One Day Work Up Results

Well, we are back from Colorado with a lot to think about. I want to apologize ahead of time for this long post, but there is a lot going on in my head right now. Any feedback is greatly appreciated, especially from anyone out there who has had to make similar decisions.

I didn't get the clear cut answers I was hoping for, though I didn't really expect to. I was hoping to go have these remaining tests done, and Dr. Surrey would be able to give me a clear cut yes or no as to whether we could try again with my eggs. He didn't necessarily do that, but he did make several things pretty clear to us. So here is what we do know post one day work up...

My uterus: We first did an ultra sound to look inside my uterus, check the lining, and check for blood flow with the Doppler. This is also where they did the antral follicle count (more on that in a minute). The lining looked good and thick. She did see a water filled cyst on one of my ovaries, but she said that's common after ovulation (remember this was cycle day 17 for me, so that makes sense). The blood flow wasn't great though. It wasn't terrible by any means, and she said that it may have been caused by the Claritin D that I had been taking all week. She said that if Dr. Surrey was concerned about it he would tell us more at our follow up. He actually never brought it up in our follow up, and we completely forgot to ask. We have another phone follow up with him in a couple of weeks though, and I'll be sure to remember to ask him about it then. I think that lessening caffeine intake as well as starting acupuncture for the purpose of increasing blood flow to the uterus will greatly improve things. More in regards to my uterus - we also did a hysteroscopy with Dr. Surrey. This was where he looked at my uterus with a scope and also did a trial transfer to see how my uterus will react to the process. All looked good, except I do have a fairly large polyp on my uteran wall. This will obviously have to be removed before transferring an embryo. I'm due for a yearly pap anyway, and Dr. Surrey said that my OBGYN can do it in his office. We'll just have to get a pathology analysis on the polyp, although Dr. Surrey didn't think it looked malignant. I'm wondering if this could have caused the abnormal blood flow reading earlier in the day? (I can't believe we forgot to ask about it!) Dr. Surrey also said he could remove it during an egg retrieval, if we use my own eggs and do a frozen embryo transfer (more on that in a minute, too).

Semen Analysis: I just received a phone call from ccrm (following up about something else) and I asked if any results had come in about the semen analysis. They haven't gotten the chromatin report yet, but have gotten the basic semen analysis results, which look good. His morphology (the shape of the sperm) is a little low - they like it to be 3 and his was 2, but the nurse didn't seem concerned with that. I didn't get any other report about it other than it was normal. I'm not too concerned about it and will wait to get all the details when we have the rest of the results in.

And now, for the EGGS - the big question to be answered: The ultrasound actually showed 10 resting follicles, which was a bit of a shock since 5 years ago we had 9. So that was actually a pleasant surprise. However, we have to be practical and know that just because there are 10 follicles, does not mean I would grow 10 eggs in a cycle. We also have to keep in mind that my FSH is pretty high, indicating poor egg quality. I keep going back to the fact that 5 years ago we retrieved 7 eggs and only 1 of them survived. Those odds just aren't that great.

What the Good Doc. Said -- Dr. Surrey said that it certainly wouldn't be impossible for us to get pregnant with my eggs, but it wouldn't be an easy road either. He said he would strongly suggest the CCS testing with a frozen embryo transfer. We didn't do this last time because we assumed my eggs were healthy, even though I didn't have a lot of them. Now we know a little more (1 out of 7 survived). So the CCS testing would test all of the embryos made to check for the correct number of chromosomes. Most people I know who have gone to CCRM have done this testing, so it certainly isn't an unreasonable plan. However, the chances of us ending up with an embryo that a. can make it to the 5 day mark to be able to be tested, survives the testing, and then survives thaw and transfer is minimal. My fear is that we would go through the process and end up without any embryos that tested normal, and we would have paid the 7,000 extra dollars for something that we could find out by just transferring and seeing if the embryo takes (usually non viable embryos do not implant). Of course, that has it's own trauma associated with it. I would still end up with a failed IVF cycle. Either way, chances of success are slim with my eggs. We have the problem of growing them, first of all, but then most importantly getting a normal, quality embryo is the toughest part. So basically, to finalize Dr. Surrey's theory, our chances of being successful with IVF using my eggs and CCS testing is at 40-45%. My chances of being successful with donor eggs is 85%. Honestly, I wanted the numbers to be more spread out than that, if we were to decide to go the donor egg route....like I wanted him to tell me I had a 20% chance of success. That would make the decision SO MUCH EASIER!

We also met with a donor egg counselor, which was actually pretty great. I expressed my fears about what others would think about us using donor eggs, including the comment my mom made to me about it. She really reassured me that usually people get over those feelings, especially once the baby is born. Ryan and I talked a lot about it this weekend, too, and decided that we will most definitely not keep it a secret. Talking about my struggles has always been how I cope with infertility, and not talking about it, or hiding a piece of it, would make it seem like I was ashamed of it. If I do end up getting pregnant with a donor egg baby, I would want to make sure I never let that child think I was ashamed of his/her origins. I wouldn't hide it from the child, so I certainly wouldn't hide it from family members or friends. My mom and I have a big conversation to have if we end up going this route, and I'm certain everyone will come around. And as the counselor pointed out, if they don't come around to the idea, then screw 'em!

My/Our thoughts: If this was my prognosis before having Anadine, I'd probably go for it with my own eggs. I would be in the mind frame of wanting to give it my all before trying something else (in fact, that is basically what I did 5 years ago). But now, we really only have this one shot. We simply do not have the money to spend up to $30,000 on an IVF cycle and then (assuming it would fail) spend another $40,000 on a donor egg cycle. I hate to base my final decision on money, but that really is what it boils down to - that and the fact that I really have come to terms with the idea of using donor eggs and I'm okay with it. Ryan and I talked a lot about it over the weekend, and I think we both agree that donor eggs will be the most effective (cost and otherwise) way to go. We haven't made any final decisions yet, but that's kind of where we are now.

Here are the pros and cons we came up with:

Pros of using own eggs:
-DNA is the same
-Don't have to explain to family
-Don't have to explain to potential child about origins later down the road
-Less expensive (assuming it works)

Cons of using own eggs:
-little chance of success
-injecting all of the hormones into my body (increases cancer risks, etc)
- mental stress - which probably wouldn't be very helpful for success

Pros of donor eggs:
-more of a sure thing
-easier on my body
-less time consuming as far as the actual cycle goes
-we have more time to prepare because it doesn't matter that I'm losing more eggs each month
-younger, healthier eggs (less chance of birth defects)
-will most likely have many embryos to work with, or possibly freeze for later children (??) or if it doesn't work the first time. 

Cons of donor eggs:
-not my DNA
-have to explain to family/future child
-Very expensive!

It's such a tough decision and we don't really know how to make it, except to trust our insticts. And both of our instincts tell us to just use donor eggs...because all of those cons (except for the expense of it- more on that though later) don't matter to us. I'll still be able to carry the baby, deliver the baby, and love the baby with every ounce of my being. The  fact that he/she doesn't have my DNA just won't matter. The pros to using donor eggs are just so much more appealing - especially the idea that we'll have several embryos to use/choose from/use later. A frozen embryo transfer will be much less expensive than doing an entire cycle, should the first one not work.

Okay, so now to talk about the expense of a donor egg cycle (prepare yourself). If we were to do a donor egg cycle at CCRM (using an anonymous donor), it would cost us close to $40,000, not including travel expenses. In addition to that, CCRM's current donor list consists of 7 donors, only two of which are Caucasian. A girl in my CCRM Facebook group, who also ended up using donor eggs, told me that I should look into San Diego Fertility Clinic (where she ultimately ended up going and has a beautiful little girl). They have a donor egg guarantee plan that costs $26,278. With the plan you get all the transfers necessary to get pregnant from the batch of embryos created with your donor, and if you don't get pregnant, you get your money back. I don't know what this means regarding if you get pregnant on the first transfer, if you still get to freeze the remaining embryos to use at a later time. I also don't know how their donor database compares to CCRM's, or if they are as picky as CCRM in accepting donors (one of the reasons CCRM's list is so short). These are all questions I plan to get answered soon. But I can tell you this, I don't know if they can tell me much that would justify us spending $20,000 extra to stay at CCRM. That does break my heart a little because I do love CCRM and have a very special place in my heart for it, but business is business and if I use donor eggs, I don't see the  need to use CCRM for it.

There's also a fertility clinic in Dallas, which would be pretty convenient, that I'm going to check out. When I googled "best donor egg fertility clinics in the US" the one in Dallas came up as number 1. I don't know much more about it than that, and I don't know what they criteria was in choosing it as number 1, but it is something I think is worth looking into. Dallas is only a 4 hour drive from here - talk about cutting down on travel expenses!

So basically both of these other options take away that last con of using donor eggs (the expense of it). Honestly, the $26,000 at SDFC is still less than a regular IVF cycle at CCRM. We are also going to look into fertility grants and possibly setting up a Go Fund Me account. I hate asking for outside help, but it is just SO expensive and insurance companies generally don't cover any of it. 

So now I have some more questions to get answered. We'll have a follow up phone consult with Dr. Surrey on the 18th, so I'm making that my deadline to make some final decisions. Time to get going on my homework!

And that's it -- if you made it this far in this post you honestly deserve some sort of medal or something. Thanks for reading (and for your patience). And again, any thoughts are welcome!

WTF

I mean, why is it that when I need my body to actually behave it doesn't? I just started my flippin' period! It's been 16 days since I last started. I wasn't due to start again for another 8 days or so. WTF?!?! So what this means...I'm going to assume nothing right now. CCRM says they want you there between days 4-15 for your work up. This will put me out there on day 17. I'm guessing they want it done during the first part of your cycle just in case you're pregnant. Since that is impossible for me, I'm going to assume it will be okay. I'll put a call in to the nurse to make sure though. Please be okay! I've already booked flights, car rental, and hotel. Not to mention I've found a sub for my class for the two days I'll be out. UGH UGH UGH!! Fingers crossed they don't want me to change it. Or even better, maybe this is just spotting due to ovulation (even though that's never happened to me, and I have cramps, and it's very much like a normal period for me). Sorry if all of this is TMI, I'm just so mad at my body right now!

UPDATE:
I called CCRM and told the nurse what was going on. She said that they could reschedule me for Feb. 2, but it would have to be done by a different doctor. She said she'd have to get that signed off with Dr. Surrey and she'd let me know. I asked her if the reason for the day restrictions were to make sure I wasn't pregnant, and explained that my tubes are tied and deformed, meaning I absolutely can't get pregnant. She didn't really give me an answer, but told me she'd check with Dr. Surrey on all of that. So I had about 45 minutes of freaking out, calling Ryan and crying, panicking about the flight change restrictions, etc. and then she called back. She said we can keep it for the 5th. (*giant sigh of relief!) She said that the one stipulation is that I don't have unprotected intercourse for that cycle. (HUH?) I asked if that's true even if my tubes are tied, yada yada yada, and she said yes. So now, how to explain this to the hubby?? I kind of want to call her bluff on that one. I mean, I feel like she's just repeating what she's been told without thinking it through. Thoughts?

I'm also still kind of hoping that this is some weird fluke and I'll stop bleeding by the end of the day. Then I can just chalk it up to ovulation, increased exercise, and stress.  Don't think I don't find the irony in the fact that I was just complaining about playing the waiting game with nothing to do or think about!

Schedule for the one day work up

Here is the schedule the nurse sent me for our one day work up at CCRM. It's pretty boring stuff, but if someone is looking at doing a work up out there, it might be nice to see the kind of day you might have. It also helps to see the costs of all the tests. 

Colorado Center for Reproductive Medicine & Fertility Labs of Colorado

10290 RidgeGate Circle, Lone Tree, Colorado  80124      (303) 788-8300

Name                  Scheduling Date: 1/6/16          

Doctor for MD appts below: Surrey               Per: Tonie                    Cycle Day 1 (est):

Appointments must be within days 5-13 of your cycle, unless otherwise approved by your physician.

We have scheduled the following appointments for you on: Friday February 5^th, 2016

Out of state patients:

We strongly recommend you arrive in Denver the evening prior to your appointments to avoid last minute stress due to a possible flight delay. Denver International Airport is approximately 1 hour of drive time away from CCRM.CCRM strongly suggests that you do not schedule a flight home until 7pm or after.  Due to the number of appointments scheduled as part of your work up, we are not able to reschedule your appointments to accommodate an earlier flight time.

On your appointment day:

Please be sure to pick up a schedule when you check in for your first appointment.  This will assure that any minor appointment time changes are reflected on the schedule you have for the day.

Remember to check in with a receptionist whenever you are ready for your next appointment as scheduled.

Appt.	Time	Test or Consult	Who	Fee
1	6:45
2	7:00	Nurse:  Orientation to IVF at CCRM / required appointment	Couple	Included in pkg.
3	8:30	Baseline Ultrasound + Doppler	Female	$670
4	9:15	Semen Analysis + Antibody Testing   (ASAB)  (+ culture to be billed by outside lab) + Chromatin Assay	Male	*-FLC pymt * $240* male $135* female + $465 for Chromatin Assay (blood  draw with other labs) + culture to be billed by outside lab
5	10:00	Fertility Labs of CO (FLC) Consent Review	Couple	Included in pkg.
6	10:45	Nurse Consultation Donor Nurse	Couple	Included in pkg.
7	11:30	Hysteroscopy	Female	$725
8	11:45	Regroup	Couple	$119
9	12:00
10	12:30	Nurse - IVF Consult Shipping Kit: Y or N Additional fees apply GC/C Collection: Y or N	Couple	Consult included in pkg. Additional shipping kit fee may apply.
11	1:45	Standard or Extended  Workup Labs, Communicable Disease, Genetic Screening Blood Tests GC/CT DNA urine Important: Discuss Genetic Screening Tests with RN prior to blood draw.	Couple	*-FLC pymt. * Standard: $415/male $415/female Extended: $1115 /female $1115/male Other & Genetic:  As recommended by your MD
12	2:30	Psychologist - Donor Recipient Consult	Couple	Included in pkg.
13	3:30	Business Office	Couple
14	4:15

* Fertility Labs of Colorado Charges – FLC is contracted with United Health Care insurance only at this time.

If you have an insurance plan other than United Health Care, or no infertility benefit with United Health Care, lab testing by FLC will be considered “patient pay” and payment is due at time of service.

We will send claim forms to you upon request for you to submit claim to your insurance if applicable.

Please note: neither CCRM nor FLC accept American Express.

This is the standard/mandatory workup.  Based on your history, your physician may recommend additional testing during your visit which may result in additional fees.  Please contact the Business Office with any financial questions. Please note that if you opt to have genetic testing done, there is a $25.00 Good Start Set-up Fee in addition the fees charged by Good Start Genetics.

Test Requirements & Instructions:

ASAB (Anti-Sperm Antibody Test) – 2-5 days abstinence prior to test.    

Baseline Scan/Doppler Ultrasound – Avoid caffeine (coffee, tea, chocolate, etc.) for 3 days/ 72 hours prior to this ultrasound examination. (Caffeine effects blood flow which is measured by Doppler.)

Hysteroscopy – The hysteroscopy can cause some cramping, similar to menstrual cramps, and you may take 800 mg of ibuprofen 1 hour prior to the procedure.  The procedure should be performed when you have a partially full bladder.

Please note:  No tampons or intercourse or submerging in water for 1 week after the procedure.

Denver, the “Mile High City,” is at 5280 feet. Our altitude is high and our humidity is low.   Please be sure to drink plenty of fluids to feel good and be well-hydrated for your blood draw.

As for me, I have some questions to ask about some of these tests that I'm scheduled for. I'm wondering that if we've already done some of them at our previous work up, will we have to do them again? I know they need to do the ultrasounds and hystoroscopy, to check my uterus and baseline follicle count, but do I really need to be tested for HIV again? I'd like to save as much money as possible, and that along with the genetic testing seems like overkill. We've already done all of that, and it all came back negative. I realize it could be possible for someone to contract HIV in five years, but I assure you I have not.

It's also interesting to see all of the restrictions listed below the schedule. I completely forgot about the abstinence from sex for 72 hours, and the no caffeine thing. No caffeine 5 years ago was a big deal and not fun. No caffeine now may be the death of me. I should probably start weening myself off slowly over the next couple of weeks. My morning coffee is what gets me moving!

In other life news, I have a girls' trip planned with my college girlfriends and I am SO EXCITED!! It will be a welcomed break and I cannot wait to see all of my friends, some of whom I haven't seen in years - like maybe 6 years? Crazy! I'll be honest...the no drinking, no caffeine thing - well, it's probably going to start after this weekend.Cheers!