Thursday, August 7, 2008

Odds are . . .

I had my best-ever RE appointment exactly 2 weeks ago.

Since then I've been chewing and mulling. Ignoring and denying. Processing and calculating. Daydreaming and nightmaring. I sit here tonight wondering what the odds are that my best RE appointment was also my last.

My first RE appointment, ever, happened in 2005 — a year and a half after DH and I, at 38, had thrown caution (read: BCPs and condoms) to the wind. I was 40 at that appointment.

I am 3 years older than 40 now and, interestingly, my quoted odds for pregnancy from any method are higher than they were back then. Not because I'm such a graceful ager, mind you. It's just that my RE-calculated odds have improved with more data. We know more about my response to different drug protocols, how my uterus performs, what kind of ICSI-assisted fertilization rate we might expect, and lots of other junk.

At 43 I have an estimated 25% chance for a successful IVF with my eggs. At 40 my chances were quoted at 4%–8% for the same procedure. You'd think I'd be ecstatic to have "achieved" such a stunning gain. But I'm not. The numbers make me ill. No achievement here.

Those early odds came from an RE who wasted the second 18-month stretch of my tick-tocking clock of child-bearing viability. With him we did tests, tests, and more tests. Never any procedures, because he wanted all possible results before giving us the same odds he quoted from the start.

As that process unfolded, the constant activity of ultrasounds, blood draws, tube testing, and sperm studies made the whole approach seem thorough. But in hindsight, especially after switching to a clinic that actually wants to help us get a take-home baby, I believe that our association with the first RE was absolutely fruitless and downright damaging to our cause. I'd love to have that money back, but I'd pay five times what we shelled out to him to recover the time. And I harbor a secret feeling that stress from that time directly caused the shockingly rapid, out-of-nowhere recurrence of problematic fibroids that resulted in my need for yet another major uterine surgery. More lost time.

I just wonder, how can I come to terms with the realization that I must have had AT LEAST a 25% shot at success 3 years ago? (That RE intentionally stalled us, and it was no surprise to read the clinic's detailed SART statistics from 2005–2006: they cycled exactly 0 patients of my age.) Three years ago everything about me (DH too) was younger and any embryos DH and I might have created would potentially have been better suited for survival.

I guess I can come to terms with the realization. That's just a fact. The problem with looking back is that I'm gutted from knowing that we stuck with that RE so long, despite having a bad feeling about him at first handshake. Funny thing is, I know many women who've had wonderful experiences at his clinic. I'd still recommend it for non-AMA patients because their facilities are top-notch and their success rates are terrific.

Back to the questions I'm asking myself. How can I feel good about a 25% chance for success when that means odds are 3 in 4 that success won't come? (Odds for miscarriage after a "success"/confirmed pregnancy = a different set of odds altogether.) Granted, for this last IVF the odds going in were only 1 in 10 that we'd succeed. We accepted those, and a pregnancy occurred. But we lost it, and odds are excellent that not only were most of the perfect-looking embryos we made chromosomally abnormal, but that any success we might have with another try would end the same way. No baby.

I don't know. I left the hopeful, encouraging RE consult buoyed by the 1 in 4 chance that IVF could work. That's the best number I've ever heard about any option using my eggs, ever-ever-ever. Yet odds seem high that I can't keep traveling this road.

No idea what we'll do, that's for sure. Dr. K says it's fine to take a couple more months to decide. That I'm on a hill (going down) but not quite falling off a cliff. Her recommendations, knowing what she knows about our fertility profile and personal wishes as a couple, were to pursue the following options in order:
  1. One more IVF with my eggs (25% odds for success; should do this soon)
  2. DE-IVF (70% odds for success; can do this anytime in the next few years, so I don't feel as time pressured)
  3. 3 or 4 IUIs (5% odds for success but a way to feel like we're doing "something")
  4. TTC on our own for a while longer (lowest odds for success — couldn't really assign a figure, but, hey, nobody can tell me now that pregnancy is totally impossible)
  5. Move on (she stressed that we could do that now with total confidence that we'd given this whole thing a proper whirl)
A year ago I didn't even want to attempt IVF with my eggs. I wanted DE-IVF, and I wanted it 2 years ago. Two years ago I wanted adoption or DE-IVF, and I wanted that 3 years ago.

Today? Tonight? I seem to want all my own eggs in the basket or nothing. Number 1 or number 5. And I want one or the other right this minute, whatever minute it happens to be.

What to do, what to do.


bb said...

Have you considered PGD w IVF?

Good luck with whatever you decide.

Mrs.X said...

Sometimes there is too much information and decisions are that much harder. A lot of this comes down to what kind of hurry you are in and how important it is to have a child with your own eggs vs donor eggs. Only you can answer that question, but I think that they may help you.

I also know how frustrating it is to look back and wonder how much time was ultimately wasted, but you also know you can't change it. You can only change what you do going forward.

You will reach a decision and it will be the right one for you. But, it may take some time. Best of luck.

Joonie said...

The problem with statistics is they are just that statistics! Just because you have one out of 4 chances of successful IVF cycle, doesn't mean your won't succeed on your first try. I make my living manipulating statistics but I find that for making decisions in my life they don't seem to offer much help.

Just go with your gut and I'm sure it'll be the right thing to do.

Evil Stepmonster said...

Apparently the 'average fertile couple' only have 25% chance of falling pg each month, so to me your odds are pretty great! To continue with your own eggs or use a donor is such a huge decision, and very personal. I wish you all the best whatever you decide to do.

Opus #6 said...

#1 does not rule out #5.

You have friends and support for whatever you decide to do.

I have always hated boxing. Sending someone with a brutalized, puffy/bloody face back into the ring seems so cruel. But when the prize is a baby. That changes the balance somehow.

Ms Heathen said...

These are such difficult questions to be faced with.

There are no right or wrong answers. Ultimately, you and your husband have to do what feels right for you as a couple.

Please know that, wherever you decide to go from here, we will all be here to support you.