Tuesday, April 23, 2013

Our next steps......

A few days after our failed IVF cycle, we made an appointment with Abington Reproductive Medicine for what many in our situation call the "WTF" meeting.  The doctors call it a failed cycle meeting...it's not something ANY couple wants to go to, especially after you just invested so much time, money and effort.  The meeting gives you and the doctor's a chance to review your cycle and talk about the positive and negative things that happened.  For example, did you respond to the medication as anticipated? or did the eggs fertilize as anticipated?  These things give them a clue as to WHY the cycle failed and what to do to improve the next one. Generally speaking only 30% of IVF cycles result in a live baby.  These odds are still markedly better than perhaps the 1% chance that alot of infertile couples are faced with.  During any given month, a fertile healthy couple only has a 20% chance of conceiving so the odds of IVF are actually a little better than mother nature.  Sadly we fell into the failed cycle category and I can honestly say without a doubt this has been the most devastated I've ever felt.  Words simply can't describe my feelings.

Our original doctor at Abington is no longer doing IVFs anymore and is slowly retiring.  So for our "WTF" meeting, we were assigned a new doctor,  Dr. Somkuti.  This is something that I was not thrilled about. Upon review of our cycle, EVERYTHING went as planned and even better than planned...until the end.  I responded to the medication well, my blood work always came back with great numbers, I had a great number of mature eggs retrieved, and more than the average were fertilized.  But then our embryos just didn't grow.  One of two things happened:  poor lab technique or poor embryo genetics.  Since most labs strive to have optimal conditions, it is likely to be poor embryo genetics in our case.  Only 2 of 7 made it to transfer but they looked great.  While many embryos look great from the outside, they are genetically"wrong" on the inside causing them to arrest or stop growing as it will not sustain a viable pregnancy anyways.  This was our problem...the DNA in either my egg or Chris's sperm, is genetically abnormal.  While the doctor's can't be sure, they are thinking it's the sperm since the majority are abnormal looking from the outside.  While there is something called a DNA fragmentation test for sperm, it is NOT accurate in predicting pregnancy rates.  Men who come back with results of many genetically abnormal sperm still move on to father children and many men with normal results do not.  Sadly a sperm cannot be tested prior to fertilizing the egg because it kills it.  This leaves them no choice but to pick out the best looking sperm based on vision alone under a microscope.  Science has not gotten much further than this.  Again, the bad news is that "you can't judge a book by it's cover", meaning just because it looks good, doesn't mean it's DNA is.  

So how do we fix this?  From what I can understand, we don't and can't.  We can't take different medications, eat better, etc...to have genetically normal sperm and egg.  It's just something your stuck with.  There is NO cure.  Our best chance is to try something called PICSI which aides the embryologist in selecting the best sperm.  A PICSI is a procedure with a specialized petri dish with three dots of hyaluronan.  The sperm that bind to this agent are supposedly more mature and have less genetic problems than ones just picked out visually.  As of yet, there is not enough scientific research to prove that this works.  It is worth trying because it MAY help, but cannot harm our chances.  The doctor also suggested something called co-culture which only a few clinics in the country do.  Basically, before my eggs are retrieved, they do a biopsy and take cells from the uterus. They allow these to grow in a petri dish and then place our embryos on top of them.  The advantage is that this can produce a more natural environment for the embryos to grow...however this still may not matter if the embryos are genetically abnormal.  Again, scientifically this has not been proven to help, but it also cannot hurt our chances.  The problem is that these additions to our cycle add more dollars to our bottom line....about and additional $2,000 worth.  

We can also choose to do PGD, or genetic testing on the embryos prior to the transfer.  However this will only give us an answer as it if they are indeed genetically abnormal. It still doesn't point fingers to the egg or the sperm and there is still not cure.  It will only provide us with a piece of mind as to why the cycle failed....for an additional cost of $5,000 on top of the $12,000 to $15,000 the cycle costs.  It's money we don't have so we are choosing not to do this.  

We are at a loss since there's not much that we or the doctor's can do.  I have had a second opinion with RMA of Philadelphia.  They agree that this is our problem but have little solution to "fix" it.  The doctor there did suggest perhaps changing my medication to try to get better quality eggs.  Since both doctor's agree what our problem is but have different opinions how to help us I feel it is necessary to seek a third opinion as a "tie breaker".  Our consult with Dr. Peters at SIRM is May 2nd.  Navigating this path and getting answers is daunting.  Choosing a final clinic we will go through has weighed on our minds heavily.  The wrong decision could mean another failed cycle.  A few statistics and a "gut feeling" are all we have to go by because it seems no matter what we choose, it's all still a gamble.  

This has not been easy and has been a long bumpy road.  Often times it's hard to keep going and even get out of bed in the morning but we have to keep moving towards our goal.  It's been a rough few weeks and now more than ever we see that life just isn't fair.  Why do so many other people have what we want?  Why do so many take it for granted?  We can't afford another IVF cycle as we drained our savings from the first.  Our only option is to ask for help which isn't easy to do.  

3 comments:

  1. Rachel - Hang in there and know that we are thinking about you and Chris, doing what we can to help you raise funds to make IVF possible and we're praying that you have good news to share with the world. xo-Kathy

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  2. Wow....I loved reading your blogs! I have been on this long journey/ struggle and I feel your words to be so true as to how I feel. We are also at a challenging point as to if we even want to try IVF. I have been following with a physician at SIRM and have had 2 IUIs thinking of trying a third but he isn't hopeful that it will be successful and thinks I should consider IVF and that's how I found your blog while researching information. I look forward to your updates and hope nothing but the best for you!!

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  3. WOW Abington Reproductive charger you 15K for one round of IVF? thats alot. Did that include medications?

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