The Plan

We met with the doctor yesterday to discuss the results of our tests, and the plan. As expected, my high FSH predicts a lower chance of success with IVF. According to the doctor, if the number had been normal, our chances of success in one cycle would be about 70%. With my FSH between 12 and 13, success drops to about 55% at their clinic. This number still seems pretty good, but it is weird to spend all this money, time, effort and emotion for something that is as likely as a coin toss. I don't like those odds. But then again, even if she told me the odds were something like 30%, that's still better than the likelihood of having it work out on our own. I guess it's all about setting expectations.

We also talked about what may have caused the decline in my ovarian reserve at the ripe old age of 28. For most people, the reason is never known, even when they look for a reason. But there are a few genetic causes that account for a significant portion of this population. The highest percentage of genetic abnormalities can be attributed to something called Fragile-X syndrome. This is typically thought of as a genetic disorder causing mental retardation in boys. It is an x-linked triplet repeat abnormality. So little boys who get a mutated x chromosome from their mother (the father passes a y to boys) will have mental retardation if the mutation has >200 copies of the extra piece of this gene. If they have less than 200 copies, but it's still more than normal, then the boys can have autistic features or can have psychiatric problems. Girls, on the other hand, have 2 x chromosomes, so they don't get mental retardation usually. But instead they get ovarian insufficiency.

If fragile x syndrome were indeed the cause of my problems, I would not want to pass it on. So I rolled up my sleeve and my blood is now somewhere en route to be processed and my genes examined. I'll know in about 3 weeks. It seems unlikely, but too important not to find out.

So the doctor has this whole plan for how to change up the IVF regimen from what I did last time. I won't get suppression with birth control pills or lupron, which is good because the lupron caused me to have a migraine EVERY SINGLE Day that I was on it. Instead I'll take estrogen supplements for a few weeks before starting the stimulation. Then I'll be on FSH agonists and LH agonists, at pretty high doses. In fact, the look on the doctor's face when she said "Really High Doses" was a little scary... Then, instead of Ovidrel to stimulate ovulation, I'll take a combo of Lupron (hopefully just a short course) and Beta HCG concentrated from the urine of pregnant women. This last one smacks of some sort of witch doctor magic, but at least I understand the reason behind it. I like a little irony though.

I'll start all of this next month, with April being the month where the big stuff happens. If all goes to plan, we'll have a pregnancy test at the end of april/beginning of May. The timing is tight with me starting residency on May 22nd, but at least it will provide a distraction regardless of what the outcome of the IVF is.

So last night I sat in our tiny bathtub, sunk up to my neck in steamy hot water, and began mentally preparing myself for this battle. I wish I could think of it not as a battle, but I know that it will wreak havoc on my body and my mind, and possibly my soul.
Part of me thinks this is a foolish fight. There is a saying: "If you want to hear God laugh, tell Him your plans." If this is true, then I should send God a bill for all the good rolling laughs he must be having these days. But then again, "The Lord helps those who help themselves." How do I balance these things? My plan was so perfect. I knew that many women in medicine put off having children until it is too late, waiting until residency and fellowship are finished and they have established a career. But I didn't wait! I planned a year off to be able to stay at home with a baby. I tried so hard to avoid the craziness that must certainly be pregnancy in residency and all too short maternity leave. But in the end, I feel I don't really have control.

Maybe preparing for a battle is not the right analogy. I am preparing for a wild ride. A ride where I just need to hold on, and hope. Hope that in the end I at least have my sanity and my marriage, and maybe a little something more.