We received most of the latest test results for me.
Thyroid: Normal. They detected some antibodies which mean that at some point I had a mild case of thyroiditis, but nothing looks amiss now.
Genetic tests: I am not a mosaic. Hurrah. Didn't even know what that was until today.
We are still waiting to hear if I am a Fragile X carrier. This is the piece of the puzzle that we need to have before setting a direction.
Prior to the meeting, Mr. Turtle and I went over the information we have so far and mapped out a plan, and wrote down questions. Since meetings at The Fertility Clinic take weeks to schedule, and go by so quickly, I wanted to make sure that we had a clear sense of what we wanted to communicate and what we wanted to learn. Even more importantly, as a couple we need to be working together and understand what we are getting into. This was something I committed to when we got the first diagnosis, and luckily Mr. Turtle believes in communication and cooperation, too. One of the first blogs I ever read was CGD's Adventures in Infertility Land. Sadly, in addition to their unsuccessful quest to have a baby, CGD and her husband also ended up divorced. Although CGD's blog is no longer available, she did share her experience on Episode 18 of Bitter Infertiles, and I think everyone who is pursuing fertility treatments should listen to it. In fact, if you haven't, go ahead and do so right now.
We also both read Chapter 3, "Planning Your Itinerary" in Melissa Ford's book Navigating the Land of IF (another resource I highly recommend). In the chapter Mel (She of the Stirrup Queens) goes over eight factors influencing decisions about infertility:
- Certainty of reaching parenthood
- Sureness of leaving infertility
- Possibility of a genetic link
- Possibility of a biological link
- Amount of control over prenatal health
- Average speed of resolving infertility
- importance of maternal age
Mel suggests each partner independently rank these factors and then compare notes. That is what we did. We had the same top two:
- Certainty of reaching parenthood
- Amount of control over prenatal health
We were slightly different for number 3; Mr. Turtle put down Possibility of a Genetic Link, and I put down Importance of Maternal Age. But when you think about it those show similar priorities because if I am to be genetically related, my age does matter because of the POF.
So, this is what we put together.
Fresh IVF cycle, our own gametes. (Assuming I do not carry Fragile X.)
We would like to try to have a genetically related biological child. We realize that due to the DOR/POF particularly, the odds are slanted against us. I am not going to produce a lot of eggs and there is a chance I won't produce any. IVF is a game of diminishing returns in the best of cases, and we are not the best of cases. (If there even is such a thing as "the best case" when talking about infertiles.) However, that doesn't mean I won't produce eggs and we won't get an embryo and hopefully a pregnancy and baby. Neither of us is happy to walk away without at least trying. Fresh IVF is a gamble, and we will be sad if it doesn't work, but we can't draw a line under this option without at least giving it a try.
I will go on DHEA and Co-Enzyme Q10 for 3 months before starting the cycle. It will be Flare Protocol. SO LONG FAREWELL to my un-medicated existence untouched by doctors with prescription pads. It was nice while it lasted. One thing's for sure, there's no cosmic reward for living your life "naturally." (What, me bitter? OK, maybe just a little.)
Reassess Plan A either: A) after one unsuccessful cycle or B) after diagnosis of Fragile X
IVF cycle with donor eggs
Should my own gametes be formally declared a hopeless case, then we will look at donor eggs. In Canada it is illegal to buy or sell gametes, so no paying an egg donor for her services. Doctors are also not allowed to treat anyone who is not Canadian, so no bringing a donor from another country. That means we can either A) find our own volunteer Canadian donor ("Sister, can you spare some eggs?") or B) use a donor in the USA or vitrified oocyctes from an American egg bank ("you can buy and sell anything in the States," sez Dr. Cotter). Not sure which route we would end up taking here, but I would think the USA donor/egg bank is more likely. Plan B needs more research and is still a bit surreal, admittedly.
Because I was curious about it, I asked about how an IUI cycle with donor sperm would compare to a donor egg IVF cycle. Dr. Cotter clearly recommended donor egg IVF over IUI with donor sperm, which she gave no more than a 5-10% chance of success, due to my dodgy ovulation. "You're at the end of your reproductive life, so it's hard to tell what your ovaries are going to do." Not one to mince words, eh.
We also asked about embryo adoption, and Dr. Cotter said, yes, there is a list. You need to have done one cycle of IVF before being eligible for the waitlist.
Reassess Plan B when: Not sure; we'd make that decision when we get to Plan B.
We didn't discuss this yet, but Plan C comes into place whenever we are done with unsuccessful fertility treatments, which for me, would be in 2, max 3 years. I could change my mind, of course, but I'm pretty sure I don't have it in me to do treatment after treatment, year after year. One way or another, infertility will be resolved.
We also asked Dr. Cotter for her views on naturopathy. I have started acupuncture treatments, as I previously described, and Mr. Turtle has been seeing a lymphatic drainage specialist. It is taking a lot of trial and error for him to find a way of reducing the edema of the scrotum, but he is optimistic about the most recent technique. Of course, we don't know if reducing the swelling will improve sperm quality, but it seems like a logical assumption and worth pursuing. And if it only helps Mr. Turtle be more comfortable and less self-conscious, it will have been worth it. Mr. Turtle also plans to talk to Dr. Q to see if she can suggest anything else for him.
Dr. Cotter said there is no evidence of acupuncture making any difference in achieving pregnancy, though there is some ongoing research into that. She did say that it helps fertility patients "live through what we do to them." So, acupuncture is OK. Lifestyle or dietary modifications are also OK, "as long as it is not excessive." I asked her about herbal remedies in general (nothing specific has been proposed to me) and she was adamantly against the whole idea. She said that there is more money spent on natural remedies in the USA than on prescription drugs, and that there is no regulation or accountability in the industry. So basically, when you take a supplement, you have no idea what you are taking or what effect it will have on you or on a fetus. She said (with some heat) that that is a completely unfair thing to do to a baby ("the effect on you will be short lived, but the child will live with it for 80 years.")
I actually left this meeting feeling fairly confident and calm. Mr. Turtle also thought it went well. The tone was overall more optimistic than the last meeting. We felt less like deer in the headlights. Mr. Turtle observed that Dr. Cotter was using language like "when we get you pregnant" as opposed to before when she was being extremely cautious. I was very focused on getting my questions answered and I felt that I did.
But of course we still don't have the piece about the Fragile X. I expected to have all the info today but I guess the labs are not especially speedy and it just doesn't all come together perfectly. I would really like to commit to a plan, whatever it is. Because of the DOR/POF, I'm being told to waste no time, but on the other hand it always feels like we're waiting for something, and we can't just make a decision about what we are going to actually do. I don't mind a few months of hormone supplements, acupuncture, and pondering the meaning of life as long as I know we are heading somewhere.
It's funny how our goals have adjusted as a result of IF. When we first started TTC, the goal was simple: A baby! Achievable within about a year, with luck.
Then we learned about the MFI, and the goal was: Do an IVF/ICSI cycle. Hopefully get pregnant, but no promises, eh.
Then we learned about the DOR/POF, and the goal is, make enough eggs! Maybe. But no promises.
Notice how "baby" seems to be getting farther and farther away. In fact I think I don't even connect this whole process to a baby a lot of the time. I can just conceive of getting pregnant. But baby seems to exist now in some alternate universe that's made of very different matter than what I trip over every day.
But at least, we can almost see a path forward. Ask and learn and decide and one step ahead of the other. Don't get too attached to one course though, you don't know when the wind will change or if the kraken will eat your boat. But still. Maybe a path.