What if any Thing, did we learn From this?

The hardest part after receiving the news of our BFN was not processing my own feelings, but seeing the look of disappointment in Husband's eyes. I felt that I was to blame. I was entrusted with the responsibility of producing a viable pregnancy after the transfer of our embryo, and my shitty uterus failed. At least with my other two miscarriages, we had an explanation. Now we were in unexplained territory. I couldn't stop myself from rehashing everything I did post transfer. I was complaint with the no exercise, no swimming and no sex/orgasm rules for the first five days. I never missed a prenatal vitamin. We tried some new meals from a Paleo cookbook in an effort to eat healthful foods. I didn't have a drop of alcohol. Okay, that's a lie. I had a sip of Husband's glass of wine when he wasn't looking. Okay... it was two sips... I set an alarm on my phone and I never missed a single dose of my TID vaginal progesterone or my QOD PIO injections. When two extra strength Tylenol failed to ablate my headache, I yielded to temptation and downed two Advil Liqui-gels...Maybe it wasn't such a good idea to swim double sessions before my test day...

I know none of these factors had any influence. It just would be nice to have an answer. Last year, I saw a patient who miscarried twice within a six month time period. She was in her mid thirties and had two healthy pregnancies in her twenties. Oddly, she never came in for prenatal care, she just came in after the miscarriage was complete for a follow up, which made it difficult to do an adequate evaluation. We went around in circles, she kept suggesting multiple theories with innocuous events in her daily routine, but I had the same response; nothing she did or didn't do contributed to her miscarriage, but I could appreciate her desire to pinpoint a specific activity. If a causative behaviour is identified, then the formula for success is simply to avoid that action.

In my case, I needed to know what when wrong from the start and could it be fixed. It was time to meet with my RE and to discuss the postmortem of our first IVF attempt. He took a look through my chart and described it as a solid cycle by the numbers. My retrieval was within his expectations for my ovaries, the ratio of mature to immature eggs was acceptable (I read that if there are no immature eggs upon collection, it may indicate that the oocytes were over-ripe) and our fertilisation was consistent with the statistics for the lab. Unfortunately, it just doesn't seem to be enough to produce a viable and sustainable pregnancy. It feels reminiscent of when I would fault while my tennis instructor was adjusting the mechanics of my serve. "The motion looks good! ... the ball just didn't go in..."

My RE began by exposing the unfortunate reality, it's rare for IVF to succeed on the first transfer or even within the first cycle. Hearing those words fueled my resentment for those who conceive spontaneously. "You can go ahead and say 'I told you so'" I gave him latitude, "It would have been more efficient if I transferred both embryos." He laughed lightly and pointed out that if such a transfer resulted in a twin pregnancy, I would either be upset at myself or him; probably both. For what it's worth, this guy gets me. His observation from my stimulation is that my ovaries are brittle. Funny, I use a different 'b' word to describe them. Like a brittle diabetic who experiences dramatic swings in glucose levels with the slightest change in insulin regime, my ovaries over-responded in terms of estrogen production with a relatively low dose of meds (Menopur 150/Gonadal-F 150). My SD4 estradiol was over 300, he wanted to see it around 150. He doesn't feel that follicle recruitment was hindered too much by my withheld and decreased doses. Perhaps that was most disappointing to hear; I may still come up short of a dozen. However, he feels there is room to improve the quality of my oocytes by using an agonist protocol. We would start low dose lupron during the luteal phase of a natural cycle, to prime my ovaries and get them to CTFD. Then my stims would be started an an even lower dose and increased gradually.

I didn't ask, well what if that doesn't work and I'm still faced with a potentially low yield, nor did I admit that I had thoughts about wishing we had cancelled my prior retrieval. He offered that if at minimum we could get at least three embryos to the blastocyst stage, then it would be reasonable to pursue PGD testing. "I know that is important to you, although I can't claim that it is cost effective" He may have passed earlier, but I wasn't going to miss an opportunity to be wise-ass. "Well, I can claim that my instincts were correct, and if we had biopsied the embryos, we wouldn't have transferred one with a lethal anomaly." He repeated that there isn't data to demonstrate that testing is cost effective, which I think was his defense. We discussed my first transfer. I admitted that I was enticed by the promise of higher quality with a day 5 embryo and felt that I was forced to settle for less with my day 3 transfer. "I know you disagreed with my characterisation of a desperate measure, but I stand by my adjective." Once again, he laughed lightly. "A day 2 transfer would have been desperation, Jane." Okay, fair enough. He replied that he advocated so strongly for that transfer as he felt there was a good chance to result in a pregnancy with a low potential for twins. Technically, he was right. After all, if it weren't for that pesky extra chromosome, I could be in my second trimester right now. However, I was quite certain that an untested embryo would be abnormal, so I was also right.

He concluded that he still feels optimistic about our prospects, but he discouraged me from viewing our second cycle as a final cycle. Interestingly, and a bit to my surprise, he began and closed our visit by suggesting that we transfer our remaining fro-yo. We reviewed the assessment from the hottie embryologist, who seems to think it has potential. He  also noted that he prefers to complete one cycle before starting another. Who knows? Maybe this will be the one, but if not, we've only lost one month's time for a relatively small investment. So, I'm still faced with the same dilemma I was debating last week. A BFN and a WTF later, and yet I don't feel any wiser...