Our doctor was amazing enough to do our phone consult on his own time, on a Saturday afternoon. Which was perfect and so appreciated, because the official time was 11:30 on Monday and we were unsure of if we could both be conferenced in and I was worried that if it ran late I would be late for my 7th period class and there's limited cell reception in my brick beast of a building and probably the only reliable and truly private place to have this call would be in my car, plus if anything was upsetting it would make it hard to make it through the last two periods of my instructional day. So hurrah for Dr Fabulous who consistently goes above and beyond.
Bryce had a few questions he wanted to ask, but the most important one was, "Do you feel comfortable with telling us that this will just never happen, because if it seems that this is an unlikely path for us but you feel we want to keep going, we want you to know that the kindest thing if it looks unlikely is to just tell us concretely." I both appreciated and was terrified of this question. I mean, I knew if there was a "promising new protocol," that there was still hope, but I am both hoping for and terribly afraid of being told that unequivocally, I will never be able to get pregnant and stay that way. Seems an odd thing to hope for in the tiniest possible voice, but if it's not going to happen I'd rather know and mourn that and move on rather than keep toiling in this uncertainty of no answers. I'm also terribly afraid because it's my biggest fear that I am just not physically capable of pregnancy, but if we're being completely honest, if that's true I'd rather not be dicked around for the sake of feelings. Which we definitely do not have to worry about. The answer was no. It is not time for the throwing of towels, we are not at an impasse, it seems that maybe we're at the point in the swordplay where someone says "I'm not left-handed either." There's still a little glimmer of hope.
Unfortunately that hope lies in the fact that now the belief is that our biggest culprit in our ongoing saga of implantation failure is my uterus, more specifically my uterine lining. Therefore, this new protocol will address that lining. The question was asked, "Why are we just doing this now? How is this different, because I had a really lovely thick lining (over 12 mm!) with the fresh cycle and THAT still didn't work, so what's the difference?" Here is the difference, apparently. The difference is that when you are doing a fresh cycle, you get a thicker lining, yes. But if you are like me and have really high estrogen levels during ovulation induction, that can actually hamper implantation. So the ultimate sweet spot is if you can stimulate the lining through your ovaries, not oral estrogen support, but your focus is on the lining, not the eggs. This way your lining gets nice and thick and your estrogen doesn't go into the danger zone, which is apparently 3,000 plus. I went flipping through my handy dandy notebook, and was like, hmmm, but my estrogen last fresh cycle (the 12mm cycle) was 2553 at the last monitoring. HOWEVER, that was before one last 300 dose of follistim, a few days before retrieval and the application of the HCG trigger shot (which boosts estrogen levels, so much so that if you are in danger of OHSS they use a lupron trigger shot instead, which I didn't even think was a thing but then again, this is why we are with this clinic...they do crazy, cutting edge stuff!), plus with the Ganarelix to hamper ovulation, my levels were probably in actuality well over 3000. OK. There seems to be an answer for everything, which is not a bad thing!
The uncoupling theory came up again, which made me sad because that was what we were originally going to do with the first fresh cycle, the one with Bryce's embryos, and because we were so frustrated by the canceled cycle in April, we decided to just do it all at once in June. Which now I think was a mistake. We were just so gung ho, but I think especially given the fact that it was my hardest egg retrieval recovery ever, I didn't give my body enough chance. I should have listened more on that one. We (me) were a bit hardheaded on that one. BUT, at the same time, those embryos weren't blasts on day 5, they were morulas, so maybe they wouldn't have frozen well anyway. Who knows. It does no good to look back at the past, what's done is done, but it's an interesting line of thought (although not a particularly constructive one).
I asked if there were other patients with our hideous rate of failure who had gotten pregnant. The answer was yes, not a lot, but yes. We are not considered candidates for gestational carrier although at this point other patients have begun exploring that route. For us, between the legality issues in NY and the importance of pregnancy to the medical piece of things, that's not an option we're willing to pursue. If we get to the point where I am not doing the baking, I think we feel far more comfortable with domestic infant adoption than we do with the the intricacies of gestational carrier in our state. But, luckily for us as we are not comfortable with that path, it wasn't on the table.
However, here is the new plan:
- I go on the Pill after starting a period. (Hallelujah, my body gave me a scare by taking its sweet time, but it did actually do what it was supposed to do and started shedding that failed lining today.)
- During the Pill cycle, I go spend a morning at the Catholic hospital in Buffalo to have another hysteroscopy. It never fails to amuse me that these surgeries take place in a Catholic hospital, given the Church's stance on IVF. It was a nice hospital, though, and this will make sure that I haven't gone and grown anymore fun polyps that could screw up this protocol that is going to get me pregnant, and I will once again become acquainted with Zlorg the Destroyer. More fun alien invasion of my uterus pictures! Also, they will do a scratch biopsy to further up my odds while I'm under the influence of general anesthesia. I lose one day of school to this, maybe an additional half day but hopefully just the one.
- After the Pill, I will actually start Femara, I drug I've never taken (anyone familiar please weigh in), but think is somewhat similar to Clomid?
- After Femara, I start Follistim injections. I guess the combination of the two ensures that my estrogen will be made by my body, and it won't go too wacky. The goal is maybe 3 follicles, not the 20+ I usually generate in a stim cycle. They don't want my estrogen too high, just high enough to make a nice cozy lining.
- During the injection time, I drive back and forth to Buffalo for monitoring. Let's hope this Polar Vortex craziness I keep hearing about is a stupid hoax and I don't have to worry about snow in October.
- Once my follicles are ready for trigger and my lining is fantabulous, I take the handy dandy trigger shot and ovulate those suckers. One of very few times in my life I actually get to ovulate like a normal female human.
- Transfer takes place a week later, when a normal 5-day transfer would take place.
- I repeat everything we did in this last protocol -- the vitamins D & E, the benadryl 3x/day, the Lovenox, the turbuteline. Except I take the turbuteline a few extra days, through early implantation, to effectively paralyze my uterus and keep it from contracting during this time against my will. (Because, embarrassingly enough, the only time I am blessed with orgasms in my sleep is when I am explicitly NOT SUPPOSED TO HAVE THEM, and then they are followed by crampy pain that pretty much makes me feel like the embryos are doomed. This happened this time, and they think the turbuteline will help prevent it.) I tolerated the turbuteline just fine for three days, I'm sure it will be fine for a couple more. Only I could have an experience that normally would be an amazing boon and have it be something horrid. WTF, body.
- Progesterone in Oil again, which actually wasn't so bad and I only got prickles down my leg once. Bryce is amazing at this shot and I am just grateful I don't have to look at the 1 1/2 inch needle that gets skillfully plunged into my posterior.
- Monitoring of my levels during the wait (estrogen mostly) to make sure I don't need anything extra.
Sounds like a good plan to me. Get my levels where they need to be, get my lining where it needs to be, paralyze my obstreperous uterus so it can receive and not reject those last two blasts waiting in the freezer that I just know are as beautiful as these last two. I will enjoy the next week of having a bit of wine and a margarita on Friday, but having been out of practice I found the margaritas were not my friend and maybe just one is just fine for now. Enjoy some coffee for a couple weeks (the doctor said up to 200 mg a day was fine, which is like one cup of coffee, but I think for my own peace of mind when I'm building a lining NO COFFEE), and then that goes away too. I have plans to do my best to work out and shed a few of these fertility pounds that keep piling on, but I can't stress too much about it because between the hysteroscopy and starting the meds it will be difficult to squeeze in, plus school is swallowing my weekdays, but I will just do my best. A huge stress reliever is also the fact that we've already paid for this package, and so there is no more big chunk of money getting expended. Very surreal. I actually feel like the clinic is losing money on us right now, so although I know there is a fair amount of personal investment in us, there's also motivation to stop amortizing our cycles into the cheapest ones they've ever provided. That financial piece is really so helpful. It would be so much more overwhelming if each failure meant a ton more money flying out the door (and down the toilet).
There it is... keep it together for the next few weeks, try to get ever more positive, give our baby/ies another chance to come and stay for keeps.