Oscillations

Many years ago JD made an observation that the City wherein we reside seems thoroughly surprised, anew, by the appearance and/or quantity of the snow falling on its roads and streets every year, despite consistent (last several winters notwithstanding) showing by the stuff over the last several centuries at least. By which he meant that the City never budgets enough for snow removal, that the traffic the day of and after any worthwhile snowstorm is usually not for the weak of heart, and that if you happen to live on a street that requires plowing out, you can, in fact, just sleep in.

I tell you this by way of comparison and explanation, to convey why I was both breathless with panic and not particularly surprised to find, on Tuesday afternoon, just as dusk was settling in and I pulled over to the baby section of the cemetery, that the ground was covered, thoroughly, with a mixture of fallen leaves and remnants of the snow that fell the day before, frozen over courtesy of the rain that became of that snow by morning and the cold air that settled in that afternoon. Apparently the groundskeepers did not have enough time to rake the leaves, at least not everywhere, although they did plant tall wooden stakes on either side of each row to delineate them. And a good thing it is since the flat to the ground bronze grave stones are not by themselves sufficient given any precipitation beyond a dusting of snow.

The panic was because in my quest for the worst deadbabymama of the year award, we still don't have a permanent grave marker installed, just the little plexiglas-encased metal one that the funeral home put there, and I was sure I would never find it now. But I found it, on the first try, just zeroed in on the spot I thought it was in relation to the remaining bushes and the bench at the other side of the section. As I was diving down to dig, I also spotted a bit of yellow-- covering from the pot of flowers my mom left weeks ago. It confirmed that I was in the right general area, but I still dug where I was going to, a bit to the side of the yellow, and was rewarded with a touchdown-- I got the marker right away, on the first dig.

I didn't stay long, after that. I was there pretty late in the day, having dropped Monkey off at gymnastics, the place that happens to be no more than a few scant miles from the cemetery, darkness was encroaching, and I was somewhat genuinely worried about being locked inside the place by the closing of the gates, which, according to the sign, was supposed to have occurred good nine minutes before I drove in. Leaving, I tried not to think of my baby, all of our babies, out in the cold on the day like this. When, later on that evening, as we (and by that I mean I with short bursts of "Mama, let me mix that" thrown in) were making latkes to mark the first night of Hanukkah, I think back to where I've been, and I catch my breath. Such is the life we have nowadays. But even in this life the deep-fried latkes are most delicious, even if every batch after the first sticks to the wire basket a bit more than the one before.

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We had an RE appointment yesterday afternoon. Dr.YoungGun started right away by talking about odds of success for IVF cycles. So even though it was not articulated to us before, as we suspected, JD's numbers put us right into IVF with ICSI category. The good news is they are good at single embryo transfers over there. They have the same live birth rate from single embryo cycles as from two embryo cycles, about 50%, and they have about 50% chance of twins on two embryo cycles (makes sense, no?). All good, since I am all about aiming for a singleton pregnancy this time around. The other good news is that as I deduced, nothing in JD's treatment would change as a result of the tests ordered by the urologist the other day. So the plan is to move forward sooner, rather than later, mostly, it seems, because Dr.YoungGun really heard me when I told him on the phone that I need to be doing something before we get to that one year mark. And for that, I am grateful. In fact, I have a mock transfer scheduled for next Wednesday. Plus, due to this new-found speediness, I was able to reschedule all of JD's additional tests from the urologist for next week. Unfortunately, the follow-up appointment has not been moved so far due to all kinds of craziness induced by December traveling for business and pleasure.

The bad news? They seem very set on doing ICSI for us. They also don't do selection of sperm by these new-fangled experimental methods that have been shown to give nice indicators for success. And fine, they are new-fangled and all, not yet commonly accepted, but they also don't do true rescue ICSI, where one attempts IVF, and if that fails after some hours (i.e. if there are no fertilizations), proceeds to ICSI. I am all for technology, yes I am. ART and me, we are long-lost relatives, I think. But ICSI is scary to me. There is an actual chance of a set of diseases that can be caused by ICSI. These are imprinting disorders, disorders where maternal DNA in the oocyte is not properly unmarked (cleaned from evidence of previous use in a developing organism, i.e. the mother, and prepared for use in the original stem cell that is the fertilized egg) as it normally is during the process of fertilization. This is due to the sperm getting in via a needle rather than a series of molecular events starting with the binding to the surface of the oocyte and initiating a cascade of reactions that eventually take care of the DNA unmarking. There is a higher likelihood of these diseases with ICSI. Granted, the overall number is still minuscule, but it's there, and I don't like it. This feels like a choice, and one I am not very comfortable with. It feels like if we did end up in the unlucky tiny percentage, I would feel guilty about this.

What you need to know is that I don't do parental guilt. I make my decisions, given the best possible evidence I have or should have at the time, and then the decision is not to be regretted, come what may. It has worked very well for me. But this, this is different. I spent some time last night thinking about why that is. Here's what I figured out. We had three documented conceptions before, so I feel that when given a large enough number of oocytes, JD's sperm should fertilize at least some of them. The numbers say we need ICSI, but the numbers are indicative of likelihoods, not certainties. And I want to give us a chance. I am at heart an experimental scientist. I want them to run this experiment. If it fails, I will gladly embrace ICSI, and I won't feel guilty come what may.

This is what I want. In the ideal world this is what I would demand. But in this world we live in, insurance gets to be pissy if a procedure other than what they approve is performed, and I don't yet know how many total cycles I am covered for under my new insurance. If it's the state minimum of three, can we really risk one of them on this experiment? If no eggs fertilize, we are down to two cycles. And I still want to have at least the first transfer that is done to be a single embryo transfer. Risk and reward. It's all about it. I also, in all that excitement yesterday, forgot to ask what their live birth rate was for an ICSI cycle. The literature has it at 20%, which is not great, to put it mildly. So that is my plan-- I need to find out what these two things-- my coverage and their live birth rate. And then I might need to calculate my break even percentage of IVF success-- at what probability of spontaneous fertilization am I equally likely to end up with a live baby from an attempted IVF cycle without ICSI and one with ICSI. And go from there. Can you tell I am their nightmare pain in the ass patient?

And now I need to go home-- my deep fryer, potatoes, and my family are waiting. Anyone wants to stop by for some good latkes?