.

A rousing game of ‘Guess Dr. Schoolcraft’s Answer’ [updated with results]

Thanks to all of you for your help compiling questions to ask Dr. Schoolcraft during our upcoming CCRM consultation. Per your suggestions, I added some questions and prioritized them to make sure we get to my most pressing questions first. Then, during my run this morning, I got a little cocky and found myself thinking that I probably can guess Dr. Schoolcraft’s answer to most of my questions. Next I thought, why not make it interesting?

So I’m putting my educated guesses in writing, here on the interweb for all to see. [Gulp!] If you have guesses of your own, please share them in the comments! After our phone consultation on Monday, I’ll update I updated this post with Dr. Schoolcraft’s answers – so don’t forget to check back and see how well (or poorly) we all did!

[Insert cheesy game show music]

Deep announcer voice, building: And now it’s time. Let’s play…

Audience shouting in unison: GUESS! DOCTOR! SCHOOLCRAFT’S! ANSWER!

[Applause]

* My answers are shown in black. Dr. Schoolcraft’s answers (as best I can remember them) are in blue.

1. What do you estimate our chances of success with my eggs to be?

Actually, I have no idea what his answer to this one will be, which is why I want to ask it first. My fear is that he “won’t be able to say without the information from my one-day-workup.” (The one-day workup is the full set of tests that CCRM conducts – in one day – for all new out-of-state patients. If he defers to the one-day-workup as an answer to each question, then I’m going to wonder why I went to all the trouble of sending my medical records and completing the detailed medical history. I’ll also be bummed to have spent $250 for what amounts to an elaborate advertisement…)

<<DING!>>

I won’t have enough information to say until we have your results from the one day workup. I can say that between the options of 1) doing IVF again with your eggs, 2) doing nothing, and 3) doing IVF with donor eggs, your best chance of success would be from IVF with donor eggs.

2. If you think it’s worth trying with our eggs, what new information would change your mind? At what point should we seriously consider donor eggs?

Aside from perhaps deferring to the one-day-workup, I imagine that he would recommend trying at least one cycle at CCRM with my own eggs before moving on to donor eggs. Seeing how I respond to a new protocol, after 3 months of supplements, would provide additional data to inform our next steps.

<<DING!>>

I would recommend trying IVF at least once with a conventional [i.e. high-stim] protocol. That would give you the greatest chance of recruiting the maximum possible number of eggs. And then we’d know how many eggs/embryos each subsequent cycle is likely to yield.  Your response to the stimulation, as well as the results of genetic testing on any embryos retrieved, will help us to know whether your problem is with egg quality [in which case egg donation might be a good option] or if there is another issue.

3. What do you think accounts for CCRM’s remarkable success rates?/What can CCRM do to improve my prognosis relative to my local clinic?

I’m guessing he’ll say some combination of the following three things: (a) world-class embryologists (In general, I’m told the embryology lab is the biggest factor in determining IVF success rates.); (b) genetic testing (A procedure called Comprehensive Chromosomal Screening or CCS – which permits selection of only embryos with the correct number of chromosomes – was developed at CCRM. Transfer of selected embryos dramatically increases success rates, as can be seen here.); and/or (c) experience (CCRM did 2464 ART cycles in 2011, about 5 times as many as my local clinic. Such a large number of cycles per year means that the embryologists are constantly honing their skills, while the doctors have more data to draw from in choosing appropriate protocols, etc.)

<<DING!>>

The lab. The embryology lab makes the biggest difference for IVF outcomes, and we have the best lab. This is especially true in your case, where you can only afford a low margin of error. For example, if you had 17 eggs retrieved, and six make it to blast, and you get pregnant, it looks like a success, even though more than half of the eggs didn’t make it. But you’re not going to have that many; you may only have one or two eggs. You want the best embryology lab to maximize the odds that those eggs make it to blast. At CCRM, we’ve also developed several specific techniques that improve outcomes, like embryo glue [and others that I didn’t hear because C was whispering that my typing was too loud…]

4. What other kinds of tests will CCRM do? Do you recommend genetic testing in our case?

I’m not sure what all the tests they do are, but I’m pretty confident that it is more than I’ve had so far (namely Day 3 FSH, AMH, and E2 testing; antral follicle count; HSG; and saline sonogram). I’m guessing that he will recommend CCS (since I turn 35 in November), but probably not PGD/PGS (since C and I are different races and have no family history of genetic disorders).

<<DING!>>

I would definitely recommend that you do chromosomal screening [CCS]. If the cycle doesn’t work, you want to know whether it’s because of a genetic issue [which would be resolved by using a donor] or if there is some other factor – a lining issue, etc. [which would not be]. The goal is to “get a baby or get an answer.”

5. How would we go about scheduling a cycle with CCRM, given my & C’s work schedules? (I can’t exactly take off for 10 consecutive days in the middle of the semester!)

I’m not sure what he’ll say about this. Assuming he recommends a fresh cycle, I’m guessing that he’ll say I should schedule retrieval & transfer between semesters (in December/January). Alternatively, if he recommends a freeze-all cycle (as would be the case if we do CCS), maybe it wouldn’t require so much time off and I might be able to time something around Fall Break?

<<DING!>>

C would only need to be here for one day, and assuming you did most of your monitoring appointments at home, you would only need to be here for 4-5 days [since I recommend freezing all for CCS]. One possibility is that we might time it so you could come over Thanksgiving break.

6. If, due to scheduling constraints, we opt to do another cycle locally before cycling with CCRM, do you have any recommendations for our local cycle? (With regard to stims? freeze day? other?)

No idea what he’ll say to this… I’m guessing he’ll push for going straight to CCRM, but I’d love to be surprised here.

<<<BUZZ!!!>>>

Not really. Our lab is here. There’s no way to take it with you.

7. How much variability do you expect from cycle to cycle? In other words, is it worth trying a particular protocol again if the first cycle yielded nothing?

I think he’ll say that there can be variability from cycle to cycle even with the same protocol, although I’m guessing that he will also suggest a protocol change…

<<<BUZZ!!!>>>

The outcome is not likely to change much if you use the same protocol. But I would recommend changing the protocol.

8. Do you recommend trying low stim (like last time) vs. high stim? What do you think about ‘natural cycle IVF’?

Based on what I’ve heard from other CCRM patients, I think he’ll say, “There are no scientific studies to suggest that high levels of stimulation drugs damage eggs, nor any that show better outcomes for low-stim or natural cycle IVF (whether for DOR sufferers or others).” He might also add that IVF is a numbers game, and that the goal is to get as many mature eggs as we can, and that high doses of stims are our best bet to get them.

<<DING!>>

Natural cycle IVF is “a total waste of time.” You’re not taking anything to prevent ovulation, and there’s a 40% chance of ovulating prematurely. With mini-IVF [low-stim], you’ve basically decided, “I’m gonna be happy with 2 or 3 eggs.” I suggest that you give this “one really good try” [meaning with high-stims]. If you try the “Bazooka” protocol and only get 2 or 3 eggs anyway, then you’ll know that mini-IVF is just as good in your case…plus it’s a lot cheaper.

9. What particular stims would you recommend in my case? What sort of suppression drugs would you use? (Ganirelix? microdose Lupron (agonist)? Other?)

I have no idea what he’ll say. Since my cycle with Clomid/Menopur + Ganirelix yielded just three eggs and no embryos, I might expect that he would suggest trying something different, but who knows.

<<<BUZZ!!!>>>

Your particular protocol will be determined using the results of your one-day-workup.

10. Should I be avoiding alcohol? Caffeine? Exercise? For three months prior to cycling? During my cycle? During stims?

I’m guessing – okay, I’m hoping – that he’ll say something along the lines of, “As long as you’re practicing moderation (defined as 1 alcoholic beverage, 1 cup of coffee, and 1 hour of exercise per day), and assuming that you’re at a healthy weight, there’s no reason to believe that these things would hurt fertility. However, to be safe, we recommend abstaining from all three during your IVF cycle, starting at Day 1 of stims.”

<<DING! DING! Hallelujah! DINGGG!!!>>

Moderate consumption of caffeine and alcohol (up to 1 cup per day of a caffeinated beverage, and up to 3 glasses per week of wine) shouldn’t be a problem. [I volunteered that I would stop when we start stims, so he didn’t say anything about that.]

11. Is limited exposure to organic solvents (in the context of teaching lab courses) a problem?

Again, here’s what I desperately hope he will say: “In the spectrum of organic solvent exposure, working as a lab chemist or chemistry teacher (where you are educated about safety and working in rooms designed with appropriate ventilation and fume hoods) is actually quite safe. Workers at hair and nail salons, dry cleaners, janitors, exterminators, and (non-organic) farmers all have much more dangerous levels of chemical exposure, yet no link has been discovered between these professions and infertility.” I don’t actually think he’ll say this, but I’m confident that it’s true, and it would be so nice to hear (and have C hear) it coming from a world-renowned infertility expert… Sigh!

<<DING!>>

I don’t think that your exposure to chemicals caused your diminished ovarian reserve. [Boo ya!] It’s mainly a concern when we get to the point of embryo transfer. At that point, you will want to avoid chemical exposure, as you would when you’re pregnant.

12. Am I taking the right set & doses of supplements?

I think he’ll say ‘yes’, since my list is essentially the same as the CCRM-recommended list. (The exceptions are that I’m taking a higher dose of CoQ10, along with aspirin, and a high antioxidant drink powder called Nanogreens.)

<<DING!>>

Probably. When you schedule your one-day workup, we’ll give you our list of recommended supplements.

13. Should I be taking PQQ (recommended by my acupuncturist) to promote mitochondria generation?

I’m guessing he’ll say something along the lines of, “There is no evidence to suggest that PQQ improves pregnancy outcomes for patients undergoing IVF.”

<<DING!>>

There are no human studies on PQQ.

14. In your experience, does taking the aforementioned supplements actually make a difference? In AMH and/or FSH levels? In number of eggs retrieved? In embryos that make it to blast? In ultimate pregnancy outcomes?

I’m not sure what he’ll say. I haven’t found any good scientific studies that say these supplements help, but the fact that CCRM recommends them suggests that they at least believe it may help. Dr. Schoolcraft has seen enough patients that he may have an opinion about what the supplements do, even if he hasn’t gotten around to conducting and publishing a study to that effect.

<<DING!>>

Nobody knows. There isn’t good data to support it, but it probably won’t hurt. The groups of common supplements including the antioxidants (of which you have many choices, including pycnogenol, vitamin C, vitamin, E, melatonin, etc.) These decrease reactive oxygen species, which are thought to cause a deterioration in egg quality. Another supplement is CoQ10, which is thought to affect mitochondrial function. However, this has not been shown in human studies, only in a mouse study. Based on the results of the mouse study, the corresponding effective dose in humans would be 600 mg/day.

In the case of DHEA, there is retrospective data, but no good prospective data. There is good prospective data showing that testosterone priming (for at least 21 days) improves outcomes, so we will likely put you on testosterone for 21 days prior to starting stims. Based on the results with testosterone, it looks like androgens are good; it may be that DHEA is just too weak an androgen to show the same result…

15. What do you think about estrogen- and/or testosterone-priming?

Again, no idea.

<<<BUZZ!!!>>>

[See answer to #14, above.]

16. Assuming we were able to get any embryos, would you go for a fresh vs. frozen transfer?

I’m guessing that he’ll suggest we do CCS (see #s 3 and 4, above). In that case, they have to freeze the embryos while performing the testing.

<<DING!>>

I recommend doing CCS, which requires that you freeze all embryos for testing.

17. Do you recommend trying to do multiple retrievals to try and ‘bank’ embryos? How many embryos is ‘enough’?

Given my poor response on my first cycle, I think he will recommend banking embryos. Also, since the cost for CCS is ‘per test’ rather than ‘per embryo’, the most economical option is to bank a bunch of embryos and then test them all at once. The question of ‘how many is enough’ is tough to know up front. If all my embryos test normal, then I may not need that many. On the other hand, odds are good that half or more might not be. The limiting factors for determining ‘how many embryos are enough’ will probably be time and money…

<<<BUZZ!!!>>>

It depends how your first cycle goes. If you only get 1 or 2 embryos, I would probably suggest banking them to have more for CCS; if you get more, it may be worth testing them immediately.

18. What causes DOR? In other words, what could I have done differently (besides have babies in my twenties…)? Could my career choice (organic chemistry) have contributed?

I think he’ll say that he has no idea. It may be a combination of genetic and/or environmental factors, but the only environmental factor that is known to cause a decrease in egg quantity and quality is smoking (which I don’t). On the topic of chemistry and DOR, see my wishful answer to #11.

[I didn’t technically ask this question, but see his answer to #11…]

19. What would be the cost per cycle with CCRM?

I don’t need to ask this one anymore, as I found the answer here.

————————————————————————————————————-

Deep announcer voice: Well done, knalani! You correctly guessed 12 answers out of 17! Bambi, show her what her prize is…

Sultry assistant voice: It’s…a no-expense-paid trip to the lovely city of Denver!

Audience: Ooh! Aah!

Deep announcer voice: Thank you for playing, and we’ll see you next time on…

Audience shouting in unison: GUESS! DOCTOR! SCHOOLCRAFT’S! ANSWER!

[Cheesy game show music]

I need your help!

My phone consultation with CCRM is fast approaching. Faster, since I got a call from Dr. Schoolcraft’s assistant last week, asking to move up my appointment from September 16 to August 26. It may even happen sooner, as I added my name to the cancellation list. (I got one call last Friday asking me if I would do the consultation ‘right now’. I declined, since I want to have C on the phone with me!)

I also recently learned that I need to be thorough about preparing my questions prior to the phone consultation. A friend from my Resolve support group is a patient of Dr. Schoolcraft’s, and she said that he basically calls and says, “So, what questions do you have for me?” She said if I’m not ready to drive the conversation, it could be a very short one… Not exactly what I’m looking to pay $250 for!

So I’m asking for your help in compiling questions for Dr. Schoolcraft. Here’s what I have so far:

Regarding the protocol:

* Do you recommend trying low stim (like last time) vs. high stim?

*Would you use Ganirelix (antagonist) vs. microdose Lupron (agonist)? Or another drug?

*What do you think about estrogen- and/or testosterone-priming?

*Assuming we were able to get any embryos, would you go for a fresh vs. frozen transfer?

Regarding my lifestyle:

*Am I taking the right set & doses of supplements?

* Should I be taking PQQ (recommended by my acupuncturist) to promote mitochondria generation?

*Should I be avoiding alcohol? Caffeine? Exercise? For three months prior to cycling? During my cycle? During stims?

* Is limited exposure to organic solvents (in the context of teaching lab courses) a problem?

Regarding our prognosis:

* In your experience, does taking the aforementioned supplements actually make a difference? In AMH and/or FSH levels? In number of eggs retrieved? In embryos that make it to blast? In ultimate pregnancy outcomes?

*How much variability do you expect from cycle to cycle? In other words, is it worth trying a particular protocol again if the first cycle yielded nothing?

* Do you recommend trying to do multiple retrievals to try and ‘bank’ embryos? How many embryos is ‘enough’?

* What do you estimate our chances of success with my eggs to be?

* If you think it’s worth trying with our eggs, what new information would change your mind? At what point should we seriously consider donor eggs?

Regarding CCRM:

*What do you think accounts for CCRM’s remarkable success rates?

*What can CCRM do to improve my prognosis relative to my local clinic?

*How would we go about scheduling a cycle with CCRM, given my & C’s work schedules? (I can’t exactly take off for 10 consecutive days in the middle of the semester!)

*What would be the cost per cycle with CCRM?

*If, due to scheduling constraints, we opt to do another cycle locally before cycling with CCRM, do you have any recommendations for our local cycle? (With regard to stims? freeze day? other?)

Out of curiosity:

* What causes DOR? In other words, what could I have done differently (besides have babies in my twenties…)? Could my career choice (organic chemistry) have contributed?

 

And…what else?

Hit me with your awesome questions!

Old procrastinating reneger

I have a confession to make. I’ve been procrastinating from writing a sequel to my post on Supplements. I’m long overdue on an entry about antioxidants (a category that includes most of the pills I’m taking).  I’ve been working on it off and on for a few weeks, but just can’t seem to find the motivation to finish it!

In place of that post (for now), here are a few odds and ends:

1)      I forgot to mention that Dr. Y gave me copies of all my medical records at my appointment on Monday. I had asked for these to send to CCRM in advance of my upcoming phone consultation. Of course, I couldn’t resist the temptation to read the records in detail. Most of it seemed run-of-the mill but I noticed two things that caught me off guard. The first was that I was listed as having a diagnosis of “secondary infertility”. I thought this term referred to people who already had one or more kids. Does one early miscarriage really mean I don’t qualify as “primary infertility”? The other surprise was that the embryology report listed me as having “Advanced Maternal Age”. I’m 34. I thought I had at least a few more months before graduating to the “Advanced Maternal Age” club. I did a Google search and learned that apparently the definition applies to women who are 35 or older at the time of childbirth. So apparently I do belong…assuming I ever get pregnant. I feel old! (No offense…)

2)      AF arrived today, making this a whopping 18-day cycle. (Has anybody else had such a short cycle after egg retrieval?) Anyway, that leads me to believe that my fertility monitor was actually working properly, and I didn’t ovulate this month. We’ll try natural IUI again next month…

3)      I planned poorly and just realized that I am going to be a bad ICLW-er this week. Tomorrow we’re leaving for a camping trip to Pinecrest in northern California. I just learned that they don’t have WiFi or reliable cell service, so I’m probably not going to be able to blog or comment until I get back next Wednesday. I’ve been trying to ‘bank’ lots of extra comments in the first half of the week, but I still feel like a schmuck for reneging on my commitment… Sorry!

Have a great week everybody!

Message to my fertile friends

Not too much has been happening here. We finally finished up the 10-week summer research session, and I am officially “off” for the rest of the summer. (By “off,” I mean I get to sit on my couch in my PJs working on my promotion portfolio and prepping for fall classes…) It’s nice.

As many of you know, our current plan, in the wake of failed IVF#1, is to spend three months trying to improve egg quality through supplements, while also doing natural cycle IUIs. I’ve been using my CBFM, and was supposed to call the office to schedule insemination as soon as the monitor indicated impending ovulation (by displaying a little egg). We also made a just-in-case appointment for cycle day 16, in the event that the egg never appeared in the monitor window.

Today was cycle day 16, so I went in for that just-in-case appointment. The dildo cam showed no lead follicle: either this is an anovulatory cycle, or we missed ovulation. (Once again, I find myself regretting getting lazy on the BBT charting; if I had kept up, I’d know for sure which it is.) But I’m actually not that disappointed. There’s a very slim chance that we could get pregnant this month, but if not, I’m fine trying again next month.

I’ve also been dutifully taking my long list of supplements. While I have definitely NOT been “living like a monk,” I have been trying to eat well whenever possible. I’ve cut back on coffee, Diet Coke and alcohol – to 2-3 servings of each per week…instead of 1-2 servings per day. (Shoot! Does that make me sound like a lush? I just like my nightly glass of wine!) Thanks to my sister’s persistence, I’ve also started running again. We’ve gone three times in the last week; it’s only been 2.5 to 3 miles each time, but a huge improvement over the absolutely nothing that I’ve been doing for the last year and a half…

*****

But the real reason for this post is that I got an email this week that was equal parts delightful and heartbreaking, and made me want to think carefully about how my words are received.

I hope A will forgive me for sharing parts of her email here:

Hi K,

I’ve been following your blog and seeing that things are not going as you might have wanted.  I’m sorry.  I also realize you sometimes feel ‘ill-will’ according to one of your previous posts about people who have some success.  Knowing that — I still need to tell you …

that we are 18 weeks pregnant and close to going ‘facebook public.’  I didn’t want you to find out on facebook. What you’re going through is emotionally and physically draining, but as you well know — I don’t really know… I don’t understand — regardless of how much I think I might or try.  It’s very personal and I’m really happy for you that you’ve found a support network of women through your blog who do understand.  It’s also wonderful to read about how your relationship with ‘C’ has strengthened and deepened through this difficult time.

…Anyway, I’m emailing you because I didn’t want you to be surprised on facebook and wanted to tell you that you do not need to respond.

I look forward to seeing you again (someday) and I am always thinking happy, reproductive, follicular, warm fuzzy thoughts in your direction.  🙂

Your friend,

A

This message was delightful, because I’m so happy for my friend, who had been trying for awhile for a second child, and suffered a sad loss shortly before ours. I was also deeply touched that she had given so much thought and time to writing such a compassionate message.

It was heartbreaking that such an amazing friend could possibly think I might feel the slightest bit of ill-will towards her or her baby.

So this message is intended for my fertile friends. (The sentiment is equally true for my ‘lucky’ infertile bloggy friends who are now expecting.)

When I shared my blog with you, I made a choice to let you in on my most personal, raw, and unfiltered thoughts. I didn’t do this by accident. It was a sign of just how much I love and trust you.

So, please believe me when I say that I do not, will not bear you or your children any ill-will.

  • If you decide to outdo the Duggars and have 30 kids,
  • If, in your genuine attempts to comfort me you say all the wrong things,
  • If you go on to have an absolutely perfect life full of glitter and unicorn farts with your gorgeous brood of children,*

I will NOT bear you any ill will.

Believe me. It’s the truth. (And if you know me well enough for me to have shared this blog with you, then you know that I’m a terrible liar!)

Now, you may wonder, to whom do I direct all my anti-fertility ill will? Most fall into one of the following groups:

  1. Anonymous pregnant women that I see everywhere. Yes, I know. It’s totally unfair. I have no idea what they’ve been through, or the kind of parents they’ll be. I’m sure if I meet them in the future, I’ll be happy for them then. But for now, I hate them.
  2. People I never liked in the first place. If they never bothered to make time for me or show the slightest interest in developing a friendship before they were pregnant, then I feel no obligation to wish them well in their baby-making efforts now.
  3. Bad parents. These include stupid and/or oversharing parents (STFU, Parents has all the examples you never wanted to know), neglectful-to-abusive parents (Tan Mom gets to be fertile? Seriously?), and truly evil ones (The rumor that World’s Worst Mom Casey Anthony is pregnant again may have been a hoax, but that doesn’t change the fact that she never deserved to be a mom in the first place!)

As you can see, there is no shortage of targets for my infertility bitterness and ill-will.

You, dear reader, are not one of them!

——————————————————————————————————

* References to glitter and unicorn farts are shamelessly stolen from the amazing Jenny at Stupid Stork.

This and that

AF arrived yesterday, so I went to see Dr. Y for a baseline ultrasound this morning. While we are waiting for my supplements to take effect, we figured it couldn’t hurt to do a few cycles of natural IUI. (As C puts it, “so we can feel like we’re doing something…”) Originally, Dr. Y had suggested taking Clomid during the IUI cycles, but I had second thoughts about pumping my body with drugs when I’m supposedly trying to use acupuncture, supplements and diet to achieve a monastic zen-like state that will maximize the quality of my remaining eggs (or something like that…) Dr. Y quickly jumped on board with the plan, especially since he spotted a large ovarian cyst on ultrasound. The cyst would have precluded using any drugs anyway, so natural cycle it is!

The plan is for me to use an over-the-counter ovulation predictor kit (I’ll probably just stick with my CBFM) to detect my natural LH surge, and then to call the office to schedule insemination (aka turkey baster) the next day. The way I figure it, each month we get a chance (however small) that this egg might be ‘the good one’. If this month’s is the good egg, delivering C’s little swimmers directly to my uterus might slightly increase the chance that it gets fertilized.

Plus, summer research is almost over, so I’ve got time to kill. And Kaiser covers it. So, why not?

*****

I went to my second Resolve meeting last week. It was awesome. I got a lot of support in my decision to schedule a phone consultation at CCRM. More importantly, I also got a healthy dose of “it could be worse.”

Not that anybody would have said anything so insensitive, but hearing stories from my sisters in infertility helped remind me that, crappy as DOR is, it is not the worst diagnosis possible. The fact remains that C & I still have one very good option – IVF with donor eggs. Yes, it would mean giving up on genetic offspring (those adorable little hapa babies with my nose and C’s hand-eye coordination…) But it would bring our odds of success with IVF up to 70% or more per cycle. It would also ‘stop the clock’ on our fertility issues, meaning that we could have as many kids as we want, and time them as far apart as we want (well, almost… I think legit clinics refuse to transfer once I turn 50…) And our risk for age-related chromosomal issues would drop to whatever they are for our twenty-something donor.

Oh, and while I’m counting my blessings, I should probably mention that we are in the fortunate position of being able to afford egg donation as an option. (The same might not be said for a gestational carrier, which runs around $100K per try. So, we’re thankful that my uterus seems to be in good shape!)

Don’t get me wrong, I’m not giving up on my eggs just yet, but it’s nice to know that we have a good option tucked away in the sock drawer, waiting for us to pull it out whenever we’re ready. It’s also nice to know that there will be a great group of gals (and guys) down in the trenches with us who will support us, whichever path we choose.

*****

Last but not least, I got the sweetest gift from our fertile friends, S & Q. (These are the same ‘thoughtful ninjas’ who dropped off gorgeous flowers the night before a doctors visit, and a delicious care package of tasty treats on retrieval day.) Last week, the ninjas struck again, this time leaving this St. Gerard keychain:

Image

(It was timely, as I got it a few hours after reading this post by Risa at Who Shot Down My Stork? about the St. Gerard medal she got from a friend.)

As many of you know, I’m a practicing Roman Catholic (which I wrote about here), and St. Gerard is the Patron Saint of Motherhood. The Church uses a rather broad definition of motherhood here, including expectant mothers and mother-wannabes like me; as a result, couples trying to conceive will often pray to St. Gerard. (Another option is St. Gianna Beretta Molla, Patron Saint of Mothers, Unborn Children, and Physicians.) For any of you who are Catholic (or just willing to try anything at this point), here’s a common Prayer to St. Gerard:

O good St. Gerard, powerful intercessor before God

and Wonder-worker of our day,

I call on you and seek your help.

You who on earth did always fulfill God’s design,

help me to do the Holy Will of God.

Beseech the Master of Life,

from whom all paternity proceeded,

to make me fruitful in offspring,

that I may raise up children to God in this life

and heirs to the Kingdom of His glory

in the world to come. Amen.

Craptastic diagnosis

Sorry it took me a couple days to write this post. My baby sister is visiting for the summer (yay!), and this weekend her boyfriend came to visit. It was my first time meeting him, so I was pretty busy showing them around town.

Anyway, we had the WTF appointment with Dr. Y on Friday morning. (Thanks to my bloggy friends for this term, which seems like a perfect description for the appointment after a failed cycle…) It was not a cheerful conversation. It basically cemented my assessment that diminished ovarian reserve is a craptastic diagnosis. Some highlights:

  • Dr. Y was careful to point out that I am “not through menopause yet”, and therefore there is always a probability (however miniscule) that I could get pregnant naturally. So one option is to stick with timed intercourse + prayer. (In support of this option, he mentioned a patient like me who got pregnant naturally after quitting treatment…then miscarried. Not exactly a ringing endorsement…)
  • On the other end of the spectrum, Dr. Y pointed out that none of the tests to date has shown any problems with my uterus, so we expect a high probability of success from IVF with donor eggs. In that case, I would have to change care providers, because Kaiser doesn’t do third-party reproduction…
  • He was open to the idea of us doing IVF one more time with my eggs, but wanted to be very clear that he doesn’t expect a dramatic difference in outcome – we would be hoping for one quality embryo, not five. And we would want to go into it with a plan for what we would do in the (likely) event that it fails again. He does not support the idea of doing IVF bunches more times, as he said there would be a point of diminishing returns, and he doesn’t want to subject my body to all those drugs over and over if it’s not likely to yield the end result that we want.
  • Dr. Y did not recommend trying a different protocol. He is convinced that the antagonist protocol (with ganirelix/Antagon) is the best option for me. In particular, I had asked about a microflare Lupron protocol, but he felt that the ganirelix “worked” in the sense that it prevented premature ovulation, and that – as a rule – it suppresses my ovaries the least, making it the best choice for a poor responder like me.
  • Dr. Y was supportive of trying what he called “soft science” approaches to improving egg quality – including eating a high antioxidant diet, taking all the recommended supplements, and doing acupuncture – prior to trying IVF#2. He doesn’t necessarily think it will help, but he thinks it can’t hurt. He suggested doing it “all the way”, not half-heartedly, for 3 months, “living like a monk”. I think his rationale was that if I did absolutely everything I could think of, then I would be at peace with moving on with donor eggs (or adoption, or child-free living) if IVF#2 fails. (He did, however, mention that he had a DOR patient like me, who had a failed cycle, then did all the supplements, etc. for 3 months, got one embryo from IVF #2, which implanted and she is now in her 3rd trimester…)
  • We also learned that the embryologist had judged my three eggs as being of “very poor quality”. I think this is another reason for Dr. Y’s pessimism.

Here are some stats from the SART database to help illustrate why DOR is such a crappy diagnosis. For women up to the age of 40, a DOR diagnosis correlates with the worst odds of success from IVF:

SART Fresh IVF cycles Percentage of cycles resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

40.1

31.9

21.6

12.2

4.2

ovulatory dysfunction

43.3

36.9

28.3

14.1

3.2

male factor

43.2

36.7

25.6

16.6

5.2

unknown

42.5

33.4

24.7

14.1

7.1

female & male factor

39.5

30.7

20.4

11

5.1

tubal factor

39.2

31.5

20.7

14.6

3.8

endometriosis

38.9

29.6

24.6

13.2

4.7

other

36.5

30.8

21.9

13.2

4.7

multiple female factors

35.2

27.2

18.9

10.4

2.6

uterine factor

33.6

33.8

19.3

15.4

5.9

DOR

27.5

24.2

17.8

11.1

3.8

On the upside, if we ever happen to get any decent frozen embryos, the stats shift in our favor, at least given my relatively young age:

SART FET cycles Percentage of transfers resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

39.3

35.7

30.3

24.5

16.5

ovulatory dysfunction

42.1

38.4

34.5

19.4

33.3

DOR

40.8

32.6

25.9

23.3

13.1

unknown

40.8

37.3

33.1

28.7

21.3

male factor

39.9

35.6

29.3

28.1

16.7

other

39.5

37.3

34.1

31.8

16

female & male factor

38.6

35.7

29.3

21.7

17

endometriosis

37.7

33.6

32.7

28.9

3 of 12

tubal factor

37.2

35.4

24.8

12.5

28.3

mutliple female factors

35.3

33.3

31.2

26.3

18.6

uterine factor

31.8

32

31.5

17.9

17.4

Now, we both still really like Dr. Y, but I am somewhat concerned about blindly repeating IVF with someone who (I think) doesn’t believe it will work. So on Friday afternoon, I called the Colorado Center for Reproductive Medicine (CCRM) and scheduled a phone consultation with Dr. Schoolcraft. The earliest phone consultation he had available was September 16, but I figure that’s fine, since I need to take supplements for at least 3 months before trying IVF again. I can see what Dr. Schoolcraft says, and then decide whether to try again here one more time…or try at CCRM.

Why CCRM?

I have a good friend, N, who did IVF at CCRM, which is how I knew about it. (She didn’t have DOR, but had three failed cycles at her local clinic, prior to the successful one at CCRM.) I also read (and liked) Dr. Schoolcraft’s book. While my local IVF clinic is very good (maybe the best in California), CCRM is on another level. They perform 4.5 times as many IVF cycles each year as my local clinic. And their stats (as compiled by SART) are pretty amazing…even if you sort them by the diagnosis of DOR. Most importantly, my friend N is certain that Dr. Schoolcraft will be straight with me and tell me whether he thinks it’s worth continuing with treatment, or if I should give up and move on. (The skeptic in me thinks that this bluntness may explain the almost unbelievably high SART stats, as they probably don’t take cases with too low a probability of success…Still, I think it would be worth knowing whether my case is one they would take.)

What about CRMI?

The Center for Reproductive Medicine and Infertility (CRMI) at Cornell Weill Medical College is another place I am thinking about. Their stats aren’t as good (even sorted for DOR) as CCRM…and traveling to New York City would be notably less convenient than traveling to Colorado, (more time zone changes and no family nearby), but from what I can tell, it is the place for treating women with DOR. In 2011, they performed 3379 cycles (that’s more than 6 times as many as my local clinic), of which 776 were diagnosed with DOR. (By comparison, out of 2464 total cycles at CCRM, only 98 were DOR; and out of 545 total cycles at my local clinic, 85 were DOR.) So I also filled out an online form to be contacted by CRMI. If I’m feeling extravagant, I might even pay for phone consults at both clinics, just to see what they each say.

For your viewing pleasure, here’s a comparison of the fresh IVF stats for my clinic vs. CCRM vs. Cornell. You can see why CCRM is so popular:

My clinic Fresh IVF cycles Percentage of cycles resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

54.2%

43.4%

39.0%

10.0%

4 of 15

DOR

2 of 10

19.0%

6 of 19

10.7%

2 of 7

CCRM Fresh IVF cycles Percentage of cycles resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

65.0%

45.5%

35.3%

32.4%

20.6%

DOR

8 of 17

52.4%

28%

5 of 14

4.8%

Cornell Fresh IVF cycles Percentage of cycles resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

38.1%

29.2%

25.1%

14.3%

4.6%

DOR

14.6%

25.9%

25.0%

14.0%

5.3%

And a comparison of frozen transfers:

My clinic FET cycles Percentage of transfers resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

50%

41.20%

29.20%

0 of 3

0 of 1

DOR

1 of 1

1 of 2

1 of 2

0 of 0

0 of 1

CCRM FET cycles Percentage of transfers resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

67.90%

65.80%

58.90%

56.70%

33.30%

DOR

8 of 8

8 of 17

48.60%

51.70%

3 of 15

Cornell FET cycles Percentage of transfers resulting in live births

<35

35-37

38-40

41-42

>42

all diagnoses

38.30%

42.90%

34.80%

11.10%

1 of 15

DOR

2 of 5

5 of 8

5 of 11

2 of 11

1 of 8

As you can see, DOR women don’t often have an frozen embryos to transfer, hence the small numbers here.

As you can probably tell, I’m not feeling super optimistic about having my own genetic offspring at this point. I welcome any encouraging DOR stories, 2nd IVF stories, CCRM or CRMI stories, supplements improving egg quality stories, etc.