Saturday, July 25, 2009

Oh God, How Do I Make this Decision?

Five eggs. Four embryos. And my RE wants to put them all back.

And I’m completely freaked out by this.

We put four back last summer, but they were fertilized with J’s sub-par sperm, not with commercial super-sperm. And we ended up with a not-surprising negative beta.

My RE says that she doesn’t think the risk of multiples (beyond twins) is very high. Which, by the way, makes me kind of sad, because it means that maybe we’re not changing things SO much by going to donor sperm—maybe my chances of getting pregnant, even with a donor, aren’t as high as I thought.

I am so unbelievably torn. On the one hand, this cycle was pure hell (still is). And it was Cycle #5. I don’t know how much more of this shit I can take before I crack, or my body gives out completely. I REALLY REALLY REALLY NEED THIS TO WORK. Obviously, putting back four embryos greatly increases the chance of it working.

On top of all that, even assuming all four are capable of becoming bona fide fetuses, how much of that chance do I lose by freezing a couple of them? I know that a fresh cycle is a lot more likely to succeed than an FET. So what if we just transfer two, it doesn’t work, and then the FET on the other two doesn’t work because they didn’t do well with the freeze/thaw process?

And I would like twins. Yes, yes, I’m sure that if I actually have twins a year or two from now I’ll be wondering how it was possible that I ever wanted twins. I know they’d be so hard to care for as babies. But I want more than one child, and twins are my only shot at that. We put back four, there’s a higher likelihood of twins.

BUT, on the other hand:

Triplets? Quads? Reduction? Two and a half years ago, when we did our first IVF, when J and I decided to put back three embryos, we agreed that we would somehow try to survive triplets. Now I just think that’s out-of-the-question insanity. No way am I up to carrying trips, and no way am I up to caring for three babies at once.

So if we got incredibly “lucky,” we’d be looking at reduction. I haven’t Googled this process (too scary), but it sounds REALLY dangerous to the remaining fetuses. I imagine the odds of losing the whole pregnancy, or inducing pregnancy complications, are really high. What a fucking nightmare.

The other option is to put back three and freeze the one. But this sucks, too. Does this mean, if this cycle doesn’t work, that I’d have to go through a whole FET for just one embryo? (So suggests my shared risk contract.) Or could I do another fresh cycle and combine whatever frozen leftovers I have for a later FET? No idea.

This decision sucks. Maybe worse than any decision I’ve had to make. If I don’t put all four back, I’m going to spend the next two weeks freaking out that I’ve made the wrong decision. And if I do put them all back, I’m going to spend the next two weeks freaking out that I’ve made the wrong decision, and then another several weeks (assuming positive beta) wondering how many are brewing in there.

I’m almost hoping that one of them died last night. Which is just so, so wrong.


Ms. J said...

I can't begin to give advice. I am thrilled that you have some good quality ones it appears.

Has RE given you a thorough explanation of why transfet all 4? Maybe that would help you make a decision.

Dora said...

These are very scary decisions. I know this may offend some readers, but when I was being aggressive with my donor FETs (I also REALLY needed it to work), I researched selective reduction extensively. It was an incredible relief that I was not faced with that heartbreaking decision. But my research on the risks to the remaining fetus(es) depends greatly upon who does the procedure. The statistics you will generally see for the risks do not apply if you go to one of the drs who is most skilled at this procedure. There are drs for whom this is the bulk of their practice. Their complication rate is a tiny fraction of the average complication rate. IMO, it would be wise to go to one of these drs, even if it means traveling, going out of network, or even paying out of pocket.

I hope you are not faced with this, but my gut says your RE has valid reasons for his opinion.

Rambler said...

So it would be interesting to get more insight into your RE's decision. Might be based on some factors (or studies?) that only she is aware of. I hear you on the twins. One part of me *loves* the idea and then another part wonders how my body would take it and how the fun may not last for so long.

I hope you not only get some answers, and make a decision, but also garner some peace. :)

Malloryn said...

I'm sorry that you're faced with such a difficult decision. Oddly, it would probably be "easier" (nothing being easy, of course) if you were looking at 3 or 5. I hope that you and J can find an answer you can work with.

Shinejil said...

Wow, I don't know. I'm thrilled you have some good embies to work with but, yeah, the thought of reduction, which also went through my mind, is very scary (though Dora has a point that a skilled doc could likely get everyone through it).

Maybe, as others have suggested, more from the RE would help?

Lorraine said...

Four is definitely a conundrum - especially since you would probably transfer the best-looking ones and end up with either one or two second-string possibilities for the FET.

But who knows with the fancy-ass sperm? I guess if it were me on Cycle #5 (and I actually wanted twins) I would go for all four. The truth is that even if three attach, there is still a good chance that they won't all be there at the second ultrasound.

But, I am on the far end of the spectrum in terms of success rates, so it's easier for me to know that I would be more aggressive. I hope you find the answer that feels right for you.

kate said...

Wow. I want to leave a comment because I want you to know that I'm reading and that I care, but I think this is the first time I've read something where I truly have no relatable experience on which to offer comment. I wish you the best of luck making this decision. I don't envy you the decision (well, I guess a little part of me does, because it would mean that I was at a point of having an actual growing set of cells that could possibly become a baby, but still. It's otherwise not the most enviable place to be.), and I think that the best advice I could offer would be to perhaps trust the RE on this one. I hate the idea of becoming passive in medical care, but if you find that you are unable to decide which possible outcome leaves you more at ease than the other, then perhaps it may be time to let yourself be cared for by the expert. But then again, maybe leaving the decision with the RE would make you feel just as unsure. I don't know. Tricky situation, this one.

Sue said...

You never think you'll be one of those people who agrees to put back 4 embryos....until you find yourself in a situation where your RE recommends it. I'm really sorry you've been put in this position and I am wishing you strength in making your decision.

Ally said...

I'm sorry, friend. I wish I had the answers for you or knew where you could get them. What I do know is this: You will do the right thing. You are smart, strong, and will choose the best path for yourself. Breathe deeply and trust yourself-you will do what is best. I'll be thinking about you.

rg said...

Thank you so much for discussing something that I've been searching my soul/tearing my hair out over for the last few days. To go aggressive and deal with the insane aftermath or to not try hard enough and risk another bfn...where is King Solomon these days?