Thursday, 24 April 2014

Fail Better

During the early morning hours in the last week of January, I found myself staying awake to watch the Australian Open. In particular, I was drawn to Stanislas Wawrinka's amazing title run.  He accomplished an incredible feat by defeating two former champions en route to his first major title and managed to overtake Roger Federer as the number one Swiss player. He also possesses the most gorgeous one-handed backhand in the game today. Personally, I prefer the power and precision granted by the second hand, but his one-handed shot is absolutely beautiful. Oh additionally, he has that rugged handsomeness that tempts a roll around in the hay. Anyway... during his matches, the commentators made much attention over a tattooed inscription on his forearm.

Ever tried, ever fail. No matter
Try again, fail again, fail better

This time I made sure to check Husband's schedule before scheduling my second WTF appointment. "What for?" he asked "The two of you talk in your own language and I feel like the third wheel." My silence agreed with his point. It also seemed to echo that we haven't gotten very far with my brain power. Perhaps an outsider's perspective would bring more to the discussion. Thus, my strategy for this meeting was to let my RE do all the talking and have Husband ask questions. Well... most of them anyway...

Dr STIUTK once again expressed his condolences before launching into to his assessment. There's obviously an embryo quality issue. It is difficult to determine if it is specifically the eggs or sperm; but for all practical purposes, it's probably both. I wanted all cards on the table. "So, is it worthwhile to pursue another cycle with our own gametes?" Apparently he thinks it is. While I acknowledge that I was hoping to work with more, we were able to transfer four embryos generated from the six eggs that had fertilised (out of eight available mature oocytes).  In the IVF world, this is actually good; even though it didn't work. My RE also discouraged me from using the word 'failure' and replaced it with 'hasn't worked yet'. Ah, there was the spin that I was expecting. He recognised my perspective, but noted that I don't have the same vantage point to witness hundreds of failed cycles. True, most of the time I'm receiving their successful cases, and I only ask about the details that led to their current pregnancy, although some offer a recount of their struggles.  I also have 'G0 (failed fertility treatments)' written in the notes of many other patients, and I don't usually ask any follow up questions.

My RE reviewed his modifications to my protocol for Husband's benefit, as we started to look at the calendar. If I were Mary Perfect with a 28 day cycle, based on when I would be starting the mid-luteal lupron and when I would start the stims, my retrieval could coincide with Memorial Day weekend and another hockey tournament. He gave us the option of either extending my lupron for a day or two, or freezing sperm. I feel unwilling to compromise anything with this cycle, but as I tend  have a longer follicular phase, especially after being suppressed for a while, my slow to respond hypopituitary axis may work in our favour. Oh, ClearBlue Fertility Monitor, I just can't quit you! You accurately detect my LH surge and predict ovulation even when it's day 22 and even though my RE expressed skepticism about your abilities. Welcome back into my morning routine.  Actually, it will make for quite a change to not engage in awkward timed intercourse on the night of my high reading.

As my RE started to wrap up our visit by expressing that while he can't offer any guarantees, he still feels hopeful about our prospects, I stared out the window and thought about the questions I didn't ask, as I don't think they can be answered.  What happens if the next cycle unfolds like the last ? If my estrogen levels are too high on SD4, does that mean that my eggs will be spoilt? What if we still have unsynchronous follicle development? Could the lupron and lower dosed stims be too suppressive leading to a relatively low retrieval rate? If our embryos look poor, will we need to consider another day 3 transfer?

I did ask if anything can be extrapolated from the fact that one of my day 3 chromosomaly abnormal embies implanted, but both my FETs failed. My RE didn't have an explanation, as theoretically FETs should be more likely to succeed as it allows for a more optimal uterine environment. At this point in time, we will plan for PGD testing with an FET to follow if there are any normal embryos. Now that I have more failed transfers, I'll have one of my colleagues perform an endometrial biopsy to induce endometrial injury prior to the procedure.

Ultimately, I know that no one can offer any assurance that our second cycle will exhibit any improvement, nor will it be successful in producing a take home baby. Thus, the words from Samuel Beckett seem to resonate with me. Are we merely attempting to fail better?


  1. I like the fail better quote. It makes a lot of sense to me.

    I think PGD will be a worthwhile expense and exercise for you. I'll be interested to hear how it goes.

  2. I'm glad you're planning to move forward with PGD. I'm praying it gives you the answers you need!! XOXO

  3. If I recall, the reason for your high estrogen was a jacked-up stim protocol, so having learned some lessons about how you respond, I'm hoping you can avoid a repeat in that department. I wouldn't be giving up on your gametes yet either.

  4. Sounds like you have a solid plan. (And I think I understand how your husband feels during your appointments - I know some of these science-y words you're using.) I've played pretty much every sport, but I can't seem to handle tennis. Though most of the men do seem to be ruggedly handsome... Wishing you the best, Jane!

  5. I hope that the adjusted protocol will be better for your ovaries, and that PDG brings some answers. And, of course, that this actually leads to your take-home baby!

  6. It's a good quote. We are always told to learn from our mistakes, and this seems another way to say it. If you learn how to fail better each time, will it eventually give you the end result you want? Let's hope so!!! I so want this to work for you Jane.

  7. It's frustrating to have no guarantees, but I think you can take hope from the fact your RE thinks that an adjustment in protocol will lead to better results. That is perspective of someone who was told after 1 IVF cycle that there were no more options for IVF. But mainly, if it make sense to do another cycle, even if you are not super-excited or optimistic about it, I think it is a good idea to try.

  8. I know it was probably a combination of many things, including a whole lot of luck, but I really believe the endometrial biopsy finally helped something to implant. Throw everything you can at this cycle. I hope your RE learned from your response the first time and finds the right balance of meds for you. Good luck, jane!