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The Not So Fertile Goddess

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The Not So Fertile Goddess

Tag Archives: PGS

A New Plan for IVF #6

31 Wednesday Jan 2018

Posted by thenotsofertilegoddess in IVF #6 with Fresh 3-day Transfer

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Fresh Transfer, IVF, PGS

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:

  1. 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.
  2.  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?
  3. 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.

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PGS Results: Sad News

23 Tuesday Jan 2018

Posted by thenotsofertilegoddess in IVF #5

≈ 6 Comments

Tags

Coping, IVF, PGS

Another blow. I got my PGS results today and both embryos are abnormal. My heart broke when I heard the tone of the nurse’s voice as she said, “I have your results…” It was easy to tell what she was going to say next. I don’t know the details yet about what is wrong with them, but I’ll have a consult with my RE next week to go over everything. For the first time I’m feeling truly hopeless in this process. I’m wondering if it is time to quit. I’m scared I’m damaging my body with all these medications. I’m worried about getting cancer. I’m worried about how much more I can take emotionally. I feel like I’m missing out on my daughter’s life, at least a bit, because I’m so wrapped up in infertility treatment and the emotional mood swings.

I’m wondering what my chances really are at age 40? I know it works for some women, but how many does it not work for?

There are so many emotions that go with this. Right now I’m vacillating between anger, numbness, and hopelessness. That’s not a good place to be in. I’m the type of person that likes to have a plan. A direction. I like to be in control, or at least have the illusion of control, yet this whole process feels so out of control. Waiting is maddening. And now I’m waiting a week for my consult with my RE to discuss my case and options for moving forward.

How do you know when it’s time to give up on a dream? When you read IVF support groups you see so many people saying, “don’t give up!” But is that really the best advice? Is that reality? I don’t think so. And that’s one of the hardest parts of infertility. You have to make hard decisions without the aid of a crystal ball. If I knew doing one more IVF would bring me a baby then absolutely I would do it. But I don’t know that. What if one more round brings me cancer or depression instead? These are the hard decisions.

I’m not sure where I am right now. Stopping and saying good-bye to my hopes of a second child, of making my daughter a sibling that she so very much wants to be – I’m not sure I’m ready for that. But I’m scared of doing another round of this.

I have a lot of questions for my RE. I keep questioning whether PGS testing is the best way to go. Some women, especially those who have a hard time getting blasts, do 3-day transfers under the idea that the body is a better environment for the developing embryo than the lab. Maybe that’s the way to go, or maybe I’m just fooling myself. Maybe at age 40 my eggs are simply not good enough. Yes, I have a lot to discuss with my RE and much to think about. I just don’t know that there’s any right answer. That scares me.

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Waiting by the phone

11 Thursday Jan 2018

Posted by thenotsofertilegoddess in IVF #5

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Tags

Coping, IVF, PGS, waiting

waiting 2It would be easy to think that the waiting periods would get easier after you’ve done this for a while. Like you’ve gotten good at it. But I’m finding that it seems to be getting worse as time goes on. In the beginning of this second IVF journey, I was optimistic and expected good results. After all, I had success with IVF in the past. But the longer this process goes on for, the more IVFs I’ve had, the more negative experiences I accumulate. After all, if I was getting lots of good news then we wouldn’t still be at this. So every time I have to wait for news – fertilization reports, 5-day progress reports, PGS results, beta results – my brain automatically pulls up all of the experiences and outcomes from my past waiting periods. It’s starting to feel overwhelming.

Yesterday it really hit me. I had been doing fine up until that point and feeling optimistic, but the day before my 5-day progress report (which my clinic doesn’t give until day 6, ugh), I started to recall my last 2 IVF cycles where none of my embryos made it to blast. Those conversations I had with the nurse when she told me rolled through my head on a loop. They even triggered other bad news conversations, like when my nurse called with my negative beta result. I dug into my bag of healthy coping skills and pulled out everything I could. I went for a walk, attended a yoga class, talked to supportive friends, made rational responses to the negative thoughts in my head, reminded myself of my inner strength, took deep breaths, prayed, cleaned the kitchen, drank a glass of wine (hey, red wine is kinda healthy).

And I made it. After waiting half the day today, my nurse finally called. Two of my 7 embryos made it to day 5 blastocysts and were of good enough quality to biopsy. They were hoping another would make it on day 6, but it ended up dying. The others didn’t last as long. So there it is. I have 2 going into PGS testing.

I’m grateful to have these 2 little embryos. Really. None of my embryos made it to blast in my last two rounds of IVF. So this is great. But I’m still really scared. I know that the rates of abnormal embryos are high for my age group. What are the chances that either of these 2 embryos are normal? Not good based on the statistics. But that’s the thing with statistics – they tell you the averages, the probabilities, but don’t actually tell you anything about you. I’m going to try my best to keep the faith and hold onto hope. We leave tomorrow to go on vacation and visit my family out of state, and I’m so thankful for that. It will be a good distraction to help me get through at least half of the waiting period for our PGS results. These are going to be a long 7 to 10 business days…

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IVF #4 – Trying a Mini!

29 Wednesday Nov 2017

Posted by thenotsofertilegoddess in IVF #4, Uncategorized

≈ 4 Comments

Tags

ICSI, IVF, Mini IVF, PGS

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!

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