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The Debriefing - Elizabeth Unexplained
Lots of data but no answers
greyautumnrain
greyautumnrain
The Debriefing
It started snowing as I got off the T at Kenmore. Big wet white flakes. I sure hope it wasn't an omen, this April snow, just Boston's usual stupid weather tricks. I suppose if I want of sign of some sort, the fact that psychohist arrived before me is a much more positive one. He's not always the most punctual guy, when he arrives more than five minutes early its because whatever the thing he's there for is really important to him.

The occasion, of course, was the debriefing for IVF #2. What happened, what it means, what we might do differently. What Grace said several times was "we change what we can change". ART is an apt acronym for what we are doing. Assisted Reproductive Technology... sure its based in science, but there are so many complex variables and unknowns that it really is more of an art than a hard science. Its a pity, that. Hard science would be easier for me to cope with.

Grace agreed that given this last cycle we did not need to do ICSI. She had been pushing it, but our fertilization rate this time around (5 of 9) made it clear that we were OK on the fertilization front. She suggested that perhaps we might try adding LH in with the Follistim. It might help and it can't hurt. Then psychohist brought up assisted hatching. She thought it was a great idea. I asked her what the trade-off was in using it. She said the only risk was an increased chance of identical twins. Sold! So, assisted hatching it is.

Grace was also pretty enthusiastic about our plan to take an extra month before starting again. So enthusiastic that it sounded like she would have suggested it herself if she had dared.

The snow was sticking when we got out, covering the ground in a slick waterlogged slush. I suppose that trying to walk home through it in my tractionless high heels is a fair metaphor for how difficult this business of trying to reproduce has been.
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Comments
twe From: twe Date: April 5th, 2007 06:25 pm (UTC) (Link)
Okay, I must ask, what IS "assisted hatching"?
psychohist From: psychohist Date: April 5th, 2007 07:16 pm (UTC) (Link)
Assisted hatching is where the zona pellucida of the embryo - basically the human equivalent of the egg shall - is carefully punctured or thinned in order to make it easier for the embryo to break out and implant into the uterine lining.
enugent From: enugent Date: April 5th, 2007 10:21 pm (UTC) (Link)
I'm glad you have a plan. It seems odd that you guys are the ones to bring up things like assisted hatching, though. I would think it would be the role of the doctor to propose techniques, especially anything she's going to be enthusiastically on board with.

In related news, I took my first dose of Clomid today. Hopefully it won't make me crazy.
psychohist From: psychohist Date: April 6th, 2007 01:41 am (UTC) (Link)
She actually said she hadn't thought of it because usually they only try assisted hatching for women over 40. She did sound like she wished she had, though.

I also think she might be a little afraid to suggest things to us, for a couple of reasons. First, it seems like she feels guilty about prescribing only 300 units of Follistim on the first cycle, where we didn't get very many eggs, though we agreed with being conservative that cycle. Second, she was pushing intracytoplasmic sperm insertion after the first cycle and we resisted that; In retrospect I think that's because she thought only two of five oocytes fertilized because that's how many divided, while we thought four of five fertilized because another two formed astral bodies though they didn't actually divide. With five embryos this time without ICSI, it was clear that fertilization wasn't a problem.

She did suggest a change in the drug regimen and timing of the trigger, both of which suggestions seemed to make sense.
greyautumnrain From: greyautumnrain Date: April 6th, 2007 01:56 am (UTC) (Link)
We had 6 oocytes that cycle. She also seemed to be forgettig that the mysterious 7th egg of that cycle wasn't an oocyte.
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