IF Testing & Treatment Check-In w/o 4.5

bumblebee0210

@optimistgardener I like to think about these decisions in terms of what I call "regret aversion" (can you tell I am an economist?) Let's say you get two embryos, and you test both. If they are both normal, and your FET works, you may regret spending tho $3000 and couple of weeks. But if they are both abnormal (or one is), or if they are normal and your first FET doesn't work, you will have very useful information about the possible issues, and likely be grad you tested. If, on the other hand, you don't test them, and both FETs fail, you will (I think) really regret not knowing what was wrong-- embryos or something else?. So while $3000 and a couple of weeks is not nothing, it's insurance I am happy to pay for in the face of failed transfers and possible miscarriages. 

optimistgardener

Thanks @bumblebee0210. I agree that this is a good way to see it. When I spool out the different possible scenarios, it almost always I think ends with regret that I would feel for not knowing more. That having been said, I'm not sure if I will/would do this IVF process more than once. And so I could see a (not at all implausible) scenario in which I get a small number of fertilized embryos, all of which turn out to be abnormal, and then... That's that. It will of course be useful to know that that is why it turns out that way (rather than, say, wondering if it might have been some problem with my lining or whatever), but the end result will still be the same. But that is, I guess, my brain just trying to slow-wittedly find its way towards making terms with what this process really means.

acleverusername

@bumblebee0210 I dig your rational brain. 

@optimistgardener: paper on benefits of melatonin supplementation during IVF: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6769719/

laura-kay

@acleverusername I’m one of the 15% who have a 50% chance of ovulating before the follicles are ready when on stims with IUI.  Normally I think it is normal, but when on Gonal F, my body occasionally goes on a fast track.  That’s why I’m taking the Ganerelix.  19mm on day 8 though seems fast even for me.  

Mental health wise, it’s crazy at work and it is Great Lent. I know you are aware of our service schedule during Great Lent, and as a choir member I am a part of it all.  Life still is crazy, but I’m thankful for a lot of things, and am trying to have peace with everything.

optimistgardener

@laura-kay Your timeline this month is pretty much exactly what my body wants to do on stims. Both of my medicated cycles I had fully mature (20mm+) follicles after 5-6 days of stimulation (CD 8-9). My "normal" cycle is usually ovulation somewhere between days 12-14, so yeah. Anyway, I sympathize with speedmeister ovary thing.

@acleverusername thanks for the study! I'm def in the process of rethinking my melatonin hesitancy.

acleverusername

@laura-kay ah yes, Great Lent is a wonderful way to keep your mind focused on other things! I used to be in a choir at my old church too! I'm hoping to get into that again. For now, I'm learning to play the piano so that I can sing better / read notes. 

AFM, I've heard a rumor about this last week (a friend at work who is a people manager and in whom I had confided about our fertility struggles / she in me about hers) so I knew it was coming. Today work officially announced fertility benefits effective May 1, giving me a total of 2 ERs and 2 transfers per lifetime. 🎊The timing would have only been more perfect if this had been in place last August, when we started treatment, but I'll take what I can get and run with it. 

optimistgardener

@acleverusername oh hot damn that's cause for a celebration!

bows22

I never made it back here this week - it’s hard because I want to take my time to thoughtfully reply and then time gets away from me!

@optimistgardener yes, saline-infused ultrasound! My clinic does it to do the bubble test too, which is why I had it back in November 2019, but this was more for polyp searching. As far as the genetic testing, I don’t have experience with this myself, but being on the board for 2 years and seeing friends go through it, it’s not a clear answer so whatever you feel good about is what you should do. I typed this before I saw @bumblebee0210’s reply and I was thinking of how to explain my thoughts but she nailed it with the term “regret aversion” , but my thought was also that it might be easier to decide once you see how many eggs you get with your retrieval if that’s an option?

@bum@bumblebee0210 I’m glad your doctor is happy with how your cycle went, sounds like she is invested in your journey which is amazing.

@kei@keikilove that is really interesting about the trigger/IUI timing. It’s always been something that bothered me about friends’ IUIs on here - how do the doctors know they are timing it right when everyone is so different??

@laura-kay good luck tomorrow!

bows22

Forgot my own update - AFM - I had the SHG today (I may have posted before that it was supposed to be on Thursday which is a whole other story about my RE office’s disorganization but I’ll spare you the details) 

As an update to my pee saga, fully peeing for the pregnancy test and then chugging water before the SHG was an option they gave me so I guess I was on the right track with that idea haha. I have no idea why I needed a full bladder but I did. So at first there was just a transvaginal ultrasound and I chatted with the tech because she was the same one who was there for my last SHG 1.5 years ago. I must have sounded pretty confident that they were going to find something, because when she was done she was like “I’m just going to tell you, it does look like there is something there, but let’s wait for the SHG to prove it.” So then the midwife who did the SHG comes in, gets everything inserted, pushes the saline through and then 2 seconds later was like okay we’re good here. It was so fast. She said that there is an area of thickening that may be a polyp, but that the physician will have to read the images and make a decision on how to proceed. She probably said that 2-3 times like it was a standard answer and it just felt like she was being purposely formal/vague. But last time, a PA did my SHG and said right away “you have a polyp that needs to come out.” So I don’t know if a midwife is not allowed to talk about certain things, or if there is something she wasn’t saying. I’m overly paranoid because after my HSG I posted on here that I felt like the person who did it was acting weird and then it turned out she thought she saw endometrial hyperplasia, so now I trust no one, but the midwife today didn’t have quite the deer in headlights look that the HSG person was giving me so hopefully I’m not dying (which is where my mind goes haha).

My follow up is on 4/23 so not sure if I will hear anything before then or not, but I assume at least the report from today will come through my portal soon so maybe that will give me some info. 

[Deleted User]

@bows22. Glad your SHG was (mostly) uneventful! :)

@optimistgardener omg I wrote you a novel 😱

<div class=" Spoiler">I think I'm hearing you say something that touches on our thinking through the decision to test.  For one, I kind of assumed it would be covered, but I guess because we had no known genetic issues, insurance didn't automatically cover it.  So okay, maybe we would have just gone ahead and done it for free / small copay, but I'm actually *glad* we had to take a beat and think about it.  Because in our case, we ultimately decided that we had done enough ... Sciencing????  by that time, to get to the embryo stage, that we just didn't want to keep tinkering.  True that testing keeps getting better and better, but there is still a lot we don't know.  And we decided we were not willing to put the decision to keep or destroy any of them in the hands of a technician, albeit a highly skilled one.  We much preferred to put them all back into my body and let life run its course.  And regardless of whether we got two THBs out of the first two transfers (which we didn't) it still would not have changed our plan to transfer all.  I would have been prepared to have all seven kids, if that were to have been the thing!!!  Lol. So now I just have to be content with my odds, and remind myself that our odds without treatment were absolute zero.

Statistically, how many live births are you going to get out of seven untested embryos? (As a semi random example, since we got 3 to freeze the first time, and then 4 when we repeated) 1-5, wide range?  2-3 maybe more realistically? Now how many live births from seven pgs embryos...?  Still not 100%!!!  <i>Possibly 5,</i> but I find even that a stretch based on what I've seen from ppls experiences on TB.  Maybe closer to 3-4?  Final answer?  What is the mean there, still approximately three, either way?  So okay, if we knew of our seven, only four were normal, would we have done another retrieval?  Tough to say at that point, but probably not.  Or only two were normal.  I still think our doctor probably would have encouraged us to proceed to transfer.  So... Just my convoluted drawn out way of saying in our case, pgs probably would not have changed our treatment plan, or given us any more THBs, than not doing pgs did.  (If anything, I <i>felt like I would be paying someone to discard embryos for me</i>, which is not something that made sense to my poor tender heart to do.) And at the end of the day, I may admittedly have those questions of, were the losses normal or not?  Could I have done a different diet or another supplement or.. or.. I try to remind myself tho, it is what it is, and it's not worth worrying about.  BUT!  I can tell you what I'm *not* doing, is I'm not sitting here beating myself up, wondering if we could have accidentally discarded a perfectly viable embryo because s/he didn't meet xyz clinical criteria, or a mosaic, or lose any due to testing damage or human error.  At a certain point, the less we fussed with things, the more I felt I could be at peace with the outcome.  Does that make sense?

There is so. Much. We try to manage and control about this whole process, but it's only whistling in the dark bc honestly, the cold hard truth is it's not under anybody's control.  We just do the best we can, and hope for the best. 🤷 Anyway, that's just another perspective on what is ultimately a very complex and personal decision.</div>
@laura-kay @acleverusername Ah!  My fellow singer / musicians! This makes me so happy!  I broke a guitar string a week ago, so I have to sit down and restring it one of these days, maybe tomorrow.  I was going to get a new set of strings for my violin too, while I was at it, and then I saw that was going to run me $50! 😲 So anyway, I will have to pull that out of the closet and at least see how that's holding up... And then probably bite the bullet and get the new strings afterall lol I keep wanting to get back into playing more, so this conversation is giving me another nudge. ;)

[Deleted User]

@kiki047 Sometimes DH is so good... He went to Costco this afternoon and brought me back... Halloumi, Gruyére, Feta, Parmasean chips, organic beef sticks, seaweed chips, Mixed nuts, Raw cashews, no sugar bbq sauce -- among other things!  I'm planning to get bone broth, avocados, and super simple guac from the grocery store as well... Eep!  Monday is the day I go keto!  Wish me luck.  Have you decided for sure you want to try it?  Or when you want to start?  I want to still take beets, and I have a pomegranate juice concentrate I take with water to help build my lining, so I'm hoping that's not enough to knock me out of ketosis... If this whole crazy plan actually works in the first place, that is lol

acleverusername

@bows22 glad to hear that SHG didn't yield dear-in-the-headlights looks from any of the providers involved. And sounds like it was mostly painless. Hopefully they're efficient in posting your report to your portal so you don't have to wonder until 4/23. 

@BusinessWife thanks for putting together such a thoughtful response for the @optimistgardener; it certainly brings to mind that PGS testing is – as The Egg Whisperer calls it – the murkiest crystal balls of all. 

@laura-kay I hope everything went well today!!! 🤞🏻🤞🏻🤞🏻

optimistgardener

Wow, @BusinessWife, thanks for those thoughts. My reply is also a novel :

I had to sit with it for a while this morning before I felt ready to reply, and I'm still not sure I've got all the right words lined up. I think you've done a beautiful job of expressing the strange way in which at the center of this process there intersects the science (and the shall we say "science-ish" or "science-adjacent" lifestyle stuff we all experiment with) with the mysterious spark-of-life stuff that we're all hoping to achieve, be it within our bodies or in a test tube at a lab. I think I know what you mean about paying someone to discard embryos... I can certainly imagine a probability of, say, yielding 2-3 fertilized embryos that, when tested, all turn out to be aneuploid, and are thus not frozen for transfer. I can feel in me, just typing it, a wish to just wrap those things up inside me anyhow, to let my body incubate them and to hope for a miracle, even knowing that their genetic abnormality would almost certainly result in failure to implant or a miscarriage. At the same time, the pragmatic part of me says: better to know early and not spend time, emotional energy, and money on what is not viable. There is a fundamental mismatch of the rational and irrational here at the core of it that I think is present for many of us. For me, my internal mismatch feels especially mismatchy. Through most of my life, if you'd asked me, I would have said that the world already has plenty of people, and there is really no need to go to such great lengths to bring more of us into it (allow me to take this opportunity to apologize to all of us on behalf of my former self). And yet here I am, throwing huge amounts of my savings at doing precisely that, even knowing that single parenthood would/will be an uphill slog and that there may be times when I would miss the relative freedom of my childless life. I think in part that was why it took me so long to get from my early and simple efforts at pregnancy ("misreading" my cycle calendar when I was still with my last boyfriend, later DIY self-insemination efforts on a natural cycle using donor sperm from the local sperm bank in Berkeley when I lived down there, and then the assistance of a really sweet midwife who used to come to my apartment and do at-home IUIs while encouraging me to think "fertile" thoughts), to where I am today, outsourcing the whole thing to folks in white coats. Like all of us, and despite my proceeding down this path as a single person who has had to accept some degree of external aid almost from the very start, I very much wanted pregnancy to "just happen," to let that mysterious spark-of-life stuff ignite of its own volition. Having to embrace progressively more intense external intervention has meant also having to confront and learn to embrace the irrationality of my own drive to bear a child of my own biology. The question of genetic testing feels like yet another layer of that progression for me, and for some reason a particularly difficult one for me to feel settled about. I still do think it is something I will choose to do, especially since I have suspicions that my egg quality is really garbage and, who knows, maybe if that is confirmed in the form of test results it will finally help me think more seriously about adoption. But at the same time, I really really hear you about the desire to just give those embryos the chance and, for once, leave the decision-making in the hands of something bigger than yourself. And I can see how, for you, it would feel like the right choice, and the best way to avoid regret.

laura-kay

We had the IUI this morning, so now it is a matter of time.  F/X!

[Deleted User]

@optimistgardener yeah, I hear you.  There is so much to it.  I think that's one of the biggest parts I still grieve is the loss of being able to just let it happen, just "try again," simply have a warm and fuzzy date night and let the magic happen.... Like you said, having long since crossed that line where pregnancy became something we've had to outsource. :/ It's like a form of innocence lost, and I don't think I will ever not miss that.  I suppose most women feel some of that too once they hit menopause, but ykwim.  I do hope for your sake your eggs are not as crappy as you think!!!  But I have similar thoughts regarding adoption, that once we've transferred our remaining ones, there will come some kind of peace and finality to it that may make adoption a more viable path at that point.  Time will tell...

@laura-kay Congratulations!!!!  Will be on the edge of my seat for you...



AFM, CD1 here, I'm going to officially call it.
<img src="https://us.v-cdn.net/5020794/uploads/editor/3h/f2kywff45pa1.gif" alt="">

laura-kay

@BusinessWife F/X for you as well!  Also - YGPM

optimistgardener

@BusinessWife fingers crossed for your new cycle!

[Deleted User]

Thank you!!! @optimistgardener @laura-kay

acleverusername

@laura-kay hopefully this is your cycle!!!! 

@BusinessWife hooray for CD1! Let’s get it started in here!