next steps

A couple of weeks ago we had our post-IVF consult with Stein.

The most striking thing about this visit is that we were called promptly.

Ironically, J. and I actually planned that he’d arrive 45 minutes late, mostly to accommodate his work schedule, but also so he wouldn’t spend an hour seething about the interminable wait.

So J. missed the bulk of the visit. But I’m the one who does all the talking anyway.

Stein was in his most relaxed and empathetic form. He even apologized at one point for interrupting me. Maybe he felt sorry for me.

In a moment of particular weakness I even thought: Maybe I’m his favorite patient! Maybe I’m THE ONLY ONE that Stein ever apologizes to when he interrupts!

Stein and I talked about a journal article that he’s about to place, on the manipulation of fertility clinic success rate data. He printed out a copy for me. It’s an issue that clearly gets his goat, and probably with good reason.

Every patient and her mother is obsessed with finding a clinic with stellar success rates – I can’t tell you how many friends have tried to refer me to “the best RE clinics” — but few ask how many difficult cases, as Stein calls them, were rejected from the clinic’s caseload to secure those success rates.

Stein seemed to appreciate that I understood this problem. Next time I will be sure to ask him where the article was placed. Maybe I should even read up on the issue and ask him a question that indirectly showcases the depth of my knowledge.

But here’s the real outcome of the visit: we’re doing another IVF cycle in January with some slight tweaks to the protocol (step down instead of step up, for those of you who are unfortunate enough to know the difference).

Everyone asks me why the first cycle didn’t work. No one knows for sure, but here’s a tidbit of useful information: in the majority of unsuccessful IVF cycles in which the embryos and uterine environment appear to be in top form, the problem is with the chromosomal makeup of the embryos.

The way to investigate this possibility is to do genetic embryo testing which costs several thousand more dollars.

Stein suggested we set aside that option and give IVF another go.  So that is what we are going to do.

If testing eventually shows that our embryos are unfit for victory, I guess an egg donor would be the next semi-biological option.

On the question of options, check out this Dec. 11 Wall Street Journal article, Assembling the Global Baby, which profiles a concierge firm, Planethospital.com, that helps (mostly western) couples compose a child with gametes and surrogates from around the world.

I’ll write more on this later, but here’s a quick musing:

There’s a lot of debate about the increasing use of paid surrogates, particularly in India, where the practice has been actively cultivated by the government. (See, for example, this article in the NY Times.) Academics and others make excellent points about the exploitative aspects of this, but the limited stuff I’ve read doesn’t give insight into how the surrogates would like to see the practice reformed.

I mean, would they prefer a collective bargaining agreement over banning the practice altogether?  I’d be curious to hear from people who know more about this.

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One Response to “next steps”

  1. I’m so glad you’re moving forward with another cycle. I’m really really hoping this is the one for you. There’s never a reassuring answer as to why a cycle fails. You just have to play again and remember that the odds are on your side.

    As for SART results, there are indeed many many clinics who cherry-pick their patients, while other clinics take on more difficult cases and as a result might not have as high. Please do post the article when it’s published.

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