The key

I just got a phone call from a good friend and his wife in London checking on how we are doing. It’s about midnight there and the have been enjoying some wine but wanted to touch base none the less. They are a great couple, Mr Mate is the most relaxed, water-off-a-ducks back type of guy and Mrs Mate is a classic type A personality who is a bit of a high flyer etc. She was telling me that last week they were in Spain at a completely rammed beach and lost their room key in the sand and were worried as it had their room number and the hotel address on it. Surprisingly, so the story goes, Mr calm was freaking out about getting robbed and Mrs Stress head was calm for once, (which I didnt believe at all!!). Next day she decides to wander down the beach and she was no where near where they were the day before, but guess what she kicked up out of the sand as she walked down towards the water….. “Matey” (they are aussies as well) she says  “I just knew it would work out somehow, I know I would normally freak, but this time somehow I knew it would be fine, so never got worried. I had the same feeling when I once lost one of my diamond earings from my wedding in an enormouts resort pool in Sardina , Mr Mate freaked, but I didnt. He found the earing 4 days later on the bottom of the deep end of the pool. I have the same feeling with you and kids. Dont ask me how, I just do, so I am not worried at all for you guys. My mum had strong intuition, but I didnt think I did, but am starting to wonder if I do.”

I went in to Mrs IVF who has been attempting to break the world sleeping record and told her the story between grunts and groans. She is still in a lot of pain but she is starting to mangle my ears again (a personal favorite of hers) so things are hopefully, slowly, looking up

So keeping with the key theme, I wanted to respond to JV’s question against my last post over what I find are key difference at the baby factory. Here’s  10 things  in no particular order that could have helped our numbers this time (and remember, there are just my thoughts, so nothing more than that in this):

(1) They miscalculated Mrs IVF’s repsonse to stims. On paper with lower and lower egg retrievals over the last 4 cycles they took her to be a low responder so cranked the drugs right up. Pulling in E2 levels around 4-5,000 on day 5-7 stim cycle is very early in my mind, but was advantageous as we got lots of eggs and they had time to mature. In a nut shell, they over compensated for the screwed up retrieval last time, (she had a great follice count last time on half the dose of stims).  If we need to go through this again, there is no way in my mind they would do this level of drugs again.

(2) Mrs IVF is, sadly, ideal for IVF torture. She is such a lovely person who never gets angry and has such a chilled and calm attitude to life that somehow I think manifests into the fact that she doesnt wig out on these drugs she just somehow absorbs it. She is a remarkable and truly unique indivdual that way. Ok – she is in phenominal pain now, but her E2 was astounding and she hasn’t retained fluid and to date (touch wood) hasn’t required hospitalization for a dose of drugs that I’m sure could hospitalize an elephant, (but hopefully not this leopard!).  My only real life experience with IVF has been with Mrs IVF and whoever happens to be in the recover ward when Mrs IVF is doing her retrieval or transfer tour of duty and there is always somone in there who seems more wiped out and in serious trouble than Mrs IVF. Even this week somone else was panicing and screaming while Mrs IVF (pulse 62, bloody pressure 110/50) was looking to see if they give her pound cake after her retrieval.

(3) The baby factory looks closely at the little things. We feel they turned over more rocks. We did 4 IVF treatments at the other place and at no time did they do any of the following:

– do a count (which they did 4 time) of Mrs IVF’s resting follicles . She had a ridiculous count of 30 or something huge, which made them think she had polycystic ovaries, but turns out she had no other symptoms. They even went looking and found a follicle that had fluid in it that they wanted to keen an eye on, and all of this  at a 1 day workup well before any stim cycle. All up – very thorough, explained at every step and in no rush at all.  We really didnt expect them to find anything new. We were IVF veterans. We knew all. We were also wrong!

– they did a 3D view of her uterus (new to us) but can’t reacall if that had any groundbreaking discover, but looked cool. I cant wait for the Wii version.

– they tested the blood flow to the uterus and found hers to peak and trough out of recommended range, which can make implementation harder, so she is now doing a special electronic acupuncture with “the Oracle” to correct. Seen the matrix? remember the Oracle is the unassuming woman making cookies in the kitchen… thats what this acupunturist was like, completely unassuming in a small,out of the way,  somewhat untidy office, but you knew, she was a complete legend at what she does.

– Mrs IVF passed out on an original HCG (poor thing) so never completed it properly. The baby makers wanted it done again as they were worried that they saw something they werent quite happy with (thankfully – it all turned out ok)

(5) They took my male factor more seriously, (this is huge I think). I still think that Mrs IVF is probably normal and that I am causing all this (my suckers dont hit the mark on swim factor, normal shape and average 5 million a shot, I think my lowest count was 790,000 for one cycle. So well short of the 20 million normal mark.) The old clinic just thought they they still had heaps to choose from, but here they put me on a special set of vitamins (1000mg of vitamin C, 200mg of CoQ-10, centrum Untra mens and 400 mg of Vitamin e – all avail from a drug store or GNC). I was already on other ‘erbs, that the old clinic were ok with, but these guys wanted to change – so thats just a flavor of each clinic – who knows who’s right. They also wanted to do PICSI and IMSI at the baby factory (which the old clinic said they didnt think these things made a difference). Maybe they don’t, but neither hurt (one is a sperm trap in a dish and the other is $500 of looking through a very high powered microscope so neither are invasive), but even if a placebo, I felt better that they were trying to select good spermies. oh – by the way my freeze shot of 7 million last week  and then the 10 million for the “live” session on Wednesday were world records (for me). So maybe the vitamins worked or maybe its point (6)…

(6) Lifestyle. Each cycle we get tough and tougher on our lifestyle. No chocolate this time at any stage – baby makers order – and here I was for the last cycles buying Mrs IVF some chocolate on retrieval day to make her feel better. No caffeine now for a year. I used to do 5 grande black coffees a day, then decaf, then tea, now nothing. No alcohol for a year. Used to have a few beers or a night out after each retrieval, but with 60 day lag in the sperm shop, its just out full time now. More oganic food this last cycle. Looked for organic shops for lunch. Very careful what we eat. Not crazy sprout freaks, but not chowing into mexican . No painting the house. Our new kitchen (from 18 months!!!) needs a good paint and the house needs a a good internal paint overall. All off limits. I even bought wireless for the house and then never installed it as a mate of mine tells me he went to a fertility “specialist” and was against it.  Mrs IVF doesnt go under the sink and bring out chemicals and most of the household stuff is nautral now. We avoid smokers (childishly we hold out breath as we pass them)…. hand sanitizer is a constant all over work and home. We even frikkin flew to the baby factory with masks on (Mrs IVF has got sick after 2 recent flights) …all these tiny stupid rules that have crept into our lives. Writing it now sounds freakish, sad, and overkill, but nearly 3 years at this and constantly questioning everything, its just become a way of life, choices all come up with the question of “what helps with the #1 priority”.  A few extra things on the boy front, no tight boxer, no bike riding, no hot tubs, cooler showers, all these things were new whe we realised I was sub fertile and needed to change.  So – some of the luck this time is probably unmeasurable benefits from highly controlled lifestyle of all these silly little thing. Or maybe not, but we certainly will never walk away from IVF not thinking we didnt try our absolute best.

(7) blog and technical reading. We learn a lot from reading about the rest of you and seeing what you have done. It’;s like we are all in a huge dark room looking for the door and each of us has part of the flashlight.

(8) fine tuning and timing of drugs. Last time Mrs IVF did gonal F, anytime in the day. Now we time every shot to exactly the same time of the day – dr’s strict orders – and Mrs IVF was on a bigger mix of cocktails this time (probably twice as many drugs – let me know if you want to know what they are)…and they changed them up quite a bit. We even started the cetrotide early, straight after one of the phone calls, so decisions felt quick.

(9) 2 sessions with the genetic councselor were well worthwile. None of this was mandated at our old clinic and their genetic section seemed a bit disconnected from a patient perspective. I also think now that PGD isn’t so hot so maybe we shouldn’t have been so aggressive in using it. Going for day 5 vs day 3 is riskier in some ways but I now am not a fan of day 3 biopsy’s but have learnt more since earlier cycles, so have changed our way of thinking. So this ties back to point 7. 1st time IVF is really a bit blind. Cycle 5, well, at least you have some experience under you belt (sadly).

(10) The baby factory offering / approach – I think the vitrification, full 46 chromosome checking, the ability for 4-6 weeks between retrieval and transfer etc are very good advances that just havent really existed until recently. They seem logical and am hoping they are as good as they feel and the baby factory seems to have good experience at these.  They picked one path of all the scientific options avail, and well, maybe its a good one.

In the end I think different clinics have different styles. The old clinic felt they were legends at PGD ( I think they played a big role in pioneering it) and feel it’s as good as CGH and microarray, because they are just that good at it. But part of Mrs IVF and I  feel like they have an excellent VCR when the world is into DVD now. So you will always have that sort of flavor with different clinics at all different aspects of a cycle. The support is the same in either clinic. Both clinics have excellent IVF staff and Dr support and care and both clinics make mistakes. For my freeze sample last week they though I was just testing. They wouldn’t have frozen anything unless I raised it and realised they had the wrong paperwork. Hardly groundbreaking, but no one is perfect and remember, we havent seen the ugly side of the baby factory yet and that worries me as 5 cycles down we are running out of options and I feel they are more brutal and blunt here.

So the baby factory isnt perfect. Enough of you IVF veterans can read out numbers yourself and think we have a good chance but as I said yesterday, we have all seen this movie before.  The bay factory isnt a magic castle. They just do things differently, and maybe with their stats they are cutting edge and are on Bue ray while the rest of the world is DVD, but here’s another thought, lets say that we’re 30 years in the past and these guys are selling an awesome new cutting edge insulation product made with asbestos… sometimes, it can be dangerous being out in front. Who bought the 1st ipod just to find 18 months later a cheaper, bigger better one was released? We dont have time to wait 18 month, the clock wont last that long, so we made a call.

Still – overall, I feel that it’s male factor playing a huge role here and if thats it then,  well, we might just be lucky, as my “sub fertile state” might still be good enough in the masterful hands of the baby makers, and if that truly is our biggest problem then (a) this is hopefully one of the easier problems in IVF land to overcome and (b) makes Mrs IVF the most amazing woman in the world for putting herself through this for us.

Hope these thought help with a piece of your own flashlight. We have no magic pill, but hopefully I have a great friend in London with some excellent intuition.

Sorry for the long post… with our sleep world record contender going for gold, its been a long day 🙂