Category Archives: IVF #4

A Disappointing End

14 Thursday Dec 2017

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I told myself I wasn’t going to be anxious today. Today is the day that I find out if our one egg that fertilized made it to blastocyst. I said I wouldn’t be nervous because I was already counting it out. I’ve already ordered all my meds for the next cycle and the last of them will be here by tomorrow. I’m set to start my next cycle, pending a clear ultrasound, right after my period starts. It’s easy to not be nervous when your expectations are so low.

 

But here I am – sitting in my office, knowing that my phone could ring at any moment. And I’m nervous; my palms are sweating. Damn it. That means that deep inside, despite what I told myself, I’m hoping for good news. And I’m scared because I know the chance of getting good news is low. This process really takes a large toll on you. I know the feeling of being told that none of your embryos made it to blast, and I don’t want to feel that way again. I keep telling myself that I will be okay with bad news. I will get through it again. And I will. I just want my luck with this to change. I want some good news. I want it to work. And so I sit and wait…

 

Then the call came. The embryo didn’t make it. I’m not surprised and at least the wait is over. I can’t dwell on this. I can’t change it. Now I’m just going to have to focus on the next cycle. It’s all so disappointing. But where else can I move but forward?

But my body had other plans…

11 Monday Dec 2017

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My mini IVF cycle was really off to a great start. I responded excellent to the meds and at my first ultrasound I had 7 follicles. Even my left ovary, which tends to be sleepy, was producing well. It felt like this might be the protocol to do it. Each ultrasound was good and my follicles grew well and consistently. We got to last Thursday, did an ultrasound and labs to make the final decision of whether we would trigger on Friday or Saturday. My nurse called and based on my estrogen level it was decided that we would go one more day for optimal growth – trigger on Friday and retrieval on Sunday. I was right on schedule with my predicted calendar.

And then I got a second call late in the afternoon. Apparently they measured by LH in addition to my estrogen and to everyone’s surprise my LH was high – like ovulation peak high. Wait, what?! Despite the antagonist I was injecting daily, which blocks your brain from releasing LH, my brain decided to do it’s own thing. I was about to ovulate. Just two days before, my LH was low as they would expect. I was informed that my retrieval would be the next morning. I was stunned.

I spoke with my RE in the morning before the procedure. He said this happens in about 1% of the cases with antagonists. Of course I’m in that 1%. He told me of the one other patient he’s had where this happened. He waited 36 hours after the high LH reading to do the egg retrieval and ended up missing all the eggs because she had already ovulated. So, this time he’s doing it earlier – about 24 hours – in hopes of getting the eggs. Of course, the problem is you really don’t know when the surge began so there is guess work.

After waking from retrieval, I was informed that he got 2 eggs. I was devastated. And angry. Such great potential with this cycle – wasted. The issue wasn’t that I had already ovulated, rather my eggs weren’t fully detached from the fibers that hold them in the follicles. He scrapped, trying to release them, but only got 2. So we ended up being a little early. He told me to have sex since I have potentially 5 eggs that are about to be released, but I know that my chances for a natural conception are low, especially with my shotty fallopian tubes. We decided to not waste any time, since I don’t have much, and go straight into another stim cycle when my period starts in about 2 weeks. Is there a possibility that one of these 2 eggs could be the golden egg? Sure. But with stats like I’ve had, I’m not holding my breath.

This all feels surreal, as does most of the IVF process. How do we go from such a great start to this? Part of me is angry, but part of me just feels numb. And I go through the motions because what else am I going to do? After the epic failure of my last cycle, where none of my 9 eggs made it to blastocysts, this simply feels like par for the course. The fertilization report came the next day. One egg fertilized and is growing. In general, you’d expect a 50% drop off from fertilization to blastocyst. Humm, 50% of 1 isn’t looking too good. And if it did make it, would it be chromosomally normal? It’s a long shot. People have told me to have hope – that it only takes one. I get it, really I do. People want you to feel better. And they want to have hope too. But I’m getting tired. I had so much hope and optimism during these last 2 cycles and all the way up to retrieval on this 3rd. Each time I though that THIS was the one that would get me that baby. I really believed it. And all the hope and belief didn’t make it so.  I know I’m sounding really pessimistic here. But at some point, I feel like I have to protect myself from the pain. I don’t feel hopeless. I don’t feel like I’ve come to the end of my road. And neither does my RE. But right now, I need to feel neutral. I need to feel okay with a negative outcome so I don’t drown in it.

Today, I have no idea if this is going to work. I don’t know if I’ll ever have another baby. If my daughter will ever be the big sister that she so desperately wants to be. But I do know that at the end, whether I’m pregnant or not, I will have given it my best. I will have tried everything. And that’s the best that I can do.

For the next cycle we are going back to my original high dose protocol. It’s the same protocol that brought me my PGS normal embryo, as well as the failed cycle that ended in zero blasts. This will answer the question of whether that failed cycle was simply “a bad batch” or if it truly reflected a fast decline in my egg quality. My RE said that after 3 cycles of no good blasts, that’s when we would say that this isn’t going to work. I’ve had one cycle like that. I’m not counting this cycle that we just had, regardless of the outcome, because we were not able to do the egg retrieval at the right time. So I guess there is an end in sight. I truly hope there is a happy ending to this story. I’m not ready to think about the alternative.

IVF #4 – Trying a Mini!

29 Wednesday Nov 2017

Posted by in IVF #4, Uncategorized

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I went into my follow-up consult on cycle day five, just hoping for some fresh ideas to improve egg quality, and I didn’t want to hear anything fatalistic. I led off by telling my RE, “I know I’m 40 but I’m not coughing dust yet!” And like always my RE delivered. He’s not giving up on me or my eggs, and he was ready to change things up with my protocol. I have no idea if his new plan will work, but I am so grateful for this doctor who is compassionate, intelligent, humorous, and takes the time to really answer questions and explore options with me.

He reviewed the lab’s report for exactly how my eggs fertilized and what my embryo growth patterns were like. It was clear that we are dealing with egg quality, not sperm issues. He said he was really surprised that none made it to blast and they weren’t expecting that. The cycle before I got 1 PGS normal. Could it have gotten that bad in 4 months or was this a bad batch – he said it’s hard to tell now. But he created a new plan to move forward that focuses on quality over quantity.

We are doing a mini IVF. The idea here, which I’ve heard rumor is great for women over 40, is that less stim meds are used to create fewer eggs, and that hopefully allows those eggs to soak up all the resources and energy needed to improve their quality. I’m ready to try this and I was getting worried about the high doses of meds I had been on. Injecting all that stuff can’t be good long term, right?

While there are many different mini stim protocols, mine involves clomid and menopur, then later adding ganirelix to prevent early ovulation. Although I know clomid isn’t always great for women over 35, I’ve responded to it quite well at that age. Plus we are not solely relying on that. We’ll also be doing HGH a bit longer this time  – starting on day 3 of stims, simply because I wouldn’t be able to have it in time for day 1, and continuing until trigger shot. And the reason for not having it in time for stim day 1 is because I began my mini stim the night of my consultation! My RE didn’t want to waste any time so he had me start clomid that night and use some leftover menopur from last cycle. He whisked me in  for a baseline ultrasound which looked all good to go.

And so we are jumping right back in. I’m ready. The rush at the beginning to get my meds lined up was a bit nerve racking, but everything is ordered. I also had to use gonal f instead of menopur for the second day until my new meds arrived this morning because I didn’t have as much left over from last cycle as I thought. I was assured it was fine this early in the cycle since we are focusing on FSH at this stage, and both are FSH. My clinic would have given me the needed menopur but they were all out too, so gonal f it was.  I took my clomid at night for the first 2 nights and then switched to morning administration on the third day because my nurse said it’s better to take them in the AM before the ultrasounds. Changing the timing of the meds that much makes me nervous because I’m so used to them being very specific about sticking to certain times so the body has what it needs on time. But my nurse assured me that we have a lot of flexibility during the first 5 days of stims and that sticking to specific times is more important later. There’s nothing I can do about any of this now and worrying won’t change anything. So I’m letting it go and trusting that they know what their talking about.

My RE told me that there is a special medium filled with antioxidants and other goodies to “supercharge” my embryos as they grow. The idea is that this enhanced medium can better support “older” eggs in doing what they need to do. We didn’t use that last cycle because he didn’t anticipate that the quality would be as compromised.

We also discussed PGS testing and ICSI. I was concerned that maybe ICSI wasn’t working well for me and maybe we should go back to natural fertilization. My RE explained that it’s actually better on older eggs to do ICSI because the egg doesn’t have to expend a significant amount of energy pulling in the sperm. Who knew. I was pleased with our open discussion about PGS. He readily admitted that some embryos can self correct, although it is rare. He told me about a research study he did where they PGS tested embryos but put back some before the results were in to compare outcomes. He said they put an embryo back in a women and later found out it was abnormal (I forget which chromosome abnormality it had). They were all worried and expected her to miscarry, but instead she delivered a healthy baby. He explained that there are a few chromosome abnormalities that we know are incompatible with life and/or lead to significant healthy problems (I can’t remember the ones he said). Those won’t self correct. But the others, well, they just might. He said that when PGS results come back with multiple chromosome deletions or additions, then you can be confident in those results. But if the abnormal finding is do to just one chromosome issue and it’s not one of those dreaded few, then there is a possibility that the embryo could self correct or the result could be inaccurate.

I also asked about the studies showing significant variance in PGS results across labs, indicating that results just aren’t very reliable. He acknowledged those and said that you have to be careful in interpreting the results. He said that you aren’t going to find that anymore among top labs. And that’s when I put back on my psychologist “hat” and remembered what I already knew about research. People readily tout research studies published in peer reviewed, scientific journals as facts. But that simply isn’t true. A motto that was ground into my head during graduate school was, “the devil is in the interpretation.” There are issues with what the labs do, how the research is designed, and what statistics are used – even in published studies. Sadly way more often that you think, the conclusions that authors make to explain their research outcomes are simply not supported by the data. And yes, these are even published in top journals. There are often flaws in research methodology and statistics that do not support the reported conclusions. In every single graduate course I took, we had to tear apart published studies to find the flaws. They were everywhere. Now you might say, “yes but  that was psychology and this is a different topic,” however, the statistical analyses and research designs are all exactly the same. It’s math. The sad reality is that most health professionals do not have the statistical expertise to see study flaws in published work. My Ph.D. is from a research-focused program. It’s what we do.

Given all of this, I asked my RE what he would recommend to me. He said, “there are worse things than not getting pregnant,” referring to still birth, late miscarriages, and severe health disabilities.  That is true, at least to me. He advised doing PGS and agreed that we would review the results together to determine if any abnormal findings fall into the category of only one chromosome issue and that being outside of the “dreaded few”. If we have any like that – that could possibly self correct and/or be an inaccurate result – then he would do the embryo transfer if I wished. I’m comfortable with this plan as I believe it gives me the peace of mind in hopefully finding  a chromosomally normal embryo while reducing the chance of discarding one the could have made it.

So that’s the new plan for IVF #4. My first ultrasound is in 3 days!