[richmond_girl]

Ladies,

I know my MA woes are probably a little too much for this board, but I wanted to keep you all updated on our journey since you've been there with me since the beginning! We had our IVF consultation today - exactly 1 month and 4 days after learning we'll likely never conceive on our own due to DH's severe MFI. Below is my update that I posted on the MFI boards as well...

Basically, this is how things look:

1) He's not feeling good about finding enough sperm in DH's ejaculate on the day of egg retrieval, so he's recommending that we do the testicular biopsy (TESE) beforehand to hopefully find and freeze some back-up sperm. If DH ends up pulling out a miracle and we don't need to use the TESE sperm, great - at least we have it for a future 'emergency'. But, if like the last 2 times, his sample produces <20 sperms, unfortunately we'll need to tap into that reserve. Our RE recommends doing the testicular biopsy BEFORE egg retrieval (some like to do them the same day) for a few reasons - if TESE produces no sperm, it's not worth going through the painful & invasive injections/retrieval process on my end; coordinating the TESE and the egg retrieval to happen on the same day will be extremely difficult since we won't until the very last minute when the actual ER (egg retrieval) will take place; and he wants DH to be fully recovered by ER day so that he can take good care of me, which he won't be able to do if he's just had a needle shoved into his package a few hours before

2) Looks like I will be on Lupron and then a combination of drugs to produce FSH/LH for the 5-8 days after the Lupron stops (just estimates for now). After the HCG trigger I'll be on the progesterone, 81mg apsirin and medrol (a steroid to prevent my body from rejecting the embryos). RE estimates that from the moment I start the stims to when the transfer occurs will be about 2 weeks.

3) RE recommended that we transfer no more than 2 eggs. Even though I'm 30 and feel older every day, I'm considered a "young" IVF patient and everything on my end has checked out perfectly - hormones are great, my HSG today revealed perfect uterus/tubes, ovaries are nice and healthy - so he's optimistic that if we can just enough of DH's sperm to fertilize my eggs, we have a really great shot at pregnancy. For the past 8 years, his clinic has a 55%-80% success rate for IVF with ICSI, and those <35 have mostly ended up on the 75%-80% side. He's worried about multiples just because of my size (I'm relatively small - 5 feet, 100lbs) and the risk of preterm delivery if that happens Plus, our RE does "assisted hatching" as standard protocol for every IVF cycle, which was nice to hear (usually that's another $1500+ and some doctors won't do it unless you've had a few failed IVF cycles in the past) - so the little embryos will get an additional "boost" right before they're transferred back into my uterus.

4) We went through all the reasons this might NOT work - which was depressing to hear but at least we know what we are getting into. Cycles can get cancelled for any number of reasons - unplanned cysts on the ovaries, not responding enough to stims, responding too much, etc. Even if the cycle doesn't get cancelled, DH's sperm may not fertilize my eggs (although he said with ICSI that is pretty rare for that to happen), eggs may not divide correctly, and then eggs may divide but obviously may not implant or "stick".

Also, our RE did my HCG about 3 hours before the IVF consult. The timing with both occuring on the same day just happened to be a coincidence. I will say that the HCG hurt like a bitc*. The prep was uncomfortable (lots of burning, pulling, swatting "down there") but when they started pushing the dye in, holy cow was I in pain. I'm glad that's over though, because it was the last thing I needed on my end to get the full green light to start the IVF. RE said my uterus looks like a perfect nest for a little embryo

We have a crazy few days ahead of us to get ready. RE said to pick a date that we want to do the transfer and he will work around our schedule (I love our RE!). We were hoping to do the transfer before Christmas, but I'm traveling for work in early December which makes even mid/late Dec pretty aggressive (can't start stimming until after I'm traveling because i'll need to be monitored every few days via ultrasound). The lab that would do all the ICSI/TESE is also closed for the last 2 weeks of the year, so we're going to plan on doing the ER and transfer around the second week of January. Of course, that depends on how quickly DH can get the TESE done. We're hoping the urologist will be able to do that early/mid December so we can just get it out of the way. DH and I also both have to get one more round of blood tests done (HIV test) and then sign our life away on a bunch of consent forms Oh, and we have to decide whether we want to do the Shared Risk Plan, which our RE offers for patients who would be willing to try IVF multiple times to get pregnant. The IVF will cost us about $12K/cycle if we don't do the Shared Risk Plan (not including the TESE, which is an additional $5K/cycle), or we can do the Shared Risk Plan where we pay $25K upfront, and that automatically covers us for 4 fresh IVF cycles (not including the costs of meds & TESE each cycle, which add up to about $7K together). If we don't get pregnant after 4 cycles, we get a 100% refund. It's a lot of math and a lot of "what ifs" and a lot of variables (what would insurance pay in each scenario, what would our FSAs/HSAs cover in each scenario etc, how many cycles would we really attempt before moving onto adoption, etc) - so DH has a task to put together a spreadsheet and come up with the answer over the next few days!

I am overwhelmed by all the information swimming in my head right now! Costs, dates, meds, procedures - I guess this is what TTC has come down to for us - sigh. But it is what it is!!

[snsgirl336]

Wow Juli! That is a lot of info there! I'm so glad that you shared it with us! We like to keep tabs on how you're doing!
It sounds like you have quite the solid plan all set and ready to go! I hope and pray that the TESE will provide some good swimmers so that you can be on your way to an IVF baby. You really deserve it! You're such a sweet and I want to see you end up with a beautiful baby in your arms! It sounds like your RE is a very caring individual who will work really hard to get you that BFP and it sounds like the odds might be in your favor!

I'll be keeping you in my thoughts and prayers and I hope you keep us all updated on how things are progressing!

[~April04~]

Sounds like it was a really good appt Juli!. I'm sorry the HSG hurt, but luckily you won't have to do it again. Good Luck with everything. I'm rooting for you!

[richmond_girl]

Thanks ladies! You guys are the best.

The testicular biopsy (TESE) is scheduled for 1/30/09. THat was the earliest we could get - grrr!! 2 surgeons have to be involved so that was a nightmare to coordinate. At least we're on the calendar though! But I was really hoping we could do the IVF in January and looks like that won't be happening now I'm not starting my drug protocol under after the biopsy confirms we got enough spermies to even do the IVF - so that would put the estimated egg retrieval/tranfer date around the 3rd week of February. That seems so far away - 3 months!! But I'm hoping it will go by quickly - next week is Thanksgiving, then I'm traveling for work, then it's Christmas, then it's New Year, then it's time to go fishing for those spermies It'll fly by - right??

[snsgirl336]

I'm sure it seems really far off right now, but you're right with everything you have going on, it'll just fly by I'm sure!

I have a question... is there anything that they are asking your DH to do to try to improve his counts at all? I remember hearing of somethings that can help (Maca Root and some others) and I wondered if you would try that in order to up your chances... just a question!

I'll be definitely keeping you guys in my thoughts and prayers over the next few weeks!

[richmond_girl]

No, they haven't told us to do anything. His sperm count is SO low it's definitely not caused by vitamin deficiencies, infection, or lifestyle choices (like boxers vs briefs, etc). The RE said his counts are "orders of magnitude" lower than what they would be if it was caused by something easily fixable, so there's definitely something bigger going on.

Basically, if you have severe MFI, you have 1 of 2 issues: 1) Sperm production - you're not making any sperm (due to genetic/cellular issues) or you made sperm at one point and they were all killed/destroyed (bad accident, radiological exposure, etc), or 2) Sperm delivery - you're making sperm, but it's not making its way out of the testes and through the vas deferens(the tubes are closed off completely, never formed, or physically blocked). In DH's case, they determined that his issues are most likely NOT #1. His family background (one of 11 kids, only one with fertility issues), blood work, and childhood history indicate there should be nothing preventing him from making sperm. They suspect his issue is a blockage in the tubes which are again, preventing the spermies from getting to where they need to go But the fact that they are able to find SOME sperm in his specimen is actually a really good sign, because it obviously means something is getting through. They've offered to test for blockages, but the tests to diagnose a blockage are often so invasive that they do MORE damage to the testicles/vas deferens and end up making the infertility WORSE. So, in our case, the doctors have recommended that we just go straight to IVF with TESE. Getting the sperm from DH's testicles will be a much more 'direct' (efficient, if you will) way to get pregnant, with a much higher probability of success. And I agree - as long as they're going to be knocking him out and poking around down there, I'd rather they just take it the whole way and leave little up to chance!

Just in case though, I do have DH on the Fertilaid vitamin - 3 times a day! Can't hurt, right?

[snsgirl336]

Gotcha... I;m not too familiar with MFI, so I just thought I'd ask! Thanks for that great info!

[richmond_girl]

Oh, I know WAY too much about MFI LOL. Ask away! I feel like I'm not making the best of our situation if I'm not using our newfound knowledge to educate and help others!

[snsgirl336]

That's an awesome way to look at things! Helping others with what you know! I know I've learned quite a bit just from reading your posts and stuff! I feel like being informed is the first step in overcoming any obstacle!

I can't wait until we can tell our families about our struggles with TTC (though it's more length of time than anything else right now). I would really love to help out the other member's of our families who might be going through similar things and share the info I have!

[SavaAngel]

Thanks for keeping us updated. I hope you get enough spermies and you get a sticky bean (or two) in February/early March! Good Luck with all of the decisions! I hope this happens for you quickly!

[~*Jackie*~]

I'm glad you have a plan and that you really have the green light to get moving! I know it's still a little while until you could get that appt made, so I am keeping you in my thoughts and prayers that you get enough quality swimmers to get the job done, and that you get the miracle you so so deserve!

[richmond_girl]

Thanks ladies! Yes, believe me, I will be waiting with baited breath for the doctor's call after DH's surgery - all I want to hear is that they found enough spermies for us to do IVF. (Actually what I'd really like to hear is, "We hit the jackpot! We found millions of spermies!! You'll never need to go through this again!!"... but the odds are against us on that one ) This is sad, but I am probably going to be waiting with the phone in one hand and a syringe in the other! If we get good news, I'm sure I will have done my first shot of Lupron even before we're off the phone with the doctor LOL.

I will keep you girls posted. I am just taking everything one step at a time, one day at time. It's the only way to survive this roller coaster. Some days we get good news and all is right with the world, other days we get devastating news and we come crashing back down. But you girls know that already...

[TTCagain]

They've offered to test for blockages, but the tests to diagnose a blockage are often so invasive that they do MORE damage to the testicles/vas deferens and end up making the infertility WORSE[/b]

That's kind of my why we decided for me to not do the lap. surgery. My right tube is totally blocked and my left is partially open, but the RE doesn't know how open. He said he could do a lap--but that since there's nothing to do to correct the scar tissue, and the lap. would probably cause MORE scar tissue---it's not worth it.


Sounds like you have a GREAT gameplan! I know January 30th sounds so far away but you are right--with Thanksgiving and traveling for work and Christmas and New Year's--it will go quickly!

I'm excited for you--you are a great IVF candidate and I can't wait to hear about your BFP!!!!

So February is when you will be doing IVF?

[richmond_girl]

TTC Again - thank you!! Yes, we are targeting mid-February for the IVF. I'll start my injections as soon as DH's testicular biopsy confirms they found enough sperm, and we should be able to do the egg retrieval and transfer right around Valentine's Day, if all goes well - *crossing fingers*. I'm hoping for a cupid love bug

I'm sorry to hear about your blocked tubes - it definitely sounds like you're in a similar situation. I see you're going to try an IUI this cycle - good luck!!