Thursday, May 2, 2013

Third Opinion

First, let me start my expressing my gratitude towards those you are donating and/or who are supporting our decision to go through another IVF cycle.  Without your help, this would be even more of a difficult struggle.  Those who provide words of encouragement for us...this gift is priceless.  

I wanted to provide an update on where we are.  Since our post IVF meeting with Abington, we have had 2 other opinions.  Just to recap what the doctors at Abington said: Basically the IVF was picture perfect until our embryos started to grow.  There is a strong possibility that they aren't growing because they are genetically abnormal, which is caused from abnormal egg or sperm DNA.  Sadly, not much can be done to correct the DNA in our eggs and/or sperm.  The difficult part is that we do not know if it's the egg or sperm and even if we did, there's no "cure" for it.  For our next cycle, Abington will try using something called PICSI and something called co-culture.  PICSI is a procedure to pick out the healthiest sperm.  Usually it's just done visually under a microscope by an embryologist.  With PICSI, the sperm are placed on a special slide with hyaluronan.  The best sperm are supposed to bind to it and have a better chance of being genetically normal.  Co-culture involves growing my endometrium (uterine lining) in a petri dish.  The embryos will grow on top of this to provide a more "natural" environment to grow.  

A few weeks ago we had a second opinion with RMA.  We were basically told the same thing.  She recommended possibly changing my medication, as this MAY produce healthier eggs.  Other than that, there isn't much that can be changed.  

Today I had a third opinion with SIRM.  I wanted to use this doctor as a "tie breaker".  He agreed that our problem is poor embryo quality.  Again, no one knows if it's the egg or sperm but ultimately it doesn't matter.  He mentioned doing PGD (genetic testing) testing on the embryos.  It involves taking one cell from the embryo (it doesn't harm them) to see if they truly are genetically normal.  This will provide us with confirmation as to WHY they aren't growing, but again will not help us to determine if it's the egg or sperm.  It ultimately won't change the outcome of whether or not we become just provides confirmation why it's not happening.  If we ever decide to throw in the towel with having children, it will just be a way to provide us with closure that this was in fact our problem.  The issue is that it costs an additional $3,000 to $5,000 on top of the IVF fees.  That's expensive for a piece of mind, by maybe worth it.  If the embryos do turn out to be genetically normal, then something else in going on and we have to decide if and how we can fix it.  

Most reproductive endocrinologists do not believe in immunological testing because research doesn't back it up.  However the doctor at our last opinion is big on it and believes it could be a factor.  Basically my body may be "attacking" the embryos so they never implant and cause pregnancy. I'm not sure how I feel about it yet.  The test is about $500, so it may be something to consider...again for a piece of mind.  

The last doctor looked over my chart from Abington and found something wrong with me....all along we thought our only problem was with the sperm.  My AMH (anti-mullerian hormone) is slightly low.  Having low AMH could mean that I may have lower quality eggs and lower ovarian reserve (less eggs left).  My AMH is relatively borderline for my means I'm getting older and my "biological clock" is ticking faster than we all thought. I'm like a ticking time bomb, so waiting for another IVF cycle isn't the best...the sooner the better.  While my levels aren't horrible, it's still not the news you want to hear...especially with a birthday coming up so soon.  Statically after 35, the chances of pregnancy start to decrease dramatically.  Awesome! Time is of the essence.

All the doctor's threw around the idea of using a donor sperm since this is most likely the culprit in our infertility.  They don't necessarily think it should be for this IVF cycle, but something to strongly consider if we choose to try a third.  It's something that's hard to consider since we would prefer our own biological child...but being parents of ANY child will be a blessing.  

Chris and I have been doing some more talking about when and if we are going to call it quits.  Let's just say we plan on doing another cycle (this summer), but need to do alot of thinking about any more.  While it's ALL we want, it's incredibly expensive when you don't have the funds and are on a time limit and it's also emotionally draining.  As sad as it is to give up, we are ready to begin LIVING and enjoying life...even if it is our "second  best" life.  It's an incredibly difficult thing to think about.  While we haven't given up yet, everyone has their breaking point.


  1. Rachel -
    Thanks for sharing the news from your last appointment. I know it must be incredibly difficult to have to sort through all of the opinions and information.
    I have a question you may or may not be able to answer. Would PGD allow the doctors to select the best embryos for implantation? If you have several embryos to choose from, would they be able to select the embryos with the best genetic chances of survival?

  2. Wow, Rachel. This all sounds so hard. I really admire you for being your own advocate and seeking help from three different doctors. I totally get what you mean by wanting a "tie breaker." It sounds like you're getting a lot of good info and at the same time, it sure is confusing and expensive...isn't it always? Argh! I sure hope that you find solid answers soon. And more than anything, I hope that your IVF this summer turns into a pregnancy. My heart really goes out to you.

  3. The doctors have recommended using donor sperm, but could you use some from maybe Chris's side of the family to at least allow the child to be from that bloodline? I know that may seem weird, but an option.

  4. Poor embryo quality was our issue. Our first round didn't produce any viable embryos. We transferred to C quality embryos b/c it was all we had but we knew we didn't have any shot at it. My doctor said it was possible it could have been my eqq quality but didn't know for sure. With the next round, he put me on birth control for a month to "stabilize" my system, then he changed my meds/protocol and we ended up with 3 Grade A 3 day embryos, two of which we transferred and both took. The one we didn't transfer died.

    Please keep us posted on your progress. I'm very excited for you to begin your next round when the time permits :-)

  5. One more comment, I agree that everyone has their breaking point and you and Chris will decide that together. I hope it doesn't reach that point for you. I hope PICSI gives you the results you and Chris deserve.