Thursday, September 23, 2010

Schoolie says


So...we talked to Dr. Schl. in Denver finally. Boy, he is one cool cucumber. It was an interesting talk, but somewhat surprising to us. We expected major optimism from him (EIGHT NORMAL BLASTS!) but well...

He certainly wasn't pessimistic, but was not as hopeful as we thought he would be.

He said he thinks we should try this transfer and that if it doesn't work, we should consider a gestational carrier (Whoa!), because while all this time everyone has thought we have an egg issue, now that we have a number of chromosomally normal blasts, it appears we may have a uterine issue behind our failures as well (14 transferred embryos resulted in only two pregnancies, and of our five losses, two were not tested and so may or may not have been due to aneuploidy)...

Dr. Schl's warning about my uterus was more than a bit of a surprise to us, although maybe it shouldn't have been (we've wondered about my uterus ourselves). He's funny too the way he talks - he advised that we would want to consider a "proven uterus" should this cycle fail.

In terms of the "how many" question, Dr. Schl. said he thought that we should definitely transfer two normal blasts and that it would not be unreasonable to transfer three normal blasts (two "typically developing" normals and one of the day seven blasts). He said that transferring three could result in triplets, but he estimated our chances of a singleton pregnancy are 50% if we transfer three. (Of course, he's making up that number but it gives us a sense of what he's thinking). Denver normally has a 71% pregnancy rate with two normal blasts transferred, so he's thinking our chances are significantly less than typical. But hey, 50% is nothing to sneeze at, either.

Anybody else have Denver tell them they can transfer three normal blasts? Don't think I've heard of that before, that I can recall...

Apparently the embryologist will pick which embryos to transfer. Fine by us. So that's the lowdown. There's some kind of protocol they've used with women with recurrent miscarriage that is supposed to reduce inflammation, so I will be going on that once I get the specifics. In the meantime acupuncture is continuing 2-3xs/week and I'm off all caffeine.

We have many thoughts over in the Mo and Will household about our recent Dr. Schl. chat. Honestly, we don't know what we are going to do regarding the transfer. At the moment we are thinking we will transfer at least two. Three is a terrifying prospect, but then again, the idea of not getting pregnant (and being told not to try again with my uterus) is also terrifying.

More to come.

Mo




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38 comments:

  1. No thoughts, just lots of good wishes.

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  2. I would go with 3.... At this point, you have been through so much and your doctor is "somewhat" suggesting (in a round about way) to do so - I would be aggressive.
    I have written to your blog b/f over the years - I was a patient of Dr. Brian Kaplan's in Chicago (one of the best RE's in the country). Eventually, I did conceive through IVF and I have a beautiful son. We did genetic testing and I ended up with 3 normal embryos out of 18 fertilized eggs - all 3 were transfered, but I didn't end up pregnant. Please know, I am not telling you this to make you feel worse, I just want you to know your doctor wants you to have the best possible chance of getting pregnant, and if he thinks more might be better, I would go with more.
    I truly wish you the best and I can't imagine (I can to some degree from my own experiences with infertility) what you must be going through. You and your husband have been through so much trying to have a baby.
    You're not alone.

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  3. I'm glad Schl. is willing to transfer three, but somewhat saddened that he's not being more optimistic. I know it's not his job to spread happiness & light, but I'd still think that this is looking so very hopeful for you - so much better than it looked before, anyway, that some little dose of optimism is warranted!

    That said, know how much I'm thinking of you, know how much I'm wanting you here on the 'other side' of all this nonsense. Thinking of you all the time.

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  4. Oh, I wish that conversation had left you with more hope. I don't know what I'd do in your shoes... but I am thinking of you and Will, wishing you well. And whatever you decide, I'll be cheering you on.

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  5. I've never met, seen, or heard the man (oh wait, I did seem in flashing through the clinic once or twice when I was there) but from what I've been told he doesn't blow sunshine. So while he may not have sounded optimistic, does he ever sound over the top optimistic?
    As far as transferring three...when they first published their early CGH data I am pretty sure there were some three embryo transfers...I can't remember but I'll go look at the article again... I'd want to ask him specifically how many of those wound up with triplet pregnancies.

    Wishing you nothing but peace with your decision.

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  6. Wish I knew what to say to make this easier. I'm sorry this is so fucking hard. xoxo

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  7. I think that Dr. S is generally pessimistic. When I had a phone consult with him he would only talk about donor egg with me and I was devastated. At Cornell they were willing to consider transferring 4 day 3s for me and I think that is probably unheard of as well. I only ended up having 3 embryos so there was no debate but it was on the table. The GS thing is a new and rather complicated/expensive proposition!
    Take care.

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  8. the bottom line:
    you have normal embryos to work with.
    I'd do three-- two and one 7day.
    And I'd do their protocol with an open mind and curiosity. 50% is awesome (better than I ever had)-- and
    if it does not work (which would SUCK ASS) you can do the then what then. No way to do it know. You will know more no matter what.

    Personally, I am just hoping for a perfectly normal pregnancy for you, and not another F-ing learning experience.

    Sending love and good wishes and hopes and yes, I AM OPTIMISTIC!

    xox
    Kate

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  9. You seem remarkably at peace with his suggestion of the gestational carrier, even though that seems like it would be tough news to hear. I really hope you don't need to go there. And twins really isn't that scary! At least you would probably get a shorter pregnancy out of it :).

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  10. Wow. I bet you were really shocked. I can only imagine how devastating that must be for you to hear that. Well, I will be praying for positive things to happen in your uterus and with your embies so that they can nestle in for a good long 9 months!

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  11. Well, huh, his advice makes sense. Transferring 3 seems perfectly reasonable in your case, but only you guys can weigh the risks and benefits. I guess the GS path is something to consider, but it doesn't sound like you're quite there yet.

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  12. I wonder if the other thing to consider before deciding would be if selective reduction would ever be an option for you and Will. Twibs I might be ok with, triplets no way. I'd be too scared of preganacy complications.
    Good luck making your decision, cause it's a tough one no matter what.

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  13. Schoolie is an interesting cat, for sure. He never seems "optimistic" even when he is giving good news, he is just way too even-keeled for that. So don't read too much into his demeanor, that's just him. And he also likes to leave decisions to the patients, like how many to transfer. Just his way, I guess. It is lots to think about, and I don't envy you the decision. You know my thoughts (less is more) but given the talk of proven utes (what a term!!) I don't know what I'd do. Hugs to both you and Will as you mull it all over.

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  14. Oy. That's a lot to take in. No advice here- just sending you waves of strength and clarity as you figure out the next step.

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  15. Hi, I have been following your blog for a while now and I have my fingers crossed for you guys. I am writing to you because Schoolie initially recommended we transfer 3 Normals for our best chance. My history is that I have had 3 miscarriages, 1 ectopic and 1 live birth from IVF.

    However, when we got to clinic for the day of transfer the embryologist and Dr. who is the head of the CGH met us and talked us into transferring 2 as they had had a number of cases of triplets lately. We were still waffeling and then Schoolie put his foot down and said we could only do 2.

    Anyway, i ended up getting pregnant with 2 and then we lost one. Vanishing twin syndrome which they apparently see a lot. I am now 21 weeks pregnant. In hind site I wish I had transferred 3.

    Schoolie gave us similar stats, much lower than what there study is reporting. Try not to get to discouraged. That is just his way. He does not want to get your hopes up.

    It is such a personal decision but I would go for three. Best of luck and very excited for you.
    J

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  16. That's really interesting Mo. I actually think I'm going to go against the grain here (and feel free to totally ignore me...), but you are talking about chromosomally normal embryos here. If you were indeed having egg quality problems before and now just happened to get a great bunch, I would think 2 would be enough to transfer. And if you actually do have uterine problems, do you really want to "waste" 3 embryos to find out? Finally, yes, you should consider if selective reduction is an option for you because carrying 3 would be very risky!
    I don't mean to sound preachy, and again, feel free to ignore. Those are just my thoughts. Good luck on your decision - I don't envy you at all!

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  17. No advice here, but all good thoughts. Everything crossed for you two!

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  18. He recommended we transfer 3 (and we did) for an FET because I had some lining issues (and that was the only thing they could ever find wrong) and the FET success rates are lower than fresh. Nonetheless, it resulted in a BFN. I'm not at all surprised at his willingness to let you transfer 3.

    I'm also not surprised at his lack of optimism. He is not exactly known as a cheery, glass half full type of guy!

    Good luck with whatever you decide.

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  19. No advice, but lots of prayers!

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  20. Crossing my fingers for you, whatever you decide. I'm sorry these decisions (all of them) are so hard.

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  21. Are you still considering some form of immune treatment with this transfer, or is that something you and your husband have finally ruled out? As someone who has uterine issues, I'm going to have to agree with Cassie here. We're doing CGH as well (donor cycle) and assuming we ever get to transfer, I'm pretty sure we're going to do ESET and save whatever else we get for a carrier in case we need one. It's sad, but I just don't trust my uterus anymore. I'm giving it one last shot and then we're moving on to someone else's.

    It's always angered me the way doctors seem to inflate the importance of the egg in relation to everything else. I firmly believe that a significant percentage of women who get pushed into donor cycles are there because of undiagnosed uterine problems. It's good to hear that Schoolie seems to recognize that.

    Best of luck with whatever you choose!

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  22. I'm all for being as aggressive as the doc will allow. In my case, we transferred 5 to end up with a singleton. I was petrified... what if 3 or more stuck? What would we do? We couldn't afford the resulting bedrest, let alone three or more new mouths to feed! But, we knew we'd make it through whatever happened. And things just worked out. It took five to make one, and my odds were never even close to 50%. I'm hoping along with the rest of your readers that you'll end up with the baby or two that you dream of, by whatever means the doc deems appropriate.

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  23. I think you are awesome. Look where you are and how much you have accomplished. this is no casual undertaking mentally or physically or emotionally or spiritually. I think three is good. And if all three stick i still think three is good. All is well. i will be holding you in the light. Praying for a good outcome.

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  24. when we asked him our 'how many- 1 or 2?' question, his response was 'in your case it's not 1 or 2, but 2 or 3'. i think it was because of our history- 2 m/c's, 2 s/b's, and he had already given us his recommendation for surrogate after this last attempt at our odwu. what he told you sounds very much like what he told us- he didn't have a ton of faith in my uterus's track record. i was too wary of triplets or wasting my normals to transfer 3, so we did 2 ccs normals and ended up with a healthy singleton, although the pregnancy started with a second empty sac. i would rather split the transfers up with 2 max at a time. because in hindsight, the ccs normal embryo took, but it was a complicated pregnancy and i am not sure if that was due to some undiagnosed issue with my uterus or not. also, if you try with 2 to begin with and its a bfn, you can always try the next time with 3- when and if you switch to a surrogate is up to you. having a larger number of normals is good in that it gives you options to work with.

    take care!
    soulshine from ivfc

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  25. I just posted but think it got lost?

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  26. ok it did get lost - nice work mr IVF. I write a sermon and lose it. bugger

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  27. ok sorry to spam your comments mo. Will try again....

    Deja vu. big time. We had the exact same discussion with Dr Deadpan over trf 3 vs 1-2 in our head. See link and next couple of posts for how we got our head around our decision if that helps) (http://misterivf.wordpress.com/2009/11/02/chatted-with-the-baby-maker/)Thoughts to consider:
    - Dr Deadpan, I recall, also told you not to try with your own eggs. he did for us as well, and we had a batch like you and now a few hungry humans yelling in my house. he's a god, but he's not perfect. (geez - not that I will ever have a bad thing to say about that man every)
    - If you are doing electo accup then I am thinking you have similar ute blood flow issues to Mrs IVF. That may have been all we needed (once we had genetically good kiddies) to get over the line. (your trf success rates are very similar to Mrs I's)
    - you are very good at getting pregnant and now that you have proven good kiddies on ice, a personal trainer for your ute, a whole different protcol you have never done before (big cycle of stim, long break and big cycle of ute prep) and well ....just hopefully the Denver factor on your side... at the end of the day you are taking a punt on a whole new approach with one of the best IVF guys in the universe .
    - my 2 cents? no way can you do 8 cycles (argh) i can see that for sure, but think about your golden nest egg and how you would use the whole thing up if necessary. 3 now is a very large investment to prove you have a ute issue. (ok - so I am with cassie and I am thinking sort of with Pie - (but ok - we have / are successful!!))
    - you are on an extremely similar path to many of us who have been successful. This can happen to you, so don't feel the need to over compensate on the trf to make up for a history that is only partly comparable. You haven't had the prep with with the embryos or for you like you are having now. Still - there are huge level of stories here and in the end parallels can only do so much.
    - ping me for a mint tea anytime you want to just chat if it helps.
    You are so so so close. I am feeling extremely good about this. The blood flow / electo accup may just be the small tweak you need (like it was for us) that gets you ute behaving.

    Argh - who knows, I hope I have helped a little :) and sorry that i only do blunt speak .. of course wish wish you all the luck in the universe.

    Mr & Mrs IVF / dad/mumsquared

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  28. I can't tell you how many to transfer, but I do know what it is like to have both an egg issue and a uterus one. It sucks. I am sorry you are here. We are trying one last time with my ute and then moving on to the "proven uterus". Good luck with your decision.

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  29. Best of luck deciding - our first 2 transfers we only did one, but then I decided to go with whatever the doc recommended - we have done 2 the last two times with no luck. So I'd be inclined to go for 3 if that is what he's recommending - not what I'd choose for a first-timer but neither one of us is that! I understand your fears of multiples, but I have reached the point of wanting to be pregnant MORE than I want a singleton birth, we may go for 4 this last time...

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  30. Best of luck. Thinking of you.

    (it's posts like this that make me remember that my experience -- 2 babies via 2 gestational carriers -- is definitely not the norm. I know it sounds funny, but I often forget that a GC is actually kind of a big deal.)

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  31. So much to think about. I'm confident that you will know the right decision when you come to it!

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  32. I think you transfer two, but that is based on my history, which is somewhat similar to yours.

    We did 6 retrievals, 5 transfers locally. They resulted in 4 miscarriages (2 chemical pregnancies, one missed miscarriage at 8 weeks, and one blighted ovum). My local RE was recommending egg donor, so we went to CCRM to get an "answer" re: my eggs. We did one cycle there, had 3 blasts to test and ended up with two MA normals. We transferred both and now have 1 week old twins (born at 38 weeks). We didn't do anything different with transfer other than the fact that they were MA normal embryos. What made it the magical transfer? Who knows.

    Though my pregnancy was mostly uncomplicated and we made it to 38 weeks, it was not easy and I can't imagine carrying three. I think you need to give your uterus a shot with transferring two chromosomally normal embryos and see what happens. I was told the success rates at CCRM when transferring two MA normals is about 85% and their twin rate is pretty high, as well. I have a really good feeling that this next transfer will be the magical one for you, too.

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  33. I am in transfer limbo land too. Good luck to you!!

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  34. So sorry you didn't get as much of a + vibe from Dr. S as you hoped - like others said, he is definitely not warm and fuzzy and never wants to make promises. I posted a long time ago about acu. in Denver and thought I would chime in that Dr. S. did transfer 3 normals for me (age 37, 4 previous IVF BFNs transferring 3 each time but with no genetic testing then). He told me he would do 3 b/c everything had appeared to be 'perfect' on my 4 flops at other clinics, so he was going to recommend a GC for us after this last try (#5). I did get PG with triplets. So my rec would be 2. I have all appendages crossed for you and wish you the very best.

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  35. Ah what a post, so much to digest as it must be for you & Will...Noone can tell you whether two or three is best for your family (to be) but my advice is go with your gut. You know enough about your body, your hx, and medicine itself to write a book---plus you have enlisted the help of one of the top REs in the country, his opinion has to count for some weight, even if it didn't come covered in sunshine and roses, right?
    I wish you much peace on your decision, as I'm sure you will agonize over the 'what if' either way.
    As far as GS- that is a heavy prospect for you to be thinking about right now, when you have a whole new protocol and some great perfectly normal embryos to work with...Cautiously consider that, possibly, in the back of your mind and perhaps you will never have to bring it to the front anyway. *In the end, if that is the case, email me and we can talk about that like I had said a few months ago.*
    Wishing you peace and cheering you from the very wet portion of your state :)

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  36. No advice here, just wishing you peace with whatever decision you and Will reach. Transfer is coming up fast, and my prayers and good thoughts are with you.

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  37. Optimistic is not Schoolcraft's style with anyone, so please don't let that discourage you. Just wanted to share that we transferred 3 normals and ended up with twins. We had failed on 3 prior IVF attempts elsewhere and were unsure about my uterus as well-- the plan was to go to a surrogate if the cycle had not worked. But it did, and I believe it will for you as well. My advice is not to get ahead of yourself by thinking about a GS yet, trust CCRM and follow your gut. (And by the way, we love having twins.)

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  38. Hi Mo... I haven't been very good at keeping up with your blog but saw this post and wanted to comment. We had 5 normals and Dr. S said he'd be willing to transfer 3 given my history at the local clinic. I refused, saying it was too much of a risk for us, considering the fantastic results we were having at CCRM (I didn't think we could compare the local clinic's results to what might happen at CCRM). I'm sooo glad we decided that because our two transferred turned into a twin pregnancy and now I can't imagine having three "in there." One way to think about it is with respect to your lifestyle. Sure, you'd give anything to build your family, but can you handle weeks and weeks of bedrest? What about your job? Can you cut back your hours? My OB suggested either quitting or working from home after just 22 weeks, so I cut my hours back and am now working from home. Can't imagine continuing to work 10+ hour days at the office "in this condition" -- and I have 10+ more weeks to go. And I'm only having twins. I wish you the absolute BEST, whatever you decide!

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