Official ERA Results

It was a really busy day at work and I almost didn't realize another day has gone by without results until my drive home. It really helped to no longer be angry; what a relief. Anyway, I figured it's been long enough and it was time to email the doc directly. 

So at about 5:15 PM I emailed a simple message: Hi Dr. X, We were advised on Thursday that you will review the ERA results and give us a call. Since it's been a few days I wanted to follow up.  Please let me know when we can expect your call to go over to the ERA results and discuss next steps. 

See? Not bitchy or demanding at all. I honestly just wanted an estimate.  

He responded a few minutes later:  Will call now. Send best number to reach you. 

Cool!  

A few minutes later he called. Turns out he took off the weekend and he apologized for not getting back to us sooner. Awesome. That's all I needed. It didn't even bother me anymore that it took a while to get back to us. I was happy he responded and that we got our results. 

So now... on to the results. The uterine lining came back as not ideal, in other words pre-receptive. As suspected, there are two options: option one is to repeat the test delaying the biopsy by one day to confirm "receptive lining." Option two is to do the transfer one day later without repeating the test. I asked what his recommendation is and he said it's totally up to me. I asked what do other patients who do this test do generally. He said there is no "generally" since they do this test so rarely. After I pressed a little more, he said if you're going to to do the test you should do it until you get a receptive lining. It's an optional test and an added expense, but if you're going to do it you may as well do it until you get receptive. I agree with that. 

My husband and I decided to do the second biopsy to confirm the exact day. We're not interested in wasting money, and I'm not thrilled about delaying another six weeks, and I'm certainly not excited about another biopsy. But. But I'd rather do all those things rather than risk wasting an embryo. 

I want to go into the next FET knowing that we did everything possible to succeed. If this is what it takes, it is what it is. 

I'm really ok with this plan. I hope I don't get worked up halfway through the cycle and freak out about wasting time/money/meds but know I probably will. 

The upside of this delay in results is that baseline is at the end of this week. Onward.

Education

While reading other blogs I come across a lot of information. Some of it is fertility related, some baby stuff, some social issues that come with fertility stuff. Since there is such a plethora of information, I try to absorb what I can and file away "Google later" things that can wait.

I know there is a lot I don't know about pregnancy and babies. I figure when the time comes and it's relevant, I'll take the time to research it. So when I noticed a hot topic issue going around the preggo IVFers, I filed it away in my Google Later pile in the back of my mind. It's so much information and it's not even relevant to me; I'll look it up when I get pregnant.

Over the weekend I got a rash on the back of my ankle. It wasn't terrible, but it was itchy and annoying. At first I thought it was a mosquito bit (ahhh zika?!) but then it started spreading a bit. My initial thought was to ignore it, but it happened to be that my husband wasn't feeling well and needed to see the urgent care doctor so I went along and had my rash looked at. The doctor couldn't pinpoint what it was. He did, however, recommend that I get a tetanus shot on the off chance it was a bug bite of sorts. Since it's been so many years that I can't even remember when my last one was (certainly not in the last 5 years, probably not even last 10), I said sure.

As I walk out, I get a sheet explaining the shot I just got: Tdap. Hey, I recognize that! It's the thing going around all the blogs now! I didn't realize they give a combination tetanus, diphtheria, and pertussis vaccine. Turns out it's a recommendation for women to get it late in their pregnancy so that the baby gets immunized from it as well. Rather, that's the controversy - whether to get it during pregnancy or after, and whether to get all the family members in contact vaccinated also.

So I guess it was relevant after all. Not sure what this means for future pregnancies. I know that I wasn't supposed to TTC for a month after getting the MMR shot but I think that was because it was a live vaccine, as opposed to this one which is safe for pregnant ladies.

Does this mean they baby would be immune since I just got it? Would I have to get it again after 30 weeks? I know exactly when my husband got his Tdap shot because it involved a situation we won't get into, so I know he's covered. I'll ask all these questions when it's relevant, but it's interesting how things come around full circle.

This time it worked out fine, but I realize if you wait to get educated on things then by the time it's relevant it may be too late.

Quickie update WL

Not much to report on weight loss. I've only lost half a lb since the last official weigh in. I lost my motivation when I realized the FET will likely be delayed because I may need a second ERA. I did pick up a bad habit: morning coffee.

I discovered it's a great breakfast to get out the door. It's quick. It has the caffeine for energy, a little bit of milk for protein, and it's warm and filling. It usually keeps me until 10:30 AM or later when I have my morning snack of sugar snap peas and baby carrots in hummus.

I never used to drink coffee and I don't think it's a great habit to get into so I know I need an alternative. I should go back to smoothies. Maybe I'll try that this week.

Weekend

This weekend had a lot of what I needed: sleep, unhooking from all screens, spending time with people I love, walking, and lots of delicious food.

We had a potluck lunch at my sister's for a family birthday and among other things, I was in charge of dessert. I brought fresh fruit, two mousse pies (one chocolate and one vanilla) which were divine, and the winner was the mini cinnamon buns with cream cheese frosting. I am a huge fan of baked goods already but these came out really out of this world.

Mini cinnamon buns.... with cream cheese frosting

They were perfect. Even though everyone was full from lunch and the relatively heavy mousse pies, we still finished nearly 2/3 of that 9x13" pan of cinnamon buns. If you like baking, or eating delicious baked goods, I highly recommend this dessert.

I also did a lot of thinking over the weekend. As much as I feel aggravated by the doctor and his lack of phone skills, I notice I still defend him when someone trash-talks his indifferent behavior. I know I technically CAN move to a different doctor if need be but I'm not ready. The trapped feeling I have is due to needing fertility treatment in general, not necessarily this particular doctor.

I worry that changing doctors may delay the next steps somehow, as though they'll insist on repeating all the prelim testing for which we already have answers, instead of moving forward and picking up where we left off with this doc. If I was unhappy with the medical care I was receiving, that would be an acceptable delay. But the part I'm unhappy with is the manner in which he communicates. He relies too heavily on the nurse to do the majority of the communication and when he's needed to step in, he doesn't do it on my timetable. I could change to a different doctor with a more hand-holding bedside manner, but will that get me to my goal any faster?

In full disclosure, I realize that this is a common theme with this clinic. Before January I was assigned to a different nurse. I felt like she was distant and had a robotic, detached demeanor. There were several mistakes that she made that I felt warranted a complaint letter. This happened before I started the blog so I have nothing to link to, but suffice it to say that I was ready to request a new nurse then. It happened to be that I held off with the complaints wanting to think it over and in January she was assigned to a new office and I got the nurse I have now, which I love. Fast forward to a few weeks ago, I was ready to request a new financial counselor because of all the things she did. The issues are real issues and my complaints are valid, but I'm noticing a pattern here. Either everyone is incompetent or I just have extraordinary expectations.

So I need to be prepared to keep going to this place and know that I have to keep a vigilant eye on things because they tend to screw up, or I need to cut my losses and start looking for another place.

I'm inclined to give this doc one more chance simply because I don't want to lose sight of the big picture, which is trying to get pregnant with a healthy baby. We finally have a thread to pull: we were told my uterine lining is pre-receptive. We just found out we have a variable we know was wrong in the protocol. Changing it may be the key to finally getting somewhere on the road to having a baby. Do I want to put the brakes on that while I yell at him for not calling soon enough? No, that's not helpful and will not get me what I want.

Is his manner frustrating? Yes. Could he be a better doctor? Probably. But I am willing to look past this so we can move on to the next steps. I don't want to hold a grudge, I'm not interested in being mad at him, and I don't need the added stress of thinking about switching right now. I know this is probably not the last time he'll disappoint me, but my wanting a successful pregnancy supersedes all the disappointed feelings.

Putting things in perspective has really helped calm me down. It's hard not to lose the forest for the trees, especially when everything is so emotionally charged.

I am a big believer in stepping in and advocating for yourself, which has proven helpful time and again along this journey. But I also believe in balance and picking your battles. There is a time to fight and there's a time to be patient, and right now is the time to put away the boxing gloves and sit tight.

Still no call

I haven't heard from the doctor yet. I read all these fertility blogs and they all talk about how their doctors go out of their way to make them feel comfortable and supported. I get none of that from my doctor. He's a world-renowned clinician but when it comes time for anything related to the phone, he's the worst. The most recent time I felt like he didn't give me the time of day was after the chem pregnancy beta results came back and I was a complete mess. I attributed that situation to my hormones, misplaced sadness, and extraordinary circumstances that were beyond his control.  After the wtf appointment I felt better.

Until now.

Now I'm angry.

Our results from the ERA were delayed to begin with. There was anxiety already. Finally on Thursday morning (five days after we were expecting the results to begin with), my nurse emails with the results and that "I put those results on Dr. X's desk for review and he will contact you to discuss." That was at 7:44 AM on Thursday. That evening, I emailed her back and said that I didn't get a call. Maybe I misunderstood?  Was I supposed to call him? Should I have scheduled a phone appointment? Her response came back at 7:53 AM this morning, "No need to make a phone appointment. He will call you." Yet, it's now Friday evening and still no call.

It bothers me that I've been on pins and needles for nearly 48 hours waiting for these results. It bothers me that I haven't allowed my phone to leave my sight for more than a few seconds for fear that I might miss the call when it finally comes. It bothers me that the earliest I'll hear from him is probably Monday, and even then there's no guarantee.

What kind of service is this? You'd think they were doing me a favor, as though I wasn't paying thousands and thousands of dollars for their services.

It bothers me that I feel trapped because it's the best clinic, and he's considered the best RE. It bothers me that I'm stuck with them because they have my embryos. It bothers me that I'm stuck with them because I still need them.

I'm so annoyed and frustrated. It's so unfair to keep people waiting like this. No matter what benefit of the doubt I try to give him, it still doesn't excuse this kind of treatment. If he's on vacation, or has a family emergency, or is swamped with patients... whatever the excuse is.... he could've told the nurse to pass on the message that he is unable to talk immediately and he may not call for a few days. What is this madness keeping someone waiting for results???

This whole ERA process was a cluster from start to finish. Everything along the way was awful - from the financial, to the scheduling, to the appointment itself, to the checking out of the appointment, to payment, to results.

It pains me to think that we have to go through this again. Or do we? I assume I know what are options are but I don't really know because the trained medical professional has yet to call me.

I know I need to calm down. I'm so frustrated and infuriated at this trapped/dependent feeling that we're stuck with him that I have hot angry tears simmering just below the surface. Should I switch doctors? Should I complain to the office manager? Should I just suck it up and wait to get pregnant? Are my expectations just unrealistic?

Let's say I write him an angry email. Then what? What am I expecting in return? He'll say sorry? He'll write back, "Oh I don't have your file, talk to you Monday." Anything he writes will make it worse.  But a thought came across my mind that what if he doesn't even know he needs to call me? Then I thought that of course he needs to call. We have a baseline appointment next week and we don't even know if it's for another ERA or an FET. Plus the nurse would have made sure that he knew. He knows. Maybe he's ashamed for being so wrong about nothing being amiss that that we should "just keep transferring." Yeah right.

It seems like he doesn't care at all. He's won awards for his work, he has 20+ years of success. He has a pristine reputation and has nothing to prove. What's in it for him to be a good doctor? He's got no incentive to see us succeed. He gets paid regardless. In fact, the more we fail the more he gets paid. He's basically got no motivation to keep me happy or help us get pregnant.

He'll apologize, come up with some dumb reason why he didn't call sooner, and then we all have to move on because we still want to have babies.

I'm so sick of this. I'm sick of this clinic and all their bs. I'm ready to move on from them but there's nowhere to go. I'm done dealing with the uncertainty of the unknown and the dread of the news of the next phone call. I'm done with fertility treatment and I just want to move on.

Shabbat shalom.

ERA Results

After multiple calls to the lab and being on hold for a combined nineteen hours (only slightly exaggerated) with the most awful tingy music of the 90s, we finally got the results of the ERA: pre-receptive.

I'm feeling a combination of relief and disbelief. I'm relieved because we finally have an answer as to why none of the embryos stuck. They were being transferred too early! It's like hosting a dinner party: planning a menu and shopping for ingredients and cooking for days and setting the table just so and then having the guests show up three hours early when you're in your bathrobe in a mud mask brushing your teeth. Not yet, it's too early! All that planning and prep for nothing.

We got the results first thing this morning from my nurse who knew we were anxious to hear them but they still need to be reviewed by the doctor. Once he does he will call to discuss next steps.

I believe our choices are to repeat the test until we get a "receptive" result OR to guess the new transfer date based on their recommendation and hope for the best. While the thought of waiting any longer makes me want to jump out of my skin in frustration, it makes the most sense to give our embryos the best possible chance to repeat the test until we get a "receptive" result.

This means that we're probably going to do the second ERA in the end of September and not transfer anything before November. I don't like it. I don't want to wait. But I also don't want to spend October crying about another failed transfer if we don't do everything in our power to help it succeed.

The doctor was so sure that nothing needed to be changed. He was so calm that it made me feel like an alarmist who was just trying to waste money for fun. I honestly thought that the results were going to come back normal/receptive and that I was looking for issues. This just goes to show that you should always trust your gut. It is so important to do your own research so that you can make informed decisions and know what questions to ask.

I'm trying not to regret the three transfers that failed due to this error. They were a kapara. It happened. At least we didn't take his advice to "just keep transferring" and wasting the last two as well. Some people don't get this information until after 8 or more transfers. I consider myself lucky to live in a time when it's even a possibility to test for this.

Hold on, tiny embryos. Maybe we'll be together again for Thanksgiving.

On the Road Again

Our doctor is convinced that we have great quality embryos, good lining, and just need a bit of luck to get one to stick. According to him it's a numbers thing and the more times we try the more likely one will work. Sure, he has 20+ years of experience and multiple accolades in his profession, and maybe he's right. But I feel like I have to DO something.

We had three FET transfers. Three. Each one had a perfect uterine lining and a top quality PGS-tested day 6 blast transferred. Each one was perfectly timed and medicated per protocol. Only one stuck and even that ended in a chemical pregnancy.

In my mind, that is unacceptable. Some may say that if we were a "regular couple" that's the equivalent of trying 3 months in a row and doesn't it usually take at least a year of trying? To those people I say SHUT UP. Not really. I actually say: people trying naturally aren't timing it to the minute. People trying naturally don't know what their uterine lining looks like or its exact measurement. Trying naturally also doesn't filter out the embryos that are by nature incompatible with life or otherwise not in top shape.

It can't be anything to do with diet or health because women across the globe get pregnant all the time. Women who smoke, eat fried food, allergic to pineapple, addicted to crack, have 100 extra lbs on their body, with cold feet, or high blood pressure all get pregnant. So it's clearly something else.

I get conflicting thoughts when I hear of someone else announcing their pregnancy, especially another person in the IVF trenches. On one hand it's enormous joy and a secret glee: "If it can happen to her with all her issues, it can happen for me!" On the other hand I'm thinking that's one less miracle baby available for me. As if there's a quota of babies upstairs and dolling them out means less for everyone else to pick from. Both thoughts are insanely ridiculous, I'm fully aware of the absurdity. It's not only narcissistic to think that my future is directly linked to other people, but that also the world revolves around me and every act affects my life. It may be insane, but then so are superstitions and we still can't help ourselves, but I digress....

At our last wtf appointment, the doctor listed our options but not before starting with saying that he thinks the protocol is accurate and nothing needs to be changed. He offered doing an RPL workup, the ERA biopsy, or an endo scratch. He strongly advised against transferring more than one embryo because of the risk of multiples. He gently suggested that getting to a healthy weight is always helpful. I get that. I agree that it's true and I believe he said it because there literally was nothing else medically preventing a pregnancy.

So do we continue "just trying" forever? No. We will try something different every time! My way or bust!!!! Not really, but it makes me feel better to think I'm in some control.

First, we did the RPL workup. It's a simple blood test and there's no reason it's not part of the prelim testing done before you even start. Done. No issues found.

Second, we agreed that spending the time and money on an ERA biopsy was worth it. There's no point in wasting precious embryos on a transfer if we have the day wrong. Even if we hear back that the timeline is correct, at least it we have peace of mind and not wonder the what ifs in case the next one fails.

Third, if the ERA comes back that the timeline is accurate as is, we will try the endo scratch. We have nothing to lose.

If the ERA comes back that the timeline needs to be adjusted, we will adjust based on the recommendation and not do an endo scratch in that cycle - you can change only one variable each time. Like a science experiment! With my uterus! How fun!

That's the road map. If we still don't get pregnant after that, we're back to square one and have to think about IVF #5.