I didn't tell you guys this before, but the IVF clinic never called me yesterday to confirm that no fertilization occurred. The RE who called me Tuesday had told me they would "know for sure" on Wednesday morning and that they would call me. I would be lying if I said the lack of call didn't irritate me, but I feel it's pretty much par for the course with these people. So I got back to my desk this afternoon after 4 and a half hours of meetings and my cell phone went off. It was "Vivian" from the clinic calling to apologize for not calling me yesterday. She said:
- Dr Keller (my "main" RE) came by and said, "Isn't there something you forgot to do?" and Vivian was just mortified.
- I replied that it was okay as I just assumed it wasn't good news.
- Vivian said that yes, she had called back to the lab and they said there had been no change.
- She told me to stop my meds (yeah, thanks, I did that yesterday, dumbass - I don't do recreational PIO) but that I could continue my prenatal vitamin if I wanted to, if I think I "might want to go forward later on".
- She said I would get my period within 2 weeks after stopping the meds and that's the time I should call and come in and talk to them about what to maybe do next. After I've had time to "calm down" and "get rid of the hormones" and "talk to hubby" and decide what we want to do.
- I said, "Okay, thanks for calling." and got off the phone as fast as I could.
Here's how I feel about this:
- Could my doctor not have CALLED ME HERSELF today when she realized this had happened? Maybe something along the lines of, "I just found out that you were not contacted yesterday about the lack of fertilization and I am very, very sorry." Hearing from Vivian that she got in trouble from Dr. Keller is REEEEAAAAALLLLY not the same thing and really not something I could give a rat's ass about.
- FUCK ALL OF THEM, saying I need to wait until I "calm down" and "get rid of the hormones" before talking about this! If I want to talk about it now, they should DAMNED well talk to me about it now! And I have expressed nothing to them that could possibly construed as anything but calm. Plus, where's the logic in wanting to talk to an infertile woman when she's on her period!?!?!?
- They're just losers.
I'm pretty much done with them.
Also, I wanted to say how much I appreciate all of your comments. They really mean an awful lot to me. And, Sarah, you share my sentiments about my RE precisely.
Q) Why does God hate me?
A) Because you've made a lot of really bad choices in your life and haven't been living a life you should be proud of. You are being punished for your wrong choices. If you had stayed with your first husband (he of SUPER sperm, who can knock anyone up in a single bound, as is evidenced by his three children) you could have as many kids as you had wanted. If you had stayed with your second husband, instead of divorcing him practically immediately upon marrying him, you could have started this journey when you were 25 - not 30.
But! (I reply) I didn't LOVE him! (or him). Why is it wrong to want to have a baby with someone I love so dearly and "right" to have a baby with someone I don't?
-or-
God doesn't hate you. He doesn't hate anyone. God is love.
Q) Then why doesn't God align the desires of our hearts more closely with what he is willing to bless us with?
A) Because we have free will.
Q) Why do we need free will when we really don't decide anything? It's not up to us. It's all up to him/fate/the universe/whatever.
A) Because God wants us to remember that we aren't in control.
Q) So if God is in control, why does he let people get pregnant ALL THE TIME who don't want their kids? Abuse them? Neglect them? Or even abort them before they have a chance to abuse/neglect them? Why does he bless these people and not those of us aching for a child? Why couldn't God send me the baby that a friend of a friend of mine aborted a few months ago after getting pregnant by one of many guys she was sleeping with (while still married to her husband)? God had a perfectly good baby there - and apparently he was fine with giving it to someone who makes choices just as crappy as the ones I do - how come when deciding whether to give it to me or her, he chose her?
A) ...(I don't know the answer to this one. "Sucks to be you" is about the best I can come up with).
And another thing! I doubt this whole explanation the bitch-ass RE gave yesterday (did I tell you that her response to so many of the eggs not being mature was, "So it looks like we have an egg problem in addition to a sperm problem and that could be what's causing you to not be able to get pregnant"?) is all that valid. If I have some FUNDAMENTAL inability to mature eggs, how do we explain the fact that I have actually participated in the whole procreation thing before? I hate her.
I'm not sure what those "classic" stages of grief are, so I may be encountering them out of order, but I have definitely entered the anger phase.
Note: some expletives are used below (well, pretty much just one, actually). I'm apologizing up front to those who may be offended by the F word. Also, as an aside, I am fully aware of my overzealous use of "quotation marks" today - my use of them is intentional. When used in a sentence such as, "six of the 'naturally' combining eggs look like 'something' 'may' be 'going on'", they are meant to convey the fact that I think every fucking word out of every* fucking person's mouth today is bullshit - particularly those persons phoning me from my IVF clinic. I guess am feeling the need to explain my writing "conventions", after reading Sarah's blog review.
Sorry, back to my anger: I am angry that the BE-OTCH of a "reproductive endocrinologist" that called me today suggested that the problem with this cycle was MY beautiful, sweet, overachieving EGGS, to the point that she half-heartedly suggested that they might be able to tweak the dosage of Follistim in a future cycle, but barring that I'd really probably want to look at donor eggs. To that, I would like to give a giant FUCK YOU to Valerie S. Ratts, MD. How come after a 25 minute consult with Dr. Google, I find discussion of several options for dealing with immature eggs in IVF cycles in patients with PCOS? Options she couldn't propose with her fucking MEDICAL DEGREE from JOHNS fucking HOPKINS, such as:
- IVM - in vitro maturation. I realize this is experimental, but did they HAVE to throw away the 13 immature eggs they stripped? Wouldn't those have been perfect candidates for a little experimenting? Also, in this vein, I know their "plan" was to do "partial ICSI" (meaning they would do ICSI on about half of the eggs and let the others combine with the sperm "naturally"), but when they saw that 13 of the 14 eggs they stripped were immature, couldn't they have continued stripping them to find all of the mature ones and do ICSI on all of them to give them the very best chance? If it's because I had only "signed off on" partial ICSI, couldn't they have picked up the phone and discussed it with me YESTERDAY!?!?!?
- Two HCG trigger shots - apparently women of advanced maternal size (ha ha, I am soooo very funny) could possibly benefit from two Ovidrel injections to induce maturation of the oocytes.
- More closely aligning the number of follicles on ultrasound with E2 levels - while I know it's a tricky business to ramp those estradiol levels up into the several thousands, it is generally recognized that E2 levels should be about 200 for each mature follicle. The day they had me trigger, I had 34 measurable follicles (1-18, 1-17, 2-16, 8-15, 5-14, 4-13, 7-12, 2-11, 4-10), but my estradiol was 3,519. This E2 level should have meant about 17 mature follicles, but only TWO of the 34 were at least 17 mm (the generally recognized size of a mature follicle). I would think this would have told them that I had 2 mature follicles and 32 immature ones and that I needed to stim another day until the numbers matched up better.
- They could consider treating my underlying PCOS with metformin, which can increase IVF success rates.
Basically, it is my conclusion that they triggered me early, hoping to avoid OHSS, but instead resulting in a giant, expensive, painful (emotionally and physically) waste of time. Not to mention decreasing their IVF success statistics (since they probably care more about that anyway). And, instead of treating me on the phone like I am a freak show, I'm thinking she could have acknowledged that this situation is not totally uncommon in PCOS IVF cycles. I am trying to decide what to do. I am extremely irritated with this clinic and I feel like they did not tailor my protocol to my situation - it was more about when my stimulation fit into their schedule. I am thinking about continuing my stirrup hopping and getting another opinion. I am also thinking about giving up. I am tired and sad and am feeling like God hates me/this wasn't meant to be/etc... Sigh. I hate this.
*Not you guys of course, your comments echo the voice of my heart, and I love you. Muah.
and I have bad news.
Good news: the egg retrieval yesterday went really well! They got TWENTY-FIVE eggs! How's that for some stimulation? I felt pretty good yesterday. We went for Indian food and then home to chillax on the couch. We were really excited.
Bad news: the clinic called this morning.
Guess how many of those 25 eggs fertilized?
ZERO (zilch, nada, the big goose egg, ha ha ha).
They said they had planned to do ICSI on half of the eggs. The ICSI process involves "stripping" the cumulus cells from around the egg so that they can orient the egg properly to inject the sperm. They stripped 14 of them and 13/14 were immature (they hadn't extruded a polar body, which would indicate they had gone through division and were ready to be fertilized). They injected a sperm into the 14th one, but today it was doing nothing. For the other 11 they were going to let the sperm & egg combine "naturally" (yeah, if there's one word for this process, it's definitely NATURAL). Of those, ZERO have fertilized as of today (and they should have already). They can only conclude that they were immature also. BUT - six of the "naturally" combining eggs look like "something" "may" be "going on" so they won't know for sure that the cycle is a complete and total fucking failure until tomorrow morning. So that means I get to do the PIO shot tonight anyway (such fun) in the ridiculous, delusional hope that they're just late bloomers. The doctor suggested that we either try again with less aggressive stimulation in the hopes that fewer eggs "get a little more time to mature" or use donor eggs (we won't go that route). I guess I'm supposed to call and make an appointment to discuss the results and a "plan" with my main RE (this was the one who was "on call" today). So, has anyone ever experienced something like this? Looks like it's time to consult Dr. Google. Sorry to be a Debbie Downer!!!
