It wasn't my most satisfying appointment with Dr Candour, but we came out of there with a plan. The contributors to it being less satisfactory is that I really wanted a conversation about what happened and our chances, but he was having one of his over-scheduled mornings, and the results from our cytogenetics weren't back yet so we were missing one vital piece of information. He ended up spending about 10 minutes on the phone trying to get hold of the cytogenetics information, but the lab weren't cooperating. So we don't know yet if there was a genetic problem - or even if we had enough genetic material to find anything out. We briefly discussed the Prague meeting and he said it was very good, although he was a bit stunned about how much publicity it got.
We discussed the fall-out from the ERPC and my trip to the ER. He asked me if I was ready - emotionally - to try again. I said I wanted to try again as soon as possible. He wanted me to think about it whether I was prepared to be thrown into the hormonal maelstrom again. I said I was terrified about getting older and how long everything takes, and I wanted to get started. He was fine with that, he said that physically it was ok, it was just a lot of additional stress to pile onto a difficult emotionally stressful situation. We briefly discussed doing a frozen cycle. He pointed out that fresh cycles are more likely to work, although they bring with them all the extra invasive procedures and hormonal interventions. I said that we wanted to do exactly what we did last time, and he was fine with that. He told us that they've used the same or similar protocol on several women since I had it, and are becoming more comfortable with it.
So the story is, wait for my period. On the day of my period or 1-2 days after, have a scan to make sure I don't have any new endometriomas. If everything is ok, on the same day have the Zoladex shot. Four weeks-one month later, start Puregon. We'll start at 300 mIU this time. Then we'll see what happens. He gave us about a 30% chance of getting pregnant - increased odds because we got pregnant last time - and a 15-20% chance (per cycle, not per pregnancy) of having another miscarriage. That seems to mean that once we are pregnant there's a 50/50 chance we will miscarry (30% chance of a pregnancy per cycl, 15% chance of a miscarriage per cycle - am I messing up here?). After we see the heartbeat there is an ongoing 10% chance that we will still miscarry.
I asked him how many times he'd let us do this. He said five in total - three more. There is a cumulative improvement in the chances of getting pregnant through the first three cycles. And a slight improvement through the next two. After that it flatlines: "it's a bloody miracle," he said, "when people get pregnant on the 7th or 8th cycle." Because we got pregnant on the second cycle, that ups our chances of getting pregnant again, so if this one fails he'd be happy to try 3 more, assuming that we get a good follicular response on each preceding one. After that we talk about donor eggs. He assured me that we don't need to go there yet, which I'm relieved about since I'm very much not ready to go there yet. He assured me that there was nothing to worry about in that on our first cycle we had six of six eggs fertilise, while on the second only five of nine did. He was so distracted by me mentioning the six of six that he ended up writing ICSI on our prespcription form for the cycle as he was busy talking while he was writing and said while he wasn't concentrating his brain was telling him that that kind of fertilisation could not have been straight IVF!
This somewhat scuppers our holiday plans as we were planning on taking off two weeks mid/end August, but that might be just when we're stimming, depending on when my period comes. My hcg on Satuday 17th, the day we went to A&E, was just 141 which means that it should have been zero sometime the weekend before last. Which means that my period should come about two weeks or so from now. That would take us to mid August for the start of stimms. Maybe. Who knows what my body is doing. I should probably pee on a stick, as Kath suggested, and see what's going on. Not sure if it should be an OPK or a pregnancy test, I'll see what I've got in the cupboard at home. I went to do one this morning but was distracted by H being in a very grumpy mood due to the difficulty of sleeping when it's so hot. Tonight we'll talk about when else we can take a holiday. The alternative is to take the holiday while I'm on the Zoladex. That will mean that we need a slightly less strenuous holiday than we were planning since I get migraines on Zoladex if I get dehydrated or too tired. But since we don't know when I'll need to get the Zoladex shot, it might be a bit tricky to plan the holiday. Perhaps we'll have to be spontaneous for a change - and pay spontaneous prices!
I'm left feeling quite emotional, and quite sad. I'm so scared of going through another cycle and finding out it's negative. I can cope with the cycle itself. Injections are no big deal and I know now how to manage the minimal side effects that I get. It's the negative result I'm scared of. If we don't get pregnant again, the next time we'd be able to cycle is just before my 40th birthday. I never thought that's where we'd be, still not pregnant at 40. Oh how I envy those of you who started this journey at 30, or 26, or 34 (without POF) or anywhere other than 38/39/40 when you can feel that death knell of your aging eggs hanging over you. I'm more scared of us not getting pregnant than I am of getting pregnant and miscarrying again. Perhaps because getting pregnant is the first hurdle, perhaps becasuse it's the hurdle we've always fallen at before. As Dr Candour said, it's very hard in this endeavour to find the right balance between hope, which keeps us all going, and realistic expectations. Anyone would think he read infertility blogs.