Monday, January 5, 2009

You don't have an "oh shit" plan?

Yes, I swore ... that is how pissed off I am.

(But before I get onto the rant of the day, can I just ask ... did you not like my last post because I was being much more playful than I have been in the past few months and you weren't used to it ... or are you all really thin and it's just easier to say nothing than ... geez, too bad I can't relate! Really, it doesn't matter this latest cycle incident has got me moved on to bigger and better!)

Back to my foul language ... I had to swear ... what kind of monkey shop are they running? I am referring to my Sacramento clinic. This morning Berilac and I got up at 5:15AM to head up to Sacramento at 5:30AM. We got into town at 8AM and had plenty of time for breakfast before our 9AM ultrasound/bloodwork appointment.

Everything was going just swimmingly - the phlebotomist only had to take one puncture to find and retrieve the blood specimen (most labs take 2 if not 3 pokes before the well gushes) then we headed into our ultrasound to learn that my endometrium needs to be at least 8mm to proceed, and mine was a beautiful 10mm with that sought after triple stripe - yay!

We had an opportunity to meet with the doctor to discuss the advantages/disadvantages of day 3 vs. day 5 transfer because although we were originally leaning toward doing a day 5 transfer ... we've since read an article by Dr. Sher that indicated that perhaps day 3 was better (not to worry, I sent my doctor Dr. Sher's article as I was telling him that we were now leaning toward a day 3 transfer vs. a day 5 transfer). When the doctor sat us down he told me that he never actually read the article I forwarded him and he presented me with other documents by Dr. Sher and Dr. Keskintepe (which is fine) but he explained why he thought we should do a day 5 transfer over a day 3 transfer (embryos survive better in lab culture than a uterus when they are day 3 because the natural environment for them is not the uterus but the fallopian tubes, as well, the natural killer cells [they sound dangerous] will have less of chance to develop if you wait to transfer, blah-blah-blah) ... ultimately he told us we could do a day 3 transfer if we insist, but that he recommends a day 5 transfer.

Well thank you doctor for your wisdom, I'll log that away.

They were ready to escort us out when I requested a "further instructions" meeting with my nurse coordinator - you see my calendar ends today, with my ultrasound and bloodwork and in the little box marked January 5th it says "expect further instructions" ... so I wasn't about to leave without the promise of those much needed instructions.

We weren't surprised when (even after waiting 15 minutes) when we sat down at our nurse coordinators desk and she turned the screen around to show us our updated calendar - it had NO NEW data on it at all ... so we sat there with the nurse while she typed in each line of change. But before she could complete our calendar she needed to know if we were planning on a day 3 transfer or a day 5 transfer? We, of course, having only received information from our doctor minutes earlier, hadn't yet decided if we wanted a day 3 or day 5 transfer. So she told us that she couldn't provide us with medication dosing/instruction until we picked a day. So of course I got frustrated and confrontational asking her if she thought **I** was supposed to plan the cycle or if we would allow the development of the embryos to dictate the plans (as that seems like a better idea, don't you think?)

The nurse had no idea what I was talking about.

I tried explaining it to her a few times asking her if we could hope for the best (day 5 transfer) and plan for the worst (day 3 transfer) ... ultimately she needed to check with someone else via phone and their collective response back was "no" ... we need to decide if we're doing day 3 or day 5.

So I had her call her accomplice into the room, so that I could speak (condescend) to both of them at the same time. And I did it ... I dropped the S-bomb ... me. I said to her: you see we'd like to plan for a day 5 transfer and if on day 3 we learn that we only have 1 surviving embryo, then it's time for the "oh shit" plan ... meaning "oh shit, what do we do? we only have 1 embryo??!?" ... well, in that case (and many, MANY women have been in this situation and have opted for the day 3 transfer when the day 5 transfer just wasn't attainable) my clinic says .... we can't do that.

So basically - they have no "Oh shit" plan ... again I ask ... what kind of monkey shop are you running here?

Berilac and I spent 2 hours driving home and talking about "all we had learned" (read: listened to more inconsistent infertility B.S. from doctor who wants to do things his way, so ultimately we gathered no real data) at our appointment and how we can't believe that before move forward with fertilizing eggs - we have to decide which day we will be transferring.

We have NEVER fertilized an egg in vitro ... how the HELL am I supposed to know what the quality will be?

How am I supposed to know that if I transfer on day 3 I won't be:
-putting us at risk for high order multiples?
-risking the embryos as they really should be in the fallopian tubes and not in my uterus so the dish was a better environment?

Or if I elect to transfer on day 5, how do I know that I won't be:
-killing our embryos because they were too fragile for life in the petrie dish, but not the womb?

Why do I have to make this decision? Other women don't seem to have to???

If you couldn't tell, I'm sufficiently pissed and ready to get some real help from a real clinic ... does anyone wonder why CCRM will be our next stop?

Thanks for any words of wisdom.

18 comments:

  1. Oh that's a tough one! Specially if they want YOU to take the call without having any information about the quality etc of the embryos!!

    I've had a 3 day transfer once and it was a BFN. Thereafter we've been having day 5 transfers (not so much by choice of any kind, but because of the PGD timing), and I've had positive betas each time (no baby yet unfortunately)

    There's 2 schools of thought - and I'm pretty sure you know what I'm talking about. One says an embryo is better off in the womb environment, and therefore Day 3 transfer is the way to go. The other says, you know which embryos are doing better on day 5, and it's better to wait and transfer the stronger blasts. Many doctors like to watch the embryos and opt for the exact Oh Shit plan you were talking about. If they aren't growing well, you do a day 3, and if they are, wait till day 5.

    I personally have found day 5 to be more effective (for me).

    Good luck with your decision! Keep us posted.

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  2. Hi - not sure how I found your blog but I am also a Christian dealing with infertility. I have now attempted 3 IVFs with one working only to lose twins at 20 weeks. My RE has always counseled that a day 3 transfer is best when the # of embryos is small. My clinic only uses a day 5 transfer when the embryos are looking super and there are lots of them. Otherwise they go with the adage of the uterus is the best place for them. If it helps, my twin pregnancy was from a day 3 transfer and my loss had nothing to do with my infertility treatment. Kate

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  3. Thank you Kate and I'm so so sorry about your loss - I can't even imagine. My heart breaks for you. I hope you are being craddled in the arms of our Maker as you heal from the loss of your precious girls. Big hugs, Polly

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  4. Polly I'm so sorry they were so sucktastic to you. I've never made it through stms,so I really don't have much advice, but don't let them bully you. They are your embies and you should able to make the call based on how the fertilize! ((HUGS)) and good luck!!

    P.S. I just read your back fat post and I thought it was pretty darn funny. I cracked up at "slothfully" laying around"! I have plenty of back fat, so I can empathize!

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  5. Okay, before I scream about your clinic, I first have to say "Welcome to the dark side." LOL. See what happens when you hang out on foul-mouthed blogs like mine. (-;

    I am baffled why your clinic is making you decide which day to transfer. I have seriously never heard of this. Nurse "you must decide now" needs a crash course in fertility sensitivity.

    I have always done 3-day as we just don't have enough embryos to work with and all would likely arrest by day 5.

    From what I have read, 5-day is normally the day of choice because it means you have a few to choose from and you want to weed out the ones that will not make it. I also agree with the natural environment being in the uterus on day 5.

    I have read some articles that say some clinics prefer day 3 because it gives them a cop-out to say that the embryos looked good on day 3 when we put 'em in. I don't know why it didn't work. I have also read that day 3 is often preferred because the lab just can't compare to a woman's body for growing embryos.

    All that said and I still don't know which is really better and I don't know if most REs do either. I know Schoolcraft has already baselined me for a 3-day based on my previous response, but hopes we will be pleasantly surprised and be able to have enough to choose from to do a 5-day.

    Hugs, hun. I really think it is a crapshoot and you really can't make the wrong choice. If it's going to work, it's going to work. Saying extra prayers for you in the next days.

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  6. I see your dilemma, but have no words of wisdom. I'll be praying you know what to do. Sorry this continues to be so tough. Hugs....

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  7. I have no words of wisdom, either, but I want to lend my support. I'm sorry you have to make this decision and there isn't enough help from your doctor. I hope that it becomes clear to you and God gives you peace concerning each route you take. I guess that is my only words of wisdom, "be lead by peace." Someone once told me that and it proves to be good advice considering peace only comes from Holy Spirit.
    Much love, Polly.

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  8. What a bunch of clowns! So sorry to hear they're messing you around :(

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  9. Argh!! I wish I had some words of advice, too, but all I can say is good luck making your decision. It's totally unfair that they're expecting you to decide what's best. It makes much more sense, in my mind anyway, to wait and see and transfer on day 3 or 5 depending on how things look. I wish you lots of love in the next week. Hugs, my friend.

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  10. Polly
    I am so sorry that your clinic doesnt have a back-up plan. My clinic suggests 5 day transfer but it all depends on the growth of th embryos. My first IVF was day 5 with a chemical pregnancy, the second IVF was a day 3 due to the low number of embryos (got pregnant with my girls and lost them at 20.3 weeks). I also have been really stressed about the transfer thing b/c you read that 5 days is better, but I got pregnant with a 3 day?
    I think it should really depend on the number and quality of the embryos, I have no idea why your clinic isnt on the same page? I am so sorry that you are dealing with this.

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  11. I'm so sorry you have to fight so hard for this:-( I don't understand why the staff are so acting so stupid. This is obviously very frustrating and disappointing at the same time. I hope the other women have given you some insight about the transfer days.

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  12. HI Polly, like you need this crap from them at this time. I totally agree with you. The transfer day should be based on the number and quality of embryos. I was supposed to have a five day transfer but when I heard the embryo update on day three I got on the phone with my doctor and we both decided that day three was best. I think day five is only best to indicate survival of the fittest. If you are going to transfer the same number regardless on day three or day five I would go day five. That was also my clinics take. Fight for you right to decide dependent on the embroy's number and quality. That is just standard practise at good IVF centres. I don't know what kind of clinic they are running either.

    Good Luck
    Jill

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  13. Babe (do you read Janet Evanovich books? If so, think Ranger...)- I think it's a total monkey shop at all clinics today. Maybe it's the moon or something.

    I've never even gotten a fertilized egg, so I have no advice to offer. I am so sorry. Sending you my prayers.

    Many hugs -
    T

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  14. Sorry, I have no advice/assvice for you..But if I were this angry, I would have used more than the S-word!!!!!!

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  15. Truly shocked that your clinic makes you pick a day. WTF???

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  16. Hi Polly I mad a mistake on my comment and meant to say I would go day three not day five. I see that is what you are doing. I will be praying for you. By the way as far as numbers to put back if it helps any I put six back and only one took.
    Jill

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  17. I would really like to read that article by Dr. Sher. I know that 5-day transfers are all the rage, but no one ever tells you the risks of 5-day transfers. I wish we had been told so that we could have chosen which day transfer we could have had, but we were not given that information. Good for you for sticking up for what you think is right. BTW, it really sucks having to make these life and death decisions, one of the truly vile things about IVF.

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