Tuesday, January 27, 2009

CCRM Review

I apologize in advance for this being a long post. We got back late last night from CO and our work-up at CCRM. I was amazed at the size of the clinic and how many patients were there. Many of them were there, probably 8-10 couples, to also get their one day work-up done as well. Amazing and quite the testament to CCRM and how well-respected and known they are for being one of the top IF clinics!

So here was our day...

8:30- Meeting with Dr. Schoolcraft- We did a quick review of our IF history. He talked to us again about doing CGH, where they test all of our chomosomes. He said that with my age, my ability to produce lots of eggs (7 of which were "true" blasts on my cycle in August and he thought that their lab could get more blasts) and already carrying a child to term he thought that we would have no problem conceiving again. He said that he wished that all of his out of town patients had such great stats as I do. He also said that he is brutally honest and if he thought that we needed DE, DS or a GS that he would tell us that. He doesn't forsee us needing any of these. He did say that he would give us a 60% chance of success and if we do CGH he told us he was able to be "bold" in saying that we would have success in one cycle because of my age, egg producing capabilities and having L. He then said that I was an "interesting patient" because most of the couples that come to him from out of state he can look at their chart and know exactly what went wrong with their past failures. With us, he can't. He doesn't know why we have not had success. He was so nice and asked about L and told us that he wants to help us "give L a partner in crime".

9:00- Semen Analysis and Antibody Testing (ASAB) with Chromatin Assay- M had to give a sample to be sent off to South Dakota to check for DNA fragmentation and then CCRM likes to do their own SA to measure the motility, morphology, and count of sperm. I had to give a blood sample to check for antisperm antibodies. We will find out these results in the next couple of weeks and I will explain more then if anything is found.

9:30- Baseline Ultrasound and Doppler- I had an u/s to look at my uterus, lining and my ovaries. I have 6-8 resting follicles on each ovary. Now, I am not normally one to brag, but my ovaries rock!! That means that I have plenty of eggs to work with, so to speak. For those that don't know, when girls are born they are born with all of the eggs that their body will ever produce, wheras with guys they produce new sperm every 70-90 days. With having so many resting follicles I am not at risk for DOR (diminished ovarian reserve) which is another IF diagnosis. My lining was thin, but that was to be expected since AF just stopped. My uterus looked good, nothing abnormal. The doppler is done to check blood flow to the uterus. Good blood flow means that it is easier, per se, for my embryos to implant. The doppler was high, meaning that I have restricted blood flow to my uterus. To improve this I have to avoid caffeine and do electro-accupuncture while cycling.

10:00- Nurse Consultation and Medication Teaching- We met with the nurse to go over their processes and procedures and to talk about medications. This was kind of a boring meeting because we went over a lot of the same info as we had to do at our local clinic. It was a "ins and outs" of IVF sort of meeting. Since we have done four cycles, we pretty much know what we are doing by now. She did give us information on how to get my cycle day 3 labs sent from my local hospital to CCRM and information on the E-tegrity Test. This test needs to be performed by someone local (I will be calling my OB today to see if they can do it) on 9-11 days past ovulation. I have to monitor my ovulation with an OPK and then schedule the test. They will go in and scrape my lining, just as I had done previously with the endometrial biopsy, and send my tissue to an outside lab. The test measures my beta 3 integrin. This protein is needed in my endometrial lining for implantation of my embryos to occur. I have heard that the treatment for this is be on Lupron for two months prior to your cycle. If my lining is found to be absent of this protein I will explain more. The nurse also told us that they collect two sperm samples prior to egg retrieval. One of them will be frozen in the event that a sample can not be given on the day of egg retrieval or if it is an "off day" with M's sperm. We have been wanting to do this at our local clinic, but they don't find it necessary. Since M's counts have been all over the board, we were really excited to know that they highly recommend doing a frozen sample in addition to a fresh sample on the day of egg retrieval.

12:00- Lunch break- Self- explanatory:)

12:30- Hysteroscopy- Dr. Schoolcraft performed this on me. Hysteroscopy is used to look inside of my uterine cavity with a fiber optic telescope. Once the telescope is inside, he inserted carbon dioxide into my uterus with a tiny little tube so that he could visualize it better. This test is done to see if I have any fibroids, polyps or adhesions. My uterine cavity came back normal. At this time, Dr. Schoolcraft mentioned the restricted blood flow to my uterus. He actually said that my "blood flow looked funky". He didn't seem concerned about it, but then talked to me about avoiding caffeine and doing electro-accupuncture.

1:00 Business Office- We met with the business office to go over the cost of everything. They estimate that the work-up is $3,600 (I haven't tallied my receipts yet, but I know this is a high estimate). For ONE IVF at CCRM, they estimate (depending on how many stim meds you need) that it will cost between $15,000-$18,000. ICSI will cost an additional $2,600. CGH will cost an additional $5,000. I will also have to pay someone locally to monitor me before we fly to CO on cycle day 6 and we will also have to pay for all travel arrangements. I am estimating that we will be somewhere around $30,000 for one cycle. Holding a baby in my arms: Priceless. The up side is that we will get a refund from our local clinic of $25,000 if we don't have success there (more on this later) or if we decide not to cycle there again.

1:30 Consent Review- We both had to agree and sign a bunch of documents that talked about things like what to do with our embryos in the event that M dies, I die, we get divorced, etc. The documents also informed us of the risks of doing IVF, consents to do assisted hatching ICSI and cyropreservation.

2:00- Blood draws- My poor, dear husband hates needles. He had to have two vials drawn for further testing and I had to have five vials drawn for further testing. I will explain more later if anything is found.

Finally, our appts were done! What a long day and one filled with a lot of wait time between appts. After we left there we started talking about everything and DH mentioned that we should maybe do our one last cycle at our local clinic. We initially signed up for their warranty program that guarantees us three fresh cycles and any resulting frozen cycles. So far, I have only done two fresh and the two resulting frozen cycles. DH asked ever so delicately if I would be happy doing only one more cycle at CCRM and then being completely done and not doing the last remaining cycle at our local clinic? He gently asked why I am so afraid to have potentially six failed cycles? I guess my answer is that I don't like to repeatedly feel like a failure. I know that we are young and we have a lot of factors on our side as Dr. Schoolcraft pointed out, but dang it, I just want a baby!

DH explained that the next time we could cycle at either CCRM or locally would be in March and then if we have two more failures locally that we could go right to CCRM. He thinks that since we have completed the work-up that the stress will be off somewhat and that we know we are ready to go there in the event that we have failed all of our cycles locally. Not to mention too that we have already paid for one more fresh and any resulting frozen cycles locally with the warranty program. And whether we quit the warranty program now or we go through all three fresh cycles, we still get the same amount of money back -$25,000.

We also talked about the timing of everything too. DH will be going back to work in March (he is self-employed and works in construction and we shut down in the winter months in MN as it is too hard to dig with the ground being frozen) and the timing for cycling at CCRM in the spring is not good. We would prefer to cycle there in the winter months so that he doesn't have the stress of trying to conduct business long distance during his busiest time.

This all makes tons of sense to me. I know in my previous post I said that I wanted 2009 to be a defining year for us on whether or not we have another biological Angel. In thinking about this, I am not sure that I agree with that anymore. No matter when we decide to "give up" and if we don't have another Angel in the process, it will be difficult to say that our IF journey is over. So, why rush it? As Dr. Schoolcraft pointed out, if I am young, produce lots of eggs and have a child carried to term (things on my side), what is my hurry? Right now, time is on my side, so why don't I just take advantage of it and finish my cycles locally?

Of course, I may change my mind tomorrow, but it feels good to write this out and insert logic into my pea brain. DH has a good point and he is part of this journey too. I know that we have done things that neither of us ever thought we would be doing or would have had to do. And I know that I have been the one in the drivers seat pushing forward and calling the shots. So, for once, I think I will leave it up to DH and let him call the shots. After all, the shots I have been calling haven't been working and I feel like I need a break from being in charge:)


Jill M. said...

Sounds like you had a great one-day workup!!! What awesome news Dr. Sch gave you! Good luck on your decision of what to do next. One thing to keep in mind is that some of the things you did at your workup expire after 6 or 12 months and have to be redone. Hugs

Niki said...

Wow, sounds like you had a very busy day that gave you much to think about. It's very encouraging all the positive things that Dr. S at CCRM had to say about you and your chances. I will be by your side cheering you on along whatever path you (or your dh) choose! ((HUGS))

Anonymous said...

Dr s is my dr too. While my situation is different, i wanted to agree with you that he make me feel comfortable in his honest, but gentle, approach. He makes the unknowing bearable.

Josey said...

HI there - I skimmed through your March posts to try to figure out if you ended up using CCRM and couldn't figure it out. Did you? I'm in CO and considering using them for my first RE experience (we live 6 hrs from CCRM - and that's our CLOSEST option).

Do you have thoughts/recommendations about them?

Thanks for any help!

Congrats on your twins!

joseyscoville (at) gmail (dot) com