Friday, March 27, 2009

IVF #4: RE meeting

We met with the RE today and continued to discuss what to make of the latest failure and where to go from here.

He said that our repeated failures are most likely due to chromosomally abnormal embryos. However, he also said that we make lots of good-looking embryos and that based on that (and my age), he thinks we will likely succeed if we stick with it.

He emphasized that we're not near the end of the line, even though emotionally we may feel like it. He said we should not even consider donor egg at this time because he still really thinks we have a good shot at having our own genetic child.

In terms of specifics, the RE said that my eggs tend to be almost all mature at retrieval and that it's possible they would be more likely to be euploid if we triggered a day earlier when they are a little smaller than is the typical optimal size. He also said we should definitely do co-culture again.

We also talked at length about PGD. He said we could consider doing it at this point, but he doesn't really recommend it because research demonstrates PGD results in a lower live birth rate when it is used (because of the trauma to the embryos and the possibility of false positives/negatives caused by mosaicism). He said, though, that he would understand if we desired to use it just to get a read on what's going on with the embryos (even though it would lower our chances of success) and will do it if we want to. We asked if we could transfer the best looking embryos and then do PGD on any of the embryos we don't transfer, and he said that yes, we could.

He said also that given the number of failures, it would make sense at this point to look into other potential issues impacting implantation. One possibility is undiagnosed endometriosis, another is lining issues. So, he's fitting me in for a laparoscopy and hysteroscopy next Thursday to look for endometriosis and uterine issues. He'll also do an endometrial biopsy at that time to send to a colleague at Yale who does some sort of experimental testing on the lining.

We told him that we'd consulted with the head of the famous IVF clinic in Colorado and that we were going to get a consult with the head of the other great NYC clinic just to get their thoughts. He was supportive of this and said that it made sense to get second opinions. He continued to say that microarray is just not proven at this point and that it wouldn't be ideal for us because of the paucity of blasts anyway.

So that's it. Surgery scheduled for Thursday. Another consult with the other clinic in NYC the Monday after that. Colorado on hold for now.

What a whirlwind. Reasonable plan? We're not sure. Will and I both feel that our heads are spinning. And our hearts? I couldn't even begin to tell you about our hearts.

I feel like we'd agree to almost anything at this point. General anesthesia with intubation? Sure! Stomach pumped up with gas? Sounds grand! Abdominal incisions? No problem! Need to chop off my right arm? Here, just take it now! Oh, wait...that's going a bit overboard. Unless it might help...

Mo

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33 comments:

DAVs said...

Well, I think it's really encouraging that he thinks you still have a good shot with your own eggs. This from someone told after our fourth IVF failure to look into donor eggs (age 34). I'm glad you're getting additional opinions--it can't hurt. I wish this journey were easier.

Just Caz said...

I am so sad that your cycle didnt work
But glad your both being so positive.

And hey no giving up any of those arms, your going to need both of them hold your baby

glamcookie said...

It is a good sign that your RE is being so encouraging. He has nothing to gain by giving you false hope.

FYI, I had lapo a few weeks ago and the recovery has been fairly easy. There is also the peace of mind of knowing the doctor has been in there and taken a look.

Hugs and strength to you both. Sending all positive vibes your way.

Bottoms Off said...

Well, I'm glad you have a plan. I'm sure it helps to be moving forward. Best of luck.

meinsideout said...

Mo - that sounds like a great action plan. My heart goes out to you and I think of you daily.

Barefoot said...

I hope that at least a plan (and some action) can help you to get a bit of distance from the disappointment. Your RE sounds wonderful -- not that you wouldn't much rather have a sucky RE and a baby -- but that's great that he's being so supportive and encouraging of pursuing next steps.

Phoebe said...

I can't believe it took your RE this long to come to the conclusion that your issues are primarily chromosomal. Do yaa think? Honestly, I think it's irresponsible that he didn't come to this conclusion earlier. When you have chromosomal issues, then genetic testing with PGD or other methods are critical. I'm glad you are getting a third opinion (remember you did get a second opinion already). This guy really pisses me off. I think more harm can be done by doctors giving false hope. I've got a story about that if you want to hear it sometime.

Also, if you have questions about PGD and your particular issue, why don't you call RGI directly? They are the lab in Chicago that does the PGD. If you decide to do PGD, you will have to do a consult with them eventually.

I hope everything goes well with the lap.

'Murgdan' said...

Well....I'm glad you have a plan. And it sounds like a good plan, attacking from all angles. Sorry there's more hard stuff to go through though...

Mimi said...

I'm so glad there is a plan. I really believe the laparoscopy will give you some answers. I thought I was just fine and when I had my lap, they found stage 4 endo. Good luck to you and I will be thinking of you!!

Kami

musicmakermomma said...

Sounds like a very good meeting (except for the no baby yet part) - I am so glad for you that they aren't pushing DE on you. Not that I'm opposed (obviously!) but it would be a blessing for you to have your genetic child, and it sounds like the RE thinks you can!

I like that he had a plan for the next try (earlier trigger). Are you going to talk to the other REs before you decide where to cycle again? You are gonna get there!

Faith said...

Sounds like there was some good and encouraging news in there somewhere, right? I'll be thinking about you as you prepare for surgery -- I've done all of that except the biopsy, so let me know if you have any questions, ok? Hugs to you both.

Nina said...

Hope all goes well. Keep us updated!

Dora said...

Oh, Mo! Please let me know if there's anything I can do. Bring you chocolate post op? Can they do the co-culture biopsy during the hysteroscopy? I think doing PGD on the embryos you don't transfer makes sense. From what I have heard about PGD, the better clinics don't usually recommend it for exactly the reasons he said, false pos/negs and trauma to the embies.

Sending you a BIG hug. When do you want to get together so I can watch you drink tequila?

Michelle said...

Well I think it sounds like a very reasonable plan. I am glad that he is doing the laproscopy and that is something that I am going to ask my RE for. I had a dr many years ago suggest it but my current RE never has. I have some symptoms of endo but not as extreme but from what I read that does not mean anything. Good luck on Thursday! I wish you the best and hopefully all the answers and success you deserve!

nepsi said...

I am so glad your RE is great. I am sorry that this wasn't your cycle. I had a lap at after IVF #4. I can't say enough good things about Cornell or my RE. They did an awesome job. I hope all goes just as well for you with your lap.
Nicole

Melissia said...

I love that your docs are so proactive. Answers are good, the more questions the better in my opinion, it is the only way to finally know all the answers and to get the result that you want, a child.
And, I think it is really great that they are not intimidated by seeking new ideas and looking for others causes of your last cycle not working, I think that you have found a great RE.

Anonymous said...

If you can afford it and you have enough embryos next time, you should try the PGD. I was planning to do it with my last IVF (BFN) but did not have enough embryos. Those great looking embryos aren't always good. With my 2nd (of 3) IVFs, we had two beautiful Class A etc. etc. embryos transferred. I got pregnant with a singleton. It ended at 10 weeks due to trisomy 21 (Down Syndrome). So how embryos look is not a be-all and end-all. Visuals don't detect all (any?) chromosonal problems. And we have all read blogs by people who had crappy grade C 3-cell etc. embryos transferred yet got pregnant. Having gone what I went through (finally! after four years and 40K (now it's up to 60K) we are pregnant! only to find no heartbeat at 10 weeks) I would much rather do PGD, weed out the bad embryos, and not get pregnant vs. getting pregnant with an abnormal one then going through heartbreak. Just my 2 cents.

Sorry your cycle didn't work and good luck in the future.

Anonymous said...

A lot of ob/gyns and RE's really do not understand endo, its many locations or stages, or how to excise it which is the best treatment. Before or after your surgery, you might want to look into these sites. The CEC is amazing.

centerforendo.com

endometriosisurgeon.com

pelvicpain.com

endoexcision.com

endo101.com

erc.activboard.com/

endometriosis.org

endo-resolved.com

naprotechnology.com

johnleemd.com

fertilitycare.org

poppy.f.seed said...

as others say, I am hopeful about pgd helping you. I've seen it work for others. I wish you a lot of luck!!!

Melanie said...

You're doing everything right by getting advice from top clinics and pushing for answers. My advice (for what it's worth) is, after you've done your due diligence, follow your heart. It seems silly to say when ART is clearly science-based, but there is still so much we don't know, as evidenced by the different opinions you're getting from the very best clinics. There is still a mystery and a magic to this whole process, so go where you feel the most comfortable and where you believe you'll receive the best care. All sound advice pointed me to a different clinic after my second failure, but, after my due diligence, my heart told me to stay; that the clinic where I was was the most committed to getting me pregnant. I'm 100% in the camp of a doctor who believes that this will work.

Enough assvice for the day. My thoughts continue to be with both of you. Bring on spring!

Erica said...

I like that your RE is so positive. And I also like that he wasn't weirded out by you getting a second opinion. He must feel pretty confident with his remarks, which is a great thing since he thinks your eggs are most likely fine! Have you ever considered surrogacy? I'm not asking because I'm recommending, I'm really just wondering your thoughts on it. I've thought about it quite a bit, because I have a really hard time getting my lining thick enough for frozen transfers. That leaves me with fresh transfers only, and my estrogen tends to soar, so that hurts conception chances too. Ugh! This is all so frustrating.

I'm hopeful for you and Will and wish you much luck on your surgery this Thursday. Keep us posted.

What IF? said...

Mo, a Cornell RE did my diagnostic lap, which turned into an operative lap for stage IV Endo. (She did a chromopertubation and hysteroscopy simultaneously.)

Be sure your RE is also the best Endo surgeon you can find to remove all of the different kinds of Endo lesions. You never know if that might become necessary during your lap and you want the best fertility-preserving Endo surgeon money can buy.

Best of luck for Thursday - I hope you get some answers.

Me said...

I'm wondering about CGH instead of PGD?

Good Egg Hunting said...

I'm glad you're on your way to getting some solid answers. I just asked my doctor last week about whether PGD could prevent a chromosomally caused miscarriage again...she said that PGD is a good diagnostic test but not a good screening test (i.e. they have to know what they're looking for, a specific disease...many chromosomal issues are mosaics so they can't screen out based on testing certain cells). So I think your idea of testing the non-transferred embryos is a good one. I know what you mean about being willing to do anything...I have a surgery phobia and here I am three surgical procedures later (all from one cycle). Sending you lots of good vibes for good answers in the coming weeks.

momsoon said...

Thanks so much for coming by me lil update and thanks for the support...I feel as though i've kinda 'hidden' from the boards, maybe trying to focus elsewhere for selfpreservation...I do need the support though, it means alot!

I think it sounds like you are in excellent hands!!! I love a positive RE who is willing to investigate and get answers, and who ecourages 2nd opinions!

As far as my lap- I remember getting drugs :) , going under and a few tender days after...really, that was about it!! And for me the best part was getting answers...soooo worth it.
I was not working at the time, but I think if you take the two days after, you should be fine.
Let us know how thurs. goes...I will send prayers your way!
oh yeah, don't chop off your arm, it'll make blogging wayyyyyy slow.

Jo said...

Ah, the joys of having a plan.

I hope and pray that this one works out for you.

Hugs,
Jo

Andrea said...

Glad you have many options and second opinions! I so hope you get some answers!!

lostintaipei said...

CRAP, Mo + Will. I've been wallowing in my own self-absorbed world and was hoping to see a BFP when I popped back on here. Damn. SO sorry. So, so sorry and frustrated for you that it didn't work.

Your attitude is inspiring. I so hope your plan results in the long-awaited BFP!

iambrowneyedgirl said...

Sounds to me like your dr. has a really great plan for you going forward. It's also good that you're getting some second opinions. I hope you get some good answers and solutions.

ICLW

Stacie said...

Your RE sounds very responsive to your ideas, and it is promising that he feels you will succeed! One test for me is always how a doctor responds to that second opinion option. Yours seems open to that, too.

Positive vibes for Thursday. Hoping you get some answers soon!

ICLW

Emily said...

Hmmm...sounds like a good meeting all in all. He is definitely covering all his bases - not leaving many stones unturned.
Although I have had 2 REs tell me the CGH/microarray is unproven, I find the success rates hard to argue with. It is mostly likely our next step if this fet is a no go...
GL with the lap!

Leigh said...

I also think it's encouraging that he thinks your eggs are good! That's HUGE!

All the very best for your lap on Thursday.

BTW, my friend who had her retrieval and transfer the same time as you did also had a BFN - I wish I knew what to say but I don't, so big hugs to you both...

S said...

"He said that our repeated failures are most likely due to chromosomally abnormal embryos. However, he also said that we make lots of good-looking embryos and that based on that (and my age), he thinks we will likely succeed if we stick with it."

This sounds very similar to the advice I got from both my fertility specialists (what we call our REs). We did PGD on two cycles, one fresh and one frozen and it turns out only 1 in 4 embryos we create are chromosomally normal. There were a few "inconclusives" too. At the time I was up for doing PGD...because I'd rather avoid the heartache of being pregnant and then miscarrying again and having more d&cs, but my last PGD cycle was last year, and I'm all for just winging it. Funnily enough, our textbook perfect embryos were the abnormal ones in one round of PGD. And the average ones turned out normal. But then in the frozen cycle, that pattern was not repeated. We have the good fortune of creating beautiful looking embryos with chromosomal problems, hooray. I agree with your RE, our FS has always maintained that we can do this with my eggs and hubby's sperm, its a matter of getting the right embryo who will go all the way. And a lap/hysteroscopy is a great idea to rule out uterine abnormalities at the same time, I had this done recently - early March, after my 5th first tri miscarriage in Jan. Bearing in mind PGD is also very dependant on the skill of the person doing the PGD, of all the embryos we tested, we only lost one which arrested and took the biopsy badly. Is the PGS live birth lower because the number of PGD approved embryos transferred is lower? Could be. Its definitely an option to take. I wish you both the best of luck.

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