Wednesday, April 30, 2008

List of Questions for RE at IVF follow-up:

I have done tons of research this week to prepare for our IVF #1 BFN follow-up with our RE. i really do love him, but I need to know the answers to some tough questions and I think I may have been too naive to ask in the past. I'm posting the best list I've come up with, please feel free to add and additional questions you think I could ask. Thanks!

Why do believe this cycle failed?

How many cycles does it normally take for couples with similar circumstances?

Should we consider additional testing?
CC Challenge Test?

Should we try again if we can afford it?

Considering our circumstances, and the number of years we have undergone treatment with you, can you offer any fee reduction?

If there can be no reduction, can you offer a payment plan, guarantee, or some sort-of shared risk?

Do you have any donated medicine that we could use?

What would you do differently this time?
Different protocol
More stims
Letrozole with FSH

Do you offer Ultrasound Guided embryo transfer?

I’ve noticed many other clinics with success rates upwards of 60%--do you know what they’re doing to achieve such high rates?
Colorado Center for Repro Med 62% live birth; 2.4 t/f; 1236 cycles
Texas Fertility Center Austin, TX 53% live birth; 2.2t/f; 675 cycles
Vermesh Center for IF CA, 60% live birth rate; 2.6t/f; 500 cycles

Are there any new or experimental procedures we could try?

How do you feel about alternative medicine, such as acupuncture?

Am I a candidate for trans-vaginal ovarian drilling, should we consider it?

I’ve been on the same does of Metformin for years, should I increase it?

What was the quality of the eggs retrieved?

Why did we lose so many?
10 at retrieval
9 could be fertilized
6 fertilized
3 developed

Are there different culture medias to try that may improve success?

Why was a day three transfer chosen versus a day 5?

Are success rates higher with day 5 transfers?

Many clinics are pushing day 5 transfers what are the benefits/ risks?
RHI Pittsburg, PA 52% live birth rate; 1.8 transferred

Would you consider me to have luteal phase defect?

Would assisted hatching help us?

Could the missed PIO shot have contributed to the failure of the cycle?

My Mother took the drug Bendectin during her whole pregnancy with me, could that have any effect now?

I have been following the “Fertility Diet” should I continue that eating plan or should it be modified?

I have read that weight loss can reduce the effects of PCOS; I have lost considerable weight since beginning this process, why do you think we’re not seeing the results of that?

Is there anything else that you think I should be asking you, that I haven’t covered?

Tuesday, April 29, 2008

The Whole Story. . .

I have a good life. I should be happy, I have way more than some, but something's missing. A baby, a family, a whole different life. My husband and I have battled infertility for more than 5 years and at times is has consumed our lives, the treatments, the praying, and the dreaded waiting. I knew, or at least suspected, at a relatively young age that I would have trouble getting pregnant. I was diagnosed with PCOS (poly cystic ovary syndrome) in my very early 20's which causes me not to ovulate. I saw several different doctors over those early years, not for second opinions, but due to the nature of my fly by the seat of my pants lifestyle. Remarkably they all made the diagnosis seem like "No big deal," I just needed to take birth control pills. "What happens if I want to get pregnant," I asked, although I had no plans or means to do so. "Oh-we'll just put you on Clomid-it's no big deal," they said. Boy, were they wrong! I'm sure for some women that's how it works, but not, alas, for me.

After sowing my wild oats in my late teens and early 20's I cleaned up my act, and settled down a bit. I met my devoted husband (DH) at 24 and we were married just before my 26th birthday. In the rural area where we live, that's actually kind of late to marry and begin a family, so we were anxious to get started.

I went to my regular gynecologist and told him we were ready to start trying. He suggested we try on our own, which we did for about 6 months. I went back to my ob/gyn who started on low doses of Clomid and we began the dreaded temperature charts. Have you ever tried waking up in morning, lying totally still and taking your temperature every day??? It's no fun. Clomid and other drugs to treat PCOS are not covered by our health insurance and seemed costly to us at roughly $100.00/ month, little did we know then how cheap it was!

After another 6 months and no BFP (Big Fat Positive) we were referred to a Reproductive Endocrinologist, Dr. Steve Williams at Ohio Reproductive Medicine in Columbus. I liked Dr. Williams instantly! His manner is so open, and he patiently explains our options, risks and chances with each treatment approach we try. He also has an awesome staff-Nancy his nurse has really become a friend, she laughs, pray and cries with me at every turn. I am confident that they do their very best to help me.

After an initial workup by Dr. Williams, he confirmed the diagnosis of PCOS and explained that this disorder effects millions of women, yet insurance companies are not required to pay for the necessary treatments to achieve pregnancy, so they don't. He explained, that we would try the least expensive, and least invasive procedures first. Lots of women get pregnant with just a little help. He prescribed Metformin to help battle the insulin resistance part of PCOS and we tried Clomid with ultrasound monitoring and timed intercourse. We had 4 BFN (Big Fat Negative) cycles and then, finally on the 5th cycle we got a BFP! Unfortunately, I had a very early miscarriage. These cycles were costing us approx. $450.00/month so we were not able to afford cycles back to back. After the miscarriage we did 2 additional cycles with Clomid, both BFN.

Dr. Williams asked us to come in and discuss other options. He told us about a procedure called IUI, (Intra Uterine Insemination.) He recommended that we try stronger fertility drugs called gonadatropins, along with ultrasound monitoring, and instead of timed intercourse they would inseminate me with my husbands sperm. This treatment approach was more successful, more risky, and much more expensive than any of our other treatment plans, the drugs alone are about 3200.00 per cycle. We saved for months in between each treatment and tried 4 cycles over the course of 2 years, all BFN!

We had another meeting with Dr. Williams, who said that maybe my previous abdominal surgeries (I've had 2) had caused adhesions which were interfering with the IUI treatment, and he said it was time to try IVF (In Vitro Fertilization.) Ohio Reproductive Medicine has good success rates with IVF about 40% of patients take home a baby with each cycle. We decided to try and we saved for nearly a year. We just completed our 1st IVF cycle---BFN. I see Dr. Williams on Friday for his take on why it failed. I'm 31 now, and am starting to run out of time. We can no longer wait and save for a year or more between cycles without directly affecting our results.

We've willingly, happily, made sacrifices along the way so that we can continue to pursue this dream, this yearning, this need. We're very average. We're not poor, but we are definitely not wealthy. We both work full-time, DH takes side jobs, we drive used cars, cut coupons, and don't have the latest and greatest--and we're really, really happy that way!! Unfortunately these things are no longer enough to allow us to pursue having a family. We're out of resources and asking for help. It's hard to ask, but I don't believe that God would have built me to want this so deeply if He didn't intend for it to be.

Our local paper has asked to do a story and our Credit Union will set up an account to collect donations. We are working on community fundraisers, like silent auctions, and drawings that will help us raise the $9500.00 we need for another cycle. We are willing to do whatever we can to reach our goals. Prayers and suggestions are more than welcome. Thanks for your interest in our story.

Amy Love