WWYD/Help me decide ("hard" IVF cases come in please!)

[seeyalater52]

Feb 27, 2019 8:50:47 GMT -5 shoeless said:

The internet ate my reply

For the next cycle can you do Lupron with Medrol? Is your dr willing to keep you on medrol post transfer? I know Medrol can be a first step against immune issues and I had a friend who after multiple losses was finally successful when she stayed on medrol for the first trimester. Also, are you on baby aspirin, I know there's no clear science behind it, but it doesn't hurt, so I'd add it in if not already part of your protocol.

For reference in the multiple failed transfers/losses with donor egg forums there seems to be three options people pursue (and are generally successful afterwards). These won't help with the next transfer but I'll put it out there.

1. Double sperm donors or just moving to sperm donors. Many had partners who had children from previous relationships (so proven) but for whatever reason their sperm just wasn't cutting it anymore. There are new studies finally coming out that talk about the sensitivity of sperm to things like age, drinking, foods eaten, etc. Basically, everything we've been told to change for better egg quality seems to be true for sperm as well.

2. Treatment of silent Endo. There were a few posters who swore by exploratory laps. Almost all ended up with silent endo diagnosis. After the 'clean out' they were able to carry to term.

3. Immuno issues. Most consult with Dr Braverman or Dr Kwak-Kim. I believe I read that Dr K-K is easy to work with out of town and doesn't require your RE to be 'on board' with her recommended treatment protocol.

Even though the science is woo-y if I had, had a third miscarriage I was going to consult with Dr K-K. (I would have pursed option 1, but the embryos were already made and there was no way to afford another batch of donor eggs and option 2 doesn't work for me since I am post menopausal.)

I'll be thinking of you.

Thanks for the ideas! We have been doing baby aspirin for all of our transfers so far. I did medrol for one of them, but not post-transfer. My doctor won't prescribe it, but let's just say I may be able to take prednisone until about 6 weeks if I decide I want to do that. I've seen A LOT of people have success with that, although usually in conjunction with other things we don't have access to with our current RE (lovenox, prograf, low dose naltrexone, intralipids, etc.)

By lupron protocol do you mean the microdose lupron protocol (lupron beginning a week after ovulation) or do you mean depot lupron 1-2 months before transfer? My current doc will do the former but I am pretty sure not the latter. The latter is what I want but I'm guessing I'll need to get a decisive answer about endo first before I can get depot lupron. If you've done the microdose lupron protocol, can you say a little more about how it worked? When did you start lupron, did you take other meds and what was the timing, and what did your monitoring schedule look like for the cycle?

What is double sperm donor? Do you mean just double donor? We are obviously using a sperm donor (gay, lol) but will likely be changing donors for the next cycle. I think we won't do egg donation. It would be too much $$ OOP for the eggs (plus unclear if insurance will still pay for the IVF if we are using donor eggs, as I'm not old enough to meet their coverage criteria for them) and at that price point I think we'd want to start saving for adoption. 

Definitely going to work on silent endo. One of my major questions for this consult is whether the doctors are open to this and if so whether they'd do it as an exploratory lap or whether they'd opt for the ReceptivaDx biopsy. I'm agnostic; I think they can both be useful and it seems many have had success just using depot lupron before transfer for the period recommended by the Receptiva people rather than trying to excise endo, so the lap may not be entirely necessary (although it is covered by insurance, unlike Receptiva.) Receptiva also is just an endometrial biopsy, so can be done after a retrieval cycle without delaying subsequent transfers. Especially if I have to re-do other biopsies I might do it and just see what turns up. 

I have a consult with Braverman on the books for August (lol I scheduled that back in November... his schedule is ridiculous.) I will look into K-K, as I haven't yet and perhaps the wait times are less horrendous? I'm not willing to travel outside of my insurance network for treatment, so we are somewhat limited to the consult with my local RE model, which I know can be a challenge. 

Sorry, sooooo many questions. Thank you for your patience. 

[shoeless]

By double donor I mean two sperm donors, split the retrieval egg batch in half and fertilize half and half. Most couples I saw did this with once they moved from partner sperm to donor sperm just to try and take as many variables into account as possible.

I never personally did Lupron so I can't speak to what a microdose protocol would look like but given that your Dr wont do the Lupron Depot I'd personally still try and do a microdose protocol and hope it was enough to make a difference.

Sorry there isn't an easy solution available to you for your next transfer

[seeyalater52]

Feb 27, 2019 18:07:16 GMT -5 shoeless said:

By double donor I mean two sperm donors, split the retrieval egg batch in half and fertilize half and half. Most couples I saw did this with once they moved from partner sperm to donor sperm just to try and take as many variables into account as possible.

I never personally did Lupron so I can't speak to what a microdose protocol would look like but given that your Dr wont do the Lupron Depot I'd personally still try and do a microdose protocol and hope it was enough to make a difference.

Sorry there isn't an easy solution available to you for your next transfer

Oh interesting! I’ve wondered to myself if that is a possibility so it’s great to hear that someone else has done t! We would definitely consider that.

I have so many questions about how the different protocols would look but hopefully my doctor can answer them at our appointment on the 8th. Thanks for your help. ❤️

[awkwardpenguin]

Hey seeyalater52, I'm not around much these days so just seeing this. Your experience sounds a lot like my wife's, although DW only had one CP and two transfers that were just unsuccessful. I'm sorry you're going through this, it can be so lonely and sad to not be sure what the future holds.

Like you we had no specific reason to do PGS when we first did IVF. DW did 8 home insems and 2 IUIs with no BFP. We moved on to IVF, but she ovulated before her first retrieval so only three were retrieved. One made it to blast, and that transfer was a CP. We did a second cycle that yielded two embryos, and did one fresh and one frozen transfer, which both were BFNs. At that point our RE recommended PGS for "repeat implantation failure". IVF #3 yielded four blasts, two tested normal, and one of those is our daughter.

Our RE was more proactive with our third cycle. DW took egg quality vitamins for three months before retrieval, she took Methylprednisolone, loratadine, and something else I don't remember (but it was OTC). She also took lovenox from transfer to week 10 on the chance it was MTHFR (she tested positive for that). So who knows what of that worked, but something did.

From my perspective, PGS really helps figure out what's going on. Our RE advised us of the risk of having nothing test normal, but even if that had happened at least we would have known. Not knowing and the million what ifs were really hard.

FWIW, both DW and I were "hard" IVF cases and both of us eventually carried a pregnancy to term. It can be really hard to feel left behind on the boards, but there are several grads who went through long IF complicated IF journeys and eventually were successful.

[seeyalater52]

Mar 9, 2019 23:53:38 GMT -5 awkwardpenguin said:

Hey seeyalater52, I'm not around much these days so just seeing this. Your experience sounds a lot like my wife's, although DW only had one CP and two transfers that were just unsuccessful. I'm sorry you're going through this, it can be so lonely and sad to not be sure what the future holds.

Like you we had no specific reason to do PGS when we first did IVF. DW did 8 home insems and 2 IUIs with no BFP. We moved on to IVF, but she ovulated before her first retrieval so only three were retrieved. One made it to blast, and that transfer was a CP. We did a second cycle that yielded two embryos, and did one fresh and one frozen transfer, which both were BFNs. At that point our RE recommended PGS for "repeat implantation failure". IVF #3 yielded four blasts, two tested normal, and one of those is our daughter.

Our RE was more proactive with our third cycle. DW took egg quality vitamins for three months before retrieval, she took Methylprednisolone, loratadine, and something else I don't remember (but it was OTC). She also took lovenox from transfer to week 10 on the chance it was MTHFR (she tested positive for that). So who knows what of that worked, but something did.

From my perspective, PGS really helps figure out what's going on. Our RE advised us of the risk of having nothing test normal, but even if that had happened at least we would have known. Not knowing and the million what ifs were really hard.

FWIW, both DW and I were "hard" IVF cases and both of us eventually carried a pregnancy to term. It can be really hard to feel left behind on the boards, but there are several grads who went through long IF complicated IF journeys and eventually were successful.

Thanks for weighing in. I definitely know and am so encouraged that many have had success after complicated paths to and through IVF. I think what is throwing me off is that the doctors we have spoken with so far (two consults left to go) see a huge difference between repeat implantation failure and recurrent CPs. While they’re recommending supplements and PGS testing they’re also communicating clearly that they don’t believe the embryos are the primary problem, and we all seem to agree that it’s very likely that I’ve miscarried genetically normal embryos and the chances are good that I’d do so again even with testing. What confuses me about this is that none of the REs we have spoken with have a plan for what we would do in that scenario. They agree that it’s likely this will keep happening but cannot point to anything they would do in the protocol to change that outcome. It’s a numbers game to them - if we keep transferring, even if we keep miscarrying, there’s some chance it will eventually work. For me that is a huge risk emotionally. I’m just not sure we can do it. By the time I finish this last transfer I’ll have been doing IVF for a year. Seven embryos, 5 transfers. Maybe I’m just not as strong as everyone else but it’s put me over the edge. The losses have destroyed me. The thought of having more makes me want to die. I’m not sure I can do it. Between two consults so far we seem to have a pretty bad prognosis and I’m just not sure if it is maybe time to cut our losses and move on to saving for adoption instead of continuing to torture ourselves on treatment that even the most optimistic doctor thinks really might not work. I wish I knew what to do. This round of consults has gone much worse than I ever could have imagined.

[thoseareradishes]

seeyalater52, why do they think it's not an embryo problem? Is it because of the timing of the losses? I guess I don't understand why they are so pessimistic without knowing whether the embryos you have transferred are normal or not.

[seeyalater52]

Mar 10, 2019 13:57:49 GMT -5 thoseareradishes said:

seeyalater52, why do they think it's not an embryo problem? Is it because of the timing of the losses? I guess I don't understand why they are so pessimistic without knowing whether the embryos you have transferred are normal or not.

Just the number of embryos (5 so far) and my age when I did the cycle along with the identical timing of the losses. It’s improbable that the embryos are the sole cause. I agree with that statistically, especially after talking with the geneticist. According to the clinics we’ve spoken with the main benefit of doing PGS is to cut the time for the cycle down by at least a couple of embryos, not really to increase odds. It could confirm that the issue is my uterus rather than the embryos but if it’s me there’s not much they’d do differently.

Other posters keep mentioning things like longer courses of steroids, lovenox etc but my doctor and the consulting docs we have seen so far won’t consider any of those treatments no matter what happens with the PGS embryos. They really do think we will continue to have early losses and likely not be able to carry to term.

[vmars]

I am sorry your consults did not go well. Have you done genetic testing for yourself and karotyping?

I can absolutely understand needing a break. IVF and infertility can take over your life and it’s okay to take a step back. 2 friends who had multiple losses in a short period of time like you described decided to do just that for their mental health. I hope you find peace in whatever you decide to do next.

[seeyalater52]

Mar 10, 2019 18:15:04 GMT -5 vmars said:

I am sorry your consults did not go well. Have you done genetic testing for yourself and karotyping?

I can absolutely understand needing a break. IVF and infertility can take over your life and it’s okay to take a step back. 2 friends who had multiple losses in a short period of time like you described decided to do just that for their mental health. I hope you find peace in whatever you decide to do next.

Yes, I’ve had all the available testing, and the donor was also tested.

I am on a break until at least May. Maybe I’ll feel better then, but knowing that transfer is extremely likely to also end in a loss makes it really challenging to be excited or hopeful. It’s hard to know what is worse: waiting years to save up enough money to adopt, or continuing with treatments which, if they work, are less expensive but are very likely to continue to result in more losses and unclear if that will ever change. As usual with infertility there are no easy answers.