Approaching 40 next steps... @/triggerv

[ste]

I know unfortunately most of you are very knowledgeable here and thought maybe you could share with me thoughts or what to expect. We had a loss at 17w in September, after dx of t21 and discovery of a heart defect of unknown severity. We’ve been actively trying since my period returned exactly 8w later, unsuccessfully. I realize that’s not THAT long (cycle 5), but I also turn 40 this spring. The MFM we had been seeing prior to the loss suggested IVF with pgd if we wanted another, but for our insurance I apparently need a diagnosis of infertility for there to be any coverage.

Any insight greatly appreciated. I do have a consult with an RE scheduled (on my EDD ugh ... we live in the middle of nowhere so don’t have many options). TIA!

[thoseareradishes]

I'm so sorry for your loss.

Once you are over 40, you don't have to be trying very long (usually 3-6 months) to get the ball rolling on an infertility workup. That includes cycle day 3 (CD3) bloodwork, semen analysis (SA) for your H, probably an ultrasound, and a test to see the state of your tubes (HSG or something similar).

[loira]

I'm sorry for your loss.

Have you and your H had karyotyping done on yourselves? Did your MFM suggest IVF with PGS because of your age or for another reason?

Age isn't always a factor in chromosomal abnormality. Our first DD had a chromosome deletion diagnosed at 23w, and I was only 30 at the time and H only 34. We decided to TFMR. We were able to go on and have a regular, healthy pregnancy (I had a CVS just to make absolutely sure).

I probably would have taken IVF with PGS is the NHS had offered it to me though. At the time I'm sure it would have felt a lot "safer" than rolling the genetic dice.

[ste]

Feb 4, 2021 21:12:20 GMT -5 loira said:

I'm sorry for your loss.

Have you and your H had karyotyping done on yourselves? Did your MFM suggest IVF with PGS because of your age or for another reason?

Age isn't always a factor in chromosomal abnormality. Our first DD had a chromosome deletion diagnosed at 23w, and I was only 30 at the time and H only 34. We decided to TFMR. We were able to go on and have a regular, healthy pregnancy (I had a CVS just to make absolutely sure).

I probably would have taken IVF with PGS is the NHS had offered it to me though. At the time I'm sure it would have felt a lot "safer" than rolling the genetic dice.

We have not, and I don’t remember it being offered as an option- I did have an amnio though, not sure if that would make a difference? I actually don’t remember a lot of the details of some of these conversations, which is hard to believe given how all consuming they were at the time. Iirc, the suggestion of IVF was because of both my age and the slight increased risk due to having had it happen once already. There is t21 in the family, but they did not seem to think it was hereditary. I actually hadn’t really considered that we would be willing to go the IVF route, but after this many unsuccessful cycles at this point it really feels like the clock is ticking and risk just keeps going up each month. I never thought MH would be interested, but he’s the one who brought it up.

[Jalapeñomel]

I'm so sorry for your loss.

My insurance required us to do three IUIs before going to IVF, which is BS when you are approaching 40. I'd ask your MFM if they'd be willing to push through to your insurance to get you going on the IVF.

[ste]

Feb 5, 2021 11:49:08 GMT -5 Jalapeñomel said:

I'm so sorry for your loss.

My insurance required us to do three IUIs before going to IVF, which is BS when you are approaching 40. I'd ask your MFM if they'd be willing to push through to your insurance to get you going on the IVF.

Honestly I think the only reason I’d really truly consider IVF is because of the pgd part, which (I think?) is impossible with IUI. At this point I’m not sure I’m otherwise up for even going down the road of all of this (mentally/emotionally). But we’d need to talk about it, I guess MH may feel differently. I do know we cannot afford any of it without insurance coverage, so if I can’t/don’t get a dx it’s off the table anyway.

[scm1011]

Feb 5, 2021 11:49:08 GMT -5 Jalapeñomel said:

I'm so sorry for your loss.

My insurance required us to do three IUIs before going to IVF, which is BS when you are approaching 40. I'd ask your MFM if they'd be willing to push through to your insurance to get you going on the IVF.

This definitely could be an option. My RE said we were not good candidates for IUI and pushed us straight to IVF, which was covered by insurance. 

I'm so sorry for your loss, OP. Good luck.

[Jalapeñomel]

Feb 5, 2021 12:07:00 GMT -5 ste said:

Feb 5, 2021 11:49:08 GMT -5 Jalapeñomel said:

I'm so sorry for your loss.

My insurance required us to do three IUIs before going to IVF, which is BS when you are approaching 40. I'd ask your MFM if they'd be willing to push through to your insurance to get you going on the IVF.

Honestly I think the only reason I’d really truly consider IVF is because of the pgd part, which (I think?) is impossible with IUI. At this point I’m not sure I’m otherwise up for even going down the road of all of this (mentally/emotionally). But we’d need to talk about it, I guess MH may feel differently. I do know we cannot afford any of it without insurance coverage, so if I can’t/don’t get a dx it’s off the table anyway.

PGS testing is done on the embryos so not something to be done with IUIs.

You may find seeing an RE just to talk options might be a good plan for both you and your partner. But It’s totally ok not to go the medical route. And It’s ok if you change your mind in a month or 6.

It’s really hard, emotionally and physically however you go about it.

I wish you peace with whatever decision you make.

[ste]

Thank you all. I’m sorry any of you have to have any insight to share.