next steps

DH and I attended a conference yesterday with our RE and a consultation with one of the nurses to discuss our options after our first round of IVF resulted in a BFN.  We have the choice of a) starting our first FET cycle right away, b) taking some time off before continuing with FET, or c) stopping treatment altogether and cancelling our contract with ATTAIN.  It was a no-brainer for us; we chose to a) start FET right away.

The nurse instructed me to start BCPs again before our consultation yesterday so I've been taking the loathsome things for seven days now.  She actually wanted me to start the pills last Saturday, which was CD3, but I felt I needed more time to, as she put it, bleed some more.  So I started them on Sunday.  As it turns out, that was perfect timing because the plan is to take my last BCP on September 1st.  If I hadn't delayed taking them for one day, I would have had to buy another pack just for that one day since there aren't 22 active pills in a pack.  I'm so smart.  ; )  During our last cycle, the nurse told me I could delay taking the BCPs by a day or two if I felt I needed to (which I didn't) so I just took the advice for this cycle instead.

The person in charge of scheduling put us down for a one-hour conference with our RE at 9 am yesterday; we were done in 20 minutes.  He talked with us about:

• Why our last cycle didn't work when we had such a great embryo:  My uterus may have been too "jazzed up" from the meds during our last cycle and we may see success with this cycle because some embryos may prefer a more normal uterine environment as opposed to a "jazzed up" environment.  Since I will be on fewer meds this cycle, my uterus should be less jazzy.  Or there may have been a genetic issue with our embryo.  But there's no way to know that for sure without genetic testing prior to transfer, which we didn't do because there is a long waiting list and it's another $5,000 out of pocket.  But we may consider it in the future if we continue to experience failed cycles.
• How many embryos we would like to thaw for our next cycle:  I say two, DH says one.  But I wanted two last time and he wanted one and we transferred one.  So now I think it's time for two.  Our RE said we have four level 2 embryos and four level 3 embryos that are currently frozen.  He said if we want to transfer two embryos, they will start by thawing two level 2s and will know within minutes if they survived the thaw.  Then they will work their way through the remaining level 2s and onto the level 3s if necessary.  I'm praying the first two are like He-Man and She-Ra and are super strong and survive the thaw!
• Pregnancy rates based on the quality of our frozen embryos and how many we transfer:  I don't remember the specifics; the numbers weren't significant enough to change my mind about transferring one embryo vs. two.  Ooh!  But I do remember something about the twin rate being 51% if transferring two embryos, but that statistic was for a fresh cycle and not a frozen one.
• Any additional questions we had:  I asked about my uterus and if there could be a problem with embryo implantation because I begin to feel cramps EVERY month the same day I ovulate and that it continues until AF arrives.  I wanted to have a clear answer as to whether it made a difference if the cramping was in the uterus or the fallopian tubes.  The RE who did our transfer (not our regular RE) indicated that cramping on the side (in the fallopian tube area) was normal even though I had specifically asked him about cramping in the uterus.  So I wanted to clear up the confusion on my end.  Our RE said cramping in the uterus or fallopian tubes does not appear to be a factor in implantation because he's had many patients become pregnant over the years who reported the same symptoms.  He also said he can't wait to call and tell me about my positive pregnancy test and say I told you so.  I can't wait for that either.  : )

The main thing I took away from our conversation with our RE was how positive he was that this will work for us and how shocked he was that our last cycle failed.  I suppose he has to be positive in this line of work, but it still made me feel great to hear it from him, the expert.  :D

Our nurse consultation wasn't supposed to start until 10 am but since we finished talking with our RE so soon, he was able to get us into our next appointment by 9:30.  Our nurse consultation was supposed to take an hour also, but I'm not sure why - we were done in about 15 minutes, and that included speaking with the financial consultant.  I can understand the RE conference and the nurse consultation taking an hour each for a first time patient but we'd already been through a cycle so we pretty much knew what to expect.  Plus they sent us material in the mail to read before our appointments so we were well prepared.

The nurse went over my new medications and when to take them.  She faxed in my prescriptions and gave me a copy.  She also gave me a copy of our calendar and we discussed important dates.  I will start my Lupron injections (20 units) on August 29th; it will overlap for four days (like last time) with my BCPs.  I will have an estradiol check and u/s on day 10 of Lupron (September 8th).  I will also start 81 mg of baby aspirin and 2 mg (1 pill) of Estrace on September 8th, and reduce Lupron injections to 5 units.  On September 13th, I will start taking Estrace twice a day - once in the morning and once in the evening - and continue with the 5 units of Lupron.  My dose of Estrace will be increased to three pills a day - morning, lunch time, and evening - on September 17th, and that *should* also be my last dose of Lupron (still 5 units).

I will have another estradiol check on day 14 (September 21st), along with an u/s to make sure my ovaries are still "quiet."  I should not ovulate in September, the Lupron will make sure of this, since we already have embryos to transfer.  If everything goes according to plan, my frozen embryo transfer will occur on September 27th.

How will I survive that long and still manage to keep my sanity??  Oh how I wish we could fast forward to that day!

Oh, and the financial consultant printed off our records and asked us if we had received a bill in the mail yet for the cryopreservation fee (we had not).  So she gave us a copy of what would be due and said we can pay it today or wait for our bill to come in the mail.  Did I mention it was for $1,000?  Yeah.  We'll wait for the bill.  She explained the fee covered one full year of frozen embryo storage no matter how many embryos we have and that if we need storage after one year, the fee would be reduced to $276 every six months.  They did tell us about these fees up front before we even started our first cycle but it's much more of a shock when the bill is right there in front of your face.  Time to update "the numbers" tab!  : (