Epilogue: The Retrieval and Beyond

I'm writing this entry almost three years later.  Many of you have asked why I stopped writing-- read on for the explanation.  

The Retrieval
So on Monday, August 1, 2011, I went in for egg retrieval.  I've been in hospitals before for minor surgery, and I have to say that this was a relatively pleasant experience by comparison.  When I showed up at 8:30am, I was led to a quiet locker room where I changed into a gown.  I read US Weekly on a gurney until it was time for the anesthesiologist put me under.  Next thing I remember, I woke up and it was all over.

I felt no pain, just slightly groggy from the anesthesia.  My mom picked me up from the clinic and helped me home (as with all surgeries, they require you to have someone pick you up).

I had no pain from the surgery itself, and was back at work the next day (working from home because I could), but I was extremely hormonal for about three weeks afterwards.  I felt emotionally all over the place, plus I was bloated for weeks afterwards.  I finally got my period two weeks later, and it was a doozy.  It was a full month before I felt "normal" again both emotionally and physically.  I do want to point out that I get pretty PMS-y to begin with, so I probably had a greater propensity to be affected by the hormones.

I got misinformation during my initial training and from the on-site nurse the day of the procedure-- I thought they'd call me the next day to let me know how many eggs were retrieved.  However, when I emailed my usual nurse for the results, she told me that I'd find out either by letter from the RMA embryologist or from my doctor when I had my follow up appointment with him.  What follow up appointment?  Apparently I was supposed to schedule a follow up but no one told me.  The earliest he could see me was over two weeks later (August 17).  I was very annoyed, but what could I do?

Tip: If the office allows it, schedule your follow-up appointment with your doctor prior to your egg retrieval in order to get a timely slot.

The Results
About a week later, I received a letter in the mail from RMA with my results.  The letter said that they retrieved 11 eggs but only froze 10.  It included a little photo of my eggs, which I thought was a bit odd.  It was like a sonogram but waaaay less exciting.  Still, I examined it with a gross fascination-- these little guys came from inside of me and are now sitting on ice somewhere at RMA waiting to be fertilized some day.

Here's the picture of my little eggs (I added the yellow text myself, which will be explained later):

Though I had the letter in hand, my appointment with Dr. C was still ten days away.  I was frustrated.  I had a letter I did not understand and a mildly disturbing photo of my eggs (the M3's looked baaaad) and the explanation still ten days away.  I called one of the nurses asking for an explanation of my results, and I was shocked that Dr. C actually called me back the same day.  I had hardly seen him throughout my entire process, and the nurses seemed to be the first, second, and third lines of defense whenever I had any questions.  We had never spoken for longer than two minutes after the initial consultation.  On the phone, he was all, "Hey.... why didn't you just call me if you wanted to speak about this sooner?"  I wanted to strangle him.

So Dr. C told me that while 11 eggs were retrieved, they only froze 10 because the eleventh was far too immature.  Of the 10, five were fully mature (M1), two were less mature (M2) but had a good chance of being stimulated to maturity, and three were "M3", meaning they were pretty immature and it was uncertain whether they could be used, but they froze them anyway because they might get decent results.  (I mean look at the M3's-- they inspire no confidence that they can become healthy embryos.)  Dr. C admitted that while retrieval of 10 to 12 eggs was expected, he was hoping we'd get more M1 eggs (like seven or eight).

I was crushed.  I understand that every woman responds differently to treatment and that there are no guarantees, but I felt misled.  I underwent this procedure in order to preserve my fertility;  I realized too late is that one good cycle is probably not enough to really do the job.  Here's why:

A good result from one cycle is retrieving eight to ten M1 eggs.  But even with ten M1 eggs, the "fertility funnel" (I totally just made up that term) narrows the number of chances of having a baby:

• Not all eggs survive the thawing process (I'm seeing survival estimates of 80% to 90%)
• Only some of the eggs that survive will get fertilized (I'm seeing estimates of 75% to 80%)
• Only some of the fertilized eggs actually progress to embryo stage (30% to 50%)
• Then there's the matter of successful embryo implantation (they usually transfer two to three Day 5 embryos with the hope of getting one pregnancy, so I'm estimating 33% to 50% odds)
• Carrying the baby to term (~85%, though highly dependent on the individual)

This means that with ten eggs, you may have only one, maybe two, good shots at having a baby-- or maybe none at all, if you are just a little unlucky at any stage of the elimination process.  You really need 20 or more good, mature eggs if you want good odds of having a baby, and even more eggs if you want multiple kids.

I only have five good eggs (seven, if you count the M2's).  There's a good chance that after all this, I might have nothing.  This is why I stopped writing the blog.  I was so disappointed with the results and I just couldn't think about it for a while.

I don't know if all clinics are glossing over the fact that one cycle isn't enough or if it is my particular doctor who was remiss.  But if I had this information going, I might have been better prepared for my results and I probably would have prepared to undergo two cycles within a matter of months.  I highly recommend that if you plan to undergo this procedure, you have a very frank discussion with your doctor about whether one cycle is really enough.

When I went in to see Dr. C on the 17th, I asked him why my yield was so low given that both my ultrasound and hormone levels indicated that I should have good results.  The main question I had was whether it might be possible to improve on these results if I were to try again?  For the first time ever, he dropped his facade and seemed almost as disappointed as I was.  He said that with the information he had now, he would have prescribed a different cocktail of hormones, and that he would have stretched out the cycle longer to encourage follicle growth.  It made me feel better that he was being really honest with me about the fact that the course of treatment he had tried just didn't work as he'd hoped-- and it also shows you how little the doctors know about whether and how well an individual will respond to a certain course of treatment.

Although I'm disappointed by my results, I am hopeful that if I do ever need to use these eggs, medical science and technology will have improved enough that the "fertility funnel" grows wider, and that my little eggs have better odds at every stage.


Now What?
Immediately after my procedure, I briefly thought about undergoing another cycle but decided against it.  For me, the experience left a bad taste in my mouth and I was emotionally exhausted.  It wasn't just the disappointing final results;  I found the entire process frustrating.  The office felt like a factory (which I'm sure is not unique to RMA but all fertility clinics).  I got conflicting information all the time, on everything from cost estimates to how long my treatment would take to the types of medicine I'd be taking to how and when I'd receive my results.  Also, there was something about the twice daily shots that made me feel very isolated, and as the days wore on, I had the distinct feeling that I was trying to cheat nature or something.  And then there is the matter of the cost.  At the time, I thought it was a better investment of my time and energy to make a real go of finding meaningful relationships, remain healthy, etc.  I was only 34 at the time, after all.

Now I'm 37.  Almost three years and two relationships later, I'm still single, and single motherhood is now a very real possibility.  I've set a mental deadline of revisiting motherhood when I'm 38, the reasoning being that even if I do decide to try to get pregnant at 38 (assuming I do get pregnant), the kid wouldn't come along until I'm 39, and I might want a second kid.  The idea would be to use whatever eggs are left in my body and use the frozen ones as backup.

But now I'm thinking about freezing one more time.  It still nags at me that while I have some frozen eggs, there probably aren't enough to really "preserve fertility".  Could I get better results the second time around?  Even if my results are the same as the first, I'm doubling my chances, right?  I probably wouldn't have thought of this on my own, but a friend of mine recently decided to freeze her eggs, and I recommended Dr. M at RMA, the doctor who performed my Day 7 check-in.  She's having a good experience with him so far, so maybe there is hope for a better experience.

On a related note, I want to point out Jean Twenge's article about the female fertility in The Atlantic-- she says that the widely accepted notion that female fertility declines precipitously in her 30s is a myth.  This might explain why my friend had her first kid at 40 and is now preggers with baby #2 at 42-- with no reproductive intervention.  Most other women I know who have wanted to get pregnant in their late 30s and early 40s have been able to.  I'm wondering if others are seeing the same trends I am?  Would love to hear thoughts.