A womb away from home: co-culture

I went in today to get my blood drawn for the endometrial co-culture. The RE's office had said to be prepared for it being a lot of blood, and boy, they were not kidding. You know those huge syringes they use to draw your blood the day before retrieval? (At least at my clinic they use these). They filled FIVE of those. I don't have a blood or needle phobia, but geez, if you did, this would be brutal. As it was, I felt a bit woozy.

For those not familiar with endometrial co-culture, the basic idea is that next week my RE will take a tissue sample from my endometrial lining and then culture it in the lab (I believe in this vat of blood I just contributed).

Later, after I go through stimulation and egg retrieval, they will grow the embryos in this cultured tissue, sort of a womb away from home for the little ones. The idea is that the living tissue can remove toxins and introduce growth factors that will encourage better quality embryos than I would otherwise have. We shall see.

It felt weird to be back at my NYC RE's office after our second opinion last week. Like my head is still spinning. Do I believe my great NYC RE who thinks we have a really good chance? Do I believe the CCRM doc who thinks that we do not? More than ever before, I felt like I was going through the motions. Often in the past, even sitting in the RE's waiting room, I have had this sense of hope, of progress toward having a family. Today, I felt, well...woozy. And like I was just showing up.

Hopefully just showing up and doing what I am supposed to medically for this cycle will be enough to give it its best chance. It's just so odd to be going into it thinking that it will almost certainly fail. Maybe this is normal after three tanked IVFs? I don't know. I just never thought we would be at this stage with no baby in sight.

Mo

The nitty gritty

The details of our cycles and pregnancies:

IVF # 1 (NYC): September '07, age 35
Long Lupron Protocol
300 Follistim, 5 units Lupron
22 eggs retrieved, 20 mature, 14 fertilized
2 blasts transferred on day 5 (3BB, 1BB), nothing to freeze
BFP!
Betas double appropriately
Fetus measures on track
HB: 140, 151
Missed miscarriage at 8 wks, 4 days.
Cytogenetics: female with trisomy 21 and monosomy x

IVF #2 (NYC): February '08, age 36
Long Lupron Protocol
225 Follistim, 5 units Lupron
11 eggs retrieved, 10 mature, 9 fertilize with ICSI
For personal reasons freeze 6 at 2pn, culture 3, transfer one at day 3.
BFN
(When 6 are thawed three years later, none survive in culture)

Natural Pregnancy: March '08, age 36
Betas double appropriately (223, then 425, then 831)
Missed miscarriage discovered at 7 weeks.
Cytogenetics: Lab loses sample

Natural Pregnancy: May '08, age 36
Beta fails to rise appropriately
Natural miscarriage
Cytogenetics: male with trisomy 16

IVF #3 (NYC): November '08, age 36
Long Lupron Protocol
225 Follistim, 5 units Lupron
12 eggs retrieved, 10 mature, 8 fertilize without ICSI
three embryos transferred at day 3 (8, 7, 6 cells, moderate fragmentation)
BFN

IVF #4 (NYC): February '09, age 37
Antagonist Protocol with endometrial co-culture
Day 2 FSH = 6.8, E2 = 32.7, LH = 5.47
200 Follistim, 75 Menopur
15 eggs retrieved, 14 mature, 11 fertilize without ICSI
five embryos transferred at day 3 after co-culturing (9, 9, 8, 8, 8 cells, minimal fragmentation)
BFN

IVF #5 (NYC): May '09, age 37
Antagonist Protocol with endometrial co-culture
Day 2 FSH = 7.0, E2 = 30, LH = 7.5
200 Follistim, 75 Menopur
Trigger one day early (Day 9)
6 eggs retrieved, 4 mature, 3 fertilized without ICSI
Three embryos transferred at day 3 after co-culturing (9, 8, 7 cells, grade 1 and grade 2)
BFP
HCG levels: 9dp3dt: 23; 11dp3dt: 48; 13dp3dt: 36; 15dp3dt: 17
Chemical pregnancy

Natural Pregnancy: June '09, age 37
Beta #1 (15 dpo): 188!, estrogen 271, progesterone 39
Beta #2 (17 dpo): 585!, estrogen 301, progesterone 36.45
Beta #3 (19 dpo): 2,413
Beta #4 (21 dpo): 3,159
Beta #5 (23 dpo): 5,221
5 wk u/s: gestational sac, yolk sac
7 wk u/s: baby w/ heart rate of 167 bpm! Measuring 7 wks 4 days.
8 wk u/s: baby w/ heart rate of 185 bpm! Measuring 8 wks 1 day.
9 wk u/s: no heartbeat (8/6/09). D&C performed.
69XXX - triploidy

IVF #6 (Denver): March '10, age 38
Microdose Lupron Protocol
Day 3 FSH = 5.5, E2 = 33.2, AMH = 1.4
300 gonal-f, 150 menopur, 20 ml lupron every 12 hours
.33 Saizen, .5 dexamethasone
19 eggs retrieved, 14 mature, 16 fertilize with ICSI (13 immediately, 3 more after in vitro maturation with Day 2 ICSI)
7 blastocysts [6BB (Day 7 blast), 4AB (Day 7 blast), 2 x 4BB, 4AA (from Day 2 ICSI), 3BB, 3AB]
Freeze all
Sample sent for sex chromosome FISH testing and microarray to test all chromosomes

Results indicate three normal blastocysts!!!

IVF #7 (Denver): June '10, age 38
(For two months ahead took inositol, coenzyme q10, and melatonin to improve egg quality)

Microdose Lupron Protocol
300 gonal-f, 150 menopur, 20 ml lupron every 12 hours
.33 Saizen, .5 dexamethasone
25 eggs retrieved, 22 mature, 18 fertilize with ICSI

Freeze all
Sample sent for sex chromosome FISH testing and microarray to test all chromosomes

Results indicate five normal blastocysts!!!

FET #1 (Denver): October '10, age 38

Medicated cycle

Took Depot Lupron for two months prior to cycle to improve endometrium/reduce endometriosis
One month of twice weekly electro-acupuncture to improve blood flow to uterus

Transferred 3 FISH and microarray confirmed chromosomally normal blastocysts
(Embryo #5 - 06/10: Day 6 6BA, Embryo #14 - 06/10: Day 6 4BB, and Embryo #6 - 03/10: Day 7 6BB)

BFP

Start 40mg lovenox, 10mg prednisone, 40mg pepcid, 10mg claritin, baby aspirin, and intralipids for potential immune issues

Beta #1 (9dp5dt) = 26.8, estrogen = 526, progesterone = 4.87

Beta #2 (11dp5dt) = 56.0, progesterone = 28

Beta #3 (13dp5dt) = 145.5, progesterone = 33

Beta #4 (17dp5dt) = 690, progesterone = 22

Beta #5 (20dp5dt) = 1702, progesterone = 11, estrogen 543

5w5d u/s: gestational sac and yolk sac

6w2d u/s: larger sac + fetal pole?

Beta #6 (31dp5dt) = 12,691, P4 = 23.12

7w3d u/s: no heartbeat, debris in gestational sac. D&C performed.

Cytogenetics: 46XY. Chromosomally normal male baby


FET #2 (Denver): February '12, age 40

Medicated cycle

Took Depot Lupron for two months prior to cycle to improve endometrium/reduce endometriosis
One month of twice weekly electro-acupuncture to improve blood flow to uterus
One IVIG treatment 10 days before transfer to reduce NK cell activity

Took 40mg lovenox, 10mg prednisone, 40mg pepcid, 10mg claritin, and baby aspirin for any immune issues
Transferred 3 FISH and microarray confirmed chromosomally normal blastocysts
(Embryo #3 - 03/10: in vitro matured Day 7 4AA, Embryo #5 - 03/10: Day 7 4AB, and Embryo #21 - 06/10: Day 6 3AB)
BFP
Beta #1 (7dp5dt) = 69.3, estrogen = 442, progesterone = 34.3
Beta #2 (9dp5dt, 4w0d) = 155, estrogen = pending, progesterone = 31.16
Beta #3 (11dp5dt, 4w2d) = 445, estrogen = pending, progesterone = 38.68
Beta #4 (15dp5dt, 4w6d) = 3,032, progesterone = 28.2
Beta #5 (18dp5dt, 5w2d) = 7,681, estrogen = 844, progesterone =11.5
Beta #6 (20dp5dt, 5w4d) = 12,362, estrogen = 1,185, progesterone = 70.7
Beta #7 (25dp5dt, 6w2d) = 45,785, estrogen = 616, progesterone = 32.82
Beta #8 (28dp5dt, 6w5d) = 65,543, estrogen = 683, progesterone = 53.15
6w5d u/s shows hb = 127bpm, baby measuring at 7.1 wks

7w5d u/s shows hb = 154bpm, baby measuring at 7.6 weeks 

Beta #9 (36dp5dt, 7w6d) = 140,934, estrogen = 732, progesterone = 39.4

Beta #10 = (42dp5dt, 8w5d) = 182, 833, estrogen = 1,169, progesterone = 57
blood work at 10 weeks, 3 days = estrogen = 852, progesterone = 28.13
blood work at 11 weeks, 2 days = estrogen = 1,116, progesterone = 35.44

Pregnancy continues with partial placenta previa, which resolves
Gestational diabetes develops at 28 weeks but is controlled through diet and overnight insulin
****Baby girl born at 39 weeks, 1 day!!! - via c-section after failed induction****

Natural Pregnancy: February 2015, age 43

Beta #1 = 106.5
Beta #2 = 198.1 (not quite doubling)
Beta #3 = 264 (really not doubling)
Natural miscarriage

FET #3 (Denver): August 2015, age 43

Medicated cycle

Took Depot Lupron for two months prior to cycle to improve endometrium/reduce endometriosis
One IVIG treatment 5 days before transfer to reduce NK cell activity

Took 40mg lovenox, 10mg prednisone, 40mg pepcid, 10mg claritin, and baby aspirin for any immune issues
Transferred 3 blasts, 2 FISH and microarray confirmed chromosomally normal blastocysts, 1 no result
(Embryo #11, a Day 7 FISH/Microarray normal 4BB blast, Embryo #15, a Day 6 FISH/Microarray normal 3BB blast, Embryo #20, a Day 6 FISH/Microarray no result 3BC blast)
BFP
Beta #1 (7dp5dt) = 22.3, estrogen = 1127, progesterone = 10.1
Beta #2 (11dp5dt) = 

On to co-culture and IVF #4

Saw the RE yesterday. He did an ultrasound and bloodwork and said to expect my period in the next day or two.

And although I tested negative for ovulation, my period came today. Thankfully. I have a call in to the co-culture coordinator to see if I can get on the list to be seen for the biopsy later this month, with stims starting toward the end of Feb.

I laughed at myself a little this morning. I need to learn some patience! One more day and my period would have come all on its own (later than it's ever come in my entire life, even on lupron, but still). It is a challenge not to get completely wrapped up in my sense of urgency about babymaking. But I need to take a breath and somehow find a way to keep perspective.

Mo

The consult...a look back, plus a plan

So you saw our questions in the last post. Now we have some answers. Thank you for all of your ideas about what to ask - both those left as comments and those privately emailed. Will and I appreciated all of your thoughts.

The RE's main point was that we shouldn't lose hope. He feels our prognosis is still very good. That we had bad luck with the chromosomal abnormality and miscarriage our first cycle ("That could have happened to anyone"). And that we can't read too much into the failure of cycle #2 because we only cultured three embryos (freezing six others at 2pn stage) and only transferred one.

He still thinks we can succeed with our own eggs (and even said he would not allow us to use a donor at this point if we wanted to, which we don't). Surprisingly, he felt the embryo quality throughout the three cycles has been fairly good. (Could have knocked me over with a feather with that statement. I was like "Really??!")

He continued to say that PGD would do more harm than good and that CGH is still too experimental (he said he thinks that the technology is still years away). He said they don't do micro-dose lupron except in the case of poor responders ("and you're not a poor responder," which was nice to hear). He seemed so-so about assisted hatching (but I think we'll ask for it anyway).

In terms of what's next, he said we should probably do endometrial co-culture and he's changing our protocol, removing lupron, upping the dosages of the meds a bit, and adding Ganrilex and menopur.

We are on the cancellation list to try to get in to do a co-culture biopsy in late January. I'm going to stay on progesterone through Friday to delay my cycle starting (who thought I would ever agree to extra PIO shots?!). If we're able to get the endometrial biopsy done in late Jan, we'll be on to cycle again in late Jan/early Feb.

So it looks like we're on to (gulp) IVF #4.

I can't believe we have to cycle again. But since we do, it feels so so much better to have a plan.

By the way, it is freakin' COLD in NYC today. Like Minnesota cold. Those of you who live in northern climes (Canadians, I am talking to you), I applaud you. I don't know how you do it.

Thank you again for all of your encouragments, stories, suggestions on blogs to read, and medical advice. I never realized how interactive blogging can be. Your thoughts and comments have been an enormous help.

We are past the solstice. There is a bit more light today than yesterday. Hoping for brighter, warmer days ahead.

Mo

What would YOU do?

As we move forward with IVF #5, Will and I have been kicking around three scenarios about how we might approach the transfer at the end of this cycle:

1. Another "Hail Mary" 3-day transfer (a.k.a., the "damn the torpedoes" approach)
In this option, we would be extremely aggressive, as we were last time, and hope that at least something sticks. Last cycle, we transferred 5 beautiful day 3 embryos, but got nothing. Of course, if more than 3 implanted, we might be facing the dreaded selective reduction question...

2. PGD
We could do PGD this cycle. However, the literature on using PGD for aneuploidy (our problem) really suggests that this would actually lower our chances of a viable pregnancy. The test only looks at 9 of the possible chromosome disorders, is traumatic to the embryo, and has a decent-size false positive/false negative rate (meaning we still might transfer a nonviable embryo or discard a good one). Plus it costs ~$5,000. So maybe good for diagnostic purposes (i.e., to figure out if we've got any viable embryos), but not so good for actually making a baby.

3. Day 5 blastocyst transfer
We could try to go to day 5 and see what we have left at that time. In the past, however, out of all four cycles, we've only ever had 2 blasts total (out of 36 dividing embryos). yowch. Also, since we're doing co-culture, the culture medium only lasts to day 3 and so it may harm the embryos to be switched to a different medium. We're not sure if our RE would let us, but given our history, we'd still want to be aggressive at transfer time, even with blasts (if we had anything to be aggressive with).

As usual, no easy answers...We'll figure out what we're going to do, but thought we'd throw it open to the internets - what would you do if you found yourself in our suboptimal circumstances? Lurkers, we want to hear from you too!

Vote in our poll to the left and explain your rationale in the comments section... don't be timid on telling us what you think - we look forward to any and all help in thinking the issues through.

Click here to read a quick summary of our unfortunate track record so far.

Mo

Coculture procedure

I had the endometrial coculture biopsy today.

I realized last night that I was a bit nervous about it, having visions of the two unanesthetized D&Cs I went through after miscarriages 1 and 2, which were - really - rather hellish. Any procedure description that includes the words "gentle scraping" using a currette now makes me wince. From these prior experiences, I know there is not a thing gentle about it.

There was really nothing to the biopsy procedure today, though. It hurt a decent amount for the few seconds during the actual suctioning - maybe 30 seconds?- as my RE was getting his little snip of the lining. And then it was over. That was it.

The nurse held up the container to me afterward to have me check my name, but I didn't hear that part and instead marvelled at the little pink tissue bits floating in the saline. I even said, "Yup, that looks like a part of my uterine lining!" (I have to admit, I thought it was a little odd she needed me to confirm the contents.) She repeated dryly, "Your name, just look at the tag - is this your name?" Oops. Yeah.

I read some of the research on co-culture, and the process to clean and separate and then seed the cells into the dish sounds pretty cumbersome. No wonder more centers don't offer it. I'm grateful my clinic does and I am hopeful it will help.

I certainly like the idea of my own cells with their growth factors and helper cells surrounding the embryos and hopefully nourishing them as they grow and divide.

Stims start on day 2 of my cycle, probably next Tuesday or so.

IVF #4, here we come! Fingers crossed that this coculture makes the difference.

Mo

Hello, ICLW'ers!

Welcome! We're glad you're here!

Brief history for any newbies: Started TTC almost two years ago around the time of our marriage. We sought an RE's opinion before we married, worried that Mo's history of cancer and chemotherapy might make our journey to pregnancy an uphill battle.

Unfortunately our fears have not been unfounded. In September 2007, we became pregnant after our first IVF, but lost the baby to a double aneuploidy. In February 2008, we failed a 2nd IVF, then became pregnant immediately after on our own, losing the baby at 7 wks. We became pregnant yet again naturally, but had a chemical. In December of this year, we failed our third IVF and we are now beginning IVF #4, using endometrial co-culture. If we fail this attempt, we are considering traveling to Colorado to try microarray CGH to test whether we make any normal embryos, since all of our losses have been due to chromosomal abnormalities.

It's been a whirlwind so far, and this blog has turned out to be a great way for Will and I to connect with others going through their own journeys. Will's working a 14-hour day today (ah, the glamour of being a doctor!) and I am shortly to work too to try to get my dissertation rolling toward completion.

Glad you stopped by.

Longtime lurkers, this your chance - hit the comment button - say hello! (even anonymously!) Sign up to Follow This Blog (in the sidebar at left) or add us to your reader.

We look forward to finding new blogs this week and getting to check in with you all.

Mo

p.s. One question: Any food/supplement recommendations while cycling? I'm about to start stims early next week for IVF #4. What has your doctor said about caffeine, alcohol, aspartame, sugar, and the like?

The IVF twilight zone

The second meeting for the support group occurred last night. A truly nice group of women. They are all much more at the place of deciding on adoption/donor egg than I am. Three of them are already pursuing donor egg/adoption and the other one is more where I'm at, except really, really feeling that her treatments won't work.

As I sat there last night, I was thinking about how it has been great to meet this group of women and to have a place to talk and learn about all the paths available. At the same time, I was realizing that it must inevitably shape my perception of my chances and what lies ahead. Between starting this group and that mindblowing second opinion, I've had a lot to chew on mentally and emotionally for the past few weeks. Much of it not very hopeful. In fact, I have begun to grieve the loss of the idea that we will ever have a biological child.

I go in Thursday for the co-culture biopsy and will see my RE. And I expect him to be his chipper, optimistic self about all this. Funny thing is, I feel like I've traveled a great distance from where I was at when he and I and Will last met and he said he thought we had a great chance.

And yet nothing has truly changed.

My prognosis is the same as it was a few weeks ago - good or bad. My chances remain the same. It feels truly surreal to be going in to IVF #4 with the sense that it won't work and we will go to Colorado (More realistically, it feels like it might work, but overwhelmingly isn't likely to.)

So that's what I'm trying to wrap my head around today. How my perspective on all this has inexorably changed, and yet nothing has changed externally in our situation.

There is a fifth dimension beyond that which is known to man. It is a dimension
as vast as space and as timeless as infinity. It is the middle ground between
light and shadow, between science and superstition, and it lies between the pit
of (a wo)man's fears and the summit of (her) knowledge. This is the dimension of
imagination...

Science and superstition? The space between fear and knowledge?

Sounds like the elusive and yet all-too-real IVF Twilight Zone.

Mo

Triggering

As the stim phase of IVF #4 grinds to a halt, I herewith offer this catalog of a cycle:

Eight ultrasounds
Seven early morning cab rides
Five doses of Ganrilex
Twenty-nine vials of blood
Nine blood draws
One good vein (thanks, chemo!)
Eight vials of Menopur
Nine pairs of socks
One cartridge of Follistim
Twenty-two injections
Twenty-eight alcohol wipes
Three moderate-size abdominal bruises
Four pints of ice cream

I don't know where the time has gone, but somehow we're at the end of the stimulation phase and headed to retrieval. Things have been very different this time around. I feel a quiet hope but not much of the freakish obsession that has plagued me the last few tries.

It helps that I am confident we're at a good place and know that we're in good hands. I trust that my RE is talented, and I know that he truly cares for us and wants us to succeed. He has done five of my ultrasounds himself this cycle (and the rest have been conducted by other attendings, no fellow this time around). And he will perform the retrieval Monday. He also told us today he will try to come in for the transfer himself, even though it's not his day on. He told Will to email him Thursday A.M. so he can try to make it if his OR schedule isn't too crazy. This level of commitment almost brings tears to my eyes. His actions speak louder than words.

We've switched up a lot of things this cycle to try to get a better result: added co-culture, removed lupron, increased the stims, and thrown in menopur for good measure. And though no one has said so explicitly, I think Will, the RE, and I are all of the mind that we're getting toward the end of the line.

It's time to go for broke (and unfortunately, I don't just mean that figuratively). Pull out all the stops. Add all the bells and whistles and prayers and talismans that we can.

Trigger shot is set for 10:45 pm tonight.

Mo

Radio silence

Not much to say so have been hunkered down, quiet. Hopefully it's a sign of healing, rather than moping.

I survived the past weekend's baptism and my friends were very sensitive, which was much appreciated. Nothing about my situation mentioned, which was just fine. At one point, my friend R. quietly turned to me and said that she knew there were many reasons why I might not have wanted to/been able to come, including the recent surgery, my dissertation deadlines, as well as my own struggles to conceive. She told me how much she appreciated my presence and how she knew it was probably not easy to be there. Then she said it would have been ok if I'd had to say I couldn't come. That she would have understood. I thanked her and assured her I wanted to be there and then we let the subject pass. It was lovely that she acknowledged it. And I was thrilled she didn't dwell on it.

I held her daughter throughout the weekend, feeding her, burping her, soothing her. And sometimes I'd look in her eyes and she, all 2 1/2 months of her, would stare back, and I'd wonder: Could I love you? If R. gave you to me at the end of this weekend, could I love you like you were my own? Maybe. And if I could, then, could I love an adopted child? Maybe. Not sure. But maybe.

Since I've gotten back, I've been immersed in trying to get this dissertation moving. Between that and the fact that I'm not sure what to say about infertility these days, you may not hear so much from me in the next little while. But I'm here. Results section of my dissertation is due on Monday. I have another co-culture biopsy on Tuesday. Discussion section (not yet started) is due on Friday.

I am quiet but I'm here. Hope to surface again soon, on a number of levels.

Mo

Blue Christmas

Despite white snow blanketing New York City, it looks like we're in for a blue Christmas this year.

Today is 11dp3dt. Beta would have been today except that my clinic doesn't do betas over the weekend. HPT continues to be negative. It's over.

Will and I have been wrapping our minds around the likelihood that this cycle was a bust for the past few days, so the unbearable sadness is already starting to give way to a grudging acceptance. This IVF is tougher because it feels like three failures is significant. Like maybe we aren't going to get through to the other side and have a child. Which is excruciating.

It seems fitting that today is the winter solstice: longest night of the year, shortest day. Am hoping that metaphorically this means things will begin to improve. That this will be our lowest point in the journey toward a child.

We will see the RE tomorrow to get his thoughts on where to go from here.

These are the questions we are considering for him:

1. What happened? Where do you think this cycle went wrong?
2. How did embryo quality compare to previous two cycles?
3. A year ago after the first miscarriage, you said our prognosis was "fabulous." What is our prognosis now?
4. What have you learned from this cycle about how to go forward?
5. Would more aggressive stimulation help?
6. How about assisted hatching and fragment removal?
7. Or endometrial co-culture?
8. When can we cycle again?
9. Would varicocele surgery help? How long afterward would we have to wait?
   

Anything we aren't thinking of? Please chime in; we're both a little numb.

Mo

Cycle delayed

We heard from the RE's office today that they are booked solid this month for endometrial co-culture biopsy slots. Ugh. We were told to call on day 1 of my next cycle to "see if we can get on the list for next month."

The bottom line is we will be delayed a month in starting IVF #4.

I took this harder than I thought I would. I didn't realize how much I was clinging to the hope of cycling again soon to help cushion the blow of my disappointment over our last failed cycle.

Adding to it all, I have been having hot flashes since Dec. 26th. Several times a night. Which is screwing with my sleep quality and filling me with doom and gloom thoughts of perimenopause. The fact that Thursday is my 37th birthday is NOT helping (Fear is that 37 + history of chemotherapy = the end of the egg supply).

Anybody else ever have hot flashes after IVF? I've had them on Lupron - but I'm not on any drugs now. Every time I have a hot flash, I panic a little that this is it. The beginning of the end of my fertility (not that I was so fertile before, but you know).

Holding on to sanity by a thread over here. Words of wisdom very welcomed.

Mo

IVF #4: RE meeting

We met with the RE today and continued to discuss what to make of the latest failure and where to go from here.

He said that our repeated failures are most likely due to chromosomally abnormal embryos. However, he also said that we make lots of good-looking embryos and that based on that (and my age), he thinks we will likely succeed if we stick with it.

He emphasized that we're not near the end of the line, even though emotionally we may feel like it. He said we should not even consider donor egg at this time because he still really thinks we have a good shot at having our own genetic child.

In terms of specifics, the RE said that my eggs tend to be almost all mature at retrieval and that it's possible they would be more likely to be euploid if we triggered a day earlier when they are a little smaller than is the typical optimal size. He also said we should definitely do co-culture again.

We also talked at length about PGD. He said we could consider doing it at this point, but he doesn't really recommend it because research demonstrates PGD results in a lower live birth rate when it is used (because of the trauma to the embryos and the possibility of false positives/negatives caused by mosaicism). He said, though, that he would understand if we desired to use it just to get a read on what's going on with the embryos (even though it would lower our chances of success) and will do it if we want to. We asked if we could transfer the best looking embryos and then do PGD on any of the embryos we don't transfer, and he said that yes, we could.

He said also that given the number of failures, it would make sense at this point to look into other potential issues impacting implantation. One possibility is undiagnosed endometriosis, another is lining issues. So, he's fitting me in for a laparoscopy and hysteroscopy next Thursday to look for endometriosis and uterine issues. He'll also do an endometrial biopsy at that time to send to a colleague at Yale who does some sort of experimental testing on the lining.

We told him that we'd consulted with the head of the famous IVF clinic in Colorado and that we were going to get a consult with the head of the other great NYC clinic just to get their thoughts. He was supportive of this and said that it made sense to get second opinions. He continued to say that microarray is just not proven at this point and that it wouldn't be ideal for us because of the paucity of blasts anyway.

So that's it. Surgery scheduled for Thursday. Another consult with the other clinic in NYC the Monday after that. Colorado on hold for now.

What a whirlwind. Reasonable plan? We're not sure. Will and I both feel that our heads are spinning. And our hearts? I couldn't even begin to tell you about our hearts.

I feel like we'd agree to almost anything at this point. General anesthesia with intubation? Sure! Stomach pumped up with gas? Sounds grand! Abdominal incisions? No problem! Need to chop off my right arm? Here, just take it now! Oh, wait...that's going a bit overboard. Unless it might help...

Mo

Second opinion

We have a phone consult tonight with a clinic in Colorado to get a second look at our case.

Part of me wonders why we're going this route, because we're at an undisputably great clinic in NYC and I really don't have doubts about the care I've received here. I feel a little guilty getting another opinion, like it means we don't trust our RE or like we're cheating on him a little bit. But I'm hoping he would understand the desperation and anxiety we are beginning to feel. After all, we've been at IVF for over a year and a half with no baby to show for it. We also have only one more IVF left before we're out of insurance coverage (I do realize we've been very fortunate to have this much coverage in the first place).

When our NYC clinic couldn't fit me in last month for the endometrial co-culture, I started to panic. Within a few days, I'd requested my records and lined up this phone consult. This clinic in Colorado is supposed to be the best clinic in the country. We're currently receiving care at what is probably number 2. Is there a difference between the two clnics in outcome? Hard to say. But a fresh pair of eyes never hurts.

So the plan is to stay at our NYC clinic at least for IVF #4 and then see where to go from there. It feels a little weird to be going in to our next IVF cycle already preparing for #5, but that's where we're at. I am hopeful that #4 will result in a live baby but am also trying to be realistic and come up with a plan B (and also begin considering plan C - adoption/donor egg).

This is so different than where we were at emotionally when we started. We went into this IVF business excited and eager, disappointed that this was an expensive and stressful way to have a child, but really believing and expecting we would come out of this with a baby after 1 or 2 IVFs.

Those expectations have not proven to be true and we're left trying to come to terms with where things are at, to try to make sure we leave no stone unturned before we call it a day.

Tonight's talk is part of the process of looking under every stone, I suppose. Making sure we're not missing something that we should be considering while we still have the time and the financial and emotional resources to do something different. We'll see what they have to say.

Have any of you sought second opinions from another clinic? What questions should we be sure to ask?

Mo