Wednesday, July 11, 2007

A thoughtful discussion with my RE

I feel like I did when I sat across from Dr. R. this afternoon - "Where should I begin?" I keep going from, "We will just do X" to "But what about Y?" Unfortunately, this is precisely why I asked for our little chat. I was hoping to put to rest the "what if?" questions.

I have said it before, but I will say it again: I adore my RE. I know the book Unsung Lullabies talks about how infertility patients idealize their doctors. I suspect I may be a textbook example. Yet, I choose to believe that he is as compassionate, thoughtful and kind as I think he is. His stats dispassionately tell me that I can believe in his skills and experience. So why can't I take his advice and let all the "what if's" go? I am hoping I can. I am hoping that blogging about today will help.

With that said, I will just jump in and see where it goes. My apologies to Dr. R for my own interpretation about what he said.

I started by asking about natural cycle IVF.

Dr. R: If there really was a solution for someone in your situation, it would be in the literature. Where are the studies showing hundreds of women with failed IVF cycles that are having 75% success rates with natural or low dose cycles? Even the strongest proponents of natural cycle IVF are getting rates around 10%-15% and that is with younger women.

Me: I haven't seen any studies like that, but those anecdotal stories sure make me wonder, "Could that be me?" And what about those studies that find, for example, a 51% aneuploidy rate in a normal cycle and only a 35% rate with a low stim protocol?

Dr. R: Let's say that is true. On a normal cycle, we might get 20 eggs and only 10 would produce normal embryos. If we had a low stim protocol we might get 4 eggs and we would have 1 or 2 normal embryos. I just think it could be a disaster. You may not have anything to transfer.

Me: That just makes too much sense. But what about me? I'm not a statistic! I'm not going to do a hundred cycles. What if something like this would work for me? I keep thinking the answer is out there somewhere, we just need to find it. And I need to feel that I have tried everything possible.

Dr. R: You have every right to try everything you can. You need to feel comfortable at the end of this journey that you have done enough. But we can only address the things that we know about. There may be someone in Antarctica who has the answer for you, but you'll just never know it. The good news it that you can choose to be ok with whatever happens. You can choose to make the best decisions you can and decide that no matter how it turns out, you will be ok. You have many other aspects in your life. You are someones best friend, you are someone's best wife, you are someone's best patient. You have many roles and you can choose to be ok with your life however it turns out. I know you well enough to know that you are capable of that. Not that I'm saying I think donor eggs will not work for you, I do think it will work. There are just no guarantees and in the end you can choose to be happy with however it turns out.

I nodded my head to acknowledge than I understood. I would have like to have said that I knew I could make that choice - a choice to be happy no matter what. In my heart, I know I can be happy having a baby that was not my genetic baby. I just don't know if I can be happy if I never get to give birth to a baby that will live. I hope I will never find out if I am capable of making that choice.

I brought up Ernest - how I wondered if his issues were related to our infertility. In the past the "experts" said it was just bad luck. Could we have that much bad luck? He had previously agreed with the "bad luck" diagnosis, but today he admitted that he is a bit worried that it may be a sperm issue as well. Not that it is likely, he quickly added, but that he did worry about those kinds of things. When I asked what he would do if we asked him to make all the decisions for us, he said he would use donor eggs for all the embryos and donor egg plus donor sperm for some portion and then put back one of each. Or maybe he would put back two donor egg and donor sperm embryos. Or maybe he would put back three DE/DS embros! (Yes, he was kidding - or at least kidding on the square). He just wants us to have a baby. (He made it clear he was sensitive to our needs too.) He said it was a good sign that I would have likely carried Ernest to term if his issues hadn't caused the pre-term labor, it was a good indication that there weren't undiagnosed implantation issues.

We talked about a few other possibilities. We talked about the financial burden of IVF. He really doesn't want us to spend money on a cycle that isn't likely to produce a baby. He has seen some disasters (as he called it) when couples chose to do cycles when they weren't likely to work - and they didn't. He said he feels it is part of his job to discourage couples from going down that path. Some people have a hard time letting go and he doesn't want to make money off of desperate couples. If we suddenly had a financial windfall, he would feel differently about us trying a bit longer for our genetic child.

That pretty much sums up the meeting.

Now I am sitting here wondering if putting it all down helped. I think I feel a bit better about not trying again with my own eggs. I may even be able to put it completely to rest. But I don't know what to do with the donor sperm idea. And with that thought comes the thought that maybe it is a sperm issue after all and what we ought to be doing is IUI with donor sperm. Ahhh . . . but that brings me full circle. It is all those, "what if?" questions again.

I know what we need to do. We need to just make a decision and hope it will work. If it doesn't, we can choose again. I can't keep losing sleep over "what if?". There are no more answers for us. We won't know what will work until we try something that does. For myself, I like the idea of a known donor over an unknown one and we have a known egg donor. At this moment, I would choose to not try again with my own eggs. I think we should continue with an egg donor and Brad's sperm. If it doesn't work, we will do the next cycle with donor eggs and donor sperm. If we have any frozen embryos from either cycle, we will try for a sibling if we are successful or start doing FET's if we are not.

Of course, I will need to confer with Brad and see how he wants to proceed. In the meantime, it will be my job to quiet my mind to the paths that we don't choose. I'll remind myself that we are doing everything possible and making the best decisions we can with the information we have.

Wish me luck.


SULLY said...

Are you just not completely overwhelmed? I would be a basket case...but you seem, while having the "what if's" to be completely in control.

I wish you luck in making this incredible life changing decision!

Anonymous said...

Good luck - I hope you can come to terms with whatever you decide. Sounds like you have a great RE that is really putting it on the table for you.

Kami said...

Thank you Sully and Meg. I am so not in control - as much as I would like to be. At times I am completely overwhelmed, but so far (meaning about 24 hours) I have been able to remind myself that DE is the best course right now and to peacefully let go of the rest.