Surprises and second guesses

We had our WTF appointment on Tuesday.  As expected, there weren't really any answers.  Since this was our first full IVF, my RE said that there was a certain element of trial and error involved.  She believes we got a decent number of eggs, but that obviously the main problem was the fact that we only had a 50% fertilization rate.  

What surprised me was that she didn't seem to be attributing this completely to my eggs.  This is despite the fact that when using Oosight (a fancy technology that allows the embryologist to view the inside of my eggs when setting up for ICSI) only 35% of them had a normal appearance.  Instead, my RE seemed to kind of focus on M's sperm quality.  He has approximately 26% DNA fragmentation, which is slightly higher than normal, along with his abnormal acrosomes (which are what allows the sperm to drill into the egg and fertilize it).  

This is where the second guessing comes in.  When his sperm issues were first discovered, M was told to start taking a fancy male fertility supplement to see if the situation improved.  Our RE is now suggesting doing a new sperm analysis to see if it's helped any.  The problem is, it hasn't.  Because M hasn't been taking it.  He discovered pretty early on that it gives him terrible heartburn, and he quietly stopped taking it.  When I realized this, I was initially kind of pissed.  Here I was taking supplements and vitamins, injecting myself with drugs, and subjecting myself to endless blood tests and trans-vaginal ultrasounds, and he couldn't be bothered to take a damn supplement?  But on the other hand, I was convinced that our problem was my eggs, and that ICSI could fix any sperm issue.  So I didn't push it.  And now I'm wondering if I should have.

The good news is that our RE really thinks we should give IVF another try.  She suggested that we might tweak my drug protocol, and possibly try estrogen priming.  But she was heartened by both my age and the fact that despite my undetectable AMH, we managed to get 8 eggs and one good-looking blastocyst.  As for why it didn't implant, she said that even with a great blast our chances were only 50/50.  It may have just been bad luck.  But to rule out any lining issues, she's recommending doing a fancy (and expensive!) Endometrial Function Test (EFT) run by Yale University.  It's basically a mock transfer cycle, with an endo biopsy to determine whether the lining has certain specific markers that are required for implantation.  That'll be my fourth endo biopsy, for anyone who's counting.  But having had a quick glance online, I'm a bit skeptical of how helpful this particular test might be, especially since it's not like I've had repeat losses or anything.  If you've had this done, please let me know in the comments or email me and let me know if you think it helped at all.

Finally, while my RE didn't bring it up herself, she agreed to give me a prescription for DHEA.  You know, I love living in Canada most of the time, but every once in a while it feels like I'm in a Soviet gulag.  Two hours' drive away from me across the border, people are buying DHEA in the supermarket.  Here, I'm trekking halfway across downtown in the pouring rain to go to a special compounding pharmacy where they make DHEA.  It cost me $133 for a three month supply, and it's not covered by either OHIP or my drug plan.  It makes about as much sense as charging me a special "Canadian" price for books and magazines.  Or blocking me from Hulu.  Sigh.

Anyway, our tentative plan is to use next cycle for the EFT (if I decide to drop the $500 for it) and wait out the rest of the summer letting my DHEA and M's supplement (affectionately known as his "boner pills") take effect.  With any luck, we'll have super eggs and super sperm for the next go around, combining to make super embryos that will grow into super babies that will blast forth from my super vagina.  Here's hopin'.