Reults of WTF appointment

Wow - I have been a really bad blogger.. It's not that I have nothing to say, because I've written a thousand blog posts it seems in my head in the shower, but they have never made it to my Mac. I'll get better, I promise.

(Would someone please invent a device that will transcribe my thoughts from my head in the shower to my computer, and then I can just edit and hit Publish? Thanks, that would be very helpful.)

So, I had been reading blogs that talked about this WTF appointment. For those who don't know, this appointment is the one where you and partner, (Carlos, in my case) basically get a chance to talk to the RE, all three of you fully clothed and say,

"Ok, I took all my shots and pills as instructed. We had almost 30 follicles, 22 beautiful eggs, 17 of which were fertilized by the best of the over 50 motile percent of the 42 million per liter hunky sperm. We produced and our amazing embryology staff took care of 14 gorgeous embryos, and we spent 8 thousand additional dollars to have them tested for CF and other chromosomal disorders. On transfer day, we had 6 gorgeous, highly rated embryos waiting for us, alive and growing on Day 5. I had a lovely transfer (I am pretty sure I even used the work lovely to describe it.) And I took all my pills and shots and progesterone and didn't even go within walking distance of a sushi restaurant, oh yeah, AND, I even took off my acrylic nails for like the first time in 10 years and I am not pregnant. So, yo Doc.. what the fcuk?

(Please excuse me, I am not one to curse at all.. But that's the name of the appointment. I won't say it again.)

Unless the need arises. Just kidding. Sort of.

So, I didn't feel like I really had any questions, but I felt like I wanted to have the appointment, thanks to the amazing IF community that have written about theirs. My appointment was with the RE that did my retrieval and transfer. He's is the Christian man who made me cry at my retrieval, then gave me his email address. He also hugs me and Carlos every time we come in. I'll call him Dr. Hugs.

I knew I could dredge up some questions, and I felt like "when do you really get an hour to spend with a qualified specialist to ask all your questions?" Like, never. So, I made the appointment. And then started gathering my questions. I like to understand things, so, honestly, it was not that hard to come up with questions. And, honestly, I read a lot of other blogs to come over with, "they did this, why didn't I do that" kind of questions?" It was pretty easy. And the questions get you talking. And I had I knew I'd learn something if I got three smart people in a room talking. Oh yeah, and I had some dumb questions, too, because I wanted to eliminate potential paths.

So, on to the questions. I took a little liberty transcribing Carlos's notes.

Ok, here we go.

Me: So, how were my four embryos frozen? I hear some labs freeze them in "twos," so you thaw both at the same time. In that case, if we thaw 2 and one does not survive, we have to thaw the other two same time, and either transfer all three.. or what? I want two cycles (and two babies, but of course, I'm willing to settle for two cycles and one baby!) out of these embies.

Dr. H. Let me look. Plays with one of the four computers in his office, while I think "This is just like our office at home!) The are frozen individually.

Me: I love you. Next question. Should I do a fresh cycle now, and keep these frozen ones for later? I ain't getting any younger.

Dr. H: No, you're young! Let's go ahead and do the two frozen cycles - hopefully you'll get two babies, one at a time, and you'll never have to go back to a fresh cycle.

Me: Great. Let's do it. Glad you are optimistic.

But, really dude, I'm sure you haven't done them before, so I'm here to tell you the shots are not. That.Bad. Really, they are not. I will do fresh cycles anytime, if there was a better chance of a baby! And yes, on that topic of shots, I'm serious, I'll do them. (Wow, do i sound like a junkie, or what?) You really think natural frozen cycle is the way to go?

Dr. H. Yes, natural. You ovulate on your own. There is no need for shots. You'll do the OPKs and we'll take a look at your lining and do that transfer. Much less stress on you and your body. And a lot cheaper.

Me: I don't care about money. I'm 35. Been working for 13 years. Carlos too. We have pretty much been saving money our whole careers for this. I mean, not that we knew this would happen. We didn't even know each other. But I think God knew we were going to need the money for babies, so he made us have great careers and live beneath our means. We are not going for cheap, we want what works. OK, next question. Tell me about the quality of my eggs.

Dr. H. I have no concerns about the quality of your eggs. Your embryos are of high quality. There are many things we can't test or see, but I'm confident that they're high quality.

Me: I was kinda looking for a number on a scale of 1-100. And if it wasn't 100, a list of things to do to get it there. I'm all about the metrics. But whatever.

OK, the little swimmers. Is there any actual scientific way to choose the best sperm to do the ICSI with, since we have to do ICSI (actually I'll get to asking about why we have to do ICSI later) I know all about the spinnin' and all that, but part of it seems sorta subjective to me.

Dr. H: Well, there is a test. Hypoosmotic swelling test is the only test that can be done. Typically only done when ..(oh shoot, Carlos missed this part. I'll ask him or research later.) And then there is the DNA fragmentation test: looks at DNA integrity. Not really helpful. There are tests that can be done, but not on the actual sperm sample that you are using for ICSI.

Me: Even though we are theoretically picking the best sperm.. Is exercise, vitamins, toxins, etc. of concern for sperm with IVF?

Dr. H.: Carlos should keep taking the fertility vitamin. L-carnitine is beneficial, and that is in the Fertility for Men vitamins DH is taking.

Me: Ok, I asked the PGD lab, but the answer I got was not clear. It was clear that we HAVE to do ICSI, even though it would not normally be indicated because my husbands sperm are beautiful, so why do we have do do ICSI? Do we have to do ICSI?

Dr. H.: THe PGD lab requires it. Here's why. Normally sperm coat the egg and one gets through. But the other dudes might hang around the egg and they may have additional genetic material there. During the biopsy, this adds additional genetic material that could distort the testing. It's a cleaner and more reliable process with ICSI. This is especially true when single gene testing is being done. Magnification process used during testing magnifies any DNA (including contaminant sperm).

But, problems associated with ICSI are just a small fraction higher in babies than IVF with no ICSI, so it's not much of a concern.

Me: Yes, right. I'm not too concerned about the whole fraction higher thing, because that might be caused by the fact that typically the patients that do ICSI have something indicated in the sperm that is causing the need to do ICSI. I'm just saying, if we could do natural selection, that might be cool. But I totally get it now. Thanks for explaining. By the way, I've been calling Carlos's sperm gorgeous and beautiful, but I never really asked, did they test the sample the day of retrieval?

Dr. H.: Yes. His stats:
5.6 ml volume
counts in 1ml
34 million count (> 20 million normal)
53% motility (> 40 normal)
They did not test for morphology. They don't normally do that.

Me: Ok. (Note to self. If we have to do another fresh cycle, ask them to test that. I just want to know. A woman can ask, right?)

Me: Any reason to do another fresh cycle instead of moving forward with frozen? (Sometimes I like to ask questions twice, to see if I get the same answer. You know, throw them off. I should so be in FBI interrogator.)

Dr. H. See above. (Carlos refused to type the answer twice, even though the sweet doctor answered it again. I recommend moving forward with frozen. OK, cool. Like I said, beautiful. By the way, still wanting to know why this didn't work. Could I have endometriosis?

Dr. H: Yes.

Me: WHAT?

Dr. H. But it's not likely. You woudl have pain with your period, intercourse. It requires
lapropscopy to diagnose.

Note to self: If this goes on much longer, ask for more tests.

Me: Could I have PCOS? (I know all you smart IF bloggers out there are laughing at me, but I'm just trying to rule things out here.)

Dr. H.: Yes. (Dude, is he just trying to cover himself, or what?) But you have normal cycles, so not likely. In truth, there are a myriad of variables... most of which we can't test for or account for. There are a few key things we look at. In practice, it's often a combination of many small problems.

Me: New topic. After this frozen cycle. Can I swim or take a bath afterward? We're thinking about going to a beach in South America the last weekend in August.

Dr. H. Swimming is an issue is for a few days. We don't want you to get an infection.
- Not in a lake or an ocean
- But swimming pool ok after 5-6 days

Dr. H. With your Frozen IVF this time, I think we will also do an insemination at the same time. There is some evidence that combining implantation and insemination can increase chances of success because it causes ovulation.

Me: What? are you kidding? and then risk that that sperm and egg make a baby? And then it has CF? I'm not convinced that we can't get pregnant with SEX, much less IVF. If we could do IUI, I might be out to here by now.

Dr H. Oh, yes, I forgot. Can't guarantee that some sperm won't hang around and introduce the possibility of a baby with CF. Bad idea. You're right. Yeah, we won't do that.

(but I left that part in for you women that are doing IVF. Might be something to ask about. I'm cool with the doc forgetting. He has a lot of patients. And, honestly a lot of patience too. At this point, we're already at least 40 minutes in, and I'm still on the first page of my questions.

In fact, I am thinking I'll make this two blog posts. Stay tuned for the rest.