Monday, 28 April 2014

Lucky number three

Holy shitballs.  We have donors.  Several, in fact!

Late last week we got an email from our Czech clinic with a list of five potential donors.  We received basic profiles including their year of birth, height, weight, hair colour, eye colour, blood type, education level, and hobbies.  No photographs, in keeping with the Czech legal requirement for anonymity.  But one other important tidbit: three of the five had previously donated with resulting pregnancies, while a fourth had her own child.  Lots of great eggs to choose from!

In a way, I'm kind of glad that we're receiving minimal information on our donors.  We all know that I'm an anal-retentive researcher, so if I had huge profiles to look through I'd probably be stymied for weeks and then forever wonder if I'd made the right decision.  

At the same time, having limited information meant that there was relatively little to set the donors apart from one another since they had all been chosen to specifically match me as closely as possible.  In the end, we went with practicality first:  we wanted a proven donor.  Of those, we chose the one who most closely resembled me based on the characteristics on paper.  Our final choice:  lucky bachelorette number three!  With our third wedding anniversary just a few days away, and this being our third egg retrieval and transfer, it actually seems kind of fitting.  We're now waiting for the clinic to get in touch with her to confirm, then arrange scheduling and treatment plans.

This is really happening.  There is a real person out there who might give me eggs.  Holy shitballs.

Tuesday, 22 April 2014

I choo-choo-choose you!

It turns out that choosing a donor egg clinic overseas is a lot like internet dating for your uterus.  You spend a lot of time browsing through profiles online, looking for features you want and filtering out the ones you don't.  Outdoorsy?  Yes.  Gainfully employed?  Yes and yes!  Ugh, is that a shirtless photo?  He's probably a douchebag.  Wait, there's a photo of him posing in front of his sportscar.  DEFINITELY a douchebag.

I rest my case.

In our case, looking at basic criteria online proved to be pretty useless.  For instance, price for DEIVF in the Czech Republic is pretty standard across the board.  You can do it a bit cheaper in smaller cities like Brno or Zlin, but since we'd be flying into Prague (and spending the five days between fertilization and transfer there sightseeing) we'd just end up using what we saved on the procedure for extra travel.  One thing I did find to be key here was looking at exactly what was included in the price of treatment.  Some clinics offered a lower base cost, but stuff like ICSI, assisted hatching or extended cultivation were extra.  I tended to prefer the clinics that didn't mess around and had an all-in price for everything you need.

Success rates also proved to be a bit of a red herring, since pretty much every single clinic advertised a DE clinical pregnancy rate around 60 to 65%.  Ongoing pregnancy rates (based on fetal heartbeat) were generally in the 50% range, which makes sense considering that even young, healthy women have roughly a 20% chance of miscarriage.  Obviously there were small differences of a percent here or there, but not enough to make any one clinic stand out to us as really good or really bad.  The numbers were also on par with US clinics, which was a comfort as well.

Things started to fall into place when we began looking at the guarantee programs.  Unfortunately, Czech clinics don't offer US-style "live birth in X cycles or your money back" guarantees.  They do however guarantee at least 6 eggs retrieved, with 2 high-quality embryos to transfer.  If this doesn't happen for any reason, they will do a new cycle for free.  Some clinics go further and will offer you free or discounted future cycles if you are not pregnant after a few tries.  This was a big attraction for me, since only clinics that have high success rates will risk losing money by giving away a cycle based on this guarantee.  However, this is also where reading the fine print became important, because not everyone's definition of success was the same.  One clinic would have considered "pregnant" to be a positive HCG test!  Sorry kids, but I've had one of those and that's just not gonna cut it.

After a lot of reading I settled on a few contenders and reached out via email.  All of them got back to me very quickly (using excellent English) and asked me to fill out some forms with basic info about ourselves and our infertility history.  There was some back and forth with questions about guarantee programs, drug protocols and waiting times.  Then, we got asked on a date.  A Skype date, that is.

The first clinic to offer us a Skype consult did so very quickly.  It felt kind of rushed, like that guy you meet on Lavalife (I'm totally dating myself here) who asks for your number in his first email.  Being newbies, we accepted, and like most first dates, it was a bit disastrous.

Because the Czech Republic is 6 hours ahead of us and we wanted to avoid arranging a Skype consult during midday at work, we scheduled something in the early morning before we left for the office.  On the appointed day we dragged ourselves out of bed super early, got ready for work and then sat nervously before the computer, waiting for our 6am call.  When it came, we could see the RE....but we couldn't hear him.  He could hear us, apparently, so I told him that there was obviously a technical issue.  After much fiddling around, him mouthing what I assume was "can you hear me now?" and me shrugging, we agreed (through text messaging) to sign off and try again the next day. 

Perhaps it was a result of rousing ourselves at an ungodly hour for a second day in a row, but we both felt that the consult itself was underwhelming.  While the RE seemed very nice, he didn't really do much beyond tell us what we already knew about his clinic and then asked if we had questions.  I asked a little bit about donor selection and timing, but started to get a little concerned when he talked about their usual "morula transfer".  For whatever reason, this clinic does primarily Day 4 transfers which seemed a bit odd to me, and suggestive that their lab was maybe not good enough to get an embryo all the way to Day 5.  Both M and I agreed afterwards to keep looking, but did think it was pretty cute when the RE translated birth control as "anti-baby pills". 

Our second Skype consult with the next clinic went much better.  The RE had clearly read my file and actually started off discussing the fact that with my age and average number of eggs retrieved, he would suggest pursuing a few more cycles of IVF with my own eggs first.  I liked this a lot, since on paper I don't look as dismal a case as I've proven to be in real life.  Also, IVF costs a lot less than DEIVF and this helped me to feel comfortable that he was looking at me as a patient and not a bank account.  We talked about my issues with poor egg quality, and then moved on to discuss their donor program.  Unlike the other clinic we Skyped with, they prefer Day 5 single embryo transfers, which is much more in line with the standards we've come to expect here in Canada.  Both M and I finished the consult feeling really positive about this place, and eventually we decided not to bother Skyping with the other clinics that I was emailing and just go with our gut on clinic #2.

On top of the great impression made by the RE (who spoke flawless English and has almost 20 years experience in the field), this clinic also impressed me with their response to my query about their guarantee program.  They advertise the third cycle free if the first two fail, and I wanted to know how they defined "success": was it a positive HPT, fetal heartbeat or live baby?  The lovely woman that I'd been emailing wrote back with "A live birth, of course, what other measure of success would there be?", which gave me the warm fuzzies and made me feel like this clinic just got it.  The only thing that causes me even the slightest hesitation is the fact that this clinic is quite new (having opened in Fall 2013), so their success rates are based on a much smaller sample size and there are limited reviews from previous patients online.  What I can find is good, and of course one of the benefits of them being new is that there is no real waiting time, so we could potentially cycle there as early as July.  Their facility is also new and pretty state-of-the-art.  The downside is that, if things don't go well, I'll probably be kicking myself for making a bad choice and not going with one of the longer-standing clinics.  Given the pedigree and professionalism of the people I've dealt with so far, though, I'm really hoping that won't be an issue.

As a postscript to my little internet dating metaphor, once we'd made our choice I had to write to the other clinics I'd been speaking with to let them know that we wouldn't be proceeding further.  This should have been easy ("Hi, thanks for all the info, we've decided on another clinic") and yet, I am a total spazz.  I don't know if I thought that their feelings would be hurt, or if I'd get uncomfortable emails asking which other clinic and why, but I LIED.  Just like telling a guy that I didn't want to go on another date because I decided to get back together with an ex-boyfriend (really, it's because you drank an entire litre of cheap wine and then asked to sleep on my couch because you didn't want to take the bus)*, I told the other clinics that I was going to try again with my own eggs and would keep their information for later.  Like they care.  I'm such a dork.

*scenario may or may not have been drawn from actual life

Sunday, 13 April 2014

A little good news

My mom got the results of her breast surgery back on Friday.  There were nice clear margins around the lump they removed, and her lymph nodes were clear as well.  She still needs a bit of follow up (likely some radiation and possibly hormone treatment), but overall it's the best possible outcome she could have hoped for.   We're all so overjoyed to finally get a bit of good news for a change!

The past couple of weeks have actually been some of the best I've had in a while in terms of mood and energy.  It all started with my trip home to see my family after my mom's surgery a few weeks ago, which probably did me just as much good as it did for her.  My dad was the only one who knew about my visit, which I feared for a while was going to lead to disaster since he couldn't seem to wrap his head around the basics of lying to his wife.  I kept having to field questions about how he was going to get to the airport to pick me up without her knowing (answer: tell her you're going to the hardware store, where you routinely disappear for hours so she definitely won't want to come) or how he was going to stop her from sending my birthday present in the mail (obvious answer: take it and tell her you'll mail it, then DON'T MAIL IT).  It was hilarious and cute at the same time, and reassured me that my dad would never be able to pull off having a secret second family somewhere.  

Despite my doubts, Dad came through in the end and my mom's reaction (huge hug, incoherent happy tears) was definitely worth it.  Then we pulled together an impromptu 38th birthday party for me and had a big family dinner to celebrate.

The rest of the week was spent doting on my 4-year old niece, to whom I am now the awesomest person on planet earth.  We coloured Disney princesses, had a sleepover, braided each other's hair, did each other's makeup (Rocky Horror Picture Show mean anything to anyone??), went shopping, ate ice cream, skipped rope, watched "Frozen", danced about a thousand times to Pharrell's "Happy", and in general had an absolute blast.  I loved everything about being the cool aunt, and it makes me wish we lived closer to my family so I could do it more often.  By day two my niece was begging to stay home from day care so that we could hang out, and at the end of my trip she was talking about how soon she could come to Toronto to visit me.  Man, I love that kid!!

The return home to M and Buddy was bittersweet, but on the plus side spring has finally come to Toronto after what has felt like the longest winter EVER.  We've had some great weather the past couple of weekends, which has allowed us to finally get outside and clear up all of the branches and debris from the ice storm that we had just before Christmas.  We still need to hire some tree and lawn people to help with the last of the cleanup and recovery, but at least our neighbours aren't embarrassed by us anymore.

Finally, we're pretty close to narrowing down our clinic for donor egg in the Czech Republic.  We have had a few Skype consults and I'll share more about our selection process in a later post.  Also, on Friday I was psyched to see that the province of Ontario has announced that it will begin funding one cycle of IVF starting in 2015.  While it's a bit late for me, it's a huge step in the right direction for other infertile couples and goes a long way to helping a lot of people who otherwise couldn't afford it.  All in all, lots to feel good about!

Monday, 7 April 2014

Flights of fancy

For the past month, I've been transfixed by the disappearance of Malaysian Airlines flight 370.  I'm not the only one, if the 24/7 news coverage on CNN is any indication.  The idea that an entire airplane could disappear without a trace, along with all 239 people on board, is profoundly unsettling.  In those first few confusing days it seemed almost possible that the plane and its passengers might actually be found somewhere in one piece, although this would have required several creative leaps of logic and a whole lot of luck.  Personally, I kept returning to the principle of Occam's razor: the simplest solution is usually the correct one.  Which meant that the plane was more than likely already at the bottom of the ocean.

And yet, when reading or watching news coverage of the event, I continued to be struck by the insistence of the passengers' friends and family that their loved ones might still be out there, and could still come home safely.  That it might not all have ended as horribly as seemed increasingly certain to everyone else.  As sympathetic as I was to the plight of the families, as the days passed I found myself wondering how they could possibly still believe that everything was going to turn out all right.  How could they not recognize that they were deluding themselves?  Didn't they realize, deep down, how crazy it seemed to hope that their loved ones were still alive out there somewhere?

MH370 disappeared on March 8.  Or CD27, in my little world.  For the past two years, I'd watched my cycle slowly dropping in length to an average of 26 or 27 days.  I hadn't had a 28 day cycle in at least a year, and nothing longer than that since probably before I went on the pill a lifetime ago.  After my chemical pregnancy in February, I'd told myself that I wasn't even going to bother timing my cycles anymore to try naturally.  There was no point.  And yet, as the days dragged on and my period still wasn't showing up, I started to wonder if the old wives' tale about being more fertile the month after a miscarriage might not be true.  CD28 came and went, then CD29.  I got out a calendar and counted backwards.  If I'd ovulated on CD10 (as was the norm for at least the past year), then we'd had sex once in my fertile window.  Sure, I'd had a headache the night before last, which usually preceded my period.  But it could also be an early pregnancy symptom, right?  And yeah, I was spotting, which always happened before my period too.  But people also spot in early pregnancy!  

I toyed with the idea of taking a test, but I knew that even if it was negative I would find a way to doubt.  Perhaps the test would be faulty, or I would be one of those mysterious women who wouldn't get a positive HPT until six weeks into a pregnancy.  Whatever happened, I knew I wouldn't be sure until I saw blood.  Only then would I be able to let go of the hope that this cycle wasn't going to end the same way they've all ended, for almost three years.  When my period finally arrived on CD30, I felt a mixture of sadness and relief.  Sadness for yet another chance lost, and relief that I could finally let go of the hope that I'd always known, deep down, was false.

I try to imagine myself in the position of the MH370 families.  Can I really fault them for refusing to believe all of the evidence in front of them, when I do it myself every single month?  Can I blame them for desperately hoping that their loved ones are alive, just as I hope against all odds to create the life of one that I will love?  If there's one thing that infertility teaches, it's that hope is a double-edged sword that can cut you as easily as it defends you against despair.  For the families of the missing, it seems that all we can hope for now is the bittersweet relief that would come from debris in the water.