We met with the RE again yesterday and now we are officially on the IVF wait list (according to RE the wait is 1-3 months; reception said it’s 2-4 months).
When we met with the RE, he went over everything he said the last time. I have a really good memory so I was kinda like, ok get to the new stuff and let me ask my questions. But it was good that he went over everything in detail. Last time my FSH was 9 and my Antral Follicle Count (AFC) was 5. This time FSH = 9 and AFC = 7. To some, the AFC might seem like an improvement, but really they are the same and still far lower than expected.
My RE ended up saying that our actual diagnosis is Unexplained Infertility because DOR isn’t one of the traditional categories of infertility (e.g., tubal issues, ovulatory problems, male factor) and there is currently no research that says that a woman with DOR inherently has a harder time getting pregnant than someone without it. But, since we have tried for over a year, we are still dealing with infertility and my low reserve is a big red flag that deserves attention.
I asked MANY questions, which even became a joke at one point in our meeting, but Dr. Min was great about it. I must say, I really like our RE. He is candid (he flat out says if he just doesn’t know something because the research isn’t there), upfront, confident (in a way that breeds confidence in me), and really sounds like he knows his stuff.
The RE once again went over our options: we could try naturally for another 6 months (neither J or I wants to wait or has faith in this being the trick), try clomid (unlikely to make a difference – I am already ovulating regularly), try clomid + IUI (small success rate), try injectables + IUI (~22% success rate, but ours would cost about 5K and J thought the odds didn’t sound worth it), or move on to IVF right away. I asked the doctor which option he preferred and he said he’d go with IVF. That’s what I was thinking and apparently J too.
With IVF, our protocol will be microdose flare and we’d do ICSI (intracytoplasmic sperm injection) since the percent of J’s properly shaped swimmers was on the lower side (4% morphology). Dr. Min said he doesn’t need to experiment with my dosage because he isn’t worried about me overstimulating (and risking OHSS). Instead, he would max me out in an attempt to make as many follicles/eggs as possible. He said he’d be happy if he could get me to produce a high single digit/low double digit number of eggs. A Google search led me to a graph showing that >10 eggs would give a woman under 35 a 65% chance of live birth, 7-10 eggs = 58%, 3-6 = 38%, and 1-2 = 16%. Depending on the quality of my eggs/embryos/blastocysts, the RE said he’d either implant one or two (and whether it’s a day 3 or day 5 transfer would depend on quality and number of embryos).
If I produced less than 3 eggs, we’d convert to an IUI to give us a better chance and make use of our stimulated cycle. If we started with IUI, the goal would be to make 2-3 follicles. If I produced more, I could convert to an IVF but then I wouldn’t have had the higher dose of meds and I might not be capitalizing on my follicle growing potential.
So here are the things I have going for me: my age (29), my FSH isn’t super high, and my cycles are regular in frequency and length. Having fewer eggs at my age does not place me at higher risk for chromosomal abnormalities and chromosomal testing on the embryo was advised against. My acupuncturist said that ICSI is associated with higher abnormalities, but my RE said the research doesn’t substantiate that. Also, I have read that if there are chromosomal abnormalities, it’s likely due to the issue causing the infertility and not the ICSI procedure itself. However, there is an elevated risk of Klinefelter’s Syndrome (1%). KS is when a boy is born with XXY sex chromosomes. It is associated with reading disabilities and executive functioning (e.g., planning, organization, working memory, processing speed) difficulties – I work with kids with learning disabilities and ADHD (which is really an executive functioning disorder), so I understand that appropriate early intervention could make a world of difference in those respects. More concerning is that KS leads to physical differences which can affect the boy’s self-esteem and cause him to be ridiculed (e.g., smaller testes, more breast tissue). Testosterone and corrective surgery can be used as treatments. Also, individuals with KS are most likely to be infertile themselves. Overall though, the risk is still low.
We talked a bit about egg donation, but right now I feel hopeful about my own eggs. The RE knows though that I am very open to discussing donation if I don’t respond well.
As we were leaving the clinic, we were about to put our names on the IVF waiting list. We were told there’s a non-refundable $300 deposit. J and I hadn’t had a chance to discuss much in private even though we had talked about the likelihood of IVF before this appointment and we both said that was how we wanted to proceed in the office. Standing in front of the receptionist felt like an awkward place for such a conversation and when I asked J if he was sure, he said that I knew more about this stuff and if I thought it sounded best, we should go for it. I didn’t like that response because I worried that I was pressuring him. So we decided to wait and I would call it in later. We talked a bit as J drove me back to work and it became clearer that he did think IVF was best based on what he heard. I still wanted to double check last night and answer any questions he might have, as I have researched all of this so much and it’s all so new to him. He said I wasn’t pressuring him and, honestly, he didn’t understand much other than the percentages and costs (his work revolves around measurement and calculations, so this is not surprising). He said that once I started asking all my questions, he just started wondering if we could pay for it by credit card so that we could get points! I laughed out loud. Leave it to him to be so practical about it all.
So, bottom line, we’re moving forward and I’m hopeful . . .