Phone consultation

Our free phone consultation with the new doctor, let's call him Dr C, was rescheduled and took place today. He asked few questions, some of which I have already answered in their clinic questionnaire. He seems to think that the best way to go would be an aggressive stimulation IVF with immunology prep beforehand. He does not do natural IVF since he doesn't think the efforts required are justifiable with too low success rate.
He suggested that I cut out dairy (yogurt is thankfully okay), gluten (and I'd just had pasta for lunch), and alcohol completely (and he calls it a life). He also recommends to up the daily dose of CoQ10, Vitamin D, and to add Omega-3 and prenatals (I can't even describe how much I hate taking prenatals while not being pregnant). He also wants me to do blood tests for NK cells, cytokines and antiphosphilipid panel. He does not believe that my husband needs to do a Sperm Chromatine Structure Assay for his low (2%) morphology, as it was recommended by my second Dr (let's call him Dr J). He was quite adamant on this issue (but again, so was Dr J).
So, we're off for the tests on Monday. Depending on the results, we'll see whether we need IVF or we could treat immune issues and try naturally. Frankly, cards are stacked against us on all counts. We're dealing with female issues, male issues, immune issues, and we would probably have no money for IVF. And even if we had, having this endometrioma as an after-effect of Femara, I don't know if I want to risk anything like this happening again.

RE consultation

Yesterday we went for a consultation with our RE. On our way there, I was talking to my husband and feeling more and more frustrated by the minute. Frankly, I was feeling very confrontational and wanted so much to stick it out to her. However, as my husband correctly pointed out, we cannot afford a luxury of a confrontation. She cannot do anything majorly useful for us, but she can order routine tests, which are at least covered by our insurance. So we talked about that, and I agreed to try to be civil. My resolve wavered, though, when it turned out we still had to pay out of pocket for this consultation, since it's a repeat visit (wtf?!). I wanted very much to yell, "No way in hell I am paying that much to see this doctor! I'd rather pay for someone who's professional, dammit!" But we paid and we waited.
She started with a question along the lines of "what can I do for you", and I got very angry. I allowed myself to allude to her insufficient testing a year ago. Her response was, but then you were getting pregnant! Apparently testing for RPL is different from testing used for just plain infertility (yeah riiiight). Anyway, I asked what can we do now, given the situation we have. Basically she told us they can do two things: it is either IUI with Menopur and Bravelle ($3,000 - 5,000), or IVF with PGS ($25,000), using the antagonist protocol and ISCI. I asked why didn't she suggest donor eggs IVF. She replied that she remembered me being against it, and that the price is high, around $40,000.
By an unspoken agreement, we did not tell her we're seeing another Dr. and that I am on Letrozole. We did ask her about Clomid and Letrozole, and she told that my FSH is high and therefore more FSH does not make sense (and then I Googled and apparently Menopur and Bravelle work to elevate the FSH as well, wtf?). She also told us she does not do natural cycle IVF or minimal stimulation IVF ("I know about this, but we don't do that here").
And finally there was the icing on the cake. I asked her something about success rate for all the options she mentioned, and she said something along the lines of - oh but you cannot really do any of that, because your FSH is too high! This was priceless. Why did she spent so much time talking about the options that I cannot have anyway?! Her point was, I might have checked my FSH too early after the surgery, so let's recheck it in couple of months and see where we are. As much as I want to hope that there's some reason for this absurd number of 17.5, I cannot really count on that.
There were some relatively good news as well. As it happens, she did a follicle count in 2014 (she just chose not to tell me about it, and she did it on a day when I couldn't even tell where in the cycle I was - my period still hadn't returned after my 2nd miscarriage). I had the same 6 follicles I have now. My AMH is lower, but not "significantly", so it doesn't concern her as well. (I don't think she's concerned about my situation at all, though). So basically no drastic changes have occurred since the last year.
So, her advice is: go try naturally for couple of months, maybe try some acupuncture. Come back and redo the Day 3 tests, and then we'll talk.
What do I think about it? I am going to order wheatgrass and whatever shit there is out there to work with aging eggs. I am not sure I want to go to her even if my FSH gets down (because her estimate of IVF success is 10%, and while trying naturally we have just 2% chance - both numbers are too low for my taste). What we need is to find a clinic nearby (okay, at least in our state) which does natural cycle IVF, and talk to them about my options. I wish we could go to New York or Colorado, but travel is expensive (we hardly have money for IVF with PGS as it is), and there are some logistical considerations as well.

Introduction

It feels a bit like throwing a bottle into the ocean, but anyway.

I am 39. I am a mother to a wonderful girl who just turned four. Last year, we decided our kid needs a sibling - to help her deal with parents when they get old and crazy, and anyway, we always wanted at least two kids and a loud, crazy, chaotic house. And that's where it all started.

May 2013: Got pregnant on our first try, went for an ultrasound, and there was an empty sack, too small for 6th week. Missed miscarriage. I was shocked beyond belief. I didn't think things like this could happen to me. I carried an ultrasound picture, the one with an empty sack, with me for months. I don't know why they gave it to me.

September 2013: Got pregnant on our second try, while on vacation. I always wanted to conceive on vacation. I was so hopeful that I even took a picture of the house where it happened, just in case. I was pregnant long enough to get to prenatal appointment, where a well-meaning but inept nurse practitioner told us there was a heartbeat. I wasn't convinced. I remembered how it looked during my first and only successful pregnancy - so much more pronounced and clear. But I made myself believe her, and I received yet another ultrasound picture.

Then I had spotting and came for another ultrasound. The baby was no more.

This miscarriage was longer, two and a half month of hell. This time it wasn't shock, it was despair: I thought before that my first miscarriage was a glitch. Not anymore.

February 2014: Went to see RE, who ran a panel of tests and concluded that I need to take thyroid medications and receive progesterone when get pregnant. Have to say - I hated thyroid medications. I used to be a reasonably healthy person and never before had to take pills every day.

April 2014: Pregnant again, for the whole of two weeks. Endometrin (hated it) and regular beta checks, all the way trying not to get too attached. (I failed). HCG started going down pretty soon, and I never got to even have an ultrasound. RE's explanation of what happened, basically: you are old and your eggs are crap.

June 2014: Went for a second opinion to a well-respected Dr. His conclusion: the reason for what had happened is immune, we need to fight inflammation in my uterus (translation: it's not my eggs, it's my uterus that's crap). He prescribed a ton of anti-inflammatory supplements and Doxycycline for three month, and then try to get pregnant again. These were long three month. I struggled with drugs schedule for a while, but got a hand of it eventually.

October 2014: Got green light to start trying, and progesterone after ovulation. Got implantation bleeding, had positive pregnancy test and betas of 24 - just to discover in two days that it's another no-go and HCG is not rising properly. My personal record two-day pregnancy. I told myself quite firmly that it's better that way, cut your losses early and all that.

Yeah, right.

I was incredibly angry.

I soon found myself crying hysterically in a shower and yelling "I can't do this anymore!"

I do realize we are so incredibly lucky. We have a child, who makes every day a better day. But still.

Every time my kid talks to me about how she wants "a real sibling".

Every time she plays with a doll and calls it her sister.

Every time I see a pregnant woman with a kid.

Every time I think how we always wanted two kids.

It hurts so much, but I cannot stop trying yet.

November 2014: We went to our docs again. RE is pushing for IVF with genetic screening (remember, crappy eggs). I don't want to do this. It's invasive, expensive, may endanger my health (I have a bit of a history) and the success percentages are about the same as my chances to successfully conceive and carry to term on my own.

The other Dr. insists my eggs are not the issue (remember, crappy uterus). He thinks we have to deal with inflammation, and suggests we send a few tests to a lab in Chicago and go from there - either continue with current protocol, or have more serious drugs, or have a surgery for endometriosis. Our current insurance covers my RE (though it wouldn't cover IVF) and doesn't cover the other Dr. and any of his suggested options - and since the RE is, to put it mildly, not very keen on the whole "inflammation" theory, we are on our own.