Advice appreciated

[jindc]

I go in for my baseline monitoring next Friday (18th), and from there we [hopefully] start out first fresh cycle ever. I've never been pregnant, no BFP but we didn't try very long before going to an RE because my husband was born with undescended testes.

We suffer from pretty bad MFI and the only thing I have against me that I know of is weight - I'm 31, and all my numbers were fine, HSG was fine, and I ovulate on my own with normal cycles that vary in length from 26-31 days, but I've been told that's normal. I'm very physically active - 5-6 days a week...[I lost 70lbs in about 18 months, but gained about 20 back since husband came back from AFG....been trying to lose it, but decided to just eat as well as I can and stay active in this TTC time to avoid any shocks to my body, if that makes sense]

So as we start this cycle - IVF w/ ICSI at GW, Antagonist protocol - I'm looking for advice so that I don't end up spending my 30s as a human pin cushion. When I try to talk to DH about this, he says that I'm already dooming this cycle to failure, which I'm not at all - Dr. G gave us a 40% chance with a first cycle, which is actually pretty good (though, there are so many viariables...so who really knows).

At what point do you change clinics?
I have told my husband that if, after two fresh attempts, GW can't get us to a live birth, I'd like to give another clinic a shot - probably an out of town one because it seems from here that GW is the most experimental of the lot in the DC area. My reasoning is a new clinic brings a new set of eyes on the case, and the reason I'm giving GW 2 chances is because MD IPA = three lifetime cycles, and if an out of town clinic will take MD IPA, I'd be silly to pass that up (though, an out of town clinic might also take AETNA, but I know CCRM doesn't). DH says this is stupid because everyone has the same information about us and all that, and there's no reason to believe GW can't get us pregnant with ICSI to "cure" his sperm issues.

I feel like he isn't living in the real word - that fertilization and implantation aren't assured with ICSI no matter the clinic, and every clinic does different things - you wouldn't go to the same doctor to cure an actual illness if you continued to not see results, right?

Am I being too freaked out, too early?
I'm starting to worry that if it doesn't work the first time, I could end up on the slippery slope of a ton of money and all of my 30s being a science experiment. I'm trying to set expectations and be realistic...and have a game plan for "this is what's next just in case" vs. fly by the seat of my pants and assume everything will work out. Is my way a bad way to proceed?

[Anonymous]

Breathe, you are thinking correctly but putting the cart before the horse... focus on today and the cycle you are undergoing. You are trying to exert control which is understandable but there is no control in ivf. Try to focus on what you can control.... today. Good luck! There is something to what your husband is saying

[Anonymous]

Omg, you are totally me. We had the same diagnosis and got pregnant the first time at SG. My friend in Florida had MF due to low numbers and poor morphology and got pregnant the second time.

Please don't get too depressed or negative. I totally got sucked is to negative thinking and the IF forums, which totally skewed my perspective. It ruined one friendship and sapped the life out of me for at least six good months.

Focus on this cycle. MFI is a diagnosis doctors can truly help you with. It is less tricky to diagnose and overcome than other types.

[jindc]

Thanks, PPs.

I'm just worried because I keep seeing the whole, "my doctor told me it didn't work likely because I'm overweight" posts. That, and the posts about spending $60k on fertility treatments with no positive outcome.

I want a game plan - this is how many chances we'll use with this place before we move on, and hopefully we won't have to - so I don't end up broke and (like I said) spending my 30s on drugs with nothing to show for it.

I guess it's easier for a guy to say, "don't worry it'll work out!" when they aren't one undergoing any sort of medical procedures or having to take drugs.

[Anonymous]

I would not worry too much about your weight. If you are eating healthy and staying active that's really all you can do. Doing a crash diet or something else drastic like starving yourself to lose weight will negatively impact your egg quality.

I say give it 2 chances and then move on, but maybe consider other clinics in town first unless those 2 cycles point you in the direction of needing a doctor who specializes in specific cases. Also, with IVF most MFI cases are very treatable.

Tons of heavier ladies get pregnant all the time with no help so if MFI is the only issue and you are ovulating regularly then there is no reason to believe that it won't work. You will learn a lot about your body from the first cycle. Good luck OP!

[jindc]

Thanks, PP - that first part is how I figured. My girlfriend is a social worker and when I mentioned to her about weight, she said, "if heavy people couldn't get pregnant, I wouldn't have a job!"

I guess my bigger question is, in the DC area, what clinic other than GW is better for "second opinions"? I know shady grove is pretty standard, like they have their few protocols and that's it. Given that GW is really not for profit and all that, it would seem that they'd be willing to take more risks and know more about emerging research than many other places....but, I could be wrong.

I'm not especially worried, per se (I know it takes the average person more than one attempt, I think the average is 2.5 attempts?). Trying not to worry about egg quality because if egg quality is good, fertilization should be pretty good if the lab is decent.

sigh. the worry does never end!

[Anonymous]

I think it is a good idea to go into ivf with a game plan. We decided we would do two fresh ivf cycles. If the embryos from those two don't work, then we are done. It feels good to know there is an end. The end might not mean a baby, but if you agree on a plan you will have a path. We didn't have a plan for iuis, and I ended up doing seven. It was aimless and very hard on our marriage. Going into ivf, which is incredibly expensive and hard on your body, knowing ahead of time the plan has been helpful to our relationship and our planning for the future.

[Anonymous]

Sorry to be late to this, OP, but just wanted to share my two cents, which is that if GW doesn't work out (but I REALLY hope it does, on the first try!!) and you want to try another clinic, you may want to consider one that has a shared risk plan where you get your fee refunded if you don't wind up with a take-home baby. I am about the same age as you, all tests normal for us, and we were going to go with Shady Grove's shared risk because they let you withdraw at any time and get a full refund, even if you are on your 3rd or 4th cycle. I knew personally I needed a "plan" psychologically, didn't want to waste money, and probably would go to another clinic after two failed attempts and try something new. So you could try GW, and a plan B could be a clinic like that where you could do a few more attempts, but get your money back if you needed to move on.

[Anonymous]

Don't overthink too much, you have not even started yet and you're killing yourself over what ifs. It's good to have a plan B and all that but go in with the idea that it's great if it works the first time but you may have to do it again. First cycles are tough because the great unknown is how you will respond to medications.

Also, at GW talk to Catherine she's the one who draws blood in the morning and does the retrievals. She is great at explaining things and is always receptive to questions. Good luck!

[Anonymous]

Are you doing shared risk at GW or do they still have their two-for-one deal? If not, you may want to consider shared risk eitehr at GW or SG - for peace of mind if nothing else. I;m not s a doctor but I have the impression that the male factor cases are the easiest to solve (thanks to ICSI) so I have a feeling you'll be back here reporting a positive beta in no time. On the off chance you end up being a really hard case, you may be better off at CCRM in Colorado or at Cornell (they specialize in the most severe forms of male factor infertility), but I doubt it will come to that. In the meantime, you may want to consider Lisa Eave's monthly support group at "Heal from Within" - I credit that group with my sanity!!!!!!!!!!

[jindc]

I don't think I can do shared risk because I am using insurance, right??

Also, last we saw Catherine she was very, very pregnant! I don't think she'll be there when we go. Our nurse is Christine who, so far, has been wonderful and responsive.

I am trying very hard to stay positive...sigh...but the timing will be hard. Everything will likely be in February including my dog's ACL surgery (she needs both knees done). It'll be hard but that is life, sadly.

I am glad for the support here, it really is support even if only virtual