Post-IVF Regroup with Dr. Schoolcraft

I’m really sorry it has taken me this long to post about my post-IVF phone regroup conversation with Dr. Schoolcraft!

The conversation was actually far more pleasant than I expected, considering the circumstances. I felt that Dr. Schoolcraft was more personable during this call than he has been in the past.

AMH and my 11 follicles

He said that because my AFC was 11, he’d speculated that perhaps my AMH of 0.2 might not be such a big player in how I responded to IVF. He was, he said, wrong about that. He said that although I have a good number of follicles, it doesn’t appear that all of them are producing eggs.

This was the one point of the conversation that irked me. I have been wondering about this possibility all along. I pointedly asked during our post-ODWU regroup: Is it possible that some of my follicles are not active, are not producing eggs? He answered (and this is verbatim): “No, it doesn’t work like that.”

Now he is saying that it does work like that.

I didn’t call him on this discrepancy, because I sensed that would not be fruitful–what was he going to say, after all, and what does it matter now–and I knew it was in my best interest to maintain excellent rapport. I wanted the rest of the conversation to wield the most information possible.

In the end, I know that if, back in November, he’d admitted that it were possible that some of my follicles were not producing eggs, I still would have tried IVF.

Chromosomal abnormalities due to maternal age

Yes, this is definitely my problem.

He thinks my eggs are aging faster than the rest of me. He speculates that I have the eggs of a 43-year-old woman right now.

Genetics (Ma-Maw went into menopause at 40) and past behavior (smoking)

I asked Dr. Schoolcraft if there was something I did in the past to age my eggs. He said that smoking can speed up egg-aging. I did smoke in the past (quit years ago), though quite lightly, compared to most, and irregularly. Still, that could have had an effect.

But he did not seem to think that smoking was the culprit. He thinks my genetic building blocks are to blame.

He believes that I inherited the genes of my maternal grandmother, who went into menopause at age 40. She had 4 children—but she had them in her twenties.

Is there anything I can do to ameliorate my egg quality? To help them undergo meiosis properly when they meet up with sperm? 

He said that there really is nothing I can do. My eggs were built when I was in utero. The blueprint cannot be changed. They have aged and will continue to age in the way that they were programmed to.

Would he recommend another IVF?

He did not use the word “recommend.” He said, “I would be willing to do another IVF with you.” He said that he would give me a 10 – 15% chance of success the second go-around. I told him that we can’t afford to do it anyway, but I was just curious.

If we had the money, or the insurance coverage, I would try at least one more time. 10-15% isn’t 0%, after all. Every month a woman has a less than 10% chance of getting pregnant if she tries naturally, and those odds are beaten all the time.

I haven’t quite processed my feelings about not being able to try IVF again only because of finances. It is territory that causes me a deep sense of unfairness, and I have to let it go.

Would he recommend trying naturally?

Dr. Schoolcraft was quite clear that he did not recommend this path. He reminded me that I was far more likely to have a successful pregnancy through IVF + CCS than through sex. He also reminded me that the path from pregnancy to miscarriage to recovery can take as long as six months—I haven’t experienced anything quite that long yet, but it is possible.

He did say that that if I am not actively pursuing pregnancy through fertility treatments, and if I am okay with sacrificing up to six months for the remote possibility that trying naturally will work, then (he said hesitantly) I could go ahead and try.

We have, this month. Not exactly in an effortful way. But I knew that I would be ovulating two weekends ago, and we had unprotected sex all weekend long. I ovulated Sunday afternoon. But it is 8 days past ovulation, and I feel absolutely nothing; the past five times I’ve been pregnant, there have been little signals here and there, even this early on. So I don’t think I’m pregnant right now.

I go back and forth on this question of trying naturally.

My head tells me: Stop this madness. Do not try again. This chapter is over. Move ON.

My heart tells me: As long as you can manage your expectations and reactions (head interrupts: that is impossible) then you should follow your biological urge for as long as you are able to ovulate. Because you still believe that you have a few good eggs in there somewhere, and you still believe, and feel, extremely fertile. You are fertile! You have just been incredibly unlucky when it comes to your body’s random selection of which egg it will ovulate. You might get lucky some month in the future. It has happened for other women in your situation (or worse). It is possible, even the doctors say so. Don’t judge yourself for wanting to try.

And another part of me says: It doesn’t matter what head or heart says—you have absolutely no choice in the matter. As long as there is the possibility of it working out, you will try; you won’t be able to stop yourself. So please stop torturing yourself over this, throw away the condoms, and accept your future.

Lead follicle question

I asked Dr. Schoolcraft if I had lost the egg from my lead follicle, and if so, was my lead follicle egg my best shot at a healthy embryo? I asked this because a nurse had commented that the “lead follicle is usually a good one.”

Dr. Schoolcraft did not concur with the nurse. “There is no way to know which follicles or eggs turn into the best embryos. We extract all of them and don’t know which is which.” He also said that, in any case, he did not think that they did lose the lead follicle.

My embryo grades

I didn’t really understand his answer to this question—I think perhaps I am not familiar with their grading system. He did say that at Day 3, I had an 8-cell, a 7-cell, a 4-cell, and a 2-cell. He said that by Day 5, they had all basically stopped developing.

Donor eggs

Yes, definitely the best next step, according to Dr. S.

CCRM DE program

  • I would have 75 to 80% chance of success
  • The success rate is high because of lab technique; because they invented blastocyst culture and can grow the blasts to Day 5; because they use the highly effective vitrification process (more on that below)
  • the donors are screened for family history, chromosomal disorders, psychology, and genetics
  • CCRM has a pool of about 30 to 40 donors at a given time
  • 90% of donors are turned away post-screening
  • shared cycles are not done because they result in lower success rates
  • it would probably take a few months from the time we started the process to undergo transfer
  • Donor nurses like working with the outside agency Conceivability, but he does not recommend it, in my case, because of the cost. He recommends using their clinic donor pool. (He warned that many outside agencies do not screen their donors properly.)
  •  The cost would be the same as what we have already paid for regular IVF, minus the CCS, plus the 8 or 9 thousand for the donor.

Vitrification

I asked specifically about vitrification because it is becoming clear to me how important this process is.

My first question: “How important is the freezing method to the rate of success of an FET?”

His answer: “Oh, it is crucial.”

(I know that the first transfer is fresh in a usual DE cycle—but if that doesn’t work out, your backups are of course frozen.)

“When I learned about your freezing method,” I said, “I immediately began to wonder: Who else is freezing embryos in this way?”

“No one does it the way CCRM does,” he replied.

He explained that there are about 30 different ways to to freeze an embryo (that should be the title of a poem or something). Clinics buy vitrification kits from outside companies (bizarre), and there are many different kit designs, many different methods.

At CCRM, they do rapid freezing. I had learned at CCRM that this method of freezing eliminates almost entirely the formation of ice crystals inside the embryo. Ice crystals are sharp, and they can fatally puncture a fragile embryo (gah!). At CCRM: rapid freezing, near-zero ice crystals, near-zero embryo stabbings.

Dr. Schoolcraft said that there are plenty of clinics out there that still do slow freezing. Slow freezing produces those problematic ice crystals.

So ladies, be sure to ask your clinics if they do slow or rapid vitrification if you foresee yourself undergoing an FET.

Does my age affect the chance of success in a DE cycle?

Dr. Schoolcraft believes that my chance of success from now until I am about 43 or 45 will be the same. After I turn 45, however, my body will not be as likely to carry a pregnancy to term, even with a chromosomally normal embryo.

What does he think of embryo donation/adoption?

He was very clear that he did not recommend this route at all. “There are no legal guarantees that you get to keep the baby,” he said, “and there have been many lawsuits already. No laws protect you.”

He warned that you do not get to see the family/genetic history of the mother and father. “And you are generally dealing with the embryos of an infertile couple. Not only that, you are getting their leftovers.”

Even if the cycle that produced the embryo was a DE cycle, Dr. Schoolcraft said, “the father is usually older, and there have been quite a few recent studies linking advanced paternal age to autism in offspring.”

The End

For now? I don’t know. I don’t know if this is the end of my relationship with this clinic or not. I am getting a couple of checks in the mail, refunds for procedures not performed—I did not want to keep the money as a credit in my account, waiting for me there, tempting me. Going back would most likely be the most expensive option for us.

But it’s not only that. I was not entirely thrilled with my care there. My first nurse was continually exasperated and annoyed; she eventually left , without letting me know, and she was replaced by someone who was more attentive than her, but not by much. This second nurse actually forgot to tell me to take a certain injection, one night, and if I hadn’t caught the mistake, I would have gone without it.

Perhaps what bothered me the most was the incredibly frustrating process of communicating with staff. Trying to get my questions answered was a nightmare. You are not able to call and speak to a nurse directly, unless you are having an emergency. You must leave a voicemail, and then the nurse calls you back at some point; if you cannot answer the phone when she calls, she leaves you a voicemail. And so on—sometimes we’d play voicemail tags for days. Even if you are able to leave an estimated best time to call, they cannot always call you then, and sometimes, if they are able to call you then, you might not be able to pick up at that very moment (in the bathroom, driving, etc.), and the voicemail tag continues. Also, you are unable to email them. They advertise during the orientation that you can email freely with your nurses using the portal, making question asking-and-answering a breeze, but this is not so. The nurses get too many emails in their inbox and do not have the staff-power to answer them, and so I was told I could not email my questions. Nurses apologized to me, saying, “Our communication process is not yet as sophisticated as we’d like it to be.” They must be going through growing pains, their workload expanding as staffing does not. Or something. But it causes patient-care to suffer. If you have an urgent question, but it is not an emergency, you are left with voicemail tag. And sometimes a question cannot be so easily answered.

Also, I never once met my doctor, Dr. S. I don’t really mind this, but it’s just…odd. He had another doctor sit in for my ODWU. He went on vacation a couple of times. He did not do my transfer.

But all of my phone consulting was with him, which was really helpful. I like having him as my doctor for sure. I do worry about the salesman part of him, selling a product I’d be a fool to pass up, etc. But I also know that, in the end, I did purchase the right product. I probably did have the best IVF experience I could have. If I had tried elsewhere and it did not work, I would always wonder if I would have had better results elsewhere. I know that, in my case, a morphological embryo assessment would not have been helpful, and any transfers based on morphological assessment alone would have resulted in miscarriage—at least in my unlucky January cycle.

And I loved the nurse practitioner who did my IVF physical. I loved the women who drew my blood—they were the most gifted blood-drawers I’ve ever encountered, and they were warm, kind, caring. I loved one of the ultrasound technicians and two of the nurses. I loved Dr. Minjarez, who did my retrieval. I loved the nurse who came to my hotel with a my trigger shot.  I know that as a donor egg recipient, I would not be interacting with these people as much, but my donor would, and I would want her to receive excellent care and instruction.

In any case, I think our next step will be to check out a couple of the clinics in New Jersey. In the meantime, I’ll be sure to write my “Long Island IVF Part 2” post (finally!).

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20 Comments

  1. Jenny

     /  February 26, 2013

    Let me tell about staff at LIIVF, for comparison.

    They run their cycles in batches, which means they would open their clinic/lab for 6-8 weeks for IVF cycles and close the lab again for another few weeks. So they hire temporary staff to draw blood and do ultrasounds during each batch season. The temporary staff are very inexperienced. My arms were bruised from all blood draws. Bruises ran along my veins from top to bottom. They claimed I had “difficult” veins. In my all other 8 IVF cycles done at other clinics (including Quest) I had been always told I had very easy veins to get blood drawn.
    For one of my ultrasounds I had a technician who was seeing the equipment for the first time in her life. A senior IVF nurse came in to teach her how to navigate the equipment with the wand inside me at the time of the “class”! In 15 mins, she could not get to measure even 1 follicle. I was so pissed off, I had told them to have someone else measure my follicles, for which they said they were short-staffed.
    My stimulation cycle was taking unusually long that time because I got over-suppressed while they were trying to delay the start of the cycle to fit me into their busy batch. So, on the last day of their batch, they told me they had to trigger me no matter what because 2 days later they had to close the lab for retrievals. 95% of my follicles were still below 15mm. No surprise, they retrieved 20 eggs of which only 6 were mature!
    On my retrieval day, I had to tell the anesthesiologist where to put the needle in. In his 4 attempts he could not find the place where to insert the needle as my veins were blocked with blood clots from blood draws.
    I had only 4 embryos of poor quality survive to day 3 resulting in BFN.

    I know you said they seemed very caring unlike others. Trust me, caring does not equal professional, skilled, and knowledgeable in this case.

    sorry about all typos above, i am not a native english speaker.

    Reply
    • First off, I am really sorry you went through that nonsense. That sounds like the cycle from hell. I did not know that they run their cycles in batches–and that they force the woman to fit into their batch schedule. Sounds really strange. I have not dealt with a clinic that did not run cycles continuously. I also find it incredible that they did not inform you that they would be using student ultrasound technicians during your cycle—that seems like something you should have had the opportunity to approve or disapprove. You say your expereince was totally different in New Jersey? I would like to hear more about that, and about the difference, if you have a moment…

      Reply
      • Jenny

         /  March 7, 2013

        RMANJ is a CCRM-like clinic on the east cost with high success rates. The processes and technologies are very similar. They also collaborate in many ways including research projects and CCS testing.They are totally computerized when it comes to cycle monitoring (RSNY and LIIVF are paper-based and use obsolete embryo handling technologies). RMANJ are also very well organized with a lot of attention to detail. In addition, at RMANJ, you get your own nurse who you can communicate with by email and phone directly. I highly recommend them.

        I realize you are making abnormal embryos but if you decide to do another cycle, you may want to try using saizen (human growth hormone) to hopefully get more follicles to grow. I have not tried saizen personally so you have to do some research to understand pluses/minuses of using HGHs.

        CCRM were able to achieve much better results than RMANJ for me. So, while I am recommending RMANJ, CCRM Lab is still superior to RMANJ in my experience. Otherwise, RMANJ is better processes-wise.

        Reply
        • this is such great information, thank you very much. i didn’t realize that RMANJ collaborated with CCRM, very interesting. i do not know anything about saizen and will have to look it up. did you say that you went to IVF NJ, as well? i’ve heard great things about them and their success rates are on par with RMANJ. i’d love to hear any of your experiences with IVF NJ, as well, if/when you have a moment.

          Reply
  2. Wow! Isn’t it amazing how much you THINK when you are trying to get pregnant? I know I thought and thought and thought for 8 years! Your post is very thorough. Regarding embryo adoption I have to completely and utterly disagree with Dr. Schoolcraft. Why should you purchase donor eggs when you can get donated embryos for $00.00? Perhaps Dr. S is making money selling human eggs too. I can’t begin to tell you about the many interesting experiences people have had with Dr. Schoolcraft. Recently a friend of mine’s sister came from Central Asia to have IVF at CCRM – $30,000 later, no baby. Of course no one can guarantee you a successful pregnancy. I would like to encourage you to explore embryo adoption. It’s perfectly legal – it is governed by property law in the U.S. There have been NO, NONE, ZERO, NADA cases of a donor parent suing an embryo adoptive parent for custody of the resulting child(ren). NONE. Why should you spend money on creating more embryos, paying the egg donor, etc. when there are perfectly good embryos waiting to be adopted? And let me add, you should follow an embryo adoption plan rather than simple ‘get’ donated embryos from a clinic. Don’t you want to know who’s embryos you are getting? And the donor already has children from the same set of embryos they are donating – proving the embryo viability to some degree. They aren’t ‘just leftovers’. They are embryos created by a family just like you for the creation of children. Now they have all the children they wanted and need to something with their remaining embryos. Why not you? Anyway, don’t dismiss exploring embryo adoption based on Dr. Schoolcraft – he is not the expert in that arena. Google embryo adoption and find out more. You owe it to yourself.

    Reply
    • Yeah, I pretty much figured Dr. Schoolcraft was not exactly the expert on EA, but since I have not looked into the subject much myself (YET! oh, how I need the time for research right now…) I just thought I’d post what he said verbatim and leave it at that for the moment. I do plan on doing my own research about it for sure, as both DH and I are really interested in it as one option. Thanks for your input. Are you doing EA? If so, I would love to hear more about your experience.

      Reply
  3. Jay

     /  February 27, 2013

    Hi. I’ve been reading your blog for a few months. So sorry that it didn’t work out for you. I’m 40 and will be doing my last IVF at CCRM. If it doesn’t work, I’m considering DE but seems like CCRM doesn’t have many Asian donors(I’m half Asian and my husband is also part Asian). Lately I’ve read about quite a few girls that couldn’t get pregnant at CCRM even with normal blasts. In fact I think I read more about failed cycles than successful ones. Sometimes I wonder if it’s worth all the money.

    Reply
    • I hear you. For what we paid to go to CCRM, we could have cycled twice (or even three times) at other clinics. I have worried that I decreased my chances by limiting myself to being able to do only one IVF. I guess I’ll never know 100% if I made the right choice. As for DE, I looked at some of the donor profiles at CCRM online and I have to say that I was not overly impressed with the information provided about and by the donors—it seemed sparse—and the photographs are quite distorted (they are stretched wide, for some reason). I was expecting something a bit more thorough and professional, for what they charge for a DE cycle there. Anyway, thank you for your condolences and I’ll be eager to hear how your IVF goes at CCRM—keep me posted. Best of luck to you!

      Reply
  4. Chris

     /  February 27, 2013

    Interesting answers from Schoolcraft – at least he admitted he was “wrong” about the follicles not producing eggs. I guess I’m not so sure about the accuracy of that – isn’t every cycle different? Also – did you happen to ask about the gluten issue? Curious if he had an opinion on that – seems Western medicine does not relate it to fertility unless you are a true Celiac, but Eastern medicine does. Glad you got some answers – take some time to process them. :) Jenny, are you still pursuing treatments? Did I see a post mentioning an inversion on Chromosome 9 from you? My husband has that and I’m wondering if that is the cause of our failed cycles. His count, etc. is all normal and I’ve heard it’s only speculative that this may cause issues (one or two studies)…

    Reply
    • Yeah, I’m not so sure of the accuracy of info I received about follicles, etc, either! So much of it is a mysterious process and yes, every cycle is different. Dr. Schoolcraft tends to speak more in terms of one cycle being predictive of future cycles, not so much about how they are different. I did ask about gluten but totally forgot to post about it because Dr. S’s response was unremarkable; he said that “no studies have shown any links of that sort,” and that was that. But I think if I get pregnant in the future, either naturally or through DE, I will seriously study this issue and wipe the wheat/gluten out of my diet as much as possible. There was an interesting article in the Times recently about non-celiac gluten sensitivity http://well.blogs.nytimes.com/2013/02/04/gluten-free-whether-you-need-it-or-not/, by the way.

      Reply
  5. Jenny

     /  February 27, 2013

    Chris – yes, i am still pursuing treatments. I just finished another cycle with CCRM and we are waiting for CCS results. CCRM believe that chromosomes of inversion carriers are prone to micro re-arrangements affecting the embryo quality overall. These micro rearrangements can not be detected via PCR based CCS that CCRM do at their lab. So they send biopsies to an outside lab that does microarray based CCS testing, which is more likely to detect micro rearrangements. The outside lab takes 4 weeks to get the results back.
    For me personally, CCRM turned out to be the best clinic of the 4 clinics I have tried so far. I just turned 40 and I wish I had gone here 3 years ago when I just started with IVF treatments. I also would like to point out that despite 9 IVFs and 2 FETs that all failed, CCRM did not turn us down even though they gave us only 30% chance of success. In addition to the chromosome inversion issues, we also have a severe male factor (maturation arrest with 50 sperms in a sample at most). Some people say CCRM only care about their statistics. That is not true, at least in our case.

    Reply
    • chris

       /  April 30, 2013

      Hi Jenny, Wondering how you are doing and how your CCS results were. Did you learn anything more about the Chromosome 9 inversion from them? Dr. S. keeps calling it a “wild card” which scares me….

      Reply
    • chris

       /  July 17, 2013

      Jenny – Wondering if you had any updates on how your CCRM treatments are going. Considering another cycle after a miscarriage and am looking for help in making the decision.

      Reply
  6. I agree with everything Kimberly said. 50% of the embryos available for adoption were created from donor egg or sperm, for the express reason of alleviating the issue with one of the partner’s gametes. Often the donor gametes, or IVF without donor gametes, works so well that way more embryos are produced than the family is able to use! These are not “leftovers”, they were created with the express reason that be loved by, and bring joy to a family. They were desperately wanted so much that a family went to long lengths and spent lots of money to create them. Those same families are now choosing to give their embryos a chance at life.

    Embryo Adoption programs have embryos waiting for families now, while many clinics have long waiting lists.

    Reply
    • Yes, I think Dr. S’s “leftovers” comment was not accurate. I want to look into the ways in which you can find out if the embryo was produced by a DE cycle/donated sperm cycle…do you happen to know how this information is obtained by the recipient? What the scenario is like? Apologies, I’ve done near-zero research on this subject at this point and need to get started.

      Reply
  7. Jenny

     /  February 27, 2013

    To quote: “Currently the law states that adoption only covers the placement of a child after birth. For this reason, legal agreements instead of adoption agreements are used to cover donor embryos. While these agreements are considered binding, they do not not rule out possible legal complications down the road. While no cases have yet been filed by biological parents looking for their child back after birth, it doesn’t mean it couldn’t happen in the future (despite all the legal agreements). Or what if the resulting child is born with a birth defect? The potential for a lawsuit is great, which is why many fertility clinics shy away from offering the service.”

    Reply
  8. In every state in the Union, when a child is born, the name of the woman who gave birth is listed on the birth certificate as the mother. Also in every state in the Union, if she is married, her husband is presumed to be the father, and his name is also listed on the birth certificate. This is precisely why surrogacy is bound by such huge legal contracts and legal issues – because the laws governing Birth Certificates pre-supposes that the woman giving birth is the mother. This is also why many people who have heard of a birth mother changing their mind in a domestic adoption find the security of an embryo adoption to be a huge advantage.

    Even so, in the contracts that are used in the process, the donors do indeed relinquish their parental rights to the embryos.

    In Georgia, it is codified law that you can go into court and get a legal decree of adoption after pregnancy with a donor embryo is achieved, EVEN before the child is born.

    That said, one would need to make sure that they go with a reputable experience agency or donor program – or find a 3rd party reproductive attorney who knows exactly what they are doing. Not all agencies offer legal services as part of their program, I know Snowflakes Adoption Program DOES. And they are more than happy to allow any outside attorney you choose to go over the contracts as well.

    Reply
  9. Very interesting regroup with Dr. Schoolcraft. I agree with the previous comments — that DE aren’t any less viable and certainly shouldn’t be dismissed as “leftovers.”

    Reply

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