IVF #2 Post Mortem

Super-secret post
Originally composed Cycle 50 (early November, 2015)

We were able to see our doctor fairly quickly to get a debrief on the new info gained from a second failed IVF on a completely different medication protocol. Basically, the doctor was stumped. She had no idea why I wasn’t making embryos with IVF. 

She ordered karyotyping for both of us (which I asked for after the third CP and she dissuaded us since she doesn’t consider CPs to be diagnostically relevant but does consider poor IVF response to be). She was very clear that she didn’t know why this was happening and she didn’t know what the best move is.

Then came the oblique reference to donor eggs. It was very indirect but it put them on my radar. It was part of a speech about how the doctors can’t actually trace cause and effect in predictable ways 100% of the time:

  • She must have used a word like “special” or “unique” half a dozen times.
  • They don’t know why giving stims in small quantities to make a single follicle in women who ALREADY make single follicles does increase pregnancy rates.
  • She doesn’t know general lifestyle-related ways of increasing my egg quality.
  • She told a story of another patient to illustrate how they don’t know why certain treatments work: This patient made genetically-tested perfect embryos no problem but could.not.get.pregnant. The thing that worked was switching to donor eggs. The doctor has NO IDEA WHY.

That last point was the oblique reference. The realization that if they can’t solve the problem using the gametes we’re giving them, they are going to suggest donor gametes because they don’t know enough about fixing my gametes.

I guess I had a mental block that it could be a female factor they couldn’t solve because I’ve been ovulating on my own this whole time and have a hormone level and past scans which imply a huge egg reserve. I am just so stunned that my eggs could be unusable without some warning before now.

I was really upset that they don’t know more about fixing egg quality. She told me I could visit a naturopath for further ideas. This did not sit well with me; I don’t know how it works where I live but there are plenty of places where “naturopath” is not a protected term and is not held to any kind of standard. I lump naturopathy in with alternative medicine and homeopathy when it comes to self-policing by a college of professionals I can trust (and my attitude there is, if it worked, it would become real medicine, like how “willow bark tea” is aspirin). Just look at the fact that that woman who made her children suffer through whooping cough without hospitalization is allowed to call herself a naturopath somewhere in North America.

The worst part is that many things people say they go to naturopaths for are things I can get behind — preventative medicine and treating our bodies better. Of course you feel like shit; you only eat prepackaged food and you sleep 5 hours a night. Try eating yogurt daily if you get yeast infections. Gargling twice a day has actually been found to reduce the frequency and length of colds in randomized trials. But also, GET FUCKING VACCINATED OR ELSE YOU ARE A DANGER TO SOCIETY. I just feel like that kind of stuff should be covered by a family doctor who is guaranteed to take a science-based approach and can look out for warning signs of something more serious.

I pushed back immediately when she said I should see a naturopath to check my vitamin levels. I said “I prefer my medicine to be science-based. If it’s possible vitamins can be a factor in fertility, why doesn’t that fall under the purview of a reproductive endocrinologist?” She said it’s because she just never studied it, and I could see a family doctor instead if I was more comfortable.

So I found myself in the hell of unexplained. No idea of what’s wrong, so no clear way forward.

If we ended up back at IVF, she said she would switch me back to the short protocol. The one that made me much sicker. Her definition of success is ONLY “how many transferable embryos we make” not “how bad were the side effects” or even some measure of egg count or quality. She would reduce the meds a bit to still try that “concentrate the quality” trick of lower egg counts, but I didn’t relish the idea of being so sick for so long again.

But before I could face IVF again, a) we’re waiting on the karyotyping, and b) I was not able to bring myself to spend that much money again so soon without exhausting other options by backtracking. I sort of tried to skip ahead to IVF to “buy time” but even if that’s not working, I can’t stop trying.

I got the feeling that she wouldn’t continue to recommend IVF (with our own gametes) if we kept having such a crap response. Mr. EAP didn’t. He didn’t feel different at all after the appointment; I felt completely destroyed. I thought that she would say “just keep trying IVF while we try different protocols” but her complete confusion was totally demoralizing.

In the mean time she let us go “back” to medicated IUIs which we have never tried. The plan was to try me on a teeny dose of of the same follicle stimulating hormone used in IVF to make a super-follicle but still aiming for a single follicle. We were even allowed to start before we get karyotyping back, which is good because this means we can squeeze in a cycle before Christmas. My Day 1 was any day, so we could do cycle, Christmas, next cycle by mid-January. Again we bought a three-pack of IUIs (buy two, get one free) so that we can bash out a bunch of repeated attempts (being mathematicians, we have faith in medium odds; we just know that you might need to roll the die a bunch more to finally get the desired number to turn up). We can get pregnant on IUIs (2 out of 5 worked!) so it’ll be a case of seeing if we can get them to stick.

I nicknamed it “in vivo fertilization”; they wanted to keep reducing the number of eggs I made on an IVF cycle and I figured if we’re going to take it only a few eggs at a time (and each attempt taking a few months) then forget the whole “retrieving them and putting them back” strategy – let’s just work with them internally.

Although far less invasive than IVF, I had more appointments to monitor my egg count. An internal ultrasound can tell them the max number of eggs I’ll drop in a cycle and warn us about twin or higher risk (more common with stimulated IUIs than with IVF where it’s controlled how many embryos are returned).

Here we go again with IUIs but this time with a boost!

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