Breaking Up (or at least threatening it)

Dear Dr. ---,

Google is not at all helpful in giving me information on who "owns" or is CEO of Long Island IVF, but I eventually came across something that suggested you are the owner. If this is inaccurate and someone else is more appropriate for this to go to, please be so kind as to pass this on to them. This is not a complaint about any particular person, so please do not take it as such against any of the staff who have worked directly with me. It’s a complaint about the process and I don’t know who is behind each step of that. I just need someone to hear and understand my experience, someone who has the ability to make change within the organization, someone who can try to compensate for mistakes that have been made or at least help fix them for future patients.

I am a woman with a female partner; I did not come to Long Island IVF because we had been trying for years and were struggling with infertility, but simply because we needed assistance to get pregnant with donor sperm. Because the initial consultation led to the discovery of a 7cm dermoid cyst that had to be surgically removed, I was fortunate enough to be able to have all possible fertility testing done from the beginning; while in surgery, the doctors checked for endometriosis, blocked tubes, fibroids, etc. Everything has come back normal except that my progesterone is a little low so I have to take supplements. This gave us a confident start to the process.

After three failed natural IUI cycles, I met with my doctor who suggested Clomid. During the next cycle, I produced four eggs just on my right ovary (my left ovary was "hiding" and unable to be detected during that sonogram) and my lining had remained thick. We also learned that our vial of sperm had 15 million motile this time; the past few months, we'd had mostly 8 million and one vial of 10 million. This was all so promising! It seemed like we had our best chance, and knowing this gave us the confidence we needed to be able to decide on a different route if this didn't work.

But Long Island IVF did not give us our best chance, and our trust is badly shaken.

The first three cycles, the pattern has been this. My follicles consistently grow faster than expected. I'm frequently told, for example, "You're only at 16mm so we probably won't have you come back in for two days," only to be called that afternoon and told, "You're surging and need to go to Melville tomorrow" where I'm already at 21mm the next day. I’m told in that call that I need to take the Ovidrel and come in the next morning. When I go in, the sonogram reveals that I have not yet ovulated, and I'm told to come in the next day for a second round.

This time, our fourth cycle and the first with Clomid, I got the call on a Tuesday and was told to take the Ovidrel around 9:00 PM for a 9:00 AM IUI on Thursday. This was different than normal, but I was on Clomid and had several follicles at varying sizes, so everything was a bit different this time and I'm certainly not the expert here. I trusted my clinicians. I assumed Thursday would be my first IUI and Friday would be my second.

Imagine my surprise when the nurse did no sonogram. "Don't you need to see whether I ovulated or not and whether I need to come in tomorrow?" I asked in confusion. "No," the nurse said, "you were surging Tuesday and took the Ovidrel so you're ready now. There's no point in doing anything tomorrow." My heart sank. "So...today would be the day of the second IUI? I should have had one yesterday?" The nurse said, "You could request to always have two going forward if you want."

This isn't about indulging what I "want," it's about doing what will get me pregnant, and I tried to convince myself that if it was deemed that I didn't need an IUI the day before, then there was no point in it. They must know what they're doing...right?

But I had felt my familiar ovulation pains early Wednesday afternoon, like I always have the day following the Ovidrel injection. Except this time the egg would just be sitting there with no sperm waiting for it. Maybe the other eggs didn't release til that night or the next morning, but there was for certain one that was wasted, that would likely not be alive by the time of my IUI the next morning, and there was no reason for it to be missed.

When I went in for my pregnancy test, after having taken one at home to prepare myself for the negative, I asked the PA about it. She was very careful to protect her organization and to assure me that I should have been able to get pregnant with how this happened, but she did confirm after my persistent questioning that two back-to-back IUIs should be done if possible when using frozen sperm, simply due to its short life. I asked why this had not been done. Tears streaming down my face, I said, "I had the day off of work for Shavuot. I had a vial of sperm sitting in Melville. And I had an egg being released. Why was I not getting an IUI? Why was I not given every possible chance to make this cycle successful?" She could not answer me, stating only that she cannot tell from my chart how the decision was made.

I told her how disappointed I was, and explained that since I am not diagnosed with infertility, my insurance was not covering this and we are out of money. We did not think it would take more than four times to get pregnant since I had been cleared as healthy and fertile, and now we would have to take a break for several months to save up again. I told her how disappointed I was, how angry and upset, that this last cycle that we'd broken the bank with and had to partly charge on a credit card was not given every chance possible to be successful. That our over $3000 (including sperm, thawing, and medication) was treated so lightly while we now struggle to save that up all over again.

That afternoon, I got a call from my doctor. She was not even in my local office that day, so the PA must have called her about this, and I appreciate her concern and responsiveness. I appreciate immensely that she reached out. But she was reaching out to tell me that if money was the issue, we could apply for a grant for IVF, and that IVF would be a logical step after four failed IUI cycles.

We are not infertile - or at least, it is too soon to determine that. We are gay. We only have a clinic involved to help us safely and effectively give sperm access to my egg since there is no male partner. I am not ready to jump to IVF when we have only been trying to conceive for four months, and I've been saying this consistently. IVF is not only very expensive, but it's very intense and has some ethical implications that we would have to figure out our stance on. I feel like to the clinic, it's a shortcut to getting pregnant. You want your success rates, you don't want me adding to the statistics of how long it takes you to get a patient pregnant. You are probably very confident that you can get me pregnant this way and would rather skip all this other nonsense that has lower success rates. But I'm not here for a shortcut. What I AM here for is to be given expert and attentive service to give me my very best shot at getting pregnant with IUI, and I don't feel that this is happening.

How could the nurse doing the IUI say I was surging Tuesday and that's why it didn't make sense to come in Friday, but when I mentioned that to my PA, she says my record shows I was NOT surging? How does such opposite communication happen, and what/who am I supposed to believe? Why would the other person have said something different? If both my PA and my doctor admit that there should be two IUIs when using frozen sperm, how was that missed? Did someone just skim quickly over my record before calling me and not pay attention to the fact that I'm using frozen? That's a $3000 oversight. That's a waste of a vial that finally had a wonderful number of motile sperm, and a waste of the vial that is still sitting in a tank in Melville for no reason. It's a waste of my cycle, my money, my time, my roller-coaster emotions and false hopes.

Maybe I wouldn't have gotten pregnant anyway. But we'll never know, will we? The fact remains that I spent $3000 after three months of IUIs and did not receive the maximum opportunity for conception that I deserved. We feel betrayed by a clinic and by doctors that we have been pouring our money and our faith into. We don't know how to trust doing that a fifth time.

We have an unwelcome break for a few months while we save up money again for a few more IUI cycles or even IVF. I suppose this will be an opportunity for us to re-examine what the best route is now, and understandably Long Island IVF may no longer be part of that plan.

Thank you for your time,

Rachel L