IVF Take Three

Well, a lot has happened since my last post on this subject. I started a draft post mid July, but let that sit so long it's woefully out of date. So here's what's going on...

We went to the consult with the new doctor. We thought it would be a straightforward deal, just getting the details down for a try with my sister in law as the carrier. The doctor presented us with some options to mull over, though, including using donor eggs since my wife is now over forty. We went home and after a bit of hand wringing my wife decided that this is our last chance to have her own child so we would go with her eggs this time. Her sister is several years younger so if she's still willing we could try again later with donor eggs or adopted embryos. (Probably the latter since we're both not entirely comfortable with a child being from one of us but not the other, but would be fine with adoption if it weren't such an ordeal.)

Anyway, the protocol is underway. My wife is in the stimulation phase and will probably be ready for the retrieval in a week or so. Meanwhile my sister in law is primed for the transfer and waiting. (She has it easy: instead of shots she gets to use vaginal suppositories.)

We also got some good news today. My sperm numbers have improved greatly. The motility is greatly improved and the morphology is at 4% normal. The best morphology I've gotten in previous collections was 1%. I've been taking coenzyme Q-10 and vitamin E supplements most nights with dinner for the past month or so, the E for a bit longer. I don't know if that's what's made the difference, but my numbers are all at or near the minimum levels to be considered "normal" and I intend to continue. We both will be increasing our exercise as well to get in better shape, given that we now have an off chance of getting pregnant on our own. (It would be really crazy if she and her sister were both pregnant with our babies at the same time.)

I do believe we'll be having more sex. We've been off it for a bit. The low sperm counts & quality have been a bit of a downer, and it's hard not to think about it when you're thinking about sex. It just gives the whole thing a feeling of futility. Now, though, that load is lifting and we're both excited about it. I'm not sure when or if I'd be having any more analyses done, though, so there's a danger of uncertainty undermining that feeling if much time goes by with no luck that way. I guess we could always request an analysis.

With the numbers improved my wife asked the doctor if we were in IUI range now, and he said yes. I don't know if we'll do that, though. I read about a study recently that indicated that in cases of unexplained infertility using IUI (artificial insemination) or Clomid (to stimulate egg production) work no better than increasing the frequency of sex. Of course, you might say our infertility would be explained by my low counts & quality, but that in itself in unexplained, as is the fact that we've had three transfers of decent numbers of decent embryos with none implanting. I guess we'll see.

Infertility Endgame

It looks like we're going into the final stages of our fight with infertility. Our plan was to do a couple IUIs with my sperm supplemented with a donor's, then if that didn't work (and odds are it wouldn't) we'd try one last IVF with my wife's sister as the carrier. After a bit of delay, I looked over the info we had on donors and picked one I thought matched me best. (Redheads are scarce among sperm donors, by the way, so if you're a healthy male redhead who wants to make a few extra bucks, head on over to your local sperm bank.) It was a bit late to catch that cycle, so we waited until the next month.

The next month is here. In the mean time my wife has gone back and forth on whether she could do another IVF, so that's still technically up in the air, but I think if it comes to that she'll come to a point sooner or later where she's up for it. Her sister has also been having second thoughts. It seems their mother has been pressuring her to do it. I think we should tell their mother we've decided not to do it that way, for some sort of medical reason, just to take the pressure off. It's possible whatever reticence she's feeling is from an instinct to resist the pressure.

As I said, the next month is here and today my wife expressed some doubts about doing the IUI. It's a more expensive proposition with donor sperm in the mix (so to speak,) not likely to work, and with her health issues it would be a high-risk pregnancy if it did work (even though her health has improved with better diet & exercise habits.) I told her we shouldn't do anything unless and until she is comfortable with it. She went off on an errand, saying she'd think about it while she was out, and order sperm when she got back if she thought she was ready.

After she left I realized I had felt a bit of relief when she talked about not doing the IUI. As the time went by the thought of ordering that sperm, and having my wife pregnant by another man got me sicker and sicker. I realized I couldn't handle it, at least not yet, and, with the doubts she was having, maybe this approach just wasn't right for us.

When she got back I told her what I thought. She says she agrees.

I guess the plan now is to see what happens with her sister. If she and my wife sync up on the IVF we'll try that once. Beyond that, there's adoption which we may start looking into soon regardless.

This infertility thing is not for sissies.

Further Fertility Developments

We saw the new doctor today. He was very personable and more forthcoming than our old one, or at least more talkative. He looked our case over and asked some questions. He recommended that if we did do another IVF that since my wife's sister is willing using her as a gestational carrier would be the way to go, given the number of decent embryos we've put in so far. He also said, though, that our chances with three tries at IUI with donor sperm would be about the same as one try at IVF. IVF tries are generally at least two cycles apart, so with the financial considerations the IUI seems to be our best long term shot. Also, my wife is really feeling worn down emotionally by all she's gone through in the IVF's we've done and gotten nothing.

For IUI we would also have a better shot if my sister in law did it, but we were told tonight by my mother in law that my sister in law told her that while she would be just fine with carrying our child, she wasn't sure she'd be able to give up a child that was genetically hers. I can certainly see that, and understand. I think we were a bit blinded to that possibility by our desire to have a child by whatever means are left at our disposal, and I think my wife was especially so and is having a hard time dealing with it.

So, it seems our next try or three will be an IUI with my sperm augmented by donor sperm, put into my wife. I hope it works, but my wife has other health issues that would no doubt make pregnancy difficult. If the IUI doesn't work, I hope she can find it in herself to do one more IVF with her sister as the carrier.

Wish us luck. We're going to need a lot.

IVF Update And Plans

Well, in case you hadn't heard, the frozen transfer didn't implant apparently. We knew it was a long shot compared to the fresh transfers, but it's still disappointing.

We're changing gears now. Tuesday we have an appointment with a new doctor. We've heard good things about him. He does his procedures at the same fertility center as our original doctor, (I believe they and a few other doctors own it together,) so that will be convenient if potentially awkward. I'm sure other couples change doctors often enough after a few failures for them not to be really surprised. I think it's good to get a fresh pair of eyes on the situation anyway.

Unless he has some really novel insight into what could be done to improve our chances with another IVF, our plan is to shift to doing IUI with my sperm augmented with a donor's.

I'm a little bit of two minds about that. On the one hand we've produced multiple embryos via ICSI with my sperm, transferring nine in total and having some that did not make it nevertheless survive longer than initially estimated. So we know my sperm can work if given a ride to the egg. It's tempting to say "why are we bringing in donor sperm when mine is good enough?" In fact our chances per try are much better with IVF than IUI.

On the other hand, IVF is rather expensive and the protocol is rough on my wife. She is also still rather overweight, but has lost a good forty pounds or so since we started this and is continuing to improve over time. Taking a break from IVF for a little while would give her a chance to improve her health and through that improve our chances, and also give us a chance to catch up a little on the financial side of things. While we're doing that, we may as well take a few shots with the augmented IUI and maybe get lucky.

The plan is to do that for a few months, then maybe, if she is still willing by then, have my wife's sister do the IUIs. She has no interest in being a mother again, has said she would be willing to help out, and would be much cheaper and easier to monitor than a paid gestational carrier. I'm not sure if my wife would still try alongside her at that point. If their cycles were offset enough so that each would start the drugs after the other had their pregnancy test that would let us avoid the possibility of having both pregnant.

At some point my wife may decide she's up for another try at IVF. We just turned forty, so we can't put that off too long, but as long as she's losing weight it's a question of whether the aging is making our chances worse faster than the weight loss is making them better. If only we had some sort of indication of the optimum window. We don't though, so we can only guess and do what we can when we can.

Maybe Tuesday when the new doctor weighs in we'll know better where we stand.

Frozen Embryo Transfer.

We transfered two frozen embryos today. The quality varied a bit between the two. When blastocysts are frozen the collapse like raisins. When they are thawed and survive they reexpand like grapes. (Well, grapes don't actually reexpand, but you get the idea.)

One of the two was in the process of expanding at the time of the last check before the transfer. It had some ruptured cells, but that is expected in frozen embryos. The other one was still raisiny, but did have plenty live cells. The doctor told us that usually if they had only the one raisiny blast they wouldn't bother transferring it. Since we did have the fair one, though, we put back both.

Now we wait. The pregnancy test will be on the 17th, if I recall correctly. (It's been a long day.) We asked what our chances are, and after thinking about it a bit the doctor said we have a 20% shot. It's not that much, but a frozen transfer is a much less expensive and uncomfortable cycle, so it's a shot worth taking. If this doesn't work, I'm not sure what we'll try next. My wife may or may not feel up to doing another fresh cycle. Our contingency plan is to do IUI with donor sperm supplementing mine. Hopefully, though, we'll get pregnant this time and not have to worry about that.

Lining Is Good

We went in for another uterine lining measurement yesterday. It was over 8 mm and the doctor declared us ready to move on to the next phase. Today I start giving my wife injections that will shift her from growing the lining to making it hospitable.

The transfer is set for this coming Thursday afternoon. If neither embryo survives the thaw - they pretty much always lose some cells, but at this stage they can usually weather that - they'll call us around mid-day and tell us not to come in. They said we can call if we don't hear anything, to make sure. I think we'll probably call when the employees go to lunch.

I hope this one works. After this the next thing to try is IUI augmented with donor sperm along with mine. If we simply can't have a child that's mine so be it - I'll take what we can get. When we were first getting to know one another I briefly suspected our nephew might actually by my wife's son, and I was okay with that. I really hope this new child will ultimately be our own, though, and as long as what we're trying involves sperm, and I have some to contribute, I will.

For The Record

A few of you may have already heard. Our second IVF cycle failed. This time we didn't even see a chemical pregnancy, though we may have just been lucky to catch it the first cycle.

We're regrouping now. We still have two embryos frozen so we can try again at a lower cost than a full cycle, though there is a chance neither will survive being thawed. My inclination at this point is to let my wife's younger sister try carrying them, or at the very least have a more thorough examination of my wife, perhaps a scope of her uterus, to determine if there are any factors preventing implantation. If there are, and it's just something correctable, we can do something about it before we try again. If there's something that's not fixable, we'd pretty much be left with my sister in law as a carrier.

If that fails, we might consider IUI with donor sperm. I'm thinking since I do have some fair-enough sperm, though admittedly not much, I'd like to see if we could do IUIs with a mix of my sperm and that of a near-lookalike donor. At least then any child to come of it could be genetically mine.

For now, we're taking a little time off to get some distance from the disappointment so we can make good rational decisions to maximize our chances for a baby. It's not that difficult to take our minds off it at the moment, actually, since we both have bad colds. I'll be getting back to blogging about other things as well.

An Emotional Rollercoaster

A little recap to set the scene...

First we were happy to be doing something about having a baby by having an IUI. My wife responded well to the Clomid and things looked good. The next day we had fun collecting my sperm.

Then the sperm count came in, very low as I posted before. (Turns out the .3M is post-wash. Pre-wash it was .5. Still very low.) That was a blow. Our Dr. wasn't there so his partner handled us. We went ahead and injected the sperm since everything was ready, hoping for the best.

Then we figured we could probably afford at least one try at IVF, and maybe borrow from family for a second try. Things were looking a little better. The doctor called this morning to ask if his partner had gone over my numbers. My wife told him we'd seen them and she scheduled us for an initial IVF consult.

Then later this morning we got my full results faxed to us to bring for my urologist appointment tomorrow. 0% normal morphology. All my sperm are malformed. That was a heavy blow. I would have thought the doctor would have talked to my wife about that, but apparently there was confusion as to what we had seen and been told about. I called him and talked to the nurse, finally getting it through to her that we had not had a chance to ask the Dr. all our questions about the results. At that point I was feeling both sick and angry.

Then the Doctor called us back and we all go on together. It turns out that misshapen sperm can still be used with ICSI, in which a sperm cell is injected into an egg with a tiny sharp needle. The genetic material inside should be unaffected by the processes creating the misshapen sperm, although if we have a son he may have the same problem. Our chances of conception should be pretty much the same as a couple with normal sperm.

So, I'm feeling a bit more optimistic now, but I can't help wonder if the urologist is going to tell me tomorrow I have testicular cancer. :P

Regrouping

Okay. I have a low sperm count. Very low. I've got an appointment with a urologist Tuesday. My count is too low to realistically hope to improve it to the point that we don't have to go for IVF, so we've started the ball rolling scheduling that. We do think it's a good idea to get me checked out to see if the count is being lowered by some condition that could do me other harm and get that fixed if needed. If they find some sort of reversible blockage and can raise my count significantly, then so much the better, but I'm not holding my breath.

I think I'm over the initial shock. The fact that we can afford at least one try at IVF ourselves and may be able to borrow from our parents for an additional try if necessary helps, since it means we're not sunk yet. It's just not going to be as easy as we'd initially hoped. I can deal with that. As I understand things the IVF is actually more of a sure thing than the IUI was, even if I had a normal count, since pretty much the only thing left to chance is the implantation, and even that is prodded along a bit to improve conditions.

With that in mind, I feel comfortable sharing a bit more about the experience yesterday. In chronological order...

When did Hustler go hardcore? In the "collection room" which was essentially a restroom with a lounge with a love seat, (that's a two-seat couch, for any readers from countries where they don't call them that,) they had a magazine bucket with several copies of Penthouse, Playboy, Hustler, Black Tail, Big Black Butts, and some biker babe magazine. We started out with my wife flipping through a Penthouse while I took matters in hand, but there were too many ads & articles about electronics & stuff, and one nasty picture of some sports player with a bloody nose, so we switched to a Hustler. That was a bit better. The girls were no prettier, but Hustler really knows how to focus on their core competency. The last time I looked at a Hustler was almost twelve years ago, just before I tossed out my porn stash in advance of my wife's first visit to New Orleans. (I figured they were obsolete then. :) ) Back then any penetration was in the ads or in the odd video review, and censored with dots and such. Now they seem to hold nothing back. I'm pretty sure I spotted a come shot on one page, though my wife flipped by pretty quick on that one. I think she got a bit absorbed in the thing because she kept lingering over the articles & ads & cartoons. I had to remind her what we were looking at it for. :) Actually, it probably helped me hold off longer and build up a bigger deposit.

Later, after we got the bad news and went ahead with the IUI I got to push the plunger to inject the sperm into her. I think that might have been a bit more fun had the count been higher, but that's how it goes. Hopefully one of those sperm will get lucky.

Later still, at Secret Headquarters, we locked the doors, turned off the light so people looking in the windows couldn't see, and supplemented the injection a bit.

Today was a bit hectic, having our nephews & niece & SIL over while our oldest nephew cut our lawn (got some pics of the stream in back - will post them later,) doing some catch-up work at Secret Headquarters, eating dinner out with my wife's parents, but I hope to do a bit more supplementing tonight. Might as well with up to four eggs in play.

Once again, wish us luck!

Dealt a blow

We're just back home from the Dr. My wife is taking a nap.

My motile sperm count came in at 0.3M. They like to see more like 20M. Very very low. We went ahead and put them in - no sense wasting the chance, however slim - but we are now looking at IVF, or possibly donor sperm. IVF looks like it would be about $10k a pop and the Dr. says they've done it with a count as low as five. That's five sperm, not five million, so my count wouldn't really be a factor. The morphology report isn't in yet, though, so we'll see. I really don't want to go the donor sperm route, but if the IVF doesn't work out that may be all that's left. Surely out of a third of a million motile sperm there should be enough to find a good one, though.

I feel absolutely sick, but I keep reminding myself this doesn't mean it's impossible - merely difficult. Wish us luck.

Back From The Dr.

We're back, after a side trip to Chili's.

My wife had four big follicles - I saw them on the ultrasound - which the Dr. says is a lot. We've read that many doctors won't do an IUI if there are more than four, so we've aced that part of the job. They gave her a trigger shot to get them poppin' and tomorrow morning I give the sperm. Then we kill a couple hours while they're washed and go back to have them injected. With a little luck, sperm will meet egg(s) and pregnancy will ensue.

Conception May Be Soon If Not Imminent

We are scheduled to go in for an ultrasound to check my wife's follicles Sunday, with an IUI presumably Monday. She's been on Clomid. This morning she got a solid line on the ovulation predictor test and called in to see if we should go in today. A nurse will be calling back.

If we go, it may be on short notice, so I may be incommunicado for a bit. We have to drive over 50 miles to the place and we've not been there yet.

Wish us luck!

Update: Appointment at 2:30 this afternoon. Leaving at 1:00 eastern. Now the heart is fluttering. :)

Feeling A Bit More Optimistic

We went to the dermatologist today to find out what options were available. Meanwhile, she has been back on her UVB regimen and seems to be improving. The PA told us about the new drugs, giving us some information we hadn't heard elsewhere about their particular effects and which would most likely help her.

My wife is apparently feeling optimistic about it as well, because she told the PA we were actively trying to conceive, so her treatment choices would be limited by that. I felt a little bit guilty at taking personal pleasure at her saying that. I guess I still have a bit of Catholic psychic detritus to sweep up. :) Anyway, I guess my fears may have been misplaced. If it comes down to it again, though, I'd make the same choice.

She was given a cortisone injection and a prescription for a specially-mixed ointment to ease the itching, and instructions to come back in a month for a follow-up. She was also given some brochures for the new biologics. We took in the prescription to be filled, but got busy at work and entertaining my parents and never got around to picking it up. She's definitely in a stage now where it subsides and recedes, and it is a very itchy stage as those last flakes linger and irritate the hell out of her. I'm doing my best to help, slathering on one moisturizer after another in order to find the one that will do the job well enough to let her get some sleep.

And that's where things leave off for now.

Feeling a little... I don't know what.

I may have just given up my last chance to be a father.

My wife has psoriatic arthritis, and due to her recent strep throat is having the worst flare-up she's had since I've known her. Her skin hurts a lot and is very red and inflamed. She's got a UV light and is using it, along with tar treatments, but she had to skip a day while we traveled this weekend, and the flare-up is flaring up.

There are some new biologic (protein-based) drugs available that seem to be very effective, but they are expensive and they are not recommended for pregnant women unless absolutely necessary. If a woman is already on them, getting pregnant is something you simply do not do. We were planning to try IUI (intra-uterine insemination) and clomid starting this month in order to have a baby, and are currently under instructions to call in as soon as her next cycle starts to schedule the procedure for the right time. She was suffering so much tonight, though, I decided that suffering through this is too much to ask of her, so I told her we would call for an appointment with her dermatologist tomorrow. She never said a word about it affecting our baby plans. She may be too uncomfortable, and freaking out about it, right now to even think of it. I don't know. Once I got her to bed and came out here, though, I almost cried.

We have heard that pregnancy can clear it up too, though probably temporarily. Maybe if the dermatologist can give us some comparative chances of clearing for the drug vs pregnancy, and they come out about even, and what we're doing now fights it back enough for her to handle, maybe we might still try for a baby. At this point, though, I doubt it. I'm hoping for it, but I won't push it at her expense.

I'm fairly calm about it all right now, though slightly numb. If I'm actually in a bit of denial right now, though, I'm afraid of how I might feel if this does in fact turn out to be the end my chances at fatherhood. I'm pretty sure it'll hurt. Maybe a lot. I do know she's hurting now, though, and that hurts me too so one of us may as well not be hurting.