After completing yet another round of IVF without having any embryo to transfer, I knew one thing for sure. I could not do the same thing again. I read something once that said, “Doing the same thing over and over again and expecting different results is the definition of insanity.” And I felt like I was going insane.
Yet I was not ready to end my pursuit for a second child either. That led me down a rabbit hole of PGS articles, hypotheses, anecdotes, and unknowns as I searched for an alternative plan that I felt comfortable with. After much thought and careful consideration of the alternatives, I decided on a plan. I decided to go back to the basics of IVF with a 3-part plan. Here’s what I decided and why:
- Forgo PGS testing. I decided to write a separate post about why I came to this decision. It’s not an easy one to make and I don’t think there’s a “one size fits all” approach. But if you’d like to ready about why I decided against PGS testing for my next round, you can read about it here. There are also links to some good articles and research studies there. One thing I will say is that had we done PGS testing 4 years ago when I did my very first IVF that resulted in my daughter, she might not be with us today. It’s one of those unknowns. The fact is that on day 5 the embryos that we transferred were all still early blasts (we transferred 3 5-day embryos). That means they would not have been ready for biopsying and they would have had to try to grow them out to day 6 to see if they developed enough for PGS testing. I’ve never had an embryo make it to day 6 in the lab. I didn’t back then and I haven’t in our last 4 rounds. Maybe my embryos just don’t do well for that long outside of my body. I don’t know. And I just can’t shake that thought. I might not have my daughter if we did PGS testing back then. When I told my RE that I want to do another cycle and not do PGS testing, he said, “Whew! Before I came in here I was trying to think of what to say to convince you to not do PGS.” He has a lot of reservations about PGS testing too. He believes it has it’s place, but isn’t the panacea that it’s made out to be.
- Fresh transfer. Next I decided that since we don’t need to freeze for PGS, why even bother with a FET at all? Why not do a fresh transfer? Many people say that FET success rates are higher than fresh transfers. But when you really look into why that may be, you see that it’s not always the right approach in every situation. One reason FET may be preferred is because some women experience ovarian hyperstimulation syndrome (OHSS) after egg retrieval. That’s serious and painful, and doing an embryo transfer in that situation would not be a good idea. But that’s never going to be me. I simply don’t produce enough eggs. Another reason FETs can be better is because the focus of the medications during egg retrieval is really focusing on egg production – not promoting a plush lining. Women who struggle with lining issues may find better success when they can concentrate just on growing a good lining during a FET. But that has never been my problem (fingers crossed it stays that way). At my last egg retrieval my RE commented on how perfect my lining was. My lining is always ready during my stim cycle. My daughter was a fresh transfer too. So why wait and put my embryos through the stress of freezing and defrosting?
- Do a 3-day transfer of however many embryos I have instead of a 5-day transfer. So if we are already doing a fresh transfer, why grow them out to 5-days instead of putting them back on day 3? Well, if you have several embryos then allowing them to develop to day 5 and selecting the best looking blasts can be a good technique. It will narrow down the pool. But I already know I’m not going to have a large pool of embryos to select from. And at age 40, I’ll be fortunate if one of them is normal. So why wait? My RE, as well as many others, thinks that maybe the uterus – the embryo’s natural environment – is a better place than the lab to grow embryos. And I believe that too, even if it’s just opinion. Can a petri dish really match mother nature? I doubt it. The lab can be a hard place to be, especially for embryos from older women that may be more fragile. Typically the medium that the embryo is floating in is changed on day 3 and that can be stressful. Many women loose a lot of embryos from day 3 to day 5. Why not give the embryos the best fighting chance at development in their natural environment where they can get what they need?
When I proposed this 3-part plan to my RE, I prefaced it by saying, “I want you to try a hail mary with me.” (Yes, that’s a football reference.) I thought I was proposing a long shot. But to my surprise he laughed and said that that was the exact same plan he was going to propose to me. He thought that it is actually a smart plan given my history.
So we are doing IVF like they did years ago, back before the science may have gotten in the way, at least to some extent. I know this may not bring me my miracle baby. I know that if I get pregnant, and that’s a big if, I will be at higher risk for miscarriage and chromosome issues due to my age. And that will be stressful, scary, and heartbreaking if something goes wrong. But that is the same risk that fertile women have during any natural pregnancy. It happens all the time. And at least this will give me a chance at pregnancy – something I haven’t had during these last 3 rounds of IVF.
And on a side note, we are saving one of our “abnormal” embryos because the issue that it has is one deletion and my RE said there is simply no way of knowing if it might self-correct. He said it will either miscarry or correct and be fine. The lab we used doesn’t say if it’s mosaic or not – they call all mosaic embryos “abnormal”. So there is some chance this one could make it. I’m keeping this embryo just in case I need one more “hail mary”. My RE will transfer her if I want.