Tuesday, 18 March 2014

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...


  1. I'm glad your RE gets you. I hope that makes some of the discussions a little easier (though still not easy). If he and the embryologist think your leftover fro-yo has potential, I'd probably consider it... a frozen cycle, at least to me, is so much less involved than a fresh one that this would seem like the easiest next step, and give you some extra time to think...

  2. Absolutely that fro yo has potential! Makes absolute sense to clean out the freezer before going through a whole extra cycle. You just might save yourself from doing another full cycle at all!

  3. I'm glad you will be moving forward with your remaining fro-yo. I feel like I could have written your exact post a few months ago- it's supposed to all make sense- I'm still beyond perplexed as to how 11 embryos failed me with no BFP but that all of a sudden on a 6th IVF cycle, it ended up working. How the heck can that be explained?! Keep moving forward my friend- and know I'm in your corner!!! XOXO

  4. hopefully this last frozen embie will be the one that makes it! onward and upward right? sorry you didn't get the answers you were looking for, but at least you have a plan and a doctor that gets you!

  5. That is tough to walk away with no answers, but I hope you are able to find some peace with whatever you decide. I think it's human nature to want to attribute meaning and cause to events, even when there isn't any.

  6. glad you are considering using the fro-yo. Its easier, cheaper, and many of "us" got knocked up on FETs that we did not think would work. I was so ready to get a new batch of fresh donor eggs....

  7. My first IVF ended with a 2 day transfer. It was definitely desperation only I didn't realize it at the time. I was so naive then. It's hard not to think maybe you did something to stop it from working. I still blame my failure with IVF 2 on going to an NFL game during the tww. I know it's silly but the stands were shaking so much from people stomping their feet, I am convinced the embryo shook loose. It sounds even more irrational when I put t in writing!
    My vote (as if I have one) is to use the fro-yo. It could work and save you from doing another fresh cycle.

  8. Sometimes there is going to be no explanation as to why something happened or not happened, sometimes things go awry for reasons beyond our understanding. Sometimes everything aligns perfectly and we still don't succeed. Maybe in a 100 years medicine will be so advanced every BFN and every miscarriage will have an identifiable culprit, or maybe not. And all we can do is just accept it, even though knowing 'why' could possibly arm us better for the future..
    And if had a vote, I'd also vote for fro-yo.

    btw, I didn't find it in your TTC timeline, have you ever done tests for NK (natural killers)? I'm not sure how common those tests really are, my RE never suggested them and when asked point blank - admitted that they only recommend them after unsuccessful IVFs or repeated miscarriages, but if you haven't, maybe that's something to think about or ask your RE's opinion.


  9. I think you're making the right decision with the frozen embryo. Like Aubrey said, most of the time there's absolutely nothing to distinguish a successful cycle / transfer from all the failed ones that went before. That's what makes all of this so damn frustrating. It would be so much easier if we all just knew the ONE THING we had to change to fix it all.

  10. Just want to say how much I appreciate your writing & your generosity in sharing your thoughts/experience. I am so grateful for your articulate voice.

    You have also been a really great comfort because your perspective is as both a patient & a provider. I struggle with the vulnerability of being a patient. I am a great provider (CNM), but balancing my knowledge with the need to let someone be in charge of my care is really challenging. You are a really great role model in this department (Funny & Mature). Thank you x a million.