What I wish I had asked my IVF doctor...

[lkmisc]

I went through CCRM in Denver and had a successful first attempt IVF. I am about halfway through my pregnancy.

However, I am having complications, which my doctor has indicated will likely put me on mandatory hospital bedrest (when I start to bleed, which typically happens between wks 24-28) and a definite C-section.

I have a complete placenta previa, meaning the placenta is laying on the bottom covering the cervix rather than on the side of the uterus, making a vaginal birth impossible.

If the placenta has attached to the uterus, I will be at risk for hemorraging (I have already been told that I may need a transfusion) and a hysterectomy if the bleeding can't be stopped at delivery.

I have since read that IVF increases the chances of this complication by six fold because doctors like to place embryos in the lower part of the uterus, which has a higher success rate, though this location has the greatest risk for placenta previa.

I am most fearful of the hysterectomy risk since I had planned on having more kids and my doctor is not making me feel like it is a far fetched risk either.

I wish I had known about this complication in advance so I could have asked more questions. The questions I would have asked CCRM are: Do they take into consideration the risk of complete placenta previa when implanting embryos and would they change where they place them because of that risk? Also, do they track such complications with their clients and have the reported complications ever caused them to change course on their protocol?

I wonder if most clinics only focus on the success rate of a positive pregnancy, which helps their numbers they have to report, rather than the delivery complications, which don't impact them.

If anyone is going to CCRM (or any clinic), I would be interested in hearing what their response is to that question.

I did have a good experience there and would recommend them, but I still have these lingering questions in my mind.

Lin

[kerpupples]

Linda, you should check out alreadyblessed's recent post about placenta accreta in the pregnant after treatment forum.

I too have placenta previa but my doctor has not brought up placenta accreta yet at all. I think this is because they will not know for sure if we have it until delivery, and because I have read that only 10% of placenta previa cases also have placenta accreta. I understand the need to warn you of risks but in this case it is not extremely high.

Did they determine that your placenta is implanted very near to the cervix? Because if not, there is a good chance it will still move. Mine does unfortunately seem to be implanted there so I'm coming to terms with a c-section.

I did not see CCRM but I was not told about this likelihood either. I think if I had though it would have made no difference on pursuing IVF.

There is no guarantee that you will bleed with placenta previa either! Do some reading about it. It's serious but manageable. I have been asking around about it and have heard of half a dozen cases where the worst thing that happened was a preterm C-section with a completely healthy baby.

[kerpupples]

Also, I watched my ETs via ultrasound, and my RE never placed my embryos in the lower portion of my uterus. She went as high up as she could. I assumed that gravity played its part in the implantation. I did read the same thing you did about IVF and transfer location increasing risk of placenta previa though. I've got increased risk factors due to scar tissue in my uterus and being 35 as well.

[lkmisc]

My placenta is completely on the bottom, like a "U" shape. If it were like a "C" shape on either side of the uterus, it would have a chance to move off my cervix, but my dr said she has never seen one move that was completely on the bottom. The entire placenta would have to shift from a "U" to a "C".

I am not so concerned about the C-section, but I am about the hysterectomy. I asked her if the risk was similar to telling someone that they could die in surgery and she said she obviously can't predict, but the look on her face led me to believe that she thinks it's a real possibility with the current positioning.

She has already consulted with two high risk neonatal drs at my hospital about my case and has indicated that she will likely be turning me over to their care.

I have an ultrasound with them in 3 weeks, so we will know more then. They will also be able to tell if looks like accreta is starting to happen.

We had discussed having me work from home starting at week 24, as I had said I wanted to be as proactive as possible in delaying any possible bleed by staying off my feet as much as I can. So, the next u/s will be telling.

I had been planning to do an FET in early 2010. I have heard that with one C-section, your risk goes up by 3 times to have a previa and the percentage risk of getting accreta is much higher the second time around. I came across a clinical study on it.

I wouldn't have not done IVF, knowing this risk, but I would have questioned more about placement of the embryos, though it may not have made a difference.

Thanks for the tip about the other post. I will look it up.

Lin

[lynniecat]

Hey so I am the one that went to CCRM (switching from my MD clinic cause I moved west). CCRM has told me they would not cycle me without a clomid challenge test and was very negative as to whether they would cycle me at all even with the test. Something I learned after spending the initial thousands of dollars for the one day work up.


That said, I decided to try another round a back at Shady Grove in MD (and stay with a friend) since the clomid challenge would push me into the December shut down time and I would lose a bunch of months. So it proved wise as I am pg now!


But here is the thing...I asked about this stuff and Shady Grove places the embryos higher up, aiming for the middle of the uterus to top. Both my pgs with them resulted in implantation at the very top of the uterus. I was worried about the opposite, embryos floating up the tubes.

I did not even know anyone placed them lower in the uterus. I do wonder if some clinics go for the numbers and figure its better to take the risk and get you pregnant. I know Shady Grove does not.

CCRM does have high numbers and they are very proud of that so perhaps they do EVERYTHING possible to get you that BFP. The questions is whether you think its worth the risk to have that baby. One is better than 0 in my opinion, but I would not want to be facing your situation either.

They did not tell me this at my visit about placing them lower and I specifically asked about this. They just said that my transfer would definitely go well if I cycled there.

I am sorry you are going through this, it stinks they did not warn you! What is the percent of this happening? I hope all goes well and perhaps seeing a perinatologist right away for another opinion would help???

Good luck!

[Liam'sMommy]

CCRM has a high success rate for "ongoing pregnancy". However, what they consider to be an ongoing pregnancy is a joke. In the small print they say that they use guidelines set by SART which is laughable. Places like SIRM have a much higher criteria. They measure ongoing pregnancy as still having a heart beat at 10 weeks. CCRM'S criteria for ongoing pregnancy is any ultrasound evidence of pregnancy. That includes a blighted ovum and ectopic pregnancy. NOT an ongoing pregnancy in my book. So yes, i believe CCRM does everything to help their numbers and make money.

[Warren Dew]

I wouldn't have not done IVF, knowing this risk, but I would have questioned more about placement of the embryos, though it may not have made a difference.

There are always tradeoffs. A higher placement makes an ectopic pregnancy more likely. At least with previa you can still have a baby.

It would be nice if doctors would tell us all the different risk factors, but a lot of doctors don't want to confuse people with too much data. I've found that at a certain point, one pretty much has to do some research on one's own.

[lynniecat]

Yep, makes sense..higher placement increases ectopic, lower increases previa...so what to do?

I guess figure out the risks of each, like 5 percent increase for ectopic with higher and 2 percent for previa with lower so do lower placement...that kind of thing...

I have no idea what the data says on this. But when Lin hear's she may bleed a lot and have a hysterectomy, that is really really really scary. That is why I think getting another opinion pronto is important!

The thing is we all want our babies so badly that most of us our willing to take the risks, but we need to KNOW the risks! I have never heard anything about placenta previa being a risk, but maybe cause SG does higher placement. The did tell me about the ectopic risk. And of course I was petrified about that happening till I knew the sac was in the uterus and the tubes were clear.

[beachbaby]

Hi, I am so sorry you have been scared witless, and cannot enjoy your regnancy.
Regarding the placement, the embryo's do not stay where placed they will still move around to find a good spot hence why some get ectopic's. If the embryo's stayed put there would be no ectopic pregnancies through IVF.
I had 2 implanted and both took, but they were at opposite sides of the uterus but both were placed together. One high and one low.
I feel for you regarding the hysterectomy, hopefully this will not happen, it is very uncommon although it did happen to me after the birth of my twins due to my uterus not contracting back. I know it's a difficult time but with the Dr's knowing about the risks they will be set up and ready to deal with all eventualities.
Good luck and i hope it all turns out for the best.

[kerpupples]

Yes, obviously the embryos can move around before implantation or else mine would have implanted up higher where they were transferred. It seems to me though, that if they are transferred lower in the uterus they are far less likely to move up higher than vice versa. Gravity and all.

Linda, please don't get freaked out about this. It really sounds to me like your doctor was trying to prepare you for the worst that could happen, not a likelihood. I've researched too and across all pregnancies you (and I) only have a 1 in 2500 shot of this condition. Do you have any existing scar tissue? If not then you avoid that increased risk. And I agree with lynniecat, a second opinion can't hurt.

I'm not trying to make it sound like this isn't a serious condition, but all my research shows that it is indeed manageable. I think stressing over it too much will only make things worse. If you trust your doctors now then you are in capable hands for whatever happens.

I have a job where I work from home all the time - if you can arrange that then it seems like it would be helpful.