I'm in a bit of a funk about the appointment with Dr Candour today. I had a full-on anxiety dream about it yesterday, which included an appointment with Dr Condescending that never quite happened due to her being overworked, but did involve a long period sitting in an office with her with a bunch of other people who apparently couldn't go elsewhere; potential options on what we might do next, prepared by H on scrappy bits of paper and laid out by Dr Condescending for me to pick up and react to (I reacted very badly to the donor egg one); H disappearing to train with some soldiers over lunch, and me getting cross because he wasn't there to talk to Dr Condescending with me; A man conking out while sitting round the edges of Dr Condescending's office, and it turned out to be because she'd given him heparin when she shouldn't have done; us ending up at Dr Condescending's house where her husband walked out in a bad mood and she told me she was 2 days pregnant; me suddenly realising that it was 16:15 and we were late for our appointment with Dr Candour. I should add that in this dream Dr Condescending didn't look like she does in reality - she was fatter, for one thing. My shrink told me that if you dream of someone but they don't look like they do in reality, it's because you're conflating other people with them. I think I might have been adding myself into Dr Condescending in this dream, since the fatter bit would make sense, plus her hair was more like mine.
I wasn't even going to record it, since I know how much you aren't interested in my dreams, but once I started typing it all just spewed up onto the screen, sorry. I am not going to over-interpret it, suffice it to say I know I'm anxious and this didn't help calm me down.
I'm anxious because I'm going to ask some questions about donor eggs, and our chances of success, as well as the more mundane things about when can we cycle and should we do Zoladex again. In fact, here's the list I prepared and emailed to Dr Candour last night - anything missing?
- We want to do another IVF cycle as soon as we can. How soon is that, given that we are trying not to let the endo get out of control?
- Should we do zoladex again? One cycle probably isn't enough for the endometrium re-setting (I know he doesn't believe in that, anyway), so it's really just to keep the endo under control, and since I've now had 4 un-suppressed cycles since my last lap (2 IVF, one post miscarriage, one now), how much effect is the zoladex still having?
- Given the 4 cycles with estrogen floating around, should we do another lap, even in the absence of an indicative endometrioma? (although who knows, I may have one by now)
- Should we do a frozen or fresh cycle? How good are those embryos we've got frozen, really?
- If we get a good number of embryos again on a fresh cycle, shouldn't we be attempting blastocyst transfer? How good is the discrimination at day 2 really?
- Does the HFEA restriction re number of embryos transferred drop on my birthday exactly (13 Jan), or is there some leeway? How much?
- Are we kidding ourselves, and really we should be thinking about donor eggs now rather than later?
I'm also anxious because I'm remembering Julie's mantra from a post ages ago where she talked about what she wished she'd known, and one of the entries was: "If you've had three failed cycles, switch clinics. No matter how much you like your doctor, they aren't working for you." (I'm paraphrasing as I can't find the entry). I don't want to switch clinics. I like the atmosphere at ours, I trust Dr Candour and Dr Condescending, I like that I can email and get answers to science questions, that they know me, that it's convenient to our house, that they are non-profit making, that they designed a protocol just for me. And they did get us pregnant. Once.
However, I have a sneaking suspicion that I am being an idiot. As I've mentioned before, there is a clinic in the UK which has double the success rates of anywhere else in the country. I know they screen on FSH, but I would pass that screen (assuming it stays where it's been for the last 2 years). Dr Candour says they also do ET at the clinic next door for patients with crappy prognoses, so that those numbers don't show up in their stats. He is a man of integrity, so I don't think he's making it up, but still their published figures haunt me. I also know that they are much harder to work with - they don't tell you what's going on, you have to go in every day for bloods etc., and they don't give appointments so you can sometimes wait for hours (hard to do with work), sometimes you have to come back in the afternoon (similarly hard with work), etc. Plus they push ICSI and IVIG on you, at more expense. But the success rates, how they call to me. A colleague at work got pregnant there, twice - with her son, and then with her twin boys, having had five failed IVFs elsewhere, so she is pushing me to go to them. I don't want to, but I think I'm being stupid. That's not a very good combination.
To clear up a couple of questions from the last post. We can't just suddenly switch to DE, there is a whole procedure to go through and donors are very hard to find in the UK, although I understand that my clinic has a good list and that the waiting time is not too bad (it can be years). So there is no question of doing half my eggs and half donor, for example. Second, Dr Candour doesn't just uniformly suggest five cycles, he suggested five on the basis that three completely negative cycles would lead him to suggest we stop, but we've had one pregnancy so that improves our chances, hence the additional two before he'd figure we were SOL. The reason that doing additional cycles delays adoption procedures is that in the UK, social services demand that you have stopped any kind of treatment before you start the adoption process, and some even demand a six month wait time, to ensure you have mourned your biological children and let go of that (not sure six months is long enough, but there you go). So while we are still pursuing treatment, there is nothing we can do to initiate adoption.
I can't help feeling that we're coming to the end of the runway, with no take-off in sight. Yes, I know we had a short-lived pregnancy, but many people have that and never get pregnant again. Yes, I know my FSH is low, but I still don't stim easily. Yes, I know we produce good looking day 2/day 3 embryos, but who knows what they look like at day 7 or later? And I will be 40 in January. 40.
Let's see what happens this afternoon. I will probably be unable to post until later this weekend since we're heading off to see friends for the weekend, and not sure what their internet connection is like. I'll update when I can.