2nd failed IVF and nervous after RE consult

[LM1979]

Hello everyone! Sorry, this will be a long post, but any comments or answers that anyone has would be GREATLY appreciated!

I am 28 years old with endometriosis and just finished my second round of IVF with another BFN. With my first IVF, my doctor was very optimistic about our chances, giving us a 60-70% success rate. We had 13 eggs, 12 mature, and 11 fertilized with ICSI. On day 3, we had many embryos that looked good so they pushed us to a day 5 transfer. By day 5, 6 embryos had stopped growing, four were at the morula stage and one was an early blast. We transfered the early blast and the best morula and ended up with a BFN. My RE was surprised, told us that he would have bet on us getting pregnant, and told us that we had a high chance of success for our second round.

For IVF #2, he switched our protocol, and we ended up with 13 eggs, 11 mature, and all 11 fertilized with ICSI. Day 3 came along, all embryos looked good, so they pushed us to a day 5 transfer. By day 5, once again, 6 embryos had arrested and all of the 5 remaining were only at the morula stage. We transfered the best looking 3, and ended up again with a BFN. We have a total of 5 frosties from the two cycles, all blasts, with 3 that look perfect.

I expected that when we went for our consult, our RE would have told us that once again were were just unlucky. I figured he would tell us that the success rates were 60%, and we just had the misfortune of being in the 40% both times that didn't get pregnant. He told us that there wasn't much he could tweak medication-wise, so he wants us to try an FET (which he thinks could possibly work because some women have better implantation when their bodies aren't being stimulated and their hormones are not going crazy from all of the meds). He gave us a 40% chance of success for the FET and promised to be aggressive. Then he said that if the FET didn't work, then he was going to refer us to Colorado--specifically to Dr. Schoolcraft at CCRM. He said that it was extremely rare for a 28 year old to have two failed IVFs and that Schoolcraft has success rates that are one or two percentages higher, due to the media that his lab uses to culture the embryos to five days. I am SO surprised that he is referring us out so quickly, considering his reputation as one of the top REs in the Midwest (I am at FCI with Dr. Kaplan) and the equally impressive reputation of his lab. I didn't realize that two failed cycles was so uncommon for someone my age. Does that mean that my chances decrease for a third fresh cycle? It makes me nervous that there may be something else wrong. I asked my RE if I could have an egg quality problem, and he said it is a possibility due to the fact that so many of our embryos have arrested after day 3. Does having an egg quality problem mean that all eggs are bad? Or are there some eggs in each batch that can be ok? Are there any tests that can be done to determine this? I asked if this would mean that I may need to use donor eggs, and he said it was too premature to discuss that now, but of course my obsessed mind is racing.

Thank you in advance to anyone who has comments or answers to any of these questions! I know you all understand the emotional turmoil that we experience when partaking in this IVF journey.

[Ghost]

A few comments:

1. It's unfortunately not that rare for a 28-year old to not get pregnant. Nationwide, about 45% of cycles in your age group result in pregnancy. At FCI, it's about 36% (both figures as of 2006). The chance of getting two failures is actually pretty high.
2. Yes, frozens can do very well at some clinics. The endometrium is not ruined by ovarian stimulation.
3. Colorado's advantage is not in their media. They use media developed by one of their former lab directors (Gardner), but that media (commonly called Gardner's media) has been available on the open market for many years now, and is used by many clinics.
4. If you are looking for an excellent clinic not far away, consider Iowa City. The University of Iowa has excellent pregnancy rates (slightly less than Colorado's). At Colorado the chance of pregnancy in your age group is 71%, while it's 58% at Iowa. But looking closely, we see Iowa transfers on average 1.6 embryos per cycle, so they get only 19% twins. Colorado transfers 2.5 embryos per cycle gets 39% twins. The implantation rate (the percentage of embryos that implant) at Iowa is actually slightly higher at Iowa than Colorado, 53% vs 49%. (Note: I have no affiliation with any clinic mentioned here.) So they are at least as good at getting embryos to implant, but they choose to transfer fewer embryos and take less risk of twins and triplets. Iowa is also excellent with frozen embryos.
5. I'm not sure you need to change clinics. Okay, your doctor was optimistic about your chances, and most doctors are optimistic, but it sounds like he did things correctly.
6. There is no reason to conclude bad eggs. Some of your embryos arrested, but overall your embryos progressed like those of many patients. Very typical and normal. Maybe there's an egg (or sperm) issue, maybe not, but the evidence is not convincing. If you want, your clinic can genetically test your embryos and see. Then they can transfer just those that pass the genetic testing.
7. No, an egg problem would probably not rule out all of your eggs. Almost everything in this business is based on probabilities.

[wishing4baby]

I too have severe endo and am 28. We have had 2 fresh cycles and 2 FET failures (the FETs where chemical). In our first cycle our Dr gave us a 70% chance "because we are young" and a 40% chance that it would be twins. We were devasted when it failed. When the next 2 FET failed we decided to go with a new clinic. The 2nd fresh cycle failed, but our new Dr is going to do an endometrial biopsy before we do another frozen cycle (our other FETs were natural cycles).

My new Dr is much more realistic and gave us the same chances of success that Ghost mentions. Also, our 2nd round yielded double the amount of embryos as the first. In our first round, none of the 8 eggs retrieved from my left ovary fertilized and my DR told me the left ovary wasn't good. In our 2nd cycle we retrieved double the amount of eggs. Of the 20 eggs, 14 made it to healthy blast and half of those were from my left ovary.

I know how you feel. Being 28 you just expect it to work and when it doesn't it is devastating. I try to stay positive by thinking that time is on our side. We have many years ahead of us of trying. But if it doesn't work now, when I am young, how will it work when I have age to deal with too.

Hang in there. I have to think our time will come. We just have to be a little more patient than others.

[kez01]

Hey girls,

Iknow what you feel about your RE, I have changed clinic and have just had a failed cycle, I was so positive this time and therefore was devastated when it didn't work. I am waiting for my appointment and they have also put we with another doctor and I dont know why, but maybe it will beneficial, I still dont know.

I also have endometriosis but it is not stage 4, I have a friend with stage 4 endometriosis who had 3 cycles of ivf with lots of problems and she had 9 months of weekly acupuncture, her endometriosis symptoms have gone, her chocolate cysts have gone and she if pregnant following her 4th cycle. So girls their is hope

Take care
Kerry x

[LM1979]

Ghost--Thank you so much for taking the time to respond. It's so helpful to have someone like you to answer all of our questions!! Thanks for the info on the University of Iowa clinic. It is MUCH closer to home, and the success rates seem to be excellent. If it is not the media that they use at CCRM, do you know what accounts for their higher success rates?

I have to tell you that hearing you say that my development of embryos from day 3 to day 5 sounded very typical and normal helped me immensely. It is so hard not to grasp onto the notion of there being a problem when you have multiple failures, and hearing you say that the evidence of an egg problem is not convincing put my mind at ease for awhile. Thank you.

Wishing 4 baby-It's so nice to talk to someone else who is going through a similar experience. I wonder sometimes if severe endo reduces our chances of this working, although my doctor has said that he doesn't see a tremendous difference in his success rates with endo patients, and that IVF bypasses the endometriosis. What is a natural cycle FET? Are you not on Lupron, estrogen, and progesterone? Will your next FET be natural? What will the endometrial biopsy tell you? 20 eggs with 14 fertilizing is amazing!! What was your medication protocol for that cycle? I know what you mean that we are so lucky that time is on our side. I wish though that I could see into the future... Even if it took two more years of IVF, if I knew that at the end of this process I would have a healthy baby, I would be able to relax. It was just so unsettling to be referred to another clinic so quickly, as if my situation was beyond my own doctor's/lab's capabilities.

Kerry- Thanks for telling us about your friend with severe endo who got pregnant. Hearing stories like that always makes me feel better and more positive! Wishing both of you a successful cycle next time!!!

[Ghost]

If it is not the media that they use at CCRM, do you know what accounts for their higher success rates?

I've heard a few (including a lecturer) say that CCRM is very selective with what patients they will accept. Some clinics accept only the easiest patients in order to inflate their success rates. I don't have any first hand knowledge of their practice so I can't confirm it, but one poster here who went to CCRM mentioned she had to pass some acceptance criteria to qualify as a CCRM patient.

My clinic has no acceptance criteria, and if a patient with an FSH over 30 wants to try with her own eggs for the third time, we'll advise her of the low chance of success, but the decision is all hers. That's how it should be.

Of course, even with patient selection, CCRM still must be very good to get the rates they get. Clearly they know their stuff.

[wishing4baby]

Kez01, thanks for the encouraging words. It's so uplifting to hear of someone getting a positive in a similar situation. I too have been doing acupuncture for the last 8 months. It has totally eliminated the pain I would have from the endo, and I have no period cramps now.

LM1979, it is so nice to know I am not the only one having difficulty at 28. My first Dr referred to it as a "natural" FET. I was just on estrogen pills and started the progesterone injections a few days before the transfer. I basically got my period naturally and 2 weeks later he transferred the embryos.

My new Dr will do a mock cycle month where no embyros will be transferred. I will be on estrogen and progesterone injections (not sure about the lupron) and 2 weeks in he will take a sample of my lining. This allows him to make sure it is consistent with 2 to 3 days after ovulation, which I guess is the most receptive time. Then, whenever we want to do the actual transfer, he will know how many days I need to be on the estrogen and progesterone before we do the transfer. I am hoping it is just the timing that has been our problem. We have been lucky that our embryos have always looked good and been blast. Although we have not done PGD, I can't imagine that they are all bad. My husband and I have gone through pretty high level genetic testing, and thank God everything came back normal.

My medication this cycle was lupron and follistim and he also coasted me a few days, as my estrogen was very high. My first Dr did not use lupron or birth control, only follistim and ganirelix.

I know how you feel. I too could more easily endure all the ups and downs if I just knew being pregnant and having a baby was in my future. I just pray that my uterus isn't the problem. Not sure they can do much for that.

What protocol did you use? I know it sounds scary to move to a new Dr, but for us it rejuvenated the process a bit. I felt that mixing things up helped us go into it with a more refreshed outlook. Plus my new Dr had a much better bedside manner. I really feel like he is working so hard to get us pregnant. Have you tried acupuncture?

[dancingirl76]

I am sorry but I can not recommend Univ of Iowa's clinic at all. For one, there is no individualized treatment at all... everything is a numbers game and not individual to your situation. I guess if you like that then it is ok.
You are more than welcome to look at some of the problems I have had with them (post called problems during transfer and the TTC for years one too). I won't go into all the details here, but I am not the only one to have problems... which is probably why a lot of us switched to a clinic in Des Moines. It is a much different environment and your treatment is individualized. With IA City everything was always so negative... but at my current clinic they try to focus on the positive things and believe me... when your emotions are running crazy anyway... you don't need anything making it worse.

Oh... and I almost forgot. I lived 1hr from the IA City clinic and they made a HUGE deal about how far away I lived from there when treating me. To the point where I finally told them off and said you knew where I lived when I started this so if it was such a big deal why didn't you say so. I personnally think it was more of an excuse than anything to try to blame all the problems on.

Oh, and then there was the day I was sitting in their waiting room after a procedure and the dr I had the most problems with decides to come out and start talking about my case with me in front of everyone in the waiting room and stuff. Oh... and the day one of my friends who was also going there (no longer going there anymore though) was in the waiting room and heard my name and the dr and nurse were standing there in the waiting room talking about my case too.

I'd just say... think about it long and hard before going there.

[Ghost]

Wow. Dancing girl, that's an eye-opener. My impression of them is from their statistics and their research.

I suspect all clinics have their unsatisfied customers, but ...wow!

I don't see why they should care that you had to drive an hour. We sometimes have patients commute from other states and even other countries... Who cares, as long as they make their appointment?

[LM1979]

wishing4baby- I know what you mean...I haven't encountered that many people my age who are having this much trouble. I became really close friends with an acquaintance when I ran into her and her husband in the waiting room before my ER. She is 31, and she got pregnant after the first round of IVF. Other than her, I have had a couple of friends do Clomid and one or two who did IUI's, but they all got pregnant relatively easily once they began treatment.

I guess the "natural cycle" FET is the same as what I am doing, except for the Lupron. Did you have to be monitored with bloodwork and u/s while you were doing those cycles? You are so lucky that all of your embryos look good and that you have so many. We have five blasts-- three great ones (one that is hatched and 2 that have started hatching--all AB quality) and two that are BB quality. I am praying that they all survive the thaw so they can transfer the best ones. My husband and I did genetic testing too, and everything looks good for us as well. I think that you would know if your uterus was the problem when they did the saline ultrasound. From what my doctor tells me, it sounds like they know if there are any adhesions or polyps from that procedure, and as long as your lining is good each cycle, it shouldn't be an implantation problem. I guess we just have to remember that it is all a matter of probabilities, and that we will have our turns to be the lucky ones---at least that is what I keep telling myself!!

Our protocol for the first cycle was birth control pills, then lupron, then menopur/gonal-f/reduced lupron. Our second cycle was birth control pills, then menopur/gonal-f, and then ganirelex was added towards the end. I had 31 follicles during the first cycle, and only 15 or so the second time, although both times they retrieved 13 eggs (go figure!).

I did accupuncture for my second cycle, but since it didn't work, I feel like I need to save those funds for IVF. With the possiblility of having to go to Denver and with the fact that my insurance money is almost used up (I have a $25,000 lifetime maximum towards fertility treatments), I cannot justify spending the money on something I am not certain will make a difference for me. Although, so interesting to hear that since starting it, your endo pain has gone away. Do you have cysts? I have two endometriomas still lingering, but they are small enough that my RE isn't afraid that they are interfering. If I thought accupuncture would get rid of them, I might be more inclined to do it.

That's a good point that a new RE might rejuvenate us. It's so hard to "stay positive" right now with the way things are going. A new doctor with an excellent reputation may be just the thing that we need!

[wishing4baby]

LM1979 - sorry it took me so long to respond. It is great you have 5 frozen blasts! I think most women don't get any to freeze, let alone blasts. That is something to be really happy about. For my first 2 FETs I had my blood taken once a week and 2 ultrasounds before the transfer. Not quite sure how much I will be monitored during the next FET.

I know what you mean about the cost of acupuncture. We spend what would be a very nice car payment each month on acupuncture, but I feel that it really made a difference this last cycle. I had double the eggs and double the embyros during the 2nd round, when I was seeing my acupuncturist. I also changed my whole diet. Did you do that too? Sometimes it makes me mad when I think about how everything I eat or drink is hinged on a fertility diet, and I see these women do whatever they want and get pregnant easily. I guess I am at the point where I will try anything. I have had 2 laps for the endo and both times I have had endometriomas, but right now I am clear (fingers crossed it stays that way).

We have no coverage for IVF. Luckily, a good portion of the testing and diagnostic is covered, but in CA it's not mandatory to provide fertility treatment coverage. Needless to say we have been spending any money we would save to buy a home on IVF treatment. But I can't complain. We are lucky that we have the opportunity to do IVF, even if it is strain.

When will you start your FET?