Who Says You Can’t Come Home Again?

We had our Homecoming at New/Old clinic yesterday. Bill and I are both thrilled with the plan we have developed and also the stark difference in bedside manner and genuine caring we received from every individual we interacted with, especially our doctor.

I must confess that it was only six short months ago that I was angry with this clinic. I never stopped loving our doctor or nurses, but our last cycle was tough. We had a difficult transfer, lost 4 embryos total in the freeze/thaw process, and ultimately had a miscarriage. It was time for us to try something different and we did, even though I had a nagging feeling that I shouldn’t leave a team of nurses and doctors who understood me, my body and my history so well.

Over the years I have gone back and forth on the importance of beside manner. Does it matter? Do I care whether my doctor is nice to me, or for that matter even takes a moment to speak to me, as long as he gets the job done?

As it turns out, yes. It does matter to me. I want a doctor who listens to me, who has obvious passion for our joint objective, and who appreciates the power he has to eliminate stress in one aspect of this intense process.

I have that in New/Old clinic and it was clear yesterday.

First, rather than spending only 4 minutes with my doctor, we spent more like 40. Surprisingly, he put his ego completely aside and reviewed with me every aspect of my cycle with Celebrity Miracle Clinic. We discussed what we liked and didn’t like and adjusted our plan accordingly. There were a few things he said “no” to putting in the plan, but when he did he justified it with studies and science.

One example of this is intramuscular injectable progesterone. He agreed to let me do less painful suppositories, but only after I am pregnant. Studies show an ever so slight but still meaningful increase in pregnancy rates with injectable progesterone because suppositories can cause cramping and the implantation threatening uterine contractions that come a long with it.

We were most pleased with how much we accomplished yesterday and how flexible the clinic was in making it happen. Our appointment was only for a consultation, but when I told our doctor that I had a cyst since February that hadn’t budged despite being suppressed the whole time, he immediately squeezed us in for an ultrasound. When we saw that the little booger was too big to ignore, we weighed the options and decided to drain it in a painful but quick procedure. They made this happen even though is wasn’t “in the schedule” and it was late enough in the day we would likely be keeping the entire office there well past closing time.

To prepare me I was given a high powered antibiotic and 800 mg of ibuprofen. Because both could upset my stomach I was given crackers and juice. When I told the nurse I was gluten-free, she was clearly ready to check with the entire staff to see if there was anything they had in their personal stashes that I could eat. I told her that I thought it was a good excuse to break the diet and that it had been months since I had Cheez-its so not to worry.

When she left the room my husband turned to me and said “She is going to go ask everyone here if they have anything you can eat. The other clinic would have sent us to their kiosk down the corridor from their big beautiful waterfall and wouldn’t have given a damn.”

While I am not sure that is true, the point is we feel like this clinic really cares about us. Our doctor cracks us up because after decades in the business he still is obviously super geeked about advances in ART technologies. He doesn’t talk down to us and also recognizes the value of our opinion. But most of all, we are so impressed that the clinic recognized how far away we were from home and did what was necessary to remove the cyst rather than having us come back, or worse, waiting another month or two to see if the cyst went away on its own.

That just couldn’t have happened at Celebrity Miracle Clinic because access to the doctor is too limited and the clinic is too big to be that nimble.

So as you can tell we are pleased with our decision. While it may have taken more green to prove it, the grass is not always greener on the other side. And even more importantly, we are excited about our plan and even a bit surprised by some of the changes we made. Here it is in short form. As we progress through it I will pick it apart and explain the “why” behind some of what we are doing in more detail.

1) Stop birth control on April 16th and start maximum dosage of stimulation meds on April 18th. I love that we aren’t wasting any time and that we are beginning with the highest dosage to enlist as many of my resting follicles as possible. I will take 150iu of Menopur in the morning and 300iu of Gonal-F at night to stimulate growth of the egg yielding follicles in my ovaries.

2) Begin taking Omnitrope, a name brand of growth hormone, when I begin stimulation medications. I will inject 24iu a day during the entire time I am stimming. Studies show that this can improve egg quality in older women. It is theorized that because naturally produced growth hormone decreases as you age its decline may cause quality issues. Sample sizes are small for these studies but results are promising.

3) Use Cytotec to soften the cervix due to my difficult anatomy 7-10 days prior to transfer. The doctor also scheduled the transfer at a time that he was sure to be the one to do it since he knows our history with difficult transfer. We will also check my bladder level prior to going back for the procedure since it has been a problem for us in the past.

4) Inject HCG into the uterus the day prior to transfer to increase implantation rate. Studies have shown that growth factor injected into the uterus prior to transfer increases implantation rates.

5) Use time lapse photography to take snapshots every 8 seconds of the first two days the embryos are developing to rule out embryos that are not developing properly and are likely aneuploid (abnormal number of chromosomes). While this is not as accurate as genetic testing, it works to accomplish the same outcome while not damaging the embryos.

6) Assess on day two of embryo growth whether we freeze all the embryos or proceed with a fresh transfer on day three. This was a surprise. I thought we had ruled out a fresh transfer but both my doctor and my husband want to proceed with a fresh transfer if we have a number of good embryos. We will prepare my body for a fresh transfer and make a game time decision. I am as nervous about this as I am excited because it means I may be pregnant the first part of May, the same month I conceived Spork.

I feel like with this plan we are doing as much as we can to give this cycle the best chance of success possible.

We spent the entire afternoon building this plan and removing the cyst which could have been a taxing and exhausting experience.  But it wasn’t. If anything it was invigorating. We accomplished so much in one afternoon, removing all obstacles and setting up our plan of attack. It wasn’t taxing at all because we weren’t in some sterile, cold, and beautiful mecca of fertility where our doctor was kept safely behind a curtain.

We were home.