We had our IVF consult with Dr. Peppy yesterday morning, and it went pretty well. I had previously mentioned to her our preliminary concerns about doing IVF in a way that suits our conscience, and yesterday Aaron and I were able to talk about wishes out with her more clearly. She understands that we do not want to freeze or discard any embryos, and she will work with us to comply with our desires. She e-mailed the embryology lab to find out how many eggs we ought to fertilize to end up with 1 or 2 viable embryos to transfer, and I'm supposed to follow up with her next week to find out the response. Dr. Peppy's guess was that we ought to attempt to fertilize 3 or 4 eggs, which is in line with what Aaron and I anticipated. With an 80% fertilization rate, trying to fertilize 3-4 eggs should yield the targeted 1-2 embryos. (It is so strange to talk about the creation of life in terms of such statistics! I'm thankful that new life is really in the hands of our sovereign God, and not dictated by percentages.) We asked if the clinic would allow us to transfer back 3 embryos if we ended up with that many, and Dr. Peppy seemed pretty adamant that the clinic would not want to transfer more than two embryos, since I am under 30 and this is our first IVF. She didn't rule it out completely, but she copied the ASRM (American Society for Reproductive Medicine) guidelines for us. We also asked if they would be willing to transfer back non-viable embryos (ones that have stopped growing, no cell division) along with the viable, growing ones. Basically, we thought we would be more comfortable letting the non-viable embryos at least have a chance in the uterus, and we figured it wouldn't make a difference to the medical professionals whether those embryos languished in a petri dish or in my womb. However, Dr. Peppy said that is not an option, because transferring back non-viable embryos might interfere with the implantation and growth of any viable embryos. I feel okay with that, since a non-growing embryo is not really alive anymore, and we would not want to harm or hinder the embryos that are alive. The beginnings of life are so mysterious, but all we can do is operate on the principle that life begins at conception and trust God with all the miraculous minutiae.
Dr. Peppy said two things at the consult that particularly surprised me. One is that the lab might use intracytoplasmic sperm injection (ICSI) to fertilize our eggs. I thought that ICSI was normally reserved for more extreme male factor infertility, but I guess our fertility center uses it pretty much interchangeably with the more standard practise of allowing fertilization to happen "naturally" in the petri dish. In fact, Dr. Peppy said they could even do a 50/50 split between ICSI and standard fertilization. I had no idea that was ever done! The second surprising bit of information is that our odds of success are not lowered by the limited number of eggs we are allowing to be fertilized. I thought that surely Dr. Peppy would rescind her prediction of a 50-55% success rate for our IVF. But apparently that statistic is based on our ages and on transferring 1-2 embryos, regardless of the number of eggs fertilized. Pretty good news, I thought!
So after the consult, here is our IVF plan:
I continue birth control pills until April 22, then I will start Lupron shots for about 10 days. On April 16, Aaron and I will get an hour-long lesson on all the new injections from Nurse Answers. April 20, Dr. Peppy will do a mock transfer and saline sonogram on me. Sometime around the beginning of May, I will start Follistim injections to stimulate ovarian production, and I will go in for monitoring (ultrasound & bloodwork) approximately every other day. Once the follicles look ready, I'll take the Ovidrel trigger shot. All of the eggs will be retrieved, the lab will attempt to fertilize 3-4 of those, and hopefully we'll have 1-2 embryos to transfer back a couple days later. Then I will start daily progesterone-in-oil (PIO) injections while we wait two weeks to find out if any transferred embryos actually implanted to result in pregnancy.
If you didn't catch all that, don't worry - I'm sure I'll share plenty of details about each step along the way!