Bootcamp for uncertainty

In the long radio silence since my last post, I have been in bootcamp for uncertainty. I say that because it feels like I am in training for something—being tested to see how much uncertainty I can bear in any one given moment.

The Florida trip was such a difficult, uncomfortable experience. I have decided that the details of that trip should remain in my personal diary, for the most part, because it is probably poor form to describe all of those details out here in cyberspace. In truth, I think that is why I have avoided this blog for so long—I didn’t know if I could trust myself to keep a wrap on it. My future in-laws (yes, DH isn’t quite DH yet; he is DF, but didn’t want to confuse the IF community with the unusual acronym) are Korean, and anyone who knows anything about Korean culture can perhaps guess some of what we went through. But the outcome of that very long week was a gift of money that will partially cover IVF at CCRM, and for that I am very grateful.

We don’t know where the rest of the money is going to come from to pay for the remainder of treatment, flights, hotel rooms, and car rentals (uncertainty #1)—maybe from our Visa and MasterCard?

But we are still not 100% sure if we are going to do it (uncertainty #2). We will go to CCRM on September 10 for our one-day workup (ODWU), and we will have all of the tests done; after that point, Dr. Schoolcraft will tell us the percentage of success we can expect. After that we will decide for sure if we should go for it.

My phone consultation with the famous Dr. Schoolcraft was on August 8. I liked him! He has strong opinions, and I appreciate that. He said that there is no reason for someone who has had four early miscarriages to do IVF unless it is with CCS (comprehensive chromosomal screening). I countered that someone I consulted with here in New York—I didn’t name him, but that someone is Dr. Goldschlag at Cornell (CRMI)—said that chromosomal screening does not increase live birth rate; it only decreases miscarriage rate. Dr. Schoolcraft was adamant in his reply that CCS increases live birth rate. He explained that CCRM developed a lab that is the best at growing embryos to Day 5, at which point CCS can be done to assess the chromosomal abnormality/normality of sixty-cell blastocysts. He explained that this method is far more accurate than doing a morphological assessment of a six-to-eight-cell blast on Day 3—which is what Dr. Goldschlag is proposing I do.

In the days after this conversation, I used my school’s online access (still have it) to academic/medical journals to thoroughly research the difference between morphological assessment and chromosomal assessment. Why did Dr. Goldschlag say that the blasts his embryologist would give a high grade to, via morphological assessment, would wind up being the same embryos that would get a high grade through chromosomal assessment? And therefor I shouldn’t waste my money, unless I wanted to pay the extra 7 thousand simply to avoid another miscarriage? Was this true? (uncertainty #3). The older research I found certainly did support this claim of Dr. Goldschlag’s. The most recent research, however, supported Dr. Schoolcraft’s claim. The most recent research indicates that an embryo that looks normal at Day 3 can turn out, by Day 5, to be abnormal; scarily, an embryo that looks abnormal at Day 3 (and is therefore not used) might turn out to be chromosomally normal if tested through CCS by Day 5. The bottom line is that chromosomal assessment is not only more accurate than morphological assessment, it also increases live birth rates.

I have amassed this research and highlighted some of it on Morphological v Chromosomal Assessment, a page of this blog.

So!

It took me quite a while to process the above information and truly believe that paying 7 thousand dollars extra for CCS would be worth it, in my case. Not only would CCS be worth it; it would be the only reason I should even try IVF in the first place. “IVF alone will have no effect on increasing your chances of a live birth,” said Dr. Schoolcraft. I voiced some concern that my embryos would not make it to Day 5. “Here in New York, they’re telling me that most transfers happen on Day 3, because if they start looking strange by then, they don’t want to risk having them out of the maternal system for longer, especially if there are less than 10 embryos total.”

“Your embryos are probably not looking strange by Day 5,” said Dr. Schoolcraft. “The reason you are getting positive pregnancy tests, four of them, is because you probably have pretty normal-looking embryos at day 5. There is no reason your embryos would not survive to Day 5.  And the reason I’m confident that they can make it to Day 5 outside of your body is because we have developed a highly specialized lab for doing just that.”

This clicked with me. In other words, if my embryos started looking wonky at Day 3, it wasn’t because of my embryos; it was because of the ability of the lab to keep growing them—CCRM can keep growing them, Cornell most likely cannot or will not (because they automatically do Day 3 transfers if you have less then 10 embryos). I will not definitely have embryos that go on to live births, but by all indications, I will almost certainly have embryos that will make it to Day 5 chromosomal assessment at CCRM.

In all of this, of course, you have two men who are selling their products. Dr. Goldschlag here in New York is selling a much more conservative product that is based on older—but probably more voluminous–research. Dr. Schoolcraft in Colorado is selling a much more cutting-edge product that is based on the most recent research and his experiences in developing and using perhaps the best embryology lab in the world.

We are going with Dr. Schoolcraft and CCRM because it feels more aggressive and progressive and right for my situation—and because we can do this only once.

After we made the decision to go with CCRM, the problem of money loomed (and of course still looms) large. At that point, neither of us had jobs (uncertainty #4). DH has passed his dissertation (yay!) and his internship is ending this coming Friday, but at the time of the Dr. Schoolcraft consult, he did not yet have even an interview lined up for a job, though he had applied for positions around the country. I was finishing up my coursework, and in any case, could not earnestly apply for a job until DH found his (we are following his job hunt first because he is finishing first, and because his salary will be significantly higher than mine). I could not accept the position I was offered in NYC (a very impressive position, but one I probably wouldn’t have liked) because I did not know where in the country we were going to end up, or if I should accept a position and immediately ask for two weeks off in November and one week off in December for IVF! (I believe that would be uncertainty #5, 6, & 7).  Here we were, contemplating making the most expensive purchase either of us had ever made (even when subtracting the gift money), and neither of us had jobs! On top of this, both Dr. Goldschlag and Dr. Schoolcraft were saying: “The sooner the better.” When I explained how unsettled we were, and how we might be moving soon, worried about the stress, Dr. Schoolcraft said: “If moving is one of the most stressful things you’ll ever do in your life, fine, then delay treatment a month. But don’t delay it longer than that.”

Oh, the alarm bells, the alarm bells. I live in a firehouse. Hope Hathaway, my acupuncturist, laughs at these alarm bells and tells me to silence them, but I listen to them all the same.

Remarkably, incredibly, DH soon did get an interview offer—at a hospital only an hour and a half drive away from where we now live! After a couple of weeks of agonizing wait (uncertainty #8), my DH was offered the job. We celebrated for about a day and a half before the realities began to set in about how expensive it would be to move to Long Island, put a down payment and security deposit on a place, pay a broker’s fee, lease cars…where was that money going to come from, if we were spending money on CCRM- flights, hotels, and cars? (uncertainty #9). Then came the uncertainties about my job prospects. Should I take on something noncommittal and quit when I have to go to CCRM for two weeks in November? What sort of short-term work would I be able to get out there? Should I apply for full-time jobs and see if (there’s no way!) they’d be okay with me immediately taking two weeks off in November and one week off in December to go to CCRM? What employer would do that? (uncertainty #10, 11, 12).

That is more or less where we are at. I realize that we are incredibly lucky. I realize that what we are dealing with right now is most accurately called, in the field of psychology, eustress (as opposed to distress). We are deciding between alternatives, but our alternatives are coming from being provided with abundant choice, Choice with a capital “C”, which comes from the financial gift of DH’s mother. Now we have to deal with the nitty-gritty of the mini-choices that go along with that larger choice.

But at least we have that choice in the first place.

We have thought about what our lives would look like if we didn’t have this choice. Based on our experience with four losses, and the recommendation of (now) four REs, we can be fairly certain that if we keep trying naturally, we will have more losses and no baby (no matter what lovely Hope Hathaway says, as much as I’d like to believe her). The chances of it happening through only one IVF are slim, and yes we could put a down payment on a house for what we are spending, but with the choice put out on the table, won’t we always wonder “what if?” if we don’t take it?

That questions I will not label as an uncertainty—I know the answer: Yes.

Advertisements
Leave a comment

2 Comments

  1. I can totally relate to quite a few of your uncertainties and it truly is such a tough decision. I will say that the hope that CCS at CCRM is giving me is what made the decision for us. I don’t know if I can bear a fifth loss, so we’re turning our lives upside down to give Denver all we’ve got. I hope you feel peace with your decision!

    Reply
  2. Thank you so much for your support! It sounds like we are in a very similar situation. I wish you all the best! As my next post will show, things have changed a little for us, for now…

    Reply

Leave a reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: