Sadness

 I know I said I'd prefer the bad news because it means less waiting. Be careful what you wish for. I got the bad news. Our lone embryo hadn't reached blast by day 7 and was discarded. 

That makes 15 retrieved, 11 mature, 5 fertilized, 3 blasts, and 1 CCS normal.

I'm sad. Not 'you just lost a baby' sad, but 'this feels like the passing of a nice, badly wanted dream' sad. I suppose the upside of living through all-encompassing grief is that it helps you appreciate simple sadness!

I'm also angry. My clinic is having good success with artificial occyte activation. After my first two rounds both produced 66% fertilization rates with ICSI, I should have requested AOA for this last round. With five mature, we should have gotten to at least a few fertilized and a blast or two. Why didn't I advocate for myself? I couldn't have predicted a 20% fertilization rate on round 3, but it also wouldn't have hurt to try it, based on the growing body of evidence that it helps. I asked the embryologist and she said that the four that didn't fertilize showed no signs of fertilization, as opposed to fertilizing abnormally. AOA should have helped with that. 

We have one last shot. Assuming our nanny doesn't have COVID, I should start my next cycle by next week. In my mind, I vacillate a million times a day between "There are a lot of benefits to not getting another embryo. Life will be much easier with only two living kids. We can focus more on then. We'll retire earlier. I am at peace and if we don't get an embryo, I will accept that and move on." and "We are so close. And I may have leftover meds. We could swing paying for one more cycle out of pocket if I didn't have to pay for meds. Just one more."

I am usually very financially driven, so to help comfort myself in the event that we don't get another healthy embryo, I'm going to put it in writing here what "just one more" would really cost. Below are actual and projected expenses, while making the very generous assumption that our first FET would work:

2020 Medical Costs:
Insurance OOPMax: $10,800
HGH Cost (five rounds, including a cancelled cycle): $4,660
Estimated 'one more' cost: $16,500 + meds.

2021 Medical Costs
Insurance OOPMax (for cerclage and Asherman's surgery): $10,800
FET: $5,400
FET meds: $4,000

Total, if FET #1 worked and we do 'one more round': >$52,690
If we do get another CCS normal, and don't do 'one more round', we're looking at: ~$35,660.
If we don't get another CCS normal, and we stop here, we'll be at: $15,460, plus whatever reasonable medical expenses we're likely to have next year, so perhaps our deductible of $3,000 = $18,460.

So the difference between another kid and not is $34,230-$17,200.

Good grief those numbers are awful. It does help me feel better about reaching the end, although it doesn't ease the sadness at all. Really it just adds sadness for the state of health insurance in our country. 

Microblog Monday: Waiting Fatigue

As I sit here, waiting on the day 6 call, which has led to the wait for a day 7 call for the last two cycles, I realize just how much the endless waiting is wearing on me. There was the waiting for CD1. The waiting for the call to say I was cleared to start stims. The waiting for the first monitoring appointment where I'd get a sense of how things would go. The waiting for an entire extra cycle due to cancellation. The waiting for trigger instructions. The waiting for retrieval. The waiting for the fertilization call. The waiting for the day 6 and day 7 calls. The waiting for the PGS calls. So much waiting. 

I feel intensely guilty and selfish to admit this, but I almost want to get a 'nothing to biopsy' call today, because that means I won't have to wait on the CCS call. It would most likely mean the end of the road for us, but I'm honestly so fatigued that I might be ready. I never felt this way in the past. Despite all the losses and surgeries and treatment cycles and the awful HG pregnancies, I was ok with waiting because waiting meant something good might happen.

Now is somehow different. Perhaps because it's not just that it's waiting, it's that it's incredibly high-stakes, life changing, physically demanding waiting. I've been sick enough with bad nausea for the last two retrievals that it's been a harsh reminder of what I'd have to wait through for 9 months of pregnancy. In addition, psychologists talk about being in a state of 'activation.' If I'm honest with myself, all this waiting has meant endless activation. And now our nanny is out sick, and it looks like it might be COVID, so we're waiting on her test with the knowledge that we'll have to cancel our last retrieval cycle if it's positive. And I had promised myself I just had to wait through one last retrieval, which mean 3-4 last weeks, but if this is COVID, it'll be at least two months. Although two months is nothing in the grand scheme of things, it might be the proverbial wait that broke the camel's back.

Mixed News

 Retreival from my microdose lupron cycle was yesterday. Follicle sizes were: 23.5, 18.5, 18, 15.5, 12, 11, 9, 8, 6.5. I fully expected to get the same 2-3 mature we always do.

We got 5 eggs, four mature and one that matured over night! I was so excited.

Alas, only 1 fertilized. One. It blows my mind that I could go from my best cycle ever, to my worst. 

We're going to exhaust my insurance coverage on one last retrieval, and I think we're going to do MDLF again. I'm also going to request that we use calcium ionophore in the culture medium, as that's been show to increase fertilization. With 2/3, 2/3, and 1/5, fertilized, I think it's what we should have been doing all along. Aside from calcium ionophore, does anyone know of any ways to improve fertilization? This was ICSI, which my clinic requires for CCS testing.

I desperately hope I can get one more euploid. I've now done 4 back to back rounds of HGH, which in theory may help with egg quality. If only those eggs can make it to blast. 

Microblog Mondays: Streaks, Revisited

 You prepare yourself for the call. The only call you can fathom, given a day 7 embryo and your 40 year old eggs. The call that says, "I'm sorry, but I have your CCS results back and your embryo is aneuploid."

You prepare, but you never get a call.

Instead, while in pre-op for your next ER, you hear a voice asking, "Is she still awake?" Next thing you know, your nurse is in the room, and you can tell even with the mask that she's smiling. "I have good news for you guys" she says. And then she tell us that we have a perfectly healthy day 7 boy. 

I cried. DH teared up. Both nurses teared up. The surgical nurse asked my IVF nurse if this was what her job is usually like, since the surgical nurse never gets to hear that end of the story. 

When my RE came by a few minutes later, I got to tell her, because she didn't know yet. SHE teared up, too.

We got fewer eggs at retreival than I expected. We'll see if anyone is mature or fertilizes. But, guys, we have a euploid! He'll never get to leave the freezer if we don't get at least one more, because I won't put myself through all the surgeries unless I have at least two euploid. But for this one tiny moment, with one ER remaining, I have hope again. And I love that beautiful little boy in the freezer. 

Sales Gone Awry

 I'm not a sales person. I would be a terrible in Sales. I always paint the full picture. If I was selling you a frog, you'd hear "This fellow has a great green and is a fabulous hopper, but he has quite a few warts and a habit of peeing on people who touch him." Not exactly an outstanding sales pitch, there.

I get a lot of unsolicited sales pitches at work from potential vendors. A lot. Per my junk email folder, 2,610 unwanted pitches since Jan 1. I am pretty aggressive at using 'unsubscribe', yet the junk continues. I filter anything I've seen before into a junk folder, but that doesn't always fix the problem. I don't know if it's the economy, or the fact that many people are under extra pressure, but I am getting more aggressive sales pitches this year.

One particular vendor, whose unsolicited email messages I've 'unsubscribed' from at least three times, has taken to having their sales guy call me repeatedly and send personalized email in addition to the boilerplate messages. This week alone he's left two voice messages, sent four personalized email (3 in one day) and two boilerplate messages. 

Does that actually work with anyone? Does anyone who has ignored a dozen email messages and two voicemail in two weeks, not to mention two or more messages a week for the last two years, suddenly answer the phone and say "Why, yes! I've been looking for a vendor just like you! Please, allow me to open an unlimited PO and start sending me bills! I have millions just waiting to be spent with your company!"? 

In case you can't tell, I find unsolicited pitches highly irritating. I'm busy and I don't feel like it should be my responsibility to repeatedly tell a vendor 'no', whether directly or via 'unsubscribe'. This is especially true given that I never expressed interest in any of these companies! Despite the fact that this behavior really grates on me, I'm usually polite.  Today, after the third voicemail this week, I snapped. I fired back an email. It might have used phrases like "Enough already!," "unwanted deluge of email," and "complete inability to respect my unsubscribe requests." It was not the height of professionalism or respectful behavior. It will probably return to bite me in the ass someday. At this moment, as long as he stops bloody contacting me, I'm willing to take the hit.

How can I be in a world where human contact is so limited, and yet be so annoyed by human contact? Something must be wrong with me.

That Time I Did Microdose Lupron Flare

So here we are, my third/fourth IVF attempt. Because I view the whole thing as one grand, emotionally draining, financially devastating science experiment, I asked to do MDLF this time. What can I say, I haven't done it before, and I like pushing buttons to see what happens. This was an as-yet unpushed button. 

I have no idea yet what the outcome will be. My first monitoring appointment is Wednesday, so we'll see then. My AFC was 7, not great, not as bad as it's been. We have a chance, at least, albeit not a good one. 

In some ways, there's a good chance this week could be a repeat of two weeks ago. Then I got the calls that I hadn't gotten the job I wanted, and we had no blasts make it to freeze.

In an unexpected turn of events, I wound up with a lone day 7 4AA blast that was sent off to biopsy. Knowing that it's a day 7, and I'm 40, it doesn't really have a chance. See here for a great study on aneuploidy by day and grade.  

I'll probably get the 'aneuploid' call about that around Friday. The job? Well, when I got the 'you didn't get it' call, the manager also told me she was trying to get another vacancy. I think if she does, I'll be the selected candidate. Today's the day she'll find out. So there's a good chance I'll also get the 'sorry, didn't get the vacancy' or even the 'got it, but you're still not selected' call this week, too.

On the upside, after the calls three weeks ago, these won't be as bad, because I already thought I hit the worst case scenario. These will just be a confirmation of the worst case scenario! Exposing myself to the possibility of a good scenario brings with it the large risk of the worst case. So I'll grin and bear whatever calls I get this week, and keep chugging a bit further knowing that as long as I'm chugging, there's a chance of a good outcome.

A Decline in Hope

 The one thing that DH and I have had going for us in our entire 'trying to have living kids' journey is the fact that we pretty much ALWAYS reach blast. All but one or two months we tried to get pregnant, we did. Now most of those were chemicals, or losses, but the ratio of pregnancies to attempts was amazingly, improbably, consistently high. That was the main reason why our RE thought our outcomes from IVF might be better than you'd expect from our numbers.

Round one bore that out. Two fertilized led to two blasts for biopsy.

Round two marked the end of that hope. Just like last cycle, we had three mature, but only two fertilized. Unlike last cycle, neither met the criteria for biopsy and freezing.

I've known from the start that we had a very low chance of success, given my age and numbers. I know that adding PGS, while necessary due to the cerclage, realistically lowers our odds even further. Today though, was the first time I felt in my soul that we really have no chance. It was the first time I felt convinced that this is just the proverbial fool's errand.

We have two rounds of IVF covered by insurance, and we'll use them both. I am still maintaining a strict anti-inflammatory, low carb diet. I am taking all of the supplements. I am doing every last thing I can think of to do to maximize our chances. I haven't given up in my behaviors, but I think I've given up in my heart.

This sucks. But you know what? Yesterday, just after the call from embryology, T came upstairs for snack time. I squatted down to meet her at the top of the stairs and the first thing she did was run to me for a hug. So as much as it sucks that there probably won't be another tiny human for us, I have everything I could ever possibly want right here already.