A plan

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.

Comments

[Kath]

Dear Thalia, maybe he does read IF blogs. I would if I were an RE.

I just had to look up Zoladex to know what it does. Are your side effects so strong that you wouldn't want to go on holiday while taking it? Or is it purely about not knowing where you'll be in your cycle?

As others have said, your cycle might do funny things this month. Some people have to wait a long time before their period comes, while others are regular pretty quickly. I was fairly regular, but it was still a weird cycle, because I had a super-ovulation (several follicles at once) followed almost immediately by bleeding. And as I said, I still had HCG in my system until after the next period.

I know what you mean about the time factor. Last year I wasn't that concerned about it, but with every month that passes I get more worried. Despite all the anecdotal evidence around me that it can work beautifully. Sigh.

I'm afraid I didn't quite understand your 50 percent statistic -- why are your chances of miscarrying so high? Is it my math?

[Pamplemousse]

I have seen some stats that say that 50% of women 40 and over will miscarry. Now that does not mean that will happen to you as that stat covers all pregnancies, natural or ART.

It is a pity that the genetics stuff was not available today as that would give you more info but I am sure Dr Candour will have a full and frank convo with you when he has it.

It sounds like a good plan anyway and I would go for a holiday wherever you can fit it in, cycle-wise. You and H sound as if you both need some quality down-time, my dear.

[lindy]

Dr. Candour sounds fabulous as always. And the plan sounds like a good one. I hope you're able to work out a way to take the holiday. And, as always, I'm hurting for you that you have to go through this all over again. Thinking of you and wishing you comfort and all the luck in the world.

[katty]

I'm impressed by your considerate doctor. Is he in London? Is it a NHS clinic? I continue to be frustrated by my clinic, but at the same time I feel that everyone makes errors, and I hardly have the energy to move.
Yes, to fear of ageing eggs. I am 40. I had my first IUI just before my 40th birthday. My first IVF, this month, is at 40 and a half. I am going to do two more this year (if I do not have success). I think at three the clinic suggests donor eggs. But using donor eggs AND donor sperm, given that I'm single, seems a bit pointless. I may as well adopt (though I know it's not that easy).
I understand the feeling sad. I never thought I'd be here either. Or rather I feared it, but hoped the fear would ward off the event. And today at the clinc, having my first vaginal prod in five weeks (I start injections tomorrow) I felt both resigned and mournful. An 'it has come to this feeling' and also exhaustion at the idea of going through it all again, and also a fear, I try and keep at bay, of failure.
Well done for starting again so soon.
I wish you luck, and hope for your success.
K

[Avonlea]

I think you have so much bravery and courage and intelligence about this - intellectual and emotional - I can only see you succeeding.

[ninaB]

"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."

Any idea what he's basing this on?

Glad you have a plan.

[amanda]

I'm very glad you have a plan in place now. And you're right. It's not the cycle itself that is so hard to deal with. It's the aftermath. Oh, how I so hope that there will be no aftermath this time around.

[soralis]

I am sorry that all your information wasn't available during your meeting with the doc. It does sound like you had a good meeting anyway.

I will be crossing my fingers for your next cycle.

Take care

[fisher queen]

Thalia, I really think the miscarriage odds are meant to be understood independently of the odds of getting pregnant in the first place, so that it's not a 50/50 chance, but actually a 15-20% chance. That's how I read it anyway.

[Cricket]

Although it wasn't all what you wanted to hear, you sound so confident about pursuing it. I hope you can get the ball rolling soon.

[Kay]

Sounds like a good meeting, and a good plan. I really, really hear you about worrying more about a negative than another loss. Keeping everything crossed for you that this next cycle works out. And I hope you get your holiday!

[AnnMarie]

Thalia, I'm glad you're focused on another round. There are no guarantees with these things, and shit does indeed happen. It's the successful cases that inspire us to try again and again. Your RE knows your body now and I think that's half the battle. I hope you get those results soon...

[Suz]

I'm thinking of you Thalia. It sounds like a good plan and it's good to have a plan.

[Summer]

I agree with fisher queen about the miscarriage stats. Like you said, the first hurdle is pregnancy, once you've gotten over that hurdle then your chance of miscarriage is 15-20%.

But sometimes numbers can only provide small and temporary comfort (or fear). Because really, those numbers are based on populations and what you really care about is you, the individual, and the hard truth is that probabilitis for that are nonexistent.

I like your plan. Because yours is such a long protocol it seems it will allow you to work through some more emotional issues, but you're actively starting on the next cycle which cuts down on your wait time.

I hope you can get your cytogenetic tests back soon.

[Carrie P]

So glad you have a plan. Did he say what levels of success other women have had with the same or similar protocol to yours? I completely agree with Summer's point about stats applying to populations, not individuals (and I guess the sample size is tiny in this case anyway) but I bet most of us are curious about how other women get on with the same drug regimes.
Do you think that if there hadn't been any successes he'd have been reluctant to try the protocol with you for a second time?

[Lut C.]

Fisher queen is right about the statistics.

If 100 women cycle, 30 will become PG on average. Of these, 5 or 6 will miscarry on average (20% is 1/5th). That's only 5-6% of the initial group of 100.

I've become wary of statistics, though I still like to cling to them.

I can relate to your desire to keep moving and fear of another BFN. Take care.

[StellaNova]

Your Dr Candour sounds a lot like my Dr Challenge. Pretty much the right degree of hope and realism. He also put a lot of faith in the fact that we got pregnant once. But the age factor, for me, is like a dark presence shadowing my every step. And statistics are meaningless unless they apply to you - but we read everything into them anyway. When I turned 38 I thought I had plummeted into a black hole of hope. On the wrong side of statistics. But you reminded me in one of your comments to me that it is not a sudden and dramatic decline - where fertilisation and pregnancy occurs, we stil have hope. Dr Challenge said it's a matter of numbers. Most normal women don't get pregnant on the first try. It's just that our attempts cost so much and we have so much hope and every other emotion tied up in them. With normal fertility, an average woman will take 3-5 months to become pregnant - to me, I am seeing that as 3-5 IVF cycles. Maybe I'm manipulating this just a little bit too much to see it in my favour, but it's what keeps me going. I'm hoping for both of us - and every other one of us who is going through this.

[Mary Ellen]

Thalia I am glad that you have a plan. I am amazed at your strength and courage to move forward so quickly. I hope that there is no aftermath this time around. Please know that you are in my thoughts. Hugs.

[Nico]

Your plan sounds like an excellent one to me. I hope that your cycle is fairly normal, so you can get started soon. And that this time you're on the good side of all those statistice. Thinking of you!

[elle]

Dr Candour strikes again! So glad he's so on the ball and glad you can start again so soon. Hoping you find a way to squeeze in a vacation - you have certainly earned it.

[Vivien]

Sometimes I wish they would read these blogs. They would probably learn a lot.
Good luck Thalia, and I hope you can sort out some holiday - much needed. How about Norway - both beautiful and cool!

[Vanessa]

I have to agree-some down time and away-togetherness time helps massively. I know it's a lot of words, the "please don't think about the "death knell", because it's IMPOSSIBLE to not dwell on that, but try to push those thoughts away.

The good news is, you have a plan. A plan is something. A plan? It's a good thing.

[Nikole]

I'm so glad that you have a plan in place (although I'm still catching up on your posts and see that Dr Candour loses some points in the near future). A plan always makes me feel a little better about things. Yes, what a tough balance between hope and optimism, and realistically looking ahead. Sigh.