June 23, 2009 was an eventful day. It was the last day that I worker prior to a short vacation. It was the day of my initial visit with my new doctor, the RE. It was also the day that my grandfather died.
He was 96 years old, and had lived a long, full life. He had dementia for years, but it wasn't that bad. Yes, he was forgetful. Yes, he slept quite a bit. But he was still full of life and living on his own at home. He had wonderful stories to tell, and he appreciated our company. We visited in late summer of 2008 and brought our three dogs with us. Grandpa just had the best time playing with and petting the dogs, and just telling us stories of his life. We were happy to sit with him and listen. I will always remember him that way - full of stories, appreciative of those around him, and happy with the simplest pleasures of life. Then about six months ago or so, he took a very steep turn for the worst. His last few months were lived in clouds of forgetfulness, with ever-decreasing independence. I thankfully did not see him during his last few months while he declined so rapidly. I truly prefer it that way. My last memory of him is when we were pulling away last summer, he was smiling and waving, wishing the dogs could stay longer (he really loved dogs). His memorial service is this coming Saturday, July 11th. I am looking forward to seeing my family, but is a shame that it will be under these circumstances. Grandpa, you will be missed.
Now on to the other experiences of 6/23. We were able to get a late appointment (6 PM!) with the RE, which was great! It allowed me to work all day and not take time off work for it, which I am sure that I will appreciate having the time to take later. =) We headed back to meet this man who shares a first name with my husband. There was a quick joke about it, and then we dove right in. We'll just call him Dr. RE. Dr. RE walked us through the numbers that we already knew, but for the first time someone took the time to explain more about what the numbers actually meant! It would have been great, except that the picture is so bleak. With the severely low sperm analysis results, we have only a 20% chance of ever getting pregnant without any help. In all likelihood, if it ever happened, it would be years away. =\ meh. So we have just a couple of choices.
Option #1: Intra-uterine insemination (IUI) with a sperm wash is the less invasive method. With this method, I take medication to boost my ovulation, preferably producing multiple follicles, thus increasing the chances of one of them being fertilized. An internal (read vaginal) ultrasound is done shortly before the probable time of ovulation to see how many follicles have matured, how big they are, and how thick the uterine lining is. The doctor then makes predictions for when the follicles will be ready to release their mature eggs, and the IUI procedure is scheduled. 36 hours prior to the IUI procedure, my husband injects me with a hormone "trigger shot" to cause the follicles to release their eggs on cue, so that the timing can be perfect for the IUI. Then, my hubby produces a sperm sample just before the IUI, which is then "washed". This means that the bad sperm and all of the other fluids and nutrients in the semen are stripped out, leaving just a tiny drop of the lively, moving, most spunky sperm, which are inserted directly into the uterus (bypassing the cervix and the long swim through it). All of this is to give the little guys a shorter swim, and to put them as close to the eggs as possible so that they have the energy to penetrate the egg and get their DNA where it needs to be!
The second option is In-Vitro Fertilization -Intracytoplasmic Sperm Injection which is abbreviated IVF-ICSI. IVF-ICSI with the related hormone treatments is pretty much as invasive as a treatment can possibly be. In IVF-ICSI, I would undergo hormone treatments even more intense than the ones for the IUI, causing me to produce lots of eggs. I'm not sure exactly what 'lots of eggs' means, but it seems to be standard to mean 15 - 25 eggs all at once. The doctor then surgically removes those eggs from the ovaries and a sperm sample is produced the natural way. The eggs are held with an itty-bitty instrument, and a single sperm is pushed into each one, forcing fertilization. Then the eggs are given a few days to see which ones turn into little zygotes and which ones die. The ones that make it are either implanted into my uterus, or frozen. Or if I'm feeling octo-momish and Dr. RE is a very irresponsible doctor, I can have all of them put into me at once, so that I can have tons of children that I cannot possibly hope to provide for without everyone else paying my way or me exploiting them. *ahem* Sorry, enough political commentary for the day.
So here are the chances Dr. RE gave us: IUI over the course of 3 - 4 cycles, he gives us a 3 - 4% chance total. Not each cycle, but total. If we opted for IVF-ICSI, he gave us a 44% chance of success per cycle of treatment. Think about that for a minute. We have less than a 50/50 shot at pregnancy no matter how invasive the treatment, no matter how expensive it is, no matter what we do. I was pretty floored by those numbers really. I was expecting something like 15 - 20% for each IUI cycle and at least 50% for IVF. The good news of the appointment was that he was ready to start right away. He figured that there was no reason not to try a few cycles of the IUI first, even if it was a long shot, it was a good place for us to start. I had already started on the Clomid from the OB/GYN's suggestion, so why not? We scheduled the IUI ultrasound for one week later - 6/23 and headed off for our vacation.