We've Decided

For whatever reason, I’ve been putting off writing this post. It’s been hard to get my thoughts on this into a concrete format. (Warning: I captured my thoughts. This post is LONG.)

Now that the marathon is over, it is time to switch our focus back to Baby, which has become an entirely different kind of marathon. After our failed September cycle, Josh and I agreed that it made sense to take the next cycle off: it would allow me to run the marathon worry-free, and we could get our heads straight about our next steps.

After 18 months of trying and 12 failed cycles, we have decided to pursue in vitro fertilization.
 
Josh and I went it for a consult with our RE on Monday. After waiting an hour to see the guy, it was a pretty quick meeting. Our RE has pointed us in this direction all along, but we wanted to take baby steps to get here. He filled out the paperwork, and moved us to another room where we spent the next hour or so talking with a nurse and then with someone from the office about the finances of the procedure.

We will be doing in vitro fertilization (IVF) with intra cytoplasmic sperm injection (ICSI). In short, I will be on some meds to manipulate my cycle and hyper-stimulate my ovaries. I will go in for an egg retrieval procedure, where mature eggs are extracted from their follicles while I am sedated. With ICSI, Josh’s sperm will be injected directly into each egg for fertilization. After 5 days, we will pick the best embryo (or two) to transfer back to my uterus. Then we pray the embryo implants and gets cozy. This whole process will take about 6 weeks.

So much is going through my head, I’ve had a LOT to think about over the past few weeks. I wanted to document some of my thought streams. They might not all make sense, some of the thoughts are incomplete, and I may have left out some important information, so bear with me.

How did we get to this point?? Have we tried everything? Is IVF the next logical step? Is it the right step for us?
We have tried ovulation stimulation, and it worked. I did ovulate. But coupled with the slight MFI factor, I’m not pregnant. The next step could be injectable meds (like the ones they use for stims during IVF), which would hyper-stimulate my ovaries and give us more targets (eggs) for fertilization each month. BUT, there is a much higher chance of multiples with this treatment (and higher-order multiples), and we would have to be willing to pursue selective reduction if it became necessary. We don’t want to go there if we can avoid it. Also – and I HATE that money is driving any of our decisions – injectable meds are VERY expensive (like $2,500 per cycle just for the meds), and our chances of success only go up a few percentage points. While I am grateful we have some insurance coverage, its minimal ($15,000 lifetime) and we would rather use the coverage we have to try a procedure with a higher success rate. We could try intra-uterine insemination (IUI), but we would have to be on expensive meds for those cycles too (since I’ve used up my lifetime Clomid cycles), and once again the likelihood of success isn’t that much higher than what we have been doing. If we had unlimited insurance coverage, we might try injectables+IUI, but those cycles would burn through our current coverage relatively quickly and we want a baby. (We are talking success rates in the range of 8-14% for IUI to 53% for IVF). So IVF does make sense for us. And at this point, we both believe it is the right next step, but that doesn’t change the fact that I never thought we would be in this position.

How do I reconcile this with God? Can a baby created by IVF still be baptized in the Catholic Church?
I am admittedly not the best Catholic, but I still go to Church, and I believe in God and Jesus Christ. I have done some reading to educate myself, and I have read some conflicting documents. My overall understanding is this: the church does not condemn all forms of reproductive assistance, but it does condemn IVF. Up to this point, Josh and I have used hormone therapy (drugs) and timed intercourse to try to conceive, with no success. These acts were supported by the church. From what I can gather, the church is opposed to IVF because it fails to respect the dignity of human life (which by their definition begins at conception) and also violates the sacredness of the sexual act and marriage itself. The babies are “produced” in a laboratory from ovum and sperm obtained outside of a conjugal act (the church considers masturbation an immoral act). Embryos that do not meet a specific quality standard are discarded. Embryos that are not implanted are often frozen or discarded. Unused frozen embryos either die, are discarded, or can be donated. The bottom line is that many unused embryos die. We haven’t decided what we would do if we have embryos left over after we are done having children, but we would consider donating them to science, which would result in their demise. So, I know where the church stands. But I also know what is important to me. This child will be brought into a world of love, it if is conceived by the conjugal act or in a petri dish. Josh and I are believers of science, and we are willing to donate embryos for stem cell research. Hey, the creation story in Genesis is one of my favorite passages in the Bible. But I have studied and believe in evolution. Trust me, I understand the conflict. I don’t want to start any debate, nor do I want to be judged for our decision. This isn’t the first time I haven’t seen eye-to-eye with the Church (another example is our views on same-sex marriage). But you know what? At the end of the day, our child will be loved. Regardless of how it is conceived, it will still be a child of God and welcomed into the church. So at the end of the day, I am comfortable with our decision. (There are pages and pages written on this topic. I realize it’s controversial. Please, do your own research, and try not to berate me for my thoughts that I shared here.)

So, I believe in evolution, and also the importance of natural selection. Why ICSI?
We are doing ICSI because our doctor is recommending it without hesitation. There is a study out there (by a Dr. Lee I believe) that shows that fertilization rates are much higher using ICSI when <4% of the sperm are normally shaped (Josh’s morphology was 5%). In ICSI, a sperm is injected directly into the egg. This obviously circumvents the idea of natural selection – it’s not necessarily the best swimmer that gets there, just a normally-shaped forward moving guy that the embryologist picks. But when you think about it, don’t all forms of ART (assisted reproductive technology) circumvent natural selection? There is understandably a lot of discussion about whether or not ICSI increases the risk for genetic or chromosomal abnormalities. Many studies have been done, and there is no clear answer as to whether using ICSI for fertilization causes increased birth defects in the resulting child. ICSI is fairly popular. Nearly 90% of the IVF cycles done by my clinic in 2009 used ICSI for fertilization (is it obviously preferred by my group of doctors). In 2002 (out-dated, I know), the CDC reported that 53% of IVF cycles used ICSI in the US. The jury is still out on this one, and if there is an increased risk of birth defects, it would seem to be minimal and it is a risk we are willing to take.

OMG the meds! And what is this “no exercising” thing?  I can't run?!?
So, I’m a little nervous about the whole process. I’m nervous to pump my body full of so many hormones. I’m nervous about all the shots: we are looking at 30 injections or so during stims – that we have to do at home, and that doesn’t include the endless number of blood draws I will need. Its not that I’m afraid of needles; I’m mostly afraid of screwing something up. And then, from what I read, stims make you uncomfortable. It won’t really matter if my doctor orders me on restricted activity or not – with ovaries the size of softballs, it doesn’t sound like I’m going to want to be doing a whole lot of exercise anyway (I guess this will just be Baby, Blog for a while). Then there is the egg retrieval, and then the transfer. Ok, so I’m a lot nervous, and maybe even a little scared. I’m trying to prepare for the emotional rollercoaster that I'm sure this will take us on, but I’m not sure there is any way to fully prepare ourselves for this.

Do we transfer one?  Or two?
Oh, man.  As if we didn't have enough decisions to make already.  The chance of multiples increases drastically if we transfer more than one embryo back.  Of course, we would welcome twins.  It really doesn't scare me.  But admittedly, I would prefer to have my children one at a time.  I did find an article that suggests women who only have one embryo transferred during IVF didn't have any less chance of getting pregnant, but they did have a lower risk of multiples.  Right now, our game plan is to transfer one, assuming we have an embryo with the highest quality/grade.  If we have lower grade embryos, then we might decide to transfer two.  I guess nothing is set in stone at this point.  This is a decision we can actually make the day of the transfer when we have all the information, so I'm trying not to dwell on it right now.

Who do we tell? When do we tell?
Infertility is such a hard topic. I get comments all the time about when we are going to have kids or what our plans are. Our friends have kids. I participate in conversations about babies and related things. Honestly, it doesn’t bother me that much. I really try to brush my bitterness about infertility to the side. I like babies and kids. I like holding them, and seeing pictures, and talking about them. I am genuinely happy for all of our friends and acquaintances who have/are expanding their families recently. I don’t want to make anyone uncomfortable by bringing up our issues (most people don’t know what to say in return because it catches them off-guard). But, I’m not close to anyone else who is going though what we are right now. So, I’m on some chat boards on the internet and I use this blog as an outlet.  Sometimes I think it is easier talking with people you don't actually "know."  I have told my mom that we are starting IVF, but I don’t want to share too many details with our family because I still want to be able to surprise them when we find out I am pregnant. It may be selfish, but I dream about ways to share our BFP news with our families – it gets me so excited! At some point though, I might need the added support and I have to accept that.


Well, if you read all of that, you deserve a cookie! I’m sure I’ll have more thoughts in the future. This is going to be an interesting 6 weeks ahead of us, but we are content with the journey we have chosen.  Its sure to be a rollercoaster, but we are hoping for more ups than downs.  Most of all, we are hoping for a baby.