Next step after 2 m/c...

Hi everyone,
I just want to put this out there, to see if any of you have had similar experiences. I am 32, DH is 33, and we have never achieved pregnancy on our own. I was diagnosed with DOR in April 2011, with FSH 14.6, AMH 0.75. Now, FSH/AMH are 13.5/0.45. We've since had 4 IUIs, with 2 resulting in pregnancies-m/c twins at 8 weeks 10/2011 and chem preg 5/2012...I actually had decent response to the IUI+injectables, always had 3 mature follies. We just had a m/c work up and all chromosomal and immune screenings are normal, which means that my m/cs are all due to DOR, probably the low AMH.

My question, is what should our next step be? I'm expecting my RE to recommend continuing with the IUIs in hopes that we will get one healthy egg out of one of the cycles. But, obviously for us, this historically has resulted 100% in m/c, and the thought of doing this over and over again terrifies me.

Our other option is IVF. I might not be as good of a responder as most are, but I think that with the decent response to the IUI meds, I might have some hope. And if the embryos make it to day 5, wouldn't that be a great sign that they will go on to be a healthy pregnancy or baby? The clinic said that their success rate (as defined by healthy live birth) with day 5 embryos is 80%. Did I mention the clinic is in Barbados? :silly:

This might all be for naught, depending on what my RE says tomorrow. Just curious to hear what you have experienced and what you might suggest. Thanks! :wub:

I dont have any advice for you but I wanted to tell you I am rooting for you Erica and I hope that you get that sticky bean soon. :hugs:

Thanks, I've totally been stalking you and your little bean! :wub:

Hi there! I tried 5 iui's and the last three with injectables and never had a BFP so we decided to move onto IVF and I responded really well...they retrieved 31 eggs and I had 18 fertilize nicely and we had a day 5 transfer of two embryos and I am now 33 weeks pregnant. Also, I was 37 at the time! Good luck to you!!!

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Originally Posted by akhiker

Thanks, I've totally been stalking you and your little bean! :wub:

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Ill be stalking you from now till the end :hugs: I want to see you in a dd room soon and stay!

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Originally Posted by fourgulls

Hi there! I tried 5 iui's and the last three with injectables and never had a BFP so we decided to move onto IVF and I responded really well...they retrieved 31 eggs and I had 18 fertilize nicely and we had a day 5 transfer of two embryos and I am now 33 weeks pregnant. Also, I was 37 at the time! Good luck to you!!!

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Wow, that's wonderful! Thanks for the hope!

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Originally Posted by sammilynn

Ill be stalking you from now till the end :hugs: I want to see you in a dd room soon and stay!

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You and me both...

I don't have any advice, but wanted to offer good luck! (Although Barbados sounds GREAT right about now! :laugh:)

Hi everyone, thank you so much for your responses and encouragement. Our appt yesterday went alright, the RE didn't say anything that I didn't expect to hear, but I still left pretty discouraged. He believes that our m/cs are resulting from aneuploidy since we both of our karyotypes were normal. So, he believes that IVF with PGD is really our only option for a healthy pregnancy and baby. So our 3 options are:
1. IUI, risk many more m/cs before finding a healthy egg.
2. IVF without PGD-which he called 'the poor-mans IVF-not a fan of his assessment of this option. This could be IVF in Barbados (they offer PGD, but did not recommend this).
3. IVF with PGD. This would mean IVF but not in Barbados. However, after doing a lot of research last night, I can't find anything conclusive of any benefits that PGD for the case of aneuploidy might offer (it does offer great benefits for known chromosomal issues). For aneupoidy it does not provide any increased success of implantation, carrying the pregnancy, lower m/c rates, or increased live birth rates. Actually, the latest research says that rates of implantation, carrying pregnancy to term, live birth are all actually lower when PGD is used.

So, DH and I are going to talk about this on our drive home (still in town for the RE appt, 3h drive home this afternoon) and really decide what our next step will be. After doing the PGD research, I feel really good about Barbados. I think we clicked better with that RE-she is supportive of all of the complementary therapies that I have been doing, is not pushing PGD (corroborates all of the research I did last night), and it will cost about 1/2 what IVF would be in the states. We have a consultation tomorrow with Barbados, and should have a good plan after that.

Popping in and wanted to wish you good luck.

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Originally Posted by akhiker

Hi everyone, thank you so much for your responses and encouragement. Our appt yesterday went alright, the RE didn't say anything that I didn't expect to hear, but I still left pretty discouraged. He believes that our m/cs are resulting from aneuploidy since we both of our karyotypes were normal. So, he believes that IVF with PGD is really our only option for a healthy pregnancy and baby. So our 3 options are:
1. IUI, risk many more m/cs before finding a healthy egg.
2. IVF without PGD-which he called 'the poor-mans IVF-not a fan of his assessment of this option. This could be IVF in Barbados (they offer PGD, but did not recommend this).
3. IVF with PGD. This would mean IVF but not in Barbados. However, after doing a lot of research last night, I can't find anything conclusive of any benefits that PGD for the case of aneuploidy might offer (it does offer great benefits for known chromosomal issues). For aneupoidy it does not provide any increased success of implantation, carrying the pregnancy, lower m/c rates, or increased live birth rates. Actually, the latest research says that rates of implantation, carrying pregnancy to term, live birth are all actually lower when PGD is used.

So, DH and I are going to talk about this on our drive home (still in town for the RE appt, 3h drive home this afternoon) and really decide what our next step will be. After doing the PGD research, I feel really good about Barbados. I think we clicked better with that RE-she is supportive of all of the complementary therapies that I have been doing, is not pushing PGD (corroborates all of the research I did last night), and it will cost about 1/2 what IVF would be in the states. We have a consultation tomorrow with Barbados, and should have a good plan after that.

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Hi Erica, I'm sorry that the RE didn't have any concrete answers for you. It's so hard knowing what to do and everything being so pricey just adds more pressure. I'm not sure if this helps but here's what happened to us: We have a m/c at 9 weeks after a natural pregnancy. We did the d & c and they tested the fetus and concluded it had an extra chromosome, which my dr. said happens quite often so not to be alarmed. She said it was just bad luck and that in a woman's lifetime, she will miscarry at least once, usually due to an extra chromosome. She said it could evens happened again, but if it happened a 3rd time, we should look into more testing or reasses using my eggs. Since our karyotypes and other genetic testing all was clear, we were given the all clear to do another IVF whe we were ready. Is your RE guessing that's what happened to your pregnancies or did they have a chance to perform any tests to know for sure. I know that is an awful question to ask and I apologize. But it a lot to assume. What did your RE in Barbados say?

IVF got us pregnant when nothing else could. Since you had such a good response with you IUI meds, I believe it is worth a shot. You're doing everything in your power to improve your egg quality & I say go for it. And if PGD could hurt your chances, then it might not be worth it. Only you and DH can make that call. Sending you lots of :hugs:and :babydust:
And if I overstepped my bounds by any of this, I apologize. It's sometimes hard to know if im saying too much or giving an opinion that wasn't asked for. I'm behind you all the way!!

I have also seen that research about PGD, and I have the same question as to whether this is something your RE did testing for or is just assuming. It sounds like your RE in Barbados is a good one. I can't imagine, given that her clinic offers PGD, that she wouldn't suggest it if she felt it was necessary. Perhaps you should ask the Barbados doctor for her opinion?

We haven't had any fetal tissue to test, so we don't have a specific reason to do PGD. PGD really is only recommended if you have a known genetic issue, which we do not (all karyotypes are normal). Our RE pretty much said the same thing as yours, just guessing about the m/cs, that the extra or missing chromosomes happens especially when egg quality is a concern. In no way did you overstep your boundaries, I appreciate anything you might have to offer! We all have to go through this incredibly process, and I think it is great that we can come together and talk about these things. :wub:

Phew. :eyeroll: I was worried whether I'd shared too much. I don't want to push, but I did want to share what happened with us, in case that information helps. I agree with Gwenn on PGD, I mean, with your Barbados RE not specifically recommending it even though they do it. Have you had a chance to talk to your Re down there and see what they say?

I have no useful info but just wanted to wish you luck! :hugs:

I don't have any insight, but I hope your decision making process is going well! I have a feeling you'll be enjoying a nice, relaxing trip to Barbados soon :)

Thanks everyone! I spoke with the Barbados RE, and we are booked for the March 7th cycle! We fly there on the 7th, do most of the monitoring, retrieval, and transfer there, and then fly home on the 21st! The nurse is emailing the med list to me tomorrow so we can have an idea of how much that costs. It feels like the next 3 months are going to drag by, but at the same time, its just around the corner! And by doing the cycle in March, I can still fit into my bridesmaid dress in April! :winks: I am so happy that we have made a decision and are moving forward. It is really the limbo that drives me crazy.

Christmas baby, here we come!

:hooray:congratulations on making a decision!! Now you've got time to prepare for everything. Enjoy your holidays, appreciating that next year, it won't be just you two. :winks:

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Originally Posted by akhiker

Thanks everyone! I spoke with the Barbados RE, and we are booked for the March 7th cycle! We fly there on the 7th, do most of the monitoring, retrieval, and transfer there, and then fly home on the 21st! The nurse is emailing the med list to me tomorrow so we can have an idea of how much that costs. It feels like the next 3 months are going to drag by, but at the same time, its just around the corner! And by doing the cycle in March, I can still fit into my bridesmaid dress in April! :winks: I am so happy that we have made a decision and are moving forward. It is really the limbo that drives me crazy.

Christmas baby, here we come!

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So excited and hopeful for you hon!!! :hugs:

Yay!!

I bet it feels awesome to have taken the next step! Sending positive vibes and tons of :babydust: your way!!

Erica, sending lots of good vibes for this time to speed by for you guys! If I had to choose with the same shoes, I'd be going the same route you are. If I were to go that route and get pregnant and m/c then I would reevaluate PGD at that time.

Hugs!

That's so great!