"It's not your clinic, it's YOU" - reflections on a second opinion

We spoke with the head of the Colorado clinic last night. I presented our clinical situation, beginning with my health history and including our forays thus far in IVF. He was a very nice, articulate man. He gave us a lot of time, and a lot of detailed information, which we really appreciated.

But his opinion was sobering.

Bottom line, he thinks the Hodgkin's chemotherapy treatment and subsequent radiation from all of the imaging I have had done (more than 30 CT scans, gallium scans, PET scans) have damaged my eggs and are the culprits behind our multiple chromosomal losses. He said that it was pretty unusual to have a double aneuploidy and then to have another consecutive aneuploidy (and in our case two more consecutive), so he didn't think that was just random bad luck, as it has previously been explained to me by my RE and OB/GYN.

He also cited as concerning the fact that we have made many eggs and embryos during the past three cycles (40 mature eggs and 31 fertilized embryos), but only two blastocysts - all while at a top clinic.

He seemed to think our male factor issues, although fairly rough on paper, were not such a big deal since we've gotten pregnant occasionally on our own. And that it is good we don't have any uterine or clotting or other issues (all tested negative in recurrent miscarriage work up).

He said our best chance going forward is donor egg, but that "if you're not yet there philosophically," we have a couple of other options:

1. We can continue the IVF method we have been using - which he likened to a scattershot approach - hoping that eventually we will produce a chromosomally normal embryo and happen to transfer it.

2. We can come to his clinic and use a technique that is under clinical development called microarray analysis to see if any of the embryos we produce are euploid. He thinks we may find out that most or all of our embryos are abnormal. Microarray analysis would involve another fresh IVF with aggressive stimulation and attempts to grow the embryos to blastocyst (a little concerned that we've only ever had two blastocysts...but he seemed confident he could get a decent number). They would then sample the polar bodies or take a few cells from the trophoblast (part of blast destined to become placenta) and test for all 23 chromosomal pairs. It takes several weeks to complete this testing so all blasts are frozen using vitrification and those that are chromosomally normal are then thawed and transferred later (he reported a 99% survival rate after thaw). So far they've had 85 patients - mostly those who have failed other cycles - and a pregnancy rate of 70%.

Using microarray, he gave us a 25-30% chance of success. We didn't even ask about the likelihood of success with traditional IVF.

We were a bit shellshocked after the conversation (me more than Will, since I'm the defective one) but everything he said makes sense. My RE's continued optimism ("Your prognosis here is fabulous!") despite how things keep turning out has been a bit puzzling, but I have just been chalking it up to my own pessimism.

If we decide to go with the Colorado clinic, the whole process will take approximately (gasp) 4 to 5 months, beginning with a day of testing (lose a month, possibly two depending on if they need more testing) and working through the whole process of stims (one month), microarray analysis (4-6 weeks), and then a medicated FET (another month).

Daunting. We have a lot to think about.

Note to self: be careful about looking under every stone - sometimes you may not like what you find.

Mo