Thank you all for your kind words and encouragement. It's really meant a lot to me/us!
Our IVF consultation today went well, all things considered. We both LOVED Dr. Z. and his staff. From the second we walked onto the floor, we were treated very kindly and with respect and compassion...so unlike our experience with "that Portland clinic". We literally liked Dr. Z. from the second he set foot inside the exam room. He's very easy to relate to, interested in what we BOTH had to say, and very knowledgeable. He taught us some things we never knew - after all, this guy has been practicing reproductive medicine since 1982 (when I was in second grade!), and was one of the pioneers in reproductive medicine, and was the President of SART, the Society of Assisted Reproductive Technologies (he helped set up the national standards that all accredited clinics use). He really knows his stuff. He drew pictures, he talked in plain talk (with funny but appropriate analogies)...no intimidation tactics, no ego, no attempts to discredit anyone. He was just plain great.
My fertility - combined with Paul's - is what it is. There is no miracle to be had, as far as treatments go. The stats for diminished ovarian reserve plus my age plus Paul's sperm issues just aren't very good. He started recommending pre-implantation genetic diagnosis (PGD) to see what the genetic quality of our embryos is as a way of helping us decide how to proceed going forward. This is where he pretty much lost me. See, as I've noted here before, I am SO over trying with my own eggs. My goal is to conceive my husband's child. I really, truly don't give a shit anymore whether that baby comes from my own eggs or not. What I do know is that the clock is beyond ticking (heading toward ticking time bomb at this point, given my diminished ovarian reserve coupled with my age) and my window for having a take home baby is growing increasingly short. I want the best possible chance. I told Dr. Z. this, and said that this is where I am...but not where my husband is.
This led to an intense but carefully managed conversation between the three of us. He could honestly articulate both of our concerns to eachother; even though he noted he is not a counselor, he certainly has experience with the emotional aspects of infertility. We really appreciated that.
At this point, he agreed that I am correct in that our chances would be better with donor eggs, but he wanted to let us know about an experimental treatment regimen that seems to be showing some success in the 38-40+ age group for women with diminished ovarian reserve: the use of recombinent growth hormones. That is the route he recommends for us...IVF with ICSI (where they physically inject a single sperm cell into a single egg cell in the lab) using Gonal-F and Menopur, as before, probably with estrogen-priming like Dr. M. did in April, but with the addition of 7 days' recombinant growth hormone. If this doesn't work, then he recommends moving on to donor eggs...knowing we'd given it our college try.
The other thing we're both struggling with is he wants to only do a single embryo transfer in hopes of avoiding twins. Research shows (even in the packet of info we were given) that for women aged 38-40, the national recommendation is no more than 2-3 high quality or up to 4 lower quality embryos transferred. Dr. M. would do 3 if we were under his care (but he doesn't do ICSI, so that would be 3 if we got 'em) and has no concerns about me carrying twins again, although he does want to do a cerclage between 12-14 weeks next time in case I did have incompetent cervix. Dr. Z. does not want me to conceive twins again, and recommends that we meet with a perinatologist for another opinion in what went wrong with the twins and what should be done differently. He suggested two different guys at UW (ha ha, A.S., one was your doctor, whom he said is VERY opinionated, and I let him know I will not be seeing him based on your experience!). I have a recommendation for one in Tacoma, so I'll probably follow through with that. This part of the conversation solidified for both Paul and me that while we know a singleton pregnancy would be the safest and least risky for us, we do both would like the opportunity for a do-over with twins.
We've decided we're probably going to go ahead with that. Dr. Z. penciled us in for an October IVF cycle, just to get us on the books (he said it's much easier to cancel an appointment with the University than to make one). We will have an out, such that if we get to even the day before egg retrieval and things aren't looking good (i.e. we aren't reaching our pre-determined "go/no-go" follicle count), then we can cancel and get most of our money back. Having an out is good, and something we wouldn't have likely gotten at a private clinic.
So, our next steps are to figure out how to pay for this ($10,170 including ICSI and 1 year's cryopreservation of extra embryos, if any...but not including the meds, another $2500 or so, including the growth hormone, or PGD, $5000-7000 more), and to go forward with the next phase of testing (a repeat saline sonohystogram for me to check on how I'm healing from last month's surgery, a mock transfer for me, and an exam for Paul to see if there's anything that can be done for his count/motility/morphology issues).
I'm concurrently attempting to book my free 30-minute consultation with the donor egg bank director of the clinic we'll use if we need to go that route so that I can get my questions answered. It sounds like that conversation will happen on August 16th. Must cover all bases, right?
I think we both feel satisfied with the plan overall, me because it's finally the last shot before we move on, and Paul because he gets one more chance for us to try to conceive OUR genetic children. I am relieved that he has agreed to only one shot at this...and also relieved that we're starting couples grief counseling next weekend so that we can work through - finally - all the emotional shit the last five years of heartache has brought us.