Last week we finally got to meet with our doctor after getting our negative beta result from our third frozen embryo transfer. We had to wait a week and a half for this appointment, so by the time the day finally arrived we were both beyond anxious for it. There were so many ways the appointment could go…
“I don’t think you should try again”
“Maybe you won’t be able to carry your own baby”
“We should try using someone else’s eggs/sperm/embryos”
“Let’s do another egg retrieval cycle”
“Let’s just try again and hope the last 3 times have just been bad luck”
After waiting for 30 minutes past our appointment time, we were finally taken back to see our doctor. She started off by saying how sorry she was and was so surprised by the outcome we had. The embryos looked perfect...my lining looked perfect...the transfer went perfect.
I wanted to stop her right there. You say everything was perfect, but then why didn’t it work?! If everything was so perfect, why were we having our third WTF appointment with you in less than a year?!
Anyways, after the “perfect” talk, she asked what we wanted. At this point I couldn’t stop the tears from flowing. I wanted to scream we want a child! But since I have been thinking about this appointment for a week and a half now, I knew exactly what I wanted to ask and how I wanted to move forward. At the end of the day, we cannot do another transfer unless our doctor can help us get some confidence back. Clearly what we are doing isn’t working so we need to look for more answers before moving on. And that’s when the truth came out...she replied and said,
“I don’t know if I can give you that.”
And just like that we were taken back to our first appointment with our OBGYN when they told us we had unexplained infertility. There is no answer or reason why we aren’t parents yet. And we are running out of ways to try and find any sort of answer.
So back to the WTF appointment…our doctor explained that there are only so many things science can help us understand when it comes to infertility. And while we both get that, we cannot accept it until we check off any and all possible diagnostic tools we do have at our disposal. Maybe it’s the wrong choice to focus on trying to getting more answers instead of just trying again and playing the numbers game, but we are scared to death to go through another failed transfer (I will write a blog post another time on how a failed transfer has similar emotions to a miscarriage).
Our doctor said the only thing she can think of that caused this transfer not to work is the possibility that my endometritis did not go away with the antibiotics that were prescribed for it. She recommends we repeat the uterine biopsy and see if the endometritis is still present (if you read my blog post on my uterine biopsy from hell you can probably guess the choice words I was thinking to myself as she recommended this). If the endometritis is still there, we will try another round of a different antibiotic and then do the biopsy again (ugh!). This is where we got frustrated. We didn’t know it was a possibility the antibiotics wouldn’t work and this transfer could be impacted by it (since she guessed this is why our second transfer didn’t work because we didn’t find the endometritis until after it). She said that 90% of the time the first round of antibiotics will work. Our frustration came in not being advised to treat this inflammation and then re-test before putting us through another transfer (and all the emotions that come with a transfer and the subsequent failure of it), wasting 2 embryos and another $5k down the drain. So this week we will do the biopsy again and see what it has to say. If the endometritis is in fact gone, then we are back to the drawing board...again.
This is when I started asking her about any other diagnostic tools we have. I’ve done plenty of research on failed IVF transfers and miscarriages and there are a few things left to try/do that we haven’t. While many of these our doctor didn’t “believe in” or think they would yield any results, she seemed to understand how desperate we are for some sort of answers and agreed to some of them.
Endometrial Scratch
What Is It: Before a transfer, the doctor will scrape the uterine lining. The body will release hormones and chemicals to heal the uterine lining making it more receptive to the implantation of an embryo.
Depending on the rest of the diagnostic test results we get, we may be asking for this procedure before our next transfer. We didn’t bring it up with our doctor during the WTF appointment since it was down the road and we wanted to focus on the immediate next steps first.
PGS Testing on our Remaining Frozen Embryos
What Is It: PGS (pre-implantation genetic screening) involves biopsying a few cells from the outer layer of an embryo. The test is a comprehensive chromosomal screening to make sure the embryos have the correct number of chromosomes (called euploid) or incorrect number (called aneuploid). Typically, you would test the embryos before initially freezing them after an egg retrieval. We chose not to test our embryos after many that we talked to explained to us that this testing isn’t a guarantee and sometimes even abnormal embryos can correct themselves in utero and work. Plus, it was additional $5k at the time and we couldn’t afford something that wasn’t necessarily going to help give us a a guarantee...or so we thought at the time.
We have decided that we do not want to do any harm to the 4 embryos we have left and just hope that the ones we have left will work. We don’t want to do anything to impact their chances at implanting and thriving.
A Second Egg Retrieval with PGS testing
What Is It: This would involve going through another ovarian stimulation cycle and growing as many follicles (a.k.a. eggs) as possible and having the egg retrieval surgery. If we were to do this, the reasons would be to get more embryos to work with before I get too “old” and/or to do PGS testing before they are frozen.
This is our absolute last resort. Going through stims and an egg retrieval is not only the most physically demanding part of an IVF cycle, it is also the most expensive. If we added PGS testing to a second egg retrieval round we could be looking at another $20-25k. We do not want to think about going down this path unless absolutely necessary after exhausting all other options.
Immunology Testing What Is It: While this may be considered a relatively new field of thought in fertility treatments, there are studies that show that auto-immune issues can be the cause for recurrent IVF transfer failures/pregnancy loss. For example, Natural Killer cells (a.k.a. NK cells) are a type of lymphocyte (white blood cell) and are an essential part of our immune system. They help to fight off tumors and virally infected cells. Some studies have shown that uterine NK cells can be the cause for someone not getting/staying pregnant as the uterine NK cells could view the embryo as a foreign object. Another example could be an increase in blood clotting causing a limited amount of blood to reach the uterus and the implanting embryo. Many auto-immune issues can be seen as obstacles in fertility, but the entire field of reproductive immunology and its impact on IVF seems to be split 50/50 with fertility doctors from the research I’ve done. Meeting with a Reproductive Immunologist can be very expensive and our clinic does not offer this testing as they fall onto the side of the debate that there isn’t sufficient data showing these auto-immune issues are the root cause of certain fertility problems. My doctor is willing to treat some of these auto-immune issues on our next transfer attempt even without testing for them as they won’t harm me. She recommended that we add the following on top of everything we did for our third transfer:
- Increasing Prednisone: For our last 3 transfers, we have taken Prednisone (a corticosteroid) for 3 days starting the day of transfer. Our doctor is recommending we add it to our daily protocol the entire transfer prep process and through the first 12 weeks of pregnancy (if we get so lucky!). We are a little weary of this option and will probably spend some time talking through it more with our doctor if we get to our next transfer to better understand the use of Prednisone and its risks taking it through the first trimester (she had mentioned during our appointment it could affect fetal growth).
- Intralipids Infusion: Studies have found that an infusion of intralipids, administered through an IV before and after an embryo transfer, can help to deactivate the NK cells.
- Lovenox injections: an anti-coagulant that can have the following benefits:
Diagnostic Laparoscopy What Is It: This is a surgical procedure that involves making small cuts in the abdomen and inserting a laparoscope and other surgical instruments to allow doctors to look directly at the contents of the abdomen or pelvis, including the ovaries, fallopian tubes and uterus. The procedure can help a doctor diagnose and treat conditions that affect fertility like endometriosis, blocked fallopian tubes, buildups of scar tissue, fibroids or other abnormalities.
Our fertility doctor doesn’t think this will yield any answers (a.k.a. not find any endometriosis for example), but said it was something we can do if we want to check off another box. My OBGYN reached out to my fertility doctor the day after our WTF appointment to discuss this directly and they both ended up agreeing it was a good idea to move forward with this surgery. At the same time of the diagnostic laparoscopy, we will also have another hysteroscopy done at the same time to make sure the inside of my uterus looks okay and there aren’t any new issues there.
So for now we will get the biopsy done this week and wait a couple weeks for the results to come back. In the meantime, we are waiting to get our insurance authorization for the diagnostic laparoscopy and hysteroscopy so we can get that scheduled (hoping we can get it done in the next couple of months and not have to wait longer to do it).
We know we are close to the crossroad where we will decide if we keep going with fertility treatments or we look at another option (ex. Surrogacy, adoption, a childless life, etc.). We aren’t ready to give up but I would be lying if I said we aren't completely heartbroken that our conversations are starting to discuss how much more we can take. When we did our first IUI in May 2018, I don't think either of us thought by this point we wouldn't have a baby or at least be pregnant. One of the most frustrating things is that we are doing everything right and investing so much money into figuring out how we can become parents and we still don’t have anything to show for it...yet.
Comments