Warning: This post is incredibly detailed with medical jargon you may find coma-inducing.You don’t have to read it all…I bolded the important parts. Mostly I want to solidify its place in the event I can help some poor woman in the future.

In most cases, I love it when something I didn’t understand finally makes itself clear to me. I also love it when I’m right. Not this time.

We just finished the IVF with Shady Grove. We don’t know much yet but I’ll report in when we do. I’m not hopeful since I’ve endured this before, only to have it fail.  Having gone through the whole process at Shady Grove and finding it 1000 times better, more professional and easier than the other stimulated IVF we did, I have learned a ton.

My Ob/Gyn, who I love, recommended two years ago we see Dr. Asmar at Washington Fertility.  We liked him and felt like he could help us, so we began the IVF process. From the 2nd or 3rd day of the shots I was sick. I could not understand how friends of mine did this 5 and 6 times. When I reached the point where I was homicidal and knew my body could take no more, Dr. Asmar said I needed to do one more day of shots. I was beside myself. I couldn’t believe it. I knew something was wrong with my body, we had already lost faith in them when they lost X’s sperm, when they overcharged us, when they routinely made us wait an hour even though the office was empty, when their two receptionists treated us like crap, but I just knew something was wrong. From what I know now, it appears that I was overstimulated.

When your follicles are overstimulated, you will get tons of eggs, but few of them are viable. There were 15 eggs retrieved from me on Friday, February 5, 2010 at 8:30 a.m. I went home to bed. X came in around mid-afternoon and said, “Good news, 13 of the 15 eggs fertilized!” We were so happy. What we know now from our experience with Shady Grove is that the eggs take about 24 hours to “fertilize.” So a phone call 6 hours later from Washington Fertility stating 13 fertilized eggs was clearly a lie.

That evening, as it started snowing the Great Snowstorm that gave the DC area 3 feet of snow, X and I discussed how wonderful it would be to have enough embryos frozen that we could have a few kids off this one IVF cycle. We lost power that evening, as did most of the metro area. X said to me at 11:00 Friday night, “I hope they didn’t lose power at the lab.” Suddenly our minds went to our 13 little embryos, the little Velvet/X combos and my heart sank. They had told us at Washington Fertility that they planned to stay at the lab all weekend in anticipation of the storm, but as the snow pounded the city, we didn’t hear anything all weekend long. What we know now from our experience with Shady Grove is that you should get a daily phone call after egg retrieval. The day after retrieval they call with a fertilization report. The second day they call to tell you when to expect the embryos will be transferred. For a variety of reasons they determine at this point whether you should transfer the embryos on day 3 or 5 post retrieval. We received no such call from Dr. Asmar’s office at Washington Fertility.

Monday morning, February 8, 2010, the medicine cocktail I was still taking had burned through my esophagus so badly I hadn’t been able to eat all weekend without throwing it back up. Dr. Asmar’s office called to say that “only 7 eggs survived the weekend and only 3 were dividing normally.” Because they weren’t even decent quality, they recommended an immediate transfer. We asked for a delay because of my vomiting issue (I seriously just wanted my fucking body to be normal again) and he said no, this was important to do today as the embryos typically do better inside the mother. What we know now from our experience with Shady Grove is that this transfer should be scheduled the day prior, and you shouldn’t receive a panicky phone call from your allegedly competent doctor telling you to come right away.

When we got to Washington Fertility they showed us a picture of 6 embryos and said that a 4th had “started to divide.” We never did find out why they said 7 embryos on the phone but only showed us 6. What we know now from our experience with Shady Grove is that an egg doesn’t just suddenly start dividing 3 days later. If they are going to arrest development it’s early in the process, and then they don’t keep going. Because we got no phone calls from Friday afternoon with our “fake” fertilization report, until Monday morning’s panicked “you have to come right away,” it’s obvious that these people lied. They were NOT in the lab at all, because if they were, we would have received calls, and not all of those eggs would have died. The lab needs to wash, change fluids, etc, and this probably wasn’t done. It appears they left the embryos to fend for themselves and went home to shovel their driveways.

When you reach the end of your hormone shots, the clinic calls you and tells you to take a “trigger” shot that tells your follicles to release the eggs. Exactly 36 hours later, they have you go in for an egg retrieval. I had 12 follicles this time but some were sluggish. Based on the sizes, I had thought they would have me go another day on shots, and X and I were prepared for a last minute trip to the pharmacy to pick up more. When Shady Grove called with my directive to take the trigger shot I was sort of stunned. Last IVF I was begging for that shot, but this time, I could have easily gone another day. I asked the nurse why. What we know now from our experience with Shady Grove can be summed up by her response: “Well, we watch for the estrogen jump, and as long as it jumps as much the following day, we keep going. When it levels off, your body is going to stop maturing the eggs and you could risk losing the bigger follicles as they will be too old now.”  I went back to look at my records from good old Dr. Asmar.

Before I compare estrogen levels, here’s a tidbit of useful information on Estrogen and proper numbers during IVF:

Exact figures are not possible. As a rough guide, however, a level in the range of 150 to 500 pg/ml is generally considered reasonable for the eighth day of a stimulated cycle. An approximate doubling of this level every 48 hours is considered promising, as a sign of continued good follicle development.

Let’s compare Estrogen Levels for both cycles.

Washington Fertility
Day 5    149
Day 7    489
Day 10  1323
Day 11  3312
Day 12  3458

I didn’t have an appointment on Day 8, but let’s assume I was around 500 just for fun since I was at 489 on Day 7.  Following with the guide above, day 10 I should have been 1000; I was 1323. Day 12, had I been 1000, I should have been 2000; I was 3458. That’s 73% higher than I should have been. Those eggs weren’t over-easy, they were scorched.  While they don’t provide targets of estrogen because every woman is different, it appears from that example above that if you stimulate for 12 days with shots, the max your estrogen should reach is 2000.

Shady Grove
Day 6     189
Day 7     302
Day 9     481
Day 11   1106
Day 12   1380
Day 13   1599

My day 8 estrogen was clearly in the range of 150 - 500 since days 7 and 9 are in that range. It’s safe to assume though that they did it right. I was responding to the meds more slowly, but when the jump from day 9 to 11 was 625 points, then from 11 to 13 it went 493 points, it was time to trigger.

See what happened at Washington Fertility with Dr. Asmar? I was right. I was totally overstimulated, could go no further physically and they should have given me the trigger shot when I asked for it. The jump in estrogen from 1323 to 3312 was the big one, but then the fact it went only another 140 points? Dr. Asmar totally missed the entire window of opportunity and all that pain, torture and money was for nothing because my eggs weren’t viable. Couple that with the fact they weren’t at that lab that weekend, and those embryos didn’t stand a chance. I love being right, but this time it’s heartbreaking.

After my experience at Washington Fertility, I left some reviews on various doctor review sites. Like clockwork, their stupid nurses would come in right after me and leave positive reviews. Except they are soooo stupid because you can tell it’s them writing the reviews based on what they say. On one of the sites they even wrote “Velvet we know who you are and we’ll call your job and tell them you’re crazy.”  Um….nice. Except that their English isn’t that proper.  Washington Fertility has been on a massive PR parade. They also since redesigned their website and put up testimonials that are clearly fake…just as fake as their fertility reports.