Finally the day of the welcome meeting arrived. It was a very early start and breakfast was a challenge. I managed a cereal bar in the end. We arrived in plenty of time and made ourselves known to reception. As it was so early (7.30am) the reception was pretty quiet. We were asked to take a seat. Some minutes later the receptionist called us and brought us to a meeting room. There we were introduced to one of the clinic counsellors. She invited us to sit down and explained the purpose of the meeting. The main topics of discussion were how we were feeling about the treatment, the challenges that are associated with it, what support we had, if our workplaces were aware of it and basically any questions we wanted to discuss ourselves. We were also asked if we had any ethical concerns about the treatment. She asked in particular if I had made any arrangements with work as I would need to take time off at certain points throughout the treatment. I said that although I had not told my boss about the treatment, I had indicated that I would need some time off for medical reasons and he was fine with that. I also had taken two close colleagues in my section into my confidence and they were on board to help out if needed. The counsellor also explained that the ivf medical team in the clinic was a small one and that we may well see a different doctor on our next visit. She said not to worry about this as all the medical team rotate across all stages of the process so they are experienced at each stage. The counsellor gave us her contact details and said that she would be available at any stage throughout the process if we wanted to talk to her and she encouraged us to do so. She also gave us a patient information booklet which explained the process in a more practical and digestible format than the technical brochure we had received at the open meeting. Finally we were both asked to sign a document to say we had attended and understood.
The counsellor brought us to a waiting room and said that one of the doctors would come for us after she had spoken to them. I picked up a newspaper to read and ironically the page that fell open contained an article on childfree living and how those childfree by circumstance rather than choice are often a forgotten group in society. I noted down some websites mentioned. I hope it won’t come to this and we will consider all options but I have to be realistic too given our age. After 10 minutes or so, a doctor called us out. We followed her to another meeting room and she introduced herself and invited us to sit. She had a copy of our file and tests in front of her. She noted our ages and asked a good deal of background questions, our diet, lifestyle, any family history of infertility or congenital defects or serious illnesses. She made a note of the fact that my husband had mumps as a child (as indeed did I). In response to the question on how much alcohol we drink, I said I have a drink with my period, which seemed to amuse her. I said it was to get over the disappointment. I said that we had given up drinking more or less completely in hopes that it would help. She noted that our treatment would be ivf/icsi on account of the severe male factor issues. She explained that I would be undergoing the long protocol and she showed me a chart outlining the steps for this. She noted that my drug dosage would not be very high based on my test results in case of overstimulation. The long protocol runs over an approximately 6 week period divided into a few stages- down regulation, stimulation, egg retrieval, egg transfer and a two week wait to test for pregnancy.
There then followed a discussion on the option of Day 3 transfers versus blastocyst transfers. The doctor used a pictorial chart to show the difference between embryos at each stage. Transfer of more than one embryo at day 3 could result in multiple births whereas a blastocyst transfer has less risk of this (from what I remember although more than one embryo can be transferred at day 3, only one blastocyst is generally transferred- at this clinic anyway.) There is some risk in holding out for a blastocyst but there can be a higher pregnancy chance if the embryo gets this far. I was not sure which way to decide so I asked what would be advised for someone in my situation. She seemed to favour blastocyst so I said I would be happy to go with either type of transfer depending what was best of me at the time of retrieval. I don’t think this is a hard and fast decision, the purpose of this discussion was to get a general preference as far as I know. The final decision can only be made once there are embryos to be assessed. The doctor made a note of the decision (still not sure what I am ‘down for’ or how many for transfer). I asked about my husband’s chromosome and endocrinology results. The doctor said they had come back fine, with just slightly low testosterone, but nothing of concern. We were also asked to sign a number of consent forms regarding the collection and transfer as well as any freezing of embryos that may arise. The doctor asked had we any further questions but we couldn’t think of anything else. She asked when had I in mind to start and I said as soon as possible. She instructed me to make an appointment at reception for a pre-period scan, which would get the process underway.
I went to make the appointment half-fearful that it would take more weeks. The receptionist asked when I expected my next period and I said August 9th, not much more than 2 weeks away. The pre-period scan appointment was made for August 7th much to my relief. I was told I would meet a nurse that day and also that the invoice for treatment would be sent to me and would be payable that day also.
Finally I was getting close to starting. Once the pre-period scan was done and if there were no issues with it, I would begin my down regulation nasal spray on the first day of my period. Although I was getting a little nervous about this, I couldn’t also help but feel excited and relieved that now I had a plan and dates and events to focus on.
I was still worrying about the Day 3/blastocyst issue in the following days so I contacted the counsellor about my concerns and asked for her advice. She put me in contact with one of the doctors who spoke to me by phone and was very nice and helpful. He said at this stage this was only an expression of preference. At the time of egg retrieval the matter would be discussed again and much would depend on embryo quality and other factors. He explained that sometimes couples have had to be encouraged to deviate from their original preference at this stage so no decision made earlier is final. He also said that if I end up paying the extra cost for blastocyst at this stage and if it ends up that a Day 3 transfer is more suitable for me, then the extra cost is refundable or I can opt to pay for the Day 3 option and pay the extra should I proceed to blastocyst. This conversation put my mind at ease.
I resumed reading ivf books but also investigated relaxation and positive visualisation CDs as I think I need to get myself into a positive frame of mind and believe the best of the process even if our odds are not that great. I have to have hope for it.