With over 2 years of unsuccessfully trying to have a baby (including 3 IUI’s, clomid and 3 rounds of IVF) something is clearly going wrong for us. However, the frustrating thing is it’s so hard to tell exactly what the problem is. We have some theories as the embryo quality has been poor but we don’t know if that’s coming from the eggs, the sperm or maybe even the conditions in the lab?
I know the average IVF success rate isn’t great (for the US in 2013 it was 40% for women under 35 and just 31 if you’re 35-38 yr olds) so the odds aren’t in our favour. Age probably has something to do with it as I’m now 36 and my husband will be 38 soon but my doctor feels that we are still young. I hear so much advice from success stories and wonder if what they did will work for us too, but I also realize everybody is so different. It could be that the medicine I’m taking is having a negative impact on my egg quality and there’s also the possibility that my body may be rejecting the embryos due to my own immunity. Each attempt really does feel like trial and error, testing new medicines or trying new diets and just hoping one of them may work.
After the bad news of our last failure in April, we wanted to first of all have a break to process it all and then take some time to really look at our history and see if there are any patterns or clues as to what could be the issue. It seems one of the first steps to work out what’s going wrong is a process of elimination – remove all the factors that don’t seem to be the problem until we are left with a few possibilities and then work from there.
So like a pair of fertility detectives my husband and I attempted to solve the mystery ourselves. First stop? An in depth chat with our doctor to see what he thinks is going wrong, if there really was any hope for us and if there was anything we could do differently.
What we know:
We have been pregnant before with our first IVF – therefore there shouldn’t be a problem with implantation.
We reached 8 weeks so we know that growth inside my uterus is possible.
The embryo quality is not great because they have never grown to blastocyst (day 5) and I am not getting pregnant naturally.
ICSI works as we have always had fertilization success and in the last round all 5 eggs fertilized.
Sperm morphology has increased from 3% to 10-15% a complete turnaround showing anti-oxidants and clean living works.
What we dont know:
What is causing the poor embryo quality (egg, sperm, meds, stress etc).
If it’s a chromosome or genetic issue (this is usually a very low percentage but good to eliminate).
If my immunity has anything to do with rejecting the embryo.
If growth in the lab effects embryo quality.
So, with this in mind here are the list of the questions I put together along with the answers my doctor advised.
QUESTIONS FOR MY DOCTOR:
1) We didn’t have an optimal cycle this time (no pregnancy and none to freeze again). What do you think is the problem? What causes the poor embryo quality is it egg, sperm or something else? What can be done to improve it?
A: It’s still hard to say, we have been pregnant before which is half the battle it seems to be an embryo quality issue but they can’t tell exactly why. To improve it, keep doing what we’re doing lifestyle wise (antioxidants, healthy diet, exercise etc) because this has shown improvements in sperm quality and our embryos looked better.
2) Can we have the embryologist report for the quality of the eggs, sperm analysis and embryos? Was embryo transfer easy or difficult?
A: Yes, looking at it everything seemed to be responding as well as expected.
3) ICSI: Sperm morphology went up to 10-15%, and we had a 100% fertilization rate but the embryos didn’t survive past day 3 should we try without ICSI next time? Can this be damaging the egg quality?
A: No, a sign that ICSI isn’t working is that it would have had an immediate impact and many wouldn’t have fertilized. 100% fertilization is a great result for us so ICSI increased the chances.
4) Should we change protocol? I’ve always done long protocol with no success, should we try a short protocol?
A: Yes it’s time to try something different. The down regulation meds may not be helping the egg quality so if we eliminate this the overall turnaround is quicker.
5) Stimulation meds. I seem to be a poor responder to meds because without stims I have at least 5-6 follicles on each ovary but this always decreases when I’m on stims. Should we try natural IVF (without stim meds and taking only 1 or 2 naturally releasing eggs)? OR change the stim meds? I have done a mix of FSH ‘gonal F’ and a mix of ‘FSH & LH’ Menopur and had poor response.
A: Yes we can try natural IVF or depending on chromosome / genetic testing results I could do insemination after injecting with FSH (this is risky as it can cause multiple births but not of there’s a genetic problem). Sometimes too much LH can be bad for egg quality so I can try a short protocol with pure FSH.
6) We don’t think growth hormone made a difference do you think we should ditch this?
A: We don’t know if they would have been worse without it. Worth trying again.
7) Estrogen pills didn’t seem to make a difference either – should we ditch? A: Yes we can try this option, with a short protocol the estrogen isn’t necessary.
8) Is it s a good idea to take a break? How long for?
A: Yes, but more for emotional healing than physical (unless there are cysts) there are no indications that back to back IVF has negative impact on success rates.
9) Immunity – I had a really sore throat shortly after implantation. Can we explore the possibility I may have high natural killer cells? Or at least take immune meds (steroids) that help reduce problems like antiovarian antibodies?
A: No. My doctor does not believe that natural killer cells is a significant issue. They have tried this route in the past but it didn’t show any positive results. However, we will test for the following:
a) Inflammation – I took anti inflammatories in the past but they sometimes don’t help if it’s a severe case so we will do an endometrial biopsy to test for this.
b) Lupus Anticoagulant – Blood clotting disorder.
c) Homocysteine test – High levels of this amino acid can be a cause of blood clots and miscarriage.
d) Karyotyping for both of us to check for a major chromosomal anomaly.
e) Genetic testing – to check if we have the same family genetic disorder.
f) Hemoglobin (blood sugars).
g) PGS – Screens the embryo for normal chromosome number but it can also interfere with the embryo so it’s a risk
OTHER IMPORTANT TEST QUESTIONS:
What are my fsh levels? Amh levels/embryo reserve?
Am I insulin resistant?
Homocystene – clotting disorder.
Anti thospholipid syndrome – (clotting disorder)
Do I have thyroid issues? Test for TSH, FT4 and antithyroid antibodies.
Is my lining ok?
What about endometrial scratch 2-4 weeks before embryo transfer – for unexplained implantation failure. Yes this is an option.
UPDATE: The results came back for most of these tests and they were clear. This is good news but also still leaves us wondering what the problem is. Maybe we just keep trying with the hope it’s just a numbers game? Maybe there’s another reason the Universe isn’t ready for us to have a family yet or maybe our fate is to be fortunate enough to adopt. Whatever it is we’re certainly learning the valuable lesson of surrender and an openness for whatever path we are given. Until then….. it’s time for some fun!
Culled from http://www.bubblesandbumps.com/whats-going-wrong-with-ivf-questions-we-asked-the-doctor-after-3-failed-rounds-of-ivf/