Today I had my follow-up consultation. The one I never wanted to have. The “what went wrong?” consultation. Or, as it’s otherwise know, the WTF consultation. Like any good researcher, I came prepared with a typed list of questions and ideas. I wasn’t really nervous going there, but once I found myself sitting in the familiar lobby of my reproductive endocrinologist (RE), I felt that rush of anxiety flood back into my body. My palms started to sweat, my throat tightened, my heart beat just a little faster. I sat silently observing the physiological change triggered by entering this place. I reflected on how many emotions are triggered by simply being there. Anxiety, fear, excited anticipation, hope. This place represents both pain and dreams come true. Quite a paradox. I focused on taking deep breaths and observing my reactions without judgment. My reactions began to calm, and then the door opened and I was called back.
My RE was genuinely bothered by having to have this appointment with me. He expected my FET to work. He had gone over my chart repeatedly searching for an explanation. As a self proclaimed “control freak” he wanted an answer so that he could fix it. He wants this to work for me. But we had everything right: the timing based on ERA, lining thickness, PGS normal embryo, and no other conditions negatively affecting us as we have had a successful IVF in the past. As much as he hated to say it, it boiled down to bad luck. And that killed us both. He did explain that even though an embryo is PGS normal, it may still have other issues that keep it from continuing to develop. Unfortunately my embryo failed to implant at all. My RE described the embryo as a fuzzy tennis ball and explained that the uterus has receptors dispersed all over it that are like velcro strips. If you bounce the ball in there it may hit a velcro strip and stick, or it might roll around and unfortunately miss all of the velcro strips. The ball only has so much time in there to roll around and hit some velcro before it starts to disintegrate. Apparently my ball missed the velcro and that just happens sometimes. He sure loves his metaphors, but I do like that about him.
We are lucky though, because we have insurance coverage. Part of me keeps thinking that they will revoke this coverage – like they would only pay for one try – but the appeal they granted said “all treatments related to infertility”. They didn’t put any qualifiers or limitations on the approval. Given that, we are able to try again. I feel blessed for that. My RE seemed relieved because he knows what a financial burden this is and he believes we can have success if we try again. And so we will.
We are going to do a few things differently this time. First, I won’t be suppressing with birth control pills (BCP). This was a shock to me because my clinic usually uses BCPs to batch cycles. I’ve read that BCPs can be over-suppressing for women with diminished ovarian reserve (like me) and negatively impact egg quality in older women (um, me again). He said that we will just start the stimulation meds with my next period due at the end of the month. I’m not sure if this is because my period just happens to coincide with the upcoming batch of patients he has cycling or if his decision is due to the aforementioned factors. I didn’t ask. I’m interested to see how this impacts, if at all, the quantity and quality of eggs I produce. Second, we are adding human growth hormone (HGH) to my stimulation meds to try to improve egg quality. I’ve heard good things about this so I’m hopeful that this can help us get at least one normal embryo, and hopefully more.
Third, we are going to re-do the ERA test. He said we can do it during the stimulation cycle after the egg retrieval so that we don’t have to waste a month with a mock cycle. Last time we did 2 biopsies for ERA testing. The first sample came back pre-receptive and the second, done two days later, came back post-receptive. It was logical to split the difference to determine the optimal transfer day. But he said that he would like to see the test find a definitively receptive result. So we are going to do the biopsy on the day that my last ERA assumed I was receptive just to make sure, and do a second biopsy the day after just for good measure. Hopefully this will help us nail down without a doubt the ideal time for a transfer. I’m thankful we can do this during the same cycle as egg retrieval so that I don’t have to drag this out quite as long as the last IVF/FET. Fingers crossed it all works out like that. Lastly, my RE told me about a medication that can make that velcro (yes we’re back to that metaphor) bigger and longer, so that it has more “grab reach” to catch and hold on to my embryo. It’s something that I will insert (my poor overworked vagina) 5 days prior to the FET. Of course, in all the information overload, I forgot the name of this velcro aid, but I’m happy to try it.
So that’s everything. Hopefully these changes improve my egg quality, nail down the perfect transfer time, and improve my implantation odds. I’m a little nervous because I won’t have been on supplements for very long before we start stimulation medications, but I suppose time is not on my side anyway due to age. Also, my RE seemed to not be very worried about that and brushed it off saying, “you were one them not long ago,” so there’s that. And with that…here we go again: IVF #3, FET #2. May luck be on my side and the Divine bless me with fertility.