Follow me on the crazy, hopeful, discouraging, funny, and ultimately successful (one way or another) path to parenthood while facing infertility.

Thursday, January 2, 2014

How Do You Say Goodbye? Looking for Advice

I am facing a bit of an awkward situation, and I need your help figuring out the best way to go forward. You see, my husband and I have been with the same clinic for four years and change, and we have done 7 IUI attempts and 8 transfers (4 fresh and 2 frozen my eggs, 1 fresh and 1 frozen donor eggs) with the same clinic. I cringe a little bit when I say that, because it goes against so much good sense with managing your medical care, but we did change things up a lot and we did actually have two different doctors with the same clinic.

However, it is time to move on, and I'm not sure how to do this. In the time we've been with our clinic, they have grown to feel like our friends--everyone has been super invested in helping us to create our family. We have received personal calls from nurses offering condolences when things didn't work out. We have exchanged bottles of wine in appreciation. We send crazy Christmas cards with cats on them and beg to have a baby on the next card (oh well). When we walk into the clinic, we are met with "Heyyyyy! It's Jess and Bryce!" and it feels so warm and caring. However. I cannot continue to make medical decisions based on how nice people are. I cannot continue to go a path where there are more "No we don't do that"s and when the answer is "yes we will try your crazy idea" then I am the one who brings it all to the table and I am the one who catches protocol errors and I am the one who feels like I am managing my care and I am decidedly NOT an RE. I need a little innovation. Scratch that. I need A LOT of innovation. The way it always works for everyone else is definitely NOT the way it works for us. 

We almost went for a second opinion before the donor egg cycle. It was scheduled and on the books, but then I had to fill out all new paperwork and that was very overwhelming and then we made the decision to pursue donor egg definitively and I liked my clinic's program a lot more than the other clinic's program. I really wish we had consulted with somewhere like CCRM at that point, because we could have afforded it at that space in time. Now, having finally taken the leap and done a few consults elsewhere and having been a little more than a little stunned at some of the revelations thrown out there, that hindsight is kicking me in the butt. WHY didn't we move on earlier? Now, although I have heard such wonderful things about CCRM and I do believe that they are miracle workers, we just can't afford it and have adoption still on the table. And adoption needs to be on our table, because while maybe it will just take someone else with a different approach to solve our medical pieces, it feels like we are just made to be on the other side of the statistics. I would agree with the "You have to think positive!" people and say that isn't constructive to think that way, but it's just true. It doesn't mean it has to continue to be true, but for self-preservation, I have to go with the assumption that while the miracle COULD happen, it just as easily COULD NOT. If we thought it truly was not possible we would not be going into this final round of medical treatment. But we would be fools not to realize that it's a very good thing we have been opening our hearts to domestic infant adoption, as scary as that has seemed to us. And, since according to our last calculations domestic infant adoption will cost in the ballpark of $33,000 for us, and even if we take into account the supposedly $13,000 Adoption Tax Credit (that, while it was made permanent as part of the Fiscal Cliff legislation, was not made permanent in the way it was originally conceived when we go to pursue this option of creating our family -- please go to RESOLVE to learn more and continue supporting this bill!!!), it will mean a bill of at least $20,000. Which in itself is a lot to swallow but especially when you've spent so much on medical treatment that seemed promising but left you empty-handed. So, unfortunately, we cannot justify spending that much money and more on going to CCRM and traveling to Colorado multiple times in the hopes that we do not have to spend the money on adoption because our family will come to us from medical treatment. Even CCRM isn't 100%. 

We do have other options locally and have been working with a doctor that we knew previously who is with another clinic that has an amazing embryology lab. And who is open to a lot of newer things without needing convincing. And who has brought a lot of ideas and research to the table already and we haven't officially even started on as patients. Pretty impressive. We have another second opinion, our last, at a clinic nearby in about a week and a half. And while our clinic offered that if we worked with CCRM or another clinic we'd have to travel to that they would be happy to implement whatever they recommended, or do our monitoring locally, I just don't think I can do it. 

I just don't think that I want to continue on at a place that I've been to so frequently for so long with nothing to show for it but a drawer full of pictures of embryos long gone, surgical pictures of a tube swollen with a freak ectopic pregnancy from an IVF cycle, and my one and only ultrasound picture of a sac in my uterus. I can't do it. I feel almost like I have PTSD going to that clinic. I hyperventilate. And, as I wrote earlier in November, I had a massive meltdown in their office the last time I was there for something remotely treatment-related. I want this "last hurrah" to be free from all of the past losses and frustrations that are enclosed in those walls. I want this last try to be truly new in as many ways as possible. And I feel horribly guilty about it. 

But that guilt and sense of loyalty has, in a sense, held us back. Maybe. I mean, we would have had NO ISSUE seeking a second opinion earlier if we didn't just so badly want our current clinic to seal the deal. And we knew they wanted to. There have been many tears and touching moments in the transfer room. But all that aside, it's just not the best idea to stay with the same clinic for 8 cycles. Other places have fresh eyes on things. Other places have different lab procedures and different drug procedures and different tests they are more willing to do and do with more frequency. And it's time to move on. 

So, how to do that? I don't want to just slink off into the ether. I don't want to disappear after 4 years and 3 months. If I was loyal enough to stay despite limited success, it would be pretty crappy to just POOF disappear. But, at the same time, do I want to do a consult in person to say goodbye? That might prove to be pretty freaking awkward. And I don't want to feel like I have to defend my stance. I don't want to feel pressured to give it ONE MORE SHOT. Especially since in all of our second opinions so far the consensus has NOT been that we need to continue with donor eggs and that we have "age related egg quality issues." How can that be when my FSH and AMH are stellar? No, everyone else has said, "it looks like the sperm could be your issue." I felt a little like my clinic was doing a lot of lady-finger-pointing without looking at HALF the genetic material. So I do feel some frustration, but at the same time I want to be able to say goodbye and have some closure and, in some way, let them know that when (if) we are successful medically, that they will have definitely played a role in that. We wouldn't have the data to say that we are dealing with a sperm issue if we hadn't done the egg donor cycle to see that our blast development was pretty darn poor, and that occurred before the embryos even had anything to do with me. It's not a blame thing, my body/his body, but it is interesting how many times it's just assumed to be a female issue and that ICSI can overcome anything. Grrr.

So what would you do? Write a letter? Steel yourself and set up a last consult? Send an email? Make a phone call? Or fade away into the ether? 

It's awkward no matter what, but I just can't let it go completely when there's such a history. I so wish we were leaving because we were being released to our OB/GYN. That's how I dreamed it. That's what I'd hoped for. But it didn't happen, and I truly feel that it won't happen unless we let this chapter end and start up elsewhere. It seems like everything in this process is a letting go. 

Thanks for your help--I appreciate it!

15 comments:

  1. I would write a letter or email thanking them for all of their help, but telling them that you need to move on. I'm sure they will understand as the end goal is for a baby and they haven't been able to give you that.

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    1. Thank you--that is super helpful. A letter is personal but without the possibility of an uncomfortable in-person meeting... Thanks for weighing in!

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  2. I think an email or a phone call is sufficient! You've gone as far as you can with them.

    I'm looking at domestic infant adoption, too---yikes is it a lot of information to digest! Will write a post about it soon. Maybe we can help each other in researching it. I didn't realize that there was still a tax credit!

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    1. Thanks! Yes, there is A LOT of information. It is overwhelming and I am not quite ready to really delve headlong into it yet... but I have had a WONDERFUL experience with Adoption STAR, an agency here in NY but I believe they service Ohio and Florida too, and their website has a BOATLOAD of resources and information. The closest office to me is in Buffalo but they do stuff here in Rochester and also in Albany. It sure is a lot to process. I look forward to reading your post about your exploration! I agree, let's pool resources... :)

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  3. They will get it. The majority of women who access reproductive assistance never conceive. They see it all the time. It is very nice of you to be so un-jaded toward them. I still feel pretty angry with the three clinics I used who all insisted I had a chance -- when I did not. Never once did they tell me the majority of women are never able to conceive this way. We have moved on and have adopted a perfect baby girl. I wish I had moved on sooner.

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    1. Thank you for sharing your experience--I am trying hard not to be totally angry. Don't get me wrong, there are definitely frustrations and I have been downright mad, furious even with some of the short-sightedness I feel there has been, but mostly I am mad that I didn't take the reins and move on to a second opinion sooner, because who knows? A movement to something different could have either resulted in better outcomes or it could have given me the peace to move on to another family building option sooner. I am confident that 2014 will bring either medical resolution or the ability to say ENOUGH and start the adoption process. I am so happy for you and your baby girl--I hope that beautiful resolution is in my near future. I really wish that there would be more black-and-white in this, that I don't have to be ultimately the one who says I've hit my limit. I guess that's the double edged sword of medical technology...there's always some new hope out there to cling to, but never a 100% guarantee. I wish you peace! Thanks for stopping by.

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  4. I would send a letter. Expressing your feelings, but then you won't be pressured in having to fend of the "One more time" jargon in person.

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    1. Thanks, Aimee... I think I'm going with letter. I may do letter and email so that I'm sure it gets where it's supposed to go, but with the same text. I feel kind of guilty because we have those 1-day embryos still on ice there, and they thought we'd be doing something with them, but I think we have to move forward with our other plans first because I suspect those embryos aren't going to result in much. I hate to say it that way but there it is...and I can't use up what stamina I have left on questionable embryos from a cohort that was entirely disappointing. Oh well... I agree, that "one more time" jargon could be tricky in person. Thanks for your thoughts!

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  5. OK, my link to the Adoption Tax Credit site on resolve.org was busted, so I've just fixed it... hope that clears up any confusion!

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  6. i think a nice card would be appreciated. Either now, or once you have success, whether that be at another clinic or through domestic or international adoption.

    I know this has been such a hard year for you and I'm so sorry. But I am crossing my fingers for 2014 to bring happiness and resolution.

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    1. Thank you, thanks for the advice and for your thoughts on 2014. I'm so appreciative of your wishes and concern... I am so hoping that this new chapter brings us the family happiness we have been waiting so long for. (or waiting for so long, as I cringed ending on a preposition, a sign I'm ready to head back to school I guess!) :)

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  7. I agree with the ladies above. I think a letter would be best. Written word is obviously your medium and will give you the opportunity to express your appreciation for their kindness while explaining the difficult decision you need to make to move on. I think it will be appreciated. I'm sure they have their fair share of people who just disappear and then they receive a records request from another clinic.

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    1. Thanks, Lindsey! A letter (tucked into a card) is what we've decided on. Now the question is, just one, or targeted to different people? There were so many people who were cheering us on and who did more than they had to to offer condolences or support. So bittersweet (without much of the sweet). Thanks for your thoughts and the compliment! :)

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  8. I would go with the letter, for all of the above reasons. Make a clean break, and move on. They will understand.

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    1. Thanks for weighing in! Now to write this letter and get it over with... ugh.

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