Strands of Possibility (Science-Geek Stuff)

You know that famous Einstein platitude?

Insanity: doing the same thing over and over and expecting different results

I know for some of us it’s just a hunt for that one good egg, but when we’re throwing this much money and energy at a problem, there’s the need in that WTF consult to tweak the approach so there’s a medical basis for a new outcome.  This is why I have consulted with exactly 6 reproductive endocrinologists to coordinate my care, some of them the biggest names in infertility in the world.  But when you’re rounding the corner of attempt #5, and you’re going from one top IVF program to THE top IVF program…well, if you’ve been reading, you know how I’ve been feeling about my prognosis.  But as long as we’re defining “insanity” here, how about this: writing a $22,000 check, booking a trip to Colorado, missing the first 2 days of school, jumping through all the standard hoops of IVF, and doing it all while believing it’s totally fucking pointless.  That’s crazy, if not stupid.  I won’t entertain all the “stay positive” and “have faith” mantras; I outgrew that last year, filed it alongside other childish fantasies like Santa Claus and the Tooth Fairy.  Let’s just talk science for a minute because I’m comforted by the hard reality of data.  What’s different?  Why bother?

(1) So this is my first go-around with Saizen, human growth hormone I used during my first 5 days of stimulation.  Initially I was reluctant to get excited about this, mostly because I’m jaded: I was very excited about co-culture last year after my consult at Cornell, and that got me, oh right, nowhere.  But as long as we’re grabbing onto threads, the research is promising.  Do you care?  Well, just in case, here’s a video from super nerdy and uber serious medical journal Fertility and Sterility explaining who it’s helping, how, and to what extent.

(2) After the yet again confounding and inexplicable failure of IVF #4, we started looking more closely at B’s sperm.  Back in February we tested his DFI [DNA Fragmentation Index], and it came back troubling.  This prompted a consult/evaluation with Dr. Schlegel at Cornell, who is probably the top urologist in the country.  He felt some medications B is taking were at fault for causing oxidation (damage) during transport and recommended harvesting directly from the testicle for IVF.  This bothered me.  Maybe this is stupid because I have gone through 4 egg retrievals in which a doctor has sucked eggs out of my ovary by sticking a giant needle through the wall of my vagina, but I didn’t want them to cut open my poor honey’s testicle.  Then we had our work-up at CCRM, who ran a second sample to assess his DFI, and it came back within normal limits.  So we’ve been sitting on this conundrum since May, unsure how to respond to conflicting assays from different labs and whether the fuss and cash is worth it.  Yesterday B had a phone consult with Dr. Cowan, the urologist who works with CCRM, and his recommendation was to go forward with the TESE procedure, the rationale being that we’ve had repeat unexplained failure, so it makes sense to eliminate variables wherever possible; that first DFI represents a significant variable, and the research shows more and more strongly that sperm harvest improves IVF outcomes.

(3) Dr. Cowan also spoke on the phone about CCRM’s lab, their expertise, their experience with challenging cases like ours.  They are the gold standard.  We are in the best place.  I was, for example, reading about the introduction of their fun new incubator, which enables the embryologist to monitor embryos without taking them out and exposing them to environmental toxins.  These hairline adjustments matter.  Maybe they’ll matter enough.

(4) The dexamethasone is different.  It too is grounded in promising research.

(5) I went for my first follicle check today. **Note: it cost me 4+ hours of trains and subways to go to RMA, and it was worth every minute. I could see the screen, which feeds my neurotic need to check for myself.  I explained to Dr. Klein why I had come so far from home and what happened with my AFC at the local clinic and the troubling discrepancy between the verbal and written report.  He was so kind, talked me through the whole scan.  I went in there so terrified to see 4 lonely blobs on the screen, but no!  I had 3 active follicles on the right, 2 on the left, 2 more that were growing but less than 10, and a bunch of black spots that could still join in.  Plus, I am ahead of schedule.  I guess that’s the impact of the flare protocol, because I generally don’t have this many measurable follicles this early, especially a lead at 14mm; last night was only my 4th round of stims.  In fact, I would be surprised if they didn’t lower my medication tonight, and the chances of needing to stim for 11-12 days like I always have in the past look slim.  I’ve been down this road enough times to know that an encouraging monitoring appointment doesn’t mean a lot for the outcome, not after putting back a grand total of 8 embryos that looked gorgeous and perfect and had 7-8 cells on day 3 and having zero lives babies to show for it.  But, hey, it’s a start.  I passed the second checkpoint, and things look different than they have at this checkpoint before.  So I’ll give the hope some air, the potential efficacy of new treatment, the idea of possibility.

Science is cool.

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