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In an Attempt Not to Bias Readers, the Doctor Character Doesn't Get Named until the End. Also: Sorry, This is a Long One

Scene: midday Monday at the offices of The Fertility Institute at Posh Hospital; a slightly nervous couple waits to speak about IVF with a doctor they have never met

Doctor: Hi, nice to see you. (shakes hands) So, why hasn't this worked yet?

Andrea: That's what we'd like to know.

Doctor: Well, we can't tell. You're young. All your numbers look great. You've had a number of mature follicles every cycle. Your sperms counts are fine. But IUIs only give a 17-18% chance of pregnancy. IVF, for patients your age, has a 70% success rate. So I really want to push things. I want to increase your dosage and get as many eggs as we can.

Andrea: But...

Doctor: Then I'm going to say we do IVF with ICSI. (spelling it out and speaking slowly while writing on a chart) That's intra... cytoplasmic... sperm... injection...

Andrea: Yes, we know. We've actually done two IVF cycles with ICSI at a previous clinic. (thinking to herself, "It's all in that fat stack of patient records you're holding; have you glanced at those?")

Doctor: Oh. (glancing at papers) I see that.

Andrea: When we did IVF before, we only...

Doctor: (back to the chart he's writing out) So we're going to run a bunch of tests first, to make sure we don't miss anything and we have the best chance of making this work. We'll do a Clomid Challenge Test, to determine the best dose of medications for you. We'll do some bloodwork to check for antibodies that would fight against pregnancy, and for blood-clotting disorders. We'll do one test - and this one isn't covered by insurance - to check for enzymes in your endometrial lining that would support a pregnancy.

Andrea: Okay, all those tests sound fine. But you should know, we don't want to freeze or discard any embryos. We want to fertilize a small number of eggs and transfer all the viable embryos.


Doctor: Boy, kids. That really, I mean really lowers your success rates to almost nothing. I mean, I understand, I respect where you're coming from. But if you don't give me any out, I can only let you fertilize three eggs. What if they all fertilize? Three embryos is the most I'd be comfortable to transfer, and I can't take the risk of you having more than that.

Andrea: Well, when we talked about all this with Dr. Owlish, he told us that only one out of every five eggs has the genetic material to turn into a viable pregnancy. So he suggested we fertilize 6-8 eggs.

Doctor: Hmm, Dr. Owlish is usually more conservative than me. I can't let you do more than three. What if we end up with four embryos, and you have quadruplets? They'd probably have all sorts of disabilities. They wouldn't be able to take care of themselves, you wouldn't be able to train them. I would haunt you for the rest of your lives. Your lives would be a living hell.

Aaron & Andrea: ... Um, we know the concerns, but our history...

Doctor: I know my numbers. I can't do more than three.

Andrea: Look, we don't want high order multiples, either. But we fertilized four eggs at our previous clinic, and we only ended up with two embryos for a day 3 transfer for our first cycle, and one embryos that barely made it to blasocyst for a day 6 transfer for our second cycle. So doesn't that show...

Doctor: I know my numbers. We're better than your previous clinic. We have much higher pregnancy rates.

Aaron: But doesn't our track record have an influence?

Doctor: Every cycle is different. I know my numbers.

Andrea: So why, if we know fertilizing four of our eggs in the past did not result in four embryos to transfer, would it be different here?

Doctor: Better eggs. Better lab.

Andrea: Well, have you worked with patients who only fertilized three eggs before? What were the results?

Doctor: It runs the gamut. Some end up pregnant. Some don't make it to transfer. We don't have many patients who restrict us this way. I respect your position, but you have to respect that I know my numbers. I can't do more than three. You might be able to find another doctor in this area that would work with you, that would let you fertilize more eggs, but they don't have the success rates that I do. I'm sorry, kids; I know this isn't what you want to hear.

Andrea: (this is going nowhere; let's change the subject) So, we run all these tests during one cycle?

Doctor: Yes. (standing up to leave) So call on day one and we'll get you started.

Aaron & Andrea: Wait! Dr. Owlish also suggested donor embryos?

Doctor: Hmm, that's really rare. Nobody wants to do that.

Aaron & Andrea: more questions...

Doctor: more non-answers... Good luck! (exit)

(end scene)

So, how do you interpret the conversation? We were less than pleased. Whether he's right or wrong about the number of eggs we should fertilize (and I'm inclined to think he's wrong, because we know what happened with four eggs fertilized), he is not the kind of doctor I feel comfortable working with. Though this was the first time we met, he didn't do any introductions and he never addressed us by name. He didn't really listen to anything we said, and he seems far more concerned with his precious numbers than with the individual patients sitting in front of him. I'm trying, with mixed success, not to be angry at this doctor. I'm glad that my confidence is not in doctors but in God, who does hear me. Our plan, at this point, is to go ahead with all the tests (doesn't hurt to gather more information) while researching other doctors in the area and considering our next steps.

Oh, and I think the blog nickname for this particular medical professional will be Dr. Ego.


31 Words

I was tagged by Mustard Seed Baby for this post. The rules state that I should answer each question with one word. I might cheat by hyphenating some!

1. Where is your cell phone? windowsill
2. Your significant other? charming
3. Your hair? wavy
4. Your mother? Dutch
5. Your father? Dutch
6. Your favorite thing? books
7. Your dream last night? none
8. Your favorite drink? properly-prepared-tea
9. Your dream/goal? heaven
10. The room you're in? home-office
11. Your hobby? blogging!
12. Your fear? chidlessness
13. Where to you want to be in six years? here
14. What you're not? extroverted
15. Muffins? blueberry
16. One of your wish list items? this
17. Where you grew up? everywhere
18. The last thing you did? laundry
19. What are you wearing? skirt
20. Favorite gadget? immersion-blender
21. Your pet? none
22. Your computer? laptop
23. Your mood? weekend-ready
24. Missing someone? Wacoans
25. Your car? Ion
26. Something you are not wearing? socks
27. Favorite store? Ann-Taylor-Loft
28. Like someone? Michael Kitchen
29. Your favorite color? green
30. When is the last time you laughed? morning
31. Last time you cried? July?

Consider yourself tagged if you read this and want to give it a try. Happy weekend!


He Knows. He's Good.

"...then the Lord knows how to rescue the godly from trials..." (2 Peter 2:9)

I read that verse on Monday morning, before going in for my beta but knowing the results would likely be negative. That phrase, "then the Lord knows how to rescue the godly from trials," is one full of implicit questions and answers about suffering.

When faced with affliction, most of us wrestle with challenging questions. Why has God let this happen? Why won't God stop this, take this pain away? Can God control the sorrow that batters me? If he can but doesn't, can I trust him?

We need, I need, to hold tightly to two handles. The first handle is God's sovereignty, his powerful ability to control all things in heaven and on earth. Nothing happens apart from his decision. The second handle is God's goodness. Many of us only have a grip on that second handle. I think that, within contemporary Christianity at least, the most common answer to questions about suffering is that God is good and loving and would put an end to all our problems if he could, but, well, he's just not strong enough to do that. I understand how alluring that seeming solution is, but that? Isn't God. And it's ultimately a sloppy sop of comfort. If God is powerful but not good, we're all in trouble. If God is kindly but impotent, our trials are hopeless. But, praise him, he is both! He is King, and he is Love. When I suffer, I have to hang on to both handles of God's sovereignty and goodness, dangling in the paradox of the space between them, mid-air in affliction but sure of the One to whom my soul clings.

The Lord knows how to rescue the godly from trials. I am not stuck in the maze of infertility, following a God who doesn't know the way, can't see around the walls, and keeps running into dead ends. He knows how to get me out. He hasn't yet, but that's not because he takes sadistic pleasure in watching me scurry from bend to bend, corner to corner. It's because he knows the best way to rescue me. That way may be longer and have more twists than I would like, but the path that looks quickest and easiest to me would get me lost. He made the maze, and he'll lead me through it and out of it. He knows how to rescue me, and at just the right time, he will. He is a proven, wise, compassionate rescuer.

The Lord knows how to rescue the godly from trials. He knows, and he's putting that knowledge to good use.


We Called It "The Dress Car." Because It Was So Fancy.

Back in June, I wrote about how my first response to a day full of challenges was, "What next, Lord? Are you going to cause one of our cars to explode?..." Well, it turns out that was a strangely prescient though not altogether accurate thought. Today we found out that one of our cars was in fact on the brink of exploding!

Aaron's car had a leaking tire on Friday. He filled it with that fix-a-flat stuff and drove it home from work, but he noticed that it seemed wobblier than usual. Usual being not-wobbly, except when you go over a bump in the road. So we got a recommendation for a mechanic near our new home and made an appointment. "Brake problems," we thought, "or maybe suspension." Then the mechanic called. The back frame of the car is split in two. "If you had hit one big bump," he said (Hi! We live in the Midwest, where we grow pot-holes as big as Rhode Island! And we had the pot-hole-iest winter ever this year! And many of the roads haven't been fixed yet!) " could have punctured your gas tank and..." FIERY DEATH!!! "We don't recommend repairing the car," he went on to say.

I'm so grateful the Lord protected us from an EXPLODING CAR and FIERY DEATH!!!

Oh, Subaru, mostly green (though Aaron thinks you're blue) except in the parts where you got rusty (and Aaron patched you up and painted you... blue), we'll miss you and your 219,000 miles.

Anybody selling a commuter car for cheap?


I See Phelps's 8 and Raise Him 1

That is, if I can set my nine* failed assisted reproduction cycles against his eight gold medals. It's hard to say which accomplishment required more effort, endurance, and sacrifice.

Today's results were negative, in case you didn't catch that.

I'm disappointed and wondering what comes next, but still in faith for whatever the Lord has in store for us.

I read these words this morning before I left for the clinic, words that I want to be increasingly true of me, words that are being worked in me by God through this lingering trial of infertility:

"Whom have I in heaven but you?
And there is nothing on earth that I desire besides you.
My flesh and my heart may fail,
but God is the strength of my heart and my portion forever."
(Psalm 73:25-26)

*ten, if you count the IUI that was converted to timed intercourse due to an insurance requirement being missed


Accept No Gospel Substitutes!

A couple Sundays ago, Tab preached a most helpful message from Hebrews 9:15-28. You can listen to the message here. The main point was that, when it comes to relating to God, there is no substitute for the gospel, the finished work of Christ. We often think of the gospel as a one-time thing, what brings us to God when we first become believers. But the gospel isn't just the gateway of first-time access to God; it's the gateway for our everyday relationship with God. Unfortunately, we're all prone to substitute other things for the finished work of Christ, thinking we need to add to the gospel or move on to something new. Tab highlighted three "gospel substitutes;" I'm going to focus on two of them.

The first gospel substitute is self-reliance. We think there is something we can do, even have to do, that will bring us to God. Do you ever think that, because you didn't make time to pray in the morning, you can't be close to the Lord or get help from him on a certain day? Or do you think that you have to work up some specific emotion in order to connect with God while singing worship? That's the gospel substitute of self-reliance. That's forgetting that faith is not based on our works but on Christ's work. What's the remedy in those times when we think our relationship with God depends on something we do? We have to go back to the gospel. Jesus appears in the presence of God on our behalf (v. 24); he has a permanent place in heaven securing the way to God. We don't have to do anything to relate to God. We simply, completely rely on the access bought by Christ's sacrifice.

The second gospel substitute is self-atonement. This is the highly insidious belief that we have to make up for our sins before we can relate to God. As if we even could! Yet we give into the lie again and again. Here's what it looks like: We sin; then, we think we have to wait to draw near to God until we've stopped sinning. ("I can't pray for help when I still feel so angry at my husband!") Or, we think we have to wait to draw near to God until we feel forgiven. ("Yes, I confessed that sin to God. But he won't really forgive me and help me change unless I feel bad enough about what I've done.") Don't we all think those kind of thoughts? When we do, we're making our own (in)ability to atone for our sins a substitute for the gospel. What's the antidote? We remind ourselves that Jesus has appeared once for all to put away sin by the sacrifice of himself (v. 26). His once-for-all sacrifice leaves no room for any extra sacrifices we try to make to pay for our sins. What joy and freedom this good news brings!

I'm so glad to be at a church where I hear the regular call to accept no substitutes for the gospel. I've needed these truths during a busy season of moving, infertility treatments, and family visits. I'm going to continue needing these truths every day of my life, so that I can keep growing in the grace to rely on Christ and not myself.


Mixed Messages

Last Wednesday, I visited the clinic for a post-IUI scan of my ovaries. The first time I did an IUI at this office, the nurse told me that the purpose of the ultrasound was to see if I was producing enough progesterone. If the ovaries measured above a certain size, that indicated sufficient progesterone production. If the ovaries measured smaller than the desired size, then an HCG booster shot would need to be administered. The nurse I saw this past week gave me a completely different interpretation of this scan and its purposes. According to her, my enlarged ovaries mean that I am slightly hyper-stimulated and that it is not safe for me to take the standard-protocol HCG booster. So according to the first explanation, a bigger ovary measurement is a good thing; way to go, ovaries, no more HCG needed! But according to the second explanation, a bigger ovary measurement is bad news; sorry, no more nice HCG for you. Which is it? I don't know. How much affect does it have on the ultimate outcome of the cycle? I don't know that either. But I'm content to wait and see; I go in for the beta on Monday.

"But as for me, my prayer is to you, O Lord.
At an acceptable time, O God,
in the abundance of your steadfast love answer me in your saving faithfulness."
(Psalm 69:13)


Learning How to Use My "New" Oven

I declared the pork done when it caught fire.

Had I but Internet Enough, and Time

Faced with technical difficulties (a dysfunctional laptop, an Internet connection that spontaneously swapped its user name and password with another account to the bafflement of the good people at tech support) and a full schedule when I wasn't trying to straighten those issues out, I was unable to post last week. Over the next few days, I plan publish the things I wanted to write last week, from the frivolous to the medical to the spiritual, in no particular order.


Laissez-Faire Attitude Exhibit B: I Took My Trigger Shot an Hour Late on Friday and Didn't Get Anxious about It

Thanks to those who prayed for our IUI yesterday morning! The Lord mercifully caused things to go quite smoothly, despite the fact that we were exhausted when the alarm sounded and not eager for the whole IUI process. We didn't have as rushed of a morning as we often experience on IUI day. We made it to the clinic with ample time, and we were even seen early, which meant we could make it to church.

In keeping with my new, accidental laissez-faire attitude toward this cycle, I didn't pay too much attention to the report of the sperm counts for the IUI. They gave me numbers, but I honestly couldn't remember what the ranges are for good motility and post-wash count, and I didn't feel like asking. So the numbers were just... meaningless numbers. I started to look up the information this morning, then I decided that I didn't really have time to search around. Yes, knowing what kind of counts we had for this IUI might give me some idea of what to expect, but simply knowing the numbers and statistics won't affect the outcome of the procedure. So I'll just wait in blissful, distracted-by-settling-our-home ignorance.

As we sang yesterday morning in church:

We offer our lives to proclaim
What a Savior!

Anything can happen with this IUI, as long as it results in a proclamation of the greatness and kindness of Christ.


I Probably Didn't Really Have Time to Re-Write Showtune Lyrics, Anyway

At this morning's follicle check and blood draw, the nurses thought I would likely be on Follistim and Repronex for another day, back for blood and ultrasound tomorrow, then probably scheduled for a Monday IUI. I had run out of Repronex, so I had to "borrow" some from the clinic in case I needed it tonight. On my drive home, I began composing alternate lyrics to the Les Miserables tune, "One Day More," to post as a description of the pending plan. I could hear the different sections - me, the patient, in place of Valjean, the nurses in place of the Thenardiers (no insult to the nurses intended; their instructions just fit the rhythm) - joining in a glorious, swelling medley of assisted reproductive technologies. When I stopped to fill up the tank of my car, I was trying to think of rhymes for "ovary," "Follistim," and "Repronex" - not an easy task. I filed the idea away to come back to after work.

Then I checked my patient voicemail box, and found out that the doctor actually wants me to stop meds, to take the HCG trigger shot tonight, and to come in for the IUI on Sunday. So much for my new Broadway hit! Please pray for us on Sunday morning.

(For those who like the numbers, here's the run-down: two 17mm follicles on the left, a few 13s on the right, and E2 at 1023.)

(Also, it bothers me that I don't have accent marks in the proper places for all the French words and names, but I don't have time to figure out how to do that right now; please imagine little slanted hash marks.)