Friday, May 31, 2013

another one passed right by

In the past, birthdays have always been a huge deal to me. 
I usually celebrate big. 

This year, not so much.
In fact, my birthday went by with very little fan fare which was fine by me.

My 36th birthday was almost week ago. It was last Saturday. Memorial Day weekend. Great for partying it up which is usually right up my alley. This is how I usually roll on my birthdays...

Last year for my 35th b-day, I celebrated with my girlfriends at happy hour and with my hubby and his family in Mammoth.

My "annual" 29th birthday party AKA 34th b-day

At the club for my 30th with my besties

house party for my 28th birthday
You get the idea. Surrounded by friends. Smiles. Laughs. Drinks.
And my personal fave...a little dancing.

But this year I was happy to just let it slip by. Forget it was even happening. My in-laws came into town from San Diego and we had a very low key dinner. Nothing fancy. No cake. No candles. No alcohol. This was a first for me...on all counts. 

I can't tell you why. Except that I didn't really feel like I had much to celebrate. I'm another year older. Another year without a baby. We are another year as an infertile couple. Facing another year of IVF expenses and TTC. And another year closer to end of this journey.

Today is my sweet husband's birthday. Our birthdays are six days apart. He turned 37. I spoke with him a few times today since he's at work. Each time I wished him a happy birthday, he said he'd forgotten it was his birthday. I wonder if he feels the same way I felt. 

Today is cycle day one. Last night about 11pm, I welcomed AF and my frequent, unwanted visitor... endometriosis pain. It sucks but I've accepted it. The pain comes and goes. When it is gone, I always know it will return. I can count on that.

Something has changed though. And I kinda feel like it is a big something. I'm not sad. I'm not disappointed. It is what it is.

I'm just tired and I'm resolved. 

It hit me today. My hope for natural conception has officially died. This is the first month in 54 long months that I didn't force the baby dance just because I was ovulating. Just in case. Nope. I didn't even care. I knew I wouldn't get pregnant this month. I knew we wouldn't save $30,000 if we just tried...even if we weren't in the mood. It's done. We are going to Denver. I've accepted that fact. 

I no longer take my temperature or chart my cycles or take OPK's. I'm an infertility veteran. I know exactly when I'm ovulating. I no longer think this might be our month. I no longer take pregnancy tests when my boobs get sore or my period is late. I finally know better. I don't believe I'll ever get pregnant on my own. 

Maybe never get pregnant, period. But never on our own. In case you were wondering how long it takes for someone to finally accept the inevitable, for took 54 months. 

Monday, May 27, 2013

nobody gives a sh*t about your health

True story.
Especially not the FDA.
And definitely not companies that manufacture products and grow the food that we ingest. It is all about the mighty dollar.

I've felt for some time that environmental toxins are playing a role in the growing number of couples that experience infertility. As such, you can imagine my disgust when my local support group sent out this warning and video. Take a look at this news report.

 After watching the video, I took inventory of the products in our home specifically looking for triclosan. The ingredient was in every one of our Bath & Body Works hand soaps. I throw them in the trash and began my search for safer, healthier, more natural personal care products and cleaning supplies.

From my research, the following are a few more hazardous ingredients contained many personal hygiene products:
Phthalates - linked to male infertility by impairing production of testosterone
Parabens - can cause hormone imbalances, fertility issues and has been linked to breast cancer
Formaldehydes - one of the most toxic chemicals and can be a by-product of some of the other chemicals used in personal care products

All this makes me want to become a hippy. Seriously. We already buy organic food and produce whenever possible. If I had the time to make my own personal care products, I would. But since I can't, I've been searching for products with as many natural ingredients as possible. 

Here's what I have found so far.

Method hand soap - Triclosan-free and naturally-derived. 

Jason - Our bar soap has been replaced with this liquid body wash. It contains natural lavender and marigold extracts, vitamin E and Pro-vitamin B5. It states on the bottle that it doesn't contain any of the above harmful, toxic ingredients above.

Alba Botanica - I'm attempting to find a new shampoo and conditioner that is more eco-friendly and natural. The Drink It Up Coconut Milk contains certified organic coconut, pineapple, papaya fruit extract. It also has coconut and macadamia seed oils to leave your hair shiny and soft. So far my only complaint is that you have to use a lot of product for your hair to feel clean.

C. Booth - This is a product line that my friend gave me last year for my birthday. 
Tagline: Simple. Natural. Trusted. 

I love the entire C. Booth line-up, including the ginger body scrub and the multi-action lemon sugar body lotion. The lotion smoothes away dry, dull skin cells, then soothes and protects with sweet almond, apricot kernel and shea butter oils, and even caffeine, to perk up your skin.

1. My Oil of Olay facial serum got swapped for this organic Vitamin C Renewal Facial Serum. It isn't as moisturizing as my old serum but it's supposed to be age-defying. So hopefully I'll see some long-term results.

2. This Herbal Clear Deodorant is supposed to be a good substitute for the aluminum-based anti-perspirants that could potentially cause cancer. All of the studies are inconclusive but just in case...I thought I'd give this a try. The verdict: my pits were a little damp and smelly on a hot day. I don't recommend this product and currently seeking a good, natural replacement.

3. Tom's of Maine - This is the only natural toothpaste that I could find at Target. I haven't tried it yet so I don't know how well it works but I'll get back to you on this one.

What I've learned through my digging, researching and exploring is that labels can be super deceiving. You don't always know what you are putting onto your body. Your skin absorbs all of the toxins and it can be worse than ingesting toxins. As with everything else, you really have to put some work into making sure your products are fertility-friendly...or just safe in general. As you can see in the news report...just because it's on the shelves at your local store, doesn't mean it is safe.

I wanted to share my natural product finds with you but I'm definitely looking to expand this list. 
If you use any fab natural personal care products, please share them in the comments. 

Thursday, May 23, 2013

they found something

CCRM requires new patients over 35 years old to get a mammogram. I wasn't looking forward to having my boobs smashed between two cold metal plates but it had to be done. I'm turning 36 in 5 days so I wasn't expecting them to find anything.

I went into the clinic and the x-ray technician took the images she needed. Afterwards, she placed me in the waiting area and left to show the images to the radiologist. About 15 minutes later, she came back and asked if she could take some different angled shots of my right breast. Sure.

She took the images and back to the waiting area I went. She came back after another 10 minutes and said that the radiologist would like to do an ultrasound on my right breast. Hmm. Okay.

The woman with the ultrasound wand was very thorough - going over each breast until she got to the area on the top of my right breast. She kept going over the same area. Over and over. Taking shots from different angles. She said that she'd go show them to the radiologist who might be back to look at the screen herself. 

At this point, I'm starting to freak out. Imagining hearing the words "you have cancer" when she returns. Wondering what that would mean for our fertility treatment. Wondering how I'd handle the news. It was the longest 8 minutes ever.

When the ultrasound lady returned, she was alone. I thought that must be good news. She told me that they found a benign cyst on my right breast. Whew. What a relief! Apparently, they want me to return in 6 months so they can monitor it. Not sure what that means exactly. I probably should've asked. But I was so happy to hear that it wasn't cancer that I wanted to get the heck out of there as quickly as possible before they changed their minds. 

Here's the thing about this story. I conduct self-breast exams regularly. A few months ago, I told my husband that I felt that lump in my right breast. He told me to get it checked out. But I thought it was nothing. Plus, I'm too young to get cancer, right? So I did nothing. The only reason I finally went to get the mammogram was because CCRM required it. 

But if that lump had been cancerous, I'd be kicking myself that I lost precious time to start treating it. With breast cancer, it's all about early detection. The reason I wanted to write this is because I don't think I'm alone in this. I doubt I'm the only person that has ever felt a lump in their breast and ignored it. This is a plea from me to you...if you find a lump, get a mammogram.

I got lucky this time. 
But this situation could've been disastrous if I had waited and it was a cancerous tumor.

Monday, May 20, 2013

never enough

I'm having one of those days where whatever I feels like it's not enough. 
That nagging sense that I don't do enough or that I'm not enough.
It is so exhausting. 

I feel disconnected from God and my spiritual life. Who's fault is that?
Mine. I haven't been going to church lately and I haven't been praying religiously.

I feel like a bad friend. 
I've been flaking on social engagements because I haven't felt like myself. I've become my husband. LOL. And if you're one of my real life friends, you'll laugh at that. I don't want to be social which is so not like me. I want to hide out. Lay low. Bask in the quiet of a hike with my dog or losing myself in a book. I never get enough me time. Time where I don't have to think or be "on"... I can just be quiet. 

I can't keep up with blog reading, writing or commenting. I'm gaining weight because I haven't been exercising enough nor have I been eating healthy. But where is the time? I want to be fantastic at my I live it and breathe it everyday. But I'm lacking the proper balance. But please someone tell me how to fit it all in. 

How do you work more than full-time, blog like a rockstar, keep up an exercise regimen, cook and eat clean, healthy and vegan (which is pretty much what it takes to keep my endo under wraps), pray, volunteer, attend church, feed your spiritual self via fertility yoga and meditation, juggle doctor and acupuncture appointments (and now travel schedules to Denver), keep up a house, maintain friendships, prioritize family and connect with your spouse?

I'm exhausted just thinking about it. My personal and professional to-do lists are never empty. I've accepted that but I never stop spinning my wheels like a hamster in a cage to check things off the list. I always wonder if I fail to get pregnant because God knows I have zero bandwidth for a child.

Sigh. The vegan chocolate cupcake I'm eating and organic, no sulfite red wine I'm drinking are helping to improve my somber mood. Yes, those are my misguided attempts at being healthy. But honestly, am I crazy? Am I the only one who suffers from the "no matter what I do, it's never enough" syndrome?

Now opening up to comments, suggestions, techniques, strategies, solutions, insights that y'all use to manage busy, crazy lives. Or is it just me...I know I'm a perfectionist, type-A person. It could just be me. 

Friday, May 17, 2013

regret management

Thanks to my friend, Alicia's sage advice...I've adopted a new infertility mantra.

Follow the path of least regrets.

Unfortunately, none of us have a crystal ball which means it's impossible to know which decision is the right decision until you know the outcome. That being's all about regret management. What decision will I regret the least when this IVF cycle is over.

That being said, we've decided to jump ship.
I need to have 100% confidence that I'm getting the best treatment possible. CCRM is one of the best (if not the best) clinics in the country. No one has refuted that...not even my own local doctor. With this IVF attempt, I believe I will have little baby embryos to consider. They should be handled with care by the best embryologist and stored in a world-class lab. 

Having made the decision to charge forward with the more expensive yet more esteemed clinic, I feel a sense of renewed hope. As I mentioned, I love my local clinic but all of the changes to my protocol after my consult at CCRM caused me to lose some confidence. This process is difficult enough without more doubts and uncertainties creeping up. At the end of the day, I have a feeling deep in the pit of my stomach that if I stay where I am...I'm not truly giving myself the very best chance of success.

Even though having the doctors disagreeing about drugs, testing and protocols was stressful, I'm glad that I am playing an active role in this IVF attempt. I'm advocating for my health which is not an easy thing to do. Last time, I trusted 100%. I didn't try to learn the in and outs of IVF, testing and protocols. I figured...I'm not the doctor and they do this all the time. What do I know? 

But in hindsight, the squeaky wheel always gets the grease. The one who speaks up, questions, seeks answers - gets the most attention and best care. I believe that now. And I don't think I'll ever go back to being passive when it comes to my health. 

Many of you have asked why we're only doing IVF once. A would be fine with discontinuing fertility treatments now and living without children. He truly wants to leave infertility behind. To move onto the next chapter of our lives. But he knows that I want to do IVF. So our compromise is that we will only do one full IVF cycle and FETs until our frozen embryos (if we are lucky enough to have any) are gone. We both agreed to this.

So A and I are off to Denver in 2-3 weeks for our one day workup (ODWU). The ODWU is a 7-hour visit to CCRM which includes orientation, intro to our new nurse coordinator, semen testing, ultrasound, IVF consult, hysteroscopy, financial coordination meeting and other labs and tests. Some moments, switching clinics feels daunting. Others, I feel excited. Excited because of the new hope that creeps up. Hope that this trip might bring us closer than we've ever been to bringing home our baby.

Monday, May 13, 2013

when doctors disagree

Thank you to everyone who weighed in on my local clinic vs. CCRM dilemma.  
You may be wondering where we are with this decision.
Unfortunately, no closer to clarity than we were last week.

My local RE, Dr. M, is now back from vacay and wanted to talk with us. I had a phone consult with him today on my lunch break. A was not on the call as he had to work. However, A is back from the strike team. They put out the big fire in Ventura. Your prayers were much appreciated.

Here's what Dr. M had to say.

1. The 2010 SART data reflected a really bad year for my local clinic and a really good year for CCRM. In 2011, SART data shows the local clinic with a 3.5% higher success rate than CCRM for my age group.
True story. But I take this with a grain of salt because I think CCRM's cases are tougher.

2.  In regards to Dr. Surrey's concerns with Diminished Ovarian Reserve, Dr. M said that he looks at FSH (mine was normal), AMH (mine was borderline) and antral follicle count (mine borderline) to predict how a patient's ovaries will respond to stims. We now know that I don't respond well and that I need an aggressive protocol. 
Basically, what I take away is that he doesn't think it matters whether I'm borderline DOR or all of this is used to determine protocol. And we already know I need an aggressive one.

3. Dr. M said the reason we tried the long Lupron cycle last time was to suppress my endometriosis. Unfortunately, it suppressed the stims as well. He is recommending the most aggressive protocol for me now - no BCPs, Ganirelix and estrogen patches to synchronize the follicles, and max dose of stims - 225IU Follistim and 225IU Menopur.
I'm a little skeptical because he changed my protocol now that I got a second opinion. Added estrogen patches and removed BCPs. Why? Did the other doctor point out something that he missed? Was he not really feeling 100% with his initial recommendation? I know I have trust issues (my personal baggage) but it makes me wonder. 

4. Dr. M does not think I need a sperm fragmentation test. He doesn't see any value in the information it will provide. Plus, it only tests 100 sperm. A has a good sperm count and his motility is fine. His morphology is borderline. But that is why we are doing ICSI. He said that with the roughly 10 eggs he hopes to get...there will be plenty of good sperm to choose from. I said Dr. Surrey would put A on supplements if he saw anything odd with the test. Dr. M said A could take a multi-vitamin.
I'm not sure how I feel about this. He was rather dismissive and I don't really know much about this test to have an opinion one way or the other. 

5. The beta integrin 3 conversation was really the most interesting and controversial part of the discussion. Just like Dr. Surrey, Dr. M has also published papers on this topic. He said a whole lot about this subject that would be hard to paraphrase. But here's the gist. The beta integrin 3 test was created in 1950 and it's flawed. Many RE's do not test for this anymore because the tests are often inconclusive. The beta integrin 3 can be absent one month and present the next. Since it is tested by taking a biopsy of your uterine wall, you can't do it the month of your IVF cycle. 

He said the study concludes that a lack of beta 3 results in poor prognosis to IVF. But he doesn't think I need the test. He can just put me on letrozole, just in case. He sent me the study but I don't speak medical too well. Here is the conclusion directly from the study. 

We report an association between low pregnancy rates in IVF and 
an abnormal integrin expression by EMB obtained in a natural cycle. 
A lack of integrin expression was highly associated with endometriosis. 
Unexplained IVF failure in a subset of women with endometriosis 
may be avoidable using a simple 5-day treatment of the 
aromatase inhibitor, letrozole. Recognition of the importance of 
undiagnosed endometriosis in women with IVF failure, 
recurrent pregnancy loss or infertility, offers enhanced opportunities to treat patients 
with suspected implantation failure. Based on our findings and previous 
studies in IVF, the use aromatase inhibitors 
might improve the IVF success rates in a subset of women 
with endometriosis. Further, integrin testing may be indicated in 
women with unexplained infertility or mild endometriosis to 
better define the risk for unanticipated implantation failure with ART.

Great info, right? But to this I say...where was my letrozole before this consult? Why wasn't this being considered before since he knows that I have endometriosis. He said my endo isn't "that" bad so doesn't even think it will be an issue.

6. Dr. M did say that he thinks we should check one more thing. He'd like to measure my growth hormone via an IGF-1 test. If it is low, he will add growth hormone to my protocol.
I haven't been able to find anything on Dr. Google about human growth hormone and infertility so I'm left scratching my head on this one.

7. Lastly, upon my suggestion, he said it wouldn't be imprudent to do a hysteroscopy since it has been a year and four months since my laparoscopy.

In conclusion, Dr. M said it comes down to whether I want to work with him or Dr. Surrey. He did acknowledge that CCRM is one of the best clinics in the country but he also thinks his clinic is good. When I told him that I've heard that CCRM's labs and embryologist are the best. He didn't disagree.

I think I already know in the pit of my stomach what the right decision is. But going to CCRM just feels like starting completely over again from the start. More paperwork. All of the tests over again. So much more money. Sigh. A and I will regroup later this week and make a decision.

In the meantime, has anyone done the Ganirelex/Estrogen patch protocol? What about the letrozole (or Famera)? Any thoughts on Dr. M's perspective versus Dr. Surrey?

P.S. Love you guys for helping me navigate all of this craziness. It helps so much to put it all out there and hear what y'all think. 

Sunday, May 12, 2013

i love you, mom.

My mom is a private person. Like my husband, I don't think she totally digs me putting my life on the Internet for the whole world to see. But hopefully she'll bare with me here while I put her on the spot.

Thank you.
For all that you've done to give me the best life possible.
For your sacrifices. 
For your love.

You are my best friend. 
The person that I call when I'm at my lowest.
And at my highest.

You understand me.
You accept me.
Even with all of my flaws.

You are always in my corner.
Cheering me on. 
Sometimes silently. Always fervently. 

You are the person that I strive to be more like.
Despite our many differences.

You are so creative. 
So wise.
So strong.

You are my mother.
And I'm so very blessed for that.
So very grateful for all that you have done...and continue to do for me.

Happy Mother's Day!

"A best friend is someone who knows everything about you and still loves you".

Saturday, May 11, 2013

why adoption probably isn't for us...

Recently, I received an email from someone I consider a blog friend. After hemming and hawing for a bit, she finally came out out with it...why don't you just adopt? Why put yourself through IVF? And then she kindly wrote that I can tell her to "mind her own dang business" if I want to. But I'm not going to do that because I know that she is not "a completely insensitive jerkface" (her words not mine) . She is simply asking out of genuine curiosity and seeks to understand why we continue subjecting ourselves to the heartbreak of assisted reproductive technology.

I've said my blog is here to help educate people so here's my opportunity. Time to walk the walk. I decided to answer this question on my blog for other non-infertility readers who may be asking themselves the same question. 

Before I begin, I want to say how grateful I am for people who are "called" to adopt like the gal who sent me the email. And for the people who decide, after infertility, to grow their families via adoption. I think it is a huge, big-hearted and wonderful thing to do. Many of my friends (both blog and real-life) have beautiful children thanks to the gift of adoption. Never for a moment do they feel that their life should be any other way.

But adoption is not for everyone and it is not as easy as "oh, you should just adopt." Just like assisted reproductive technology, adoption is a very arduous process and an expensive endeavor that often leads to heartache as well. With adoption, there are extensive background checks. Psychological evaluations. Waiting lists that can go on for years. Birth parents who select you and then change their minds after you've already fallen in love with their child. Babies who come to you with addiction because they weren't properly carried for in the womb. A delicate relationship with the birthmother that you must navigate (should you choose open adoption). None of these scenarios are easy. And some people are better equipped to deal with these types of challenges. 
I don't know that I'm one of those people.

In addition to the reasons stated above, there are some more personal reasons that we don't just adopt. It certainly isn't because we enjoy gambling $30,000 of our hard-earned money. Or because I like sticking myself with needles and feeling hormones rage through my body. It is because I have a deep desire in my heart to have mine and my husband's biological child. I want to feel a life growing inside of my body. I want to bond with my child before I ever see his or her face. I want to see my husband's dimples when my little boy smiles. Or see my big brown eyes staring back at me when I look at my little girl. I want to know my child's health history. I want to see my mother's mannerisms in the way my child speaks. 

I want our baby.

Right now, I feel strongly that adoption isn't the right path for us. Over time, maybe our feelings will change if we do not conceive through IVF. Never say never. But at least until we grieve the idea of having our own biological child and close this chapter in our lives, we aren't even willing to entertain the idea of adoption.

If you are interested in hearing a much more articulate and emotional perspective on IVF versus adoption, check out this article

Sunday, May 5, 2013

IVF decisions will be the death of me

After our consult with CCRM,  I wrote an email to my doctor and cced my nurse coordinator. The email informed Dr. M that we got a second opinion which brought up some questions that we'd like to discuss with him. Immediately, I received an out of office reply that he won't be in until next week. About 15 minutes later, I got a call from SC - our IVF nurse coordinator.

Have I mentioned that I love this woman? She has been way more than just a nurse coordinator to me over the last few months. She's been an advocate, a trusted friend and a bright light at the clinic. Several years ago, my friend MTC went to our clinic and recommended SC to me. I'm so glad she did. We are grateful to have her in our corner. 

I told SC about our call with Dr. S and she understood our concerns. She scheduled an appointment for A and I to chat with Dr. M and get his perspective on the additional testing and protocol that Dr. S suggested. But here is the kicker. She said that she is going to tell Dr. M that she'd like to sit in on our meeting if it's okay with me. She is interested in hearing more about the beta antegrin. SC has heard of it and trusts that Dr. M is up to date on all of the same studies. She probably has a million other things to do. But that is just her....she wants to be a resource for her patients and be as knowledgable as possible.

She also reminded me to listen to my gut. I needed to hear this. She always knows what I need to hear. That being said, I am fairly certain that I'm going to push for a protocol without BCPs. A also wants to ask about CCRM's numbers. He thinks that science and technology is what it is and he doesn't think CCRM's stats can really be that much better than our clinic.

Even if the stats are right. We've already paid for our cycle at our local clinic. We believe our clinic is the best in our area. We believe we're getting good care. We are glad we got more information and fresh perspective from CCRM. But now we just have to continue to have faith and give this one more go.


The post above was written late Wednesday night - a few hours after our second opinion consult. Before I had a chance to read all of your comments. Before I had time to think it through. Before I had time to speak to my closest friends and my mom. Since hubby is gone, I haven't discussed anything with him. But here is where I am at the moment.

Everything above is based on emotion. I love my IVF nurse coordinator. It hurts to think of forking out more money to go to CCRM. We've already started down this path with our local clinic so it would be easier to stay the course. Traveling to Denver adds a whole new level of complexity to an already difficult situation.

But my head is telling me that I can't ignore those numbers. If A and I agreed that we are going to try IVF only once and give it our best shot. Isn't our best shot at CCRM? I've always said that I don't want to have any regrets. I'm afraid that I would have regrets if we stayed at our local clinic and our one and only cycle failed. I might feel differently if we were able and willing to try the local clinic and then if it fails...go to CCRM for cycle number two. But there won't be a cycle number two for us. So making this decision is so utterly important...the future life of my child could be hanging in the balance. 

That being said, I need to know two things. 
1. How much more would we have to pay to switch clinics and go to CCRM now? 
2. Are CCRM's success rate numbers legit?

1. Costs.
Our local clinic 
Cycle fee including ICSI - $12,550
Genetic Testing (outsourced to Natera) - $3,700
Meds - $3,500
TOTAL - $19,750

One day work up - $4,500
Cycle fee with ICSI - $16,110
Genetic testing (in-house) - $6,875
Meds - $3,500
TOTAL - $30,985

I'm estimating a conservative travel budget of $3,000 (4 flights + 10 nights in hotel) and we'd lose about  $1,000 in our prepaid cycle fee at our clinic for a cancellation fee and services rendered prior to my cancellation. So we are looking at an additional $15,235 to jump ship right now.

(As I type this, I'm pissed off that our insurance doesn't cover IVF. It is bull sh&t! Infertility is in the same category as breast augmentations. Seriously?!? Last time I checked, I have a legitimate medical condition preventing my body from functioning properly and allowing me to conceive a child as it was meant to. Yah, not that same as wanting a big rack. Just sayin'.)

2. The stats. (*All stats below are reported from Center for Disease Control - 2010 SART report.)
Paying the additional money (if we can come up with it) only makes sense if CCRM is really going to give me 38% higher odds of success. 

A friend said this to me last night. If I stay at my clinic, a live birth is possible at 26.5% and if I switch to CCRM a live birth is probable at 65.1%. Do I want possible or probable? 

But the saying comes to mind...if it sounds too good to be true, it probably is. Is believing in CCRM's 65% live birth success rate like believing in magic and unicorns? 

Here are the 2010 success rate stats for the rest of the Cali clinics in my age group which I feel like I should reconsider. These clinics are comparable to my clinic and CCRM in terms of volume. The clinics in black that have the higher numbers are in Southern California so they'd require hotel and airfare just like CCRM. The ones in green are driving distance. But don't have significantly higher results than our clinic to be worth the trouble of commuting. 

Beverly Hills - 82 fresh cycles - 36.6% live births
Kaiser Fremont - 125 fresh cycles - 39% live births
UCSD La Jolla - 105 fresh cycles - 49.5% live births
Stanford - 125 fresh cycles - 19.4% live births
Redondo Beach - 104 fresh cycles  - 39.4% live births
Pacific San Francisco - 128 fresh cycles - 18.8% live births
UCSF San Francisco - 129 fresh cycles - 36.4% live births
FPNC San Jose - 81 fresh cycles - 25.9% live births
San Ramon - 150 fresh cycles - 31.3% live births
PRC Torrance - 83 fresh cycles- 41% live births

Back to CCRM...I've seen threads on infertility forums claiming that CCRM only accepts "easy" cases so their numbers are skewed. But others have said that is not true. Intuitively, it doesn't seem true as I know some bloggers with tough cases that have been treated at CCRM. But how can they really be that much better than everyone else? How do I find out if these numbers are real? What does CCRM do differently that yields such better results? This is what I'm grappling with at the moment. 

If you have done your homework on CCRM and their stats, please leave your findings in the comments. I'm clearly so conflicted and would appreciate your help.

P.S. If you're still reading this, you're either a saint or a fellow infertile. Anyhow, thanks for sticking with me. 

Friday, May 3, 2013


He's gone. I thought my husband was coming home from work today. He went to work on Wednesday directly after our call with CCRM and should have returned home this morning. Instead, I got a call at midnight last night that he is being "mandatoried" to a strike team and they are heading down to Ventura. 

The headlines are all over the news.
 "Monster California Fire Reaches the Ocean and Pushes Towards Malibu"
 "Thousands Flee California Wildfires, Naval Base Threatened" 
"California Firefighters Battle to Save Homes, 30,000 Acre Wildfire"

A will be arriving at this blazing fire in a few hours. After two days on the ambulance without any sleep and an 8-hour drive to Southern California in an uncomfortable fire rig, he will battle the high winds and fight to save other people's homes and help put out this crazy fire.

Depending on whether the winds die down or pick up, he could be gone for a few days or a few weeks. Hopefully they are able to get this fire contained sooner rather than later.

This kinda puts things into perspective.
Our IVF discussion is on hold for now. 
Instead, I'll be praying for my husband's save return home.

Wednesday, May 1, 2013

the second opinion

After 2 months of waiting, we just had our second opinion phone consultation with Dr. S at CCRM. What I didn't expect was to be more confused after the call than I was beforehand. I was hoping to get clarity and/or reassurance about the right drug protocol for my next IVF attempt. But that is not what happened.

Here are the questions I asked and the doc's responses.

1. Would you have tried the Long Lupron protocol with me from the start?
Probably not. Your FSH (he said 2 something) was low and Estrogen was high. That combined with your AMH being relatively low at 1.01 (he likes to see higher than 1.4) would predict your sensitivity to suppression drugs. 

2. What IVF protocol would you recommend for my next cycle? {My doctor is recommending an Antagonist protocol.)
He would want to run all of my tests again before making a determination - AMH, FSH, Estrogen, TSH and VHD. But he thinks that I need an aggressive protocol.

3. Would you recommend birth control pills as part of my protocol?
He would likely not use birth control pills for me.

4. Should I have the endometriosis removed for best implantation before IVF?
None of the studies suggest that surgery to remove endo increases IVF success unless you have a severe case - which I do not. So no, he wouldn't recommend surgery. 

But some recent studies have shown that endometriosis patients are missing a protein in the lining of their uterus. The missing protein called beta 3 integrin is the glue that helps the embryo attach to the lining in the uterus. Without it, IVF isn't likely to work. Dr. S would recommend doing a biopsy of my uterine lining 9-10 days after ovulation to see if the integrin is present. 

If I'm indeed missing the much-needed protein, he would do an IVF cycle to retrieve as many eggs as possible and then freeze them all. Two months prior to transfer, he would put me on a long acting form of Lupron which has this protein in it. He has assured me that his clinic has a 95% survival rate when thawing embryos so I'm not likely to lose any embryos by freezing them.

5. What tests would you recommend that have not already been performed to gain more insight into diagnosing our infertility?
As part of the clinic's policy, he would require that I get a baseline mammogram if I were to be treated at CCRM. He would also recommend a sperm DNA fragmentation test. Depending on the results, he could put A on supplements if he sees any problems.

6. Do my records indicate that I have diminished ovarian reserve (DOR)? 
It is possible. He would retest my AMH level. Since my AMH level was relatively low and my antral follicle count wasn't high (count was 10), he is concerned about DOR.
*Dr. Google says women with an AMH level <1.0 are considered to have diminished ovarian reserve. Mine is barely over that at a 1.01.

At the end of our call, Dr. S made the presumptive close and wanted us to set up an in-person appointment for testing and monitoring between cycle day 5 and 13. Cycle day 5 is only a few days away. A and I had always planned on staying with our local clinic and just getting this second opinion to make sure we are making the right decision on our next protocol.

But then A asked the much better is the success rate at CCRM than our clinic?
Not much he assumed.
Here are the 2010 stats for my age range (35-37).
Our local clinic performed 83 fresh IVF cycles with 26.5% of cycles resulting in live births.
CCRM performed 109 fresh IVF cycles with 65.1% of cycles resulting in live births.
Yep! More than double.

A wanted to know why we didn't go to CCRM in the first place. I reminded him that when I mentioned CCRM in the past...he thought it was crazy to do IVF at a clinic in Denver when we live in California. Going to a more expensive clinic, adding travel expenses and additional time away from work...on top of already stressful situation was not something he was interested in doing. 

So where do we go from here? 
A and I are completely overwhelmed. He feels like we should've never had this consult because now we are questioning whether we are at the right clinic. Questioning our protocol. Considering additional tests which means more money and more time. He reminded me how much he wants this infertility phase of our lives to be over. He wants to move on. He's frustrated and angry that we are still going through this after almost 5 years.

After that, he left for work until Friday. 
I'm still sitting here. 
Confused and feeling really down. 
Will this ever get any easier?

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