Planning and decision making

We finally went for our cycle review appointment with Dr D this week. The delay was all me. I just hadn’t bothered making the appointment as I knew we couldn’t start again until January and I was pretty sure they couldn’t really tell us why it didn’t work well for us last time.

The long and short of it was that the most of the spermies didn’t want to dance with the eggies but it was weird because some did dance but only a few. The whole thing is a bit baffling apparently. Dr D said it is more likely for them to see zero fertilisation than low fertilisation and they really don’t know what low fertilisation is all about.

I’m glad it took me awhile to make my appointment as in the meantime we did some ICSI research AND I spoke with my Aunty who also had IVF. As it turns out she also had low fertilisation the first time round. Then she had ICSI (where they physically inject an egg with a sperm to encourage fertilisation) and got only one more embryo. So whatever it was that was happening with the fertilisation it was more complex than they were able understand and something ICSI wouldn’t fix. Good info for me. It is disheartening in a way but it also allows me to manage my expectations.

So that was the first story I took to Dr D as I wanted to know if maybe it was genetic. Apparently “there is no evidence to suggest that low fertilisation is genetic” so that’s a positive.

We the chatted a bit about ICSI.

What is ICSI anyway and is it safe and likely to improve our chances?

So we went into Dr D armed with all our Google research. Far out that must frustrate Drs these days but hey, I’m a person who likes information and I feel good abut being informed so I’m not about to change my ways now. I’m more than happy to trust a Dr if he tells me my research is wrong, but I just want the opp to discuss it.

Everyone talks about ICSI like it’s the saviour and for a lot of women it is but there is also the possibility that it won’t work for some women, a la my aunt. I didn’t know much about that – the not working out thing – so it is good information to have on board. It helps with the expectation machine that goes on in my mind.

The second thing we learned about ICSI doing our research is that there is some info out there that suggests that you are twice as likely to have a baby with birth defects if you do ICSI. This one freaked us out a little bit. We never intended to not do the ICSI but we wanted to talk this aspect through.

I was really pleased with the way Dr D handled it. Yes, there is research out there that makes this assertion. However he says it is not conclusive yet and there are a lot of people challenging it right now. Also, when the term ‘birth defects’ is used it can mean even tiny little things that would not effect someone’s overall life or even need treatment. This is also an interesting thing to consider as it widens the net somewhat.

Lastly, he spent time talking us through how the sperm is selected for injection into the egg. The reason most clinics prefer natural IVF is it means that the strongest best sperm gets the chance to win the egg. It’s a bit of a natural selection thing. If you choose the sperm then you take away that factor. However, the lab does do some tests that actually involve slowing the sperm down so they can see them and then choosing the one moving in more quickly, with the nicest looking morphology and a bunch of other things.

Essentially, it’s still quite scientific. It’s not down to complete chance and they do the best to choose a strong healthy normal looking sperm.  This greatly set our mind at ease.

CGH testing

Once we went through all that Eric asked Dr D “If money was no object at alll, is there anything else you’d recommend we try”. And Dr D suggested this CGH testing. It is essentially chromosone testing of embryos to check quality and viability.

I had no idea but apparently even if you get a good looking embryo at blastocyst stage it is still quite random as to whether or not genetically it is able to become a baby. Some will be abnormal and will never take no matter what you do. By doing the CGH testing you are finding out before implanting the embryo if this is the case. And the dodgy ones you just discard. So theoretically you are increasing your chances of getting a baby as you actually have an embryo that is chromosonally capable of becoming one…if that makes sense.

Amazing stuff! We have to do blood tests this week so they can see our chromosones and then they’ll compare that to the embryos they test. Freaking science. It is truly incredible.

It’s not cheap. We pay $550 as a biopsy fee and then $500 per embryo to test up to a max of 6 embryos. If there are more than six it is a flat fee of $3k plus the fee. It also isn’t covered by our public or private health cover so it is 100% out of pocket.

The down side of this is that I can’t have a fresh transfer the month we do stims – so we’ll be stimming again in January but then embryos will be off for ICSI then biopsy and then we will do a frozen transfer the following month. Which means February next year. It just seems to be getting further and further away.

One last thing…some younger sperm!

Freakishly, we actually have some banked sperm at a lab in Sydney from right after Eric turned 41 (he is now 45). That was right when we started trying to have our monkey and Eric was paranoid about it taking forever so insisted on banking this younger sperm. We have been paying for this freaking banked sperm for 4 years now. I actually tried to get Eric to ditch it two years ago before we embarked on this journey as we hated each other then and were seeing other people so I thought we’d never need it HA.

Well boy am I ever glad that he convinced me to just keep it on and pay the exhorbitant freezing fees as when he mentioned it to Dr D yesterday the dude’s eyes lit up. They are very enthused at this prospect so as soon as we get it up there they are going to do some analysis and compare it to some of Eric’s fresh sperm. They may even do the ICSI with some fresh, some frozen. It has opened up all sorts of possibilities.

Last but not least, Eric is insisting I work less and has said he will pay me for any hours I give up. While giving up work completely isn’t for me (I’m a work at home mum) I am going to dial it back a lot. We are investing a lot in this process. It makes sense for me to be the best version of myself that I can be while it happens. I am struggling to let go of my independence and be vulnerable – that is a whole other post – but I’m going to try hard to trust and just fall back and hope the support is there.

So there you have it…my very long winded update. Sorry it was a bit sciency and technical and stuff. I wanted to make it useful if someone else going through all this crap came across it.

Hasta la vista baby.

Ems x

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18 thoughts on “Planning and decision making

  1. Wow – lots and lots of info there. Gosh it’s so complicated. Good that you have the info from your aunt that ICSI might not be the answer, especially as she experienced the same as you. I’ve thought such a lot about what happened with the eggs not fertilising, wondering how much of that goes on with all of us month after month – it’s just impossible to understand.
    But wow – frozen sperm from 4 years ago!!! That is really exciting! Thank goodness you didn’t get rid of them. You’re right about being frustrated about the time slipping away – for me it’s always been the BIGGEST issue. The time, ticking by. I hate even thinking about it. Especially given our 3 year old was 9 months old when we started trying… sigh.
    Anyway, glad to hear an update – I check regularly even though you said nothing would happen til the new year. Always hoping for a miracle for you xxxx

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  2. Wow, this whole thing is so interesting. Sounds like you have a lot going in your favor. I’m glad you are sharing all of this. I have a friend who is at the beginning of her fertility journey and I sent her your blog. She’s grateful for it. Xoxo

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    • Oh I’m sooooo pleased it is helping someone going through all this. I feel bad when I write some of these posts as I know they aren’t relevant to everyone but I really want the info to be useful for those who need it. Thx for that comment. It made me feel good. xx PS How are you????

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  3. This is fascinating! Science is such an incredible thing, and I hope that all of this info, in the end, brings you a little one. I’m glad Eric is being so supportive, both emotionally and now financially. Good luck, can’t wait to hear how things go!

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  4. This all sounds great! That is very interesting about your aunt, but I’m glad your doctor said fertilization wasn’t genetic. And as for genetic testing, that’s awesome that you’re going to do that. I really wanted to, but it’s a $4,500 flat rate at my clinic, so we decided to give it at least one go without it. I think it would be amazing for reassurance, though. Plus, the rate of miscarriages is lower for genetically tested (and normal) embryos. Plus, plus, I think they only put one genetically normal embryo back instead of two (at least at my clinic), so there’s less chances of twins. I’m so excited for you–you have so much to look forward to!

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    • Apparently until recently it used to be $5k flat rate at my clinic too. My acupuncturist was saying that now the price has gone down she thinks a lot more people will do it and it will almost become common. I tend to agree. I think the benefits are def worth it if you can afford it. Like you said – no need for two to transfer because you aren’t gambling with quality. I’m eager to see how it pans out for us.

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  5. I’m confused why your clinic says they “prefer” not to do ICSI. The standard at the most successful US clinics, including the gold standard CCRM, is mandatory ICSI, even with no male factor issues. That’s why if you pull their published stats, they will be close to 100% ICSI.

    It’s pretty well-documented to increase fertilization, so I am wondering where this preference comes from and what exactly that means. A preference for a less successful method?

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    • This is a good question and really it just comes down to the fact that ICSI is less natural. If you allow natural fertilization then it is down to the whole nature “survival of the fittest” concept and that makes sense to me. You want the best sperm to fertilise the egg and that is more likely to take place in a natural environment. While scientifically they do the best they can to choose the best sperm in ICSI they can never really know if they do. Hence the research out there suggesting that ICSI results in double the amount of birth defects in live births. As my Dr said, as yet it is not conclusive and it is being challenged but there is still the possibility when the science in inconclusive. As for why we didn’t do ICSI in the first place there was no indication that my fertilization rate would be low. I have a son already and have had two early losses this year so it would seem that my partner’s sperm is, in fact, fertilising the eggs. So they felt that this would be the case for me in a natrual fertilisation scenario. But when we had them all there in a natural environment that didn’t happen. So now we do ICSI. Incidentally, if you want to do genetic testing (which we are also doing now) you have to do ICSI. That’s all I can really tell you. Btw..I follow plenty of North American blogs that don’t do ICSI as the standard. 🙂

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      • The US stats are all public at the CDC. Pick pretty much any state and the clinic with the highest success rates will have something close to 100% ICSI. Just in my city there are multiple clinics with almost 100% ISCI rates. Do with that what you will, and obviously you have to make the right choice for you, but it is not an uncommon requirement.

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        • lol I wasn’t suggesting that it wasn’t. I’m not sure what this comment is all about though as I clearly stated in this post and my reply that we are doing ICSI this time. It’s like you are trying to convince me of something we are already doing. Hmmmm

          As far as if ICSI is more successful, of course it is! But is IVF just about whether or not the egg fertilizes or is it about getting a healthy baby at the end of it? The healthiest possible baby. If you let the strongest, fastest, most persistent sperm get the egg naturally then you are more guaranteed to get that result. Nature is ALWAYS best in my opinion and despite the negative outcome of my last cycle I wouldn’t change the path we took.

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