Friday, June 14, 2013

LESS Questions, MORE Trust

Letting go of control and learning to trust doctors is one of the hardest things to master along this infertility journey. Maybe it's because I got off on the wrong foot in this journey to begin with.

I started out in July 2011 with my OB/GYN, taking Clomid, only to be told "Your case is too complicated, so I'm referring you to a specialist." This is the same OB/GYN that I later had a 10 minute debate with on why doing a CD21 progesterone test would not show ovulation in my case, because sometimes I do not ovulate until CD21 or later. Clearly this would not be accurate, but she didn't get it.

I moved on to an RE, Dr. Burger, who seemed to be taking me in the right direction, only to keep finding mistakes and snafoos in her protocol.
My final cycle with her was spent arguing whether or not I ovulated or should begin Prometrium supplementation during the luteal phase. Even though I'd had a huge BBT temperature spike and I was having post-ovulation symptoms, she refused to agree that I ovulated.  I insisted on a P4 test which proved I did ovulate. Only then did she write me the Rx for the Prometrium, and I was able to start the medication as she had outlined in her own protocol originally. This is only one instance among others, but it just always felt like pulling teeth. Totally exhausting working with her.

Fast forward to the RE I see currently see. My first cycle with him was like a dream come true. I did not have to remind him where I was at in my cycle. We clicked. He predicted exactly how I would respond, and I did. I became pregnant my second cycle with him using Femara and IUI...unfortunately it was an ectopic pregnancy and a long drawn out process to finally move on from it. It was then that IVF was recommended.

Then, despite not becoming pregnant, my first cycle of IVF went really well! Despite having low AMH/DOR, we got 17 eggs, 14 mature, 12 fertilized naturally, 2 were transferred and 5 blastocysts of 150-200 cells each were frozen. Again, I responded just as predicted and then some. Unfortunately our first attempt did not work, but at least we have frozen embryos to try again.

When I think about it, even though we've been seeing Dr. Vaughn now for 10 months, which seems like forever because of the never-ending ectopic pregnancy, long IVF process and break period in between, we've only actually done 3 rounds of treatment with him total.  In that time, he has given us every reason in the world to prove his expertise and he has actually never done anything to give me any real reason to doubt him, even if his protocols aren't the most aggressive in nature (in regards to reproductive immunology at least) and even if we haven't had ultimate success YET.

Lately, I find myself questioning more; Questioning him more, questioning the process, questioning whether or not this will work. Why? For one, the months and years are passing by and we've yet to achieve a successful pregnancy. Plus, there is so much information out there about what "other doctors are doing." This field is not cut and dry like cardiology for instance. There are many different schools of thought and protocols, and it's maddening comparing oneself to others and others' treatment processes. Hubby and I are both becoming drained emotionally from the whole roller coaster of it all. Time passing is a scary thing, and when coupled with my already impatient and inquisitive nature, it makes for an extremely restless situation.

I didn't even realize this until hubby pointed it out today, but even though it's already mid-June, we've actually only had one full cycle of treatment in 2013. Furthermore, when you think about it, considering I've only done 3 cycles total with my new RE, we have made good progress during those cycle. I've been pregnant once and have gotten a nice haul of good quality eggs and embryos in those few tries. When I think of it that way, it's much easier to contend with.

There is definitely a good time and place for questions, but I can also see that some of my endless questioning becomes detrimental sometimes. Today's appointment for my lining check was a perfect example. Condensed version of our apt..

Dr. V:  "Everything looks great for your transfer one week from today."

Me: "8.1 mm? Is that it?"

Dr. V:  "What did you expect it to be?" 

Me: "Above 9. Double digits would have been nice. "

Dr. V: "Well in our clinic anything above 7 is considered good for an FET."

Me: "I am just having a hard time grasping why some doctors want above 9, some say 8-9 is "iffy" but you are happy with a 7. I feel like I'm at the bottom of the range. "

(que me covering my head in my hand and trying to hold back tears unsuccessfully)

Me: "We just really need this to work!" wahhhhh

A 5 minute discussion ensued as to why my lining is fine, but we were given the choice to wait another week to see if it will thicken more. BUT there is a small risk of ovulation and thus a cancelled cycle if we did decide to wait. Just what neither of us wanted in today's appointment...more decisions. If I could just trust what the doctor is telling me I know I'd save my husband and I both a great deal of stress and anxiety, but I'm always questioning EVERY little thing. Then when I get frustrated with the prospect of yet another decision and scared of making the wrong one, it turns into more frustration and tears.

Yes, I am a mess. Could it be the 3 doses of estrogen I'm taking daily? Could it be previous experiences with other doctors that have scarred my ability to trust them fully? Could it be that I cannot endure another failure and I want to make sure all conditions are as perfect as possible so that we don't have to endure another negative result? Could it be that I just learned of another friend's pregnancy only moments before my appointment?

It could be all of those things, but I need to take a step back and realize that HE IS THE EXPERT in this relationship and I have got to be more trusting. If he says my lining is good, I have to trust that it is and just shut the fuck up!  The live birth rate at my clinic is actually equal to what it was for my fresh cycle and according to my nurse their FET rates were closer to 70% last month. Here is the most recent SART data for 2011...

Worth mentioning that they had 918 IVF cycles that year, so it's not their first rodeo. My doctor has helped people like Lance Armstrong conceive all 3 of his children via IVF at his clinic.  I mean, if my RE is good enough for Lance, he should be good enough for me right?

I've said all along that I will fully trust Dr. Vaughn until he, God forbid, strikes out 3 times with IVF/FET.  If at that point, I am still not pregnant we will have other considerations to make, but for now I've got to give him the benefit of the doubt and just follow doctor's orders like a good patient.

Yes, I am still happy I am taking the Lovenox on my own accord, because in my case I think it can only help. However, I also respect my RE's perspective that there just aren't enough peer reviewed double blind studies on the efficacy of Lovenox during IVF to start prescribing it to all of his patients.  It is more of an experimental approach in all honestly, rather than something with extremely solid proof. When it comes down to it, all of this is one big ole crapshoot really.

Still, I know I'm in good hands. I have to believe that God put Dr. Vaughn in our lives for a reason and that he'll be the one who helps us have our baby. For my husband's and my own mental sanity, I've got to let go of the control a little more and just go with the flow. I am of course, trusting in God first and foremost,  but I've also got to trust the person He's given the tools to help us here on the physical earth. So, from here on out LESS QUESTIONS and MORE TRUST.


  1. YES! I am (finally) coming to the same conclusion. Letting go and trusting the Doctor is such a relief and much easier on everyone involved.

    p.s. My lining was around 8 for both of my transfers and I always worried it was too low, although my clinic said anything above 7 was good.

    I'm sending you tons of good luck for your upcoming cycle :)

  2. Oh man… this is exactly where I am… every step of the way my doctor has been proven right, but I've got to ask a zillion questions at every single step…. I just can't let go and believe that he know's what he's talking about and that he CARES. Trust is so hard! Hoping that your lining continues to plump up in the next few days for your peace of mind!

  3. I admire your infertility intelligence and think that questioning can be a good trait. But, I'm a lot like you, I question my re too much and trust very little. Its hard to trust 100% when there are so many unknowns, so many variables, and so much that isn't in our hands OR our RE's hands. Questioning has it's time and place, I feel. Once you've agreed on a protcol, and its go time, thats probably the time that we need to let go and trust the professional. Easier said than done, I know. Hugs, friend. I know how hard this can be

  4. It's so hard to trust this process...especially when it's already failed. As the cycles have rolled by I initially intellectualized the experience with forums and every book on the subject. But I've left that person was extremely stressful...and at the end of the day I just have know "I've done all I can do"...I'm following my doctor's instructions....but I believe....that if it's meant to will. And I hope it's meant to be for both of us...THIS time around :o)

  5. I'm dealing with these same questions and concerns with my doctor. I don't feel as knowledgeable as you regarding my body and infertility in general (good for you, by the way)...but I do still feel that restlessness. There are always those nagging questions - are we at the right clinic? Is this the right doctor? Is this the best protocol? I'm questioning these things even though our daughter was conceived under the guidance of our current doc. I'm so sorry that you're having to deal with more tough questions. Ugh. It certainly sounds like you are equipped to make the right call though. And I really like the "keep calm..." thing you posted at the end. Great advice.

  6. First, I'm so sorry you had to hear news of another friend's pregnancy - that is always SO hard to hear. Second, I can totally relate to what you're saying... It's SO hard not comparing what your doctor is doing to what others' doctors are doing. Going into my cycle with CCRM I promised myself I wouldn't google and go crazy researching all of the meds I will be on or my protocol. I wanted to just do it and trust the doctor. In part it's been so hard just sitting back (and popping pills). But man am I stressed! I think it sounds like your doctor is great. I know my local RE only requires a lining of 7, too. Try to trust him - I am crossing EVERYTHING for you, girl!! xoxo

  7. I really believe in this FET and that it's going to work out for you. I know it's so easy to mistrust, so easy to question, so easy to wonder if this is going to work. I have seen so many successful FETs on the threads where fresh failed. And while the failures you've experienced are devastating, they are only leading you towards success. With all my heart Em, I pray for you. I think of you often. Been trying to stay quieter for you but I follow you, pray, and believe your miracle is coming..and soon! *big hugs*

  8. Em, you are and I are so much alike. It is extremely hard to trust...especially when you have so much riding on this. Interestingly, one of the first things said to us when we got to CCRM is to stay off the blogs because it just causes anxiety. And let them do their jobs and not try to dictate our own protocols...we came there for a reason. It is true! They are the experts. I'm proud of you for recognizing it is a problem and working at trusting. I think this is your cycle. XOXO

  9. Emily- ha ha, I sent you a message today and reading your post it's kinda funny because I empathized with this exact problem. I am (as you well know) absolutely horrible at trusting doctors. Horrible. I think your doctor knows what he is doing and he will get you pregnant this round. It has to work. I want this so much for you.

  10. It is natural for us infertiles to question everything. Which is good because we prove to our RE's that we are more invested in this than they think. I am glad you are voicing out your concerns because you get that reassurance from him if you aren't content with his first answer. If he got you pregnant once I think you should relax and trust in his protocol even though sometimes it's the hardest thing to do.

  11. My Doctor requires at least 7mm lining to doing FET as well. They have some of the highest success rates in FETs so I trust them completely. In the end, just let go and let God. You will become a mother one day.
    The study I am in is wrapping up in the next couple months. Dr. Zhang said he has enough data to "Drop a bomb on Infertility as we know it." Great things are about to come for us women who struggle with infertility.
    My FET is scheduled for Tuesday, June 18th. My lining is at 9.1mm after a D&C and hysteroscopy to remove a polyp on my uterine wall just a couple weeks ago. I pray this LO sticks! When is your FET? I will continue to pray for you and I will be stalking for an POSITIVE update soon!

  12. Oh, my heart hurts reading this. So hard!! Praying for trust, yes, but more importantly PEACE!

    Psalm 46:10 (AMP)
    Let be and be still; know, recognize, and understand that I am God.

  13. I'm joining Danielle and praying for peace too! I know there are so many decisions involved in all of this and I pray you put your ultimate trust in God, whose thoughts and ways never waver or change. He always remains the same!!

  14. It's hard to trust that everything will all work out. And even harder not to wonder if your doctor is making the best choices for you. I think you are balancing all of it wonderfully! You've done a lot of research and are knowledgable enough to know if you're really on the right track. Yes, trusting your doctor is important and I'm all for handing the reigns over to them no questions asked. But always trust your intuition too. It's just as important in my opinion. At the end of the day, you want to know that you've gotten your money's worth and did everything you could. So much luck being sent your way for a great thaw and transfer on Thursday!

  15. Thinking of you today Emily....

  16. Liked this article. I know that is not a smooth road to go through. There are lots of hurdles to face but one needs to be patient and strong enough to endure all of it. Some of the people follow family balancing process & prediction and the results are pretty much positive.