Ivf. Doctor seemed overly negative.

[mikkyr]

So husband and I have had 3 failed ivf cycles in the last 2 years. I am 41 and husband has had a vasectomy (previously married). Given the time constraints we decided that a testes biopsy was the best route to go instead of a vasectomy reversal which may not be successful and then still need to do a sperm extraction via biopsy at a later stage.

My last cycle failed completely whereas before I have had two early miscarriages. Without going into all the medical jargon I retrieved a fair amount of eggs for my age, they were reasonable quality, the embryos were not A grade but also not the worst. Everything seemed pretty average.

My appt with doc yesterday was terrible. I went in feeling so full of hope that we would be able to do another egg retrieval, ICSI and transfer before Christmas. But the doctor was so negative. He didn’t have anything hopeful to say. Basically I’m old my eggs have aged. My husbands sperm is less than great because it’s been extracted via biopsy and a vasectomy after 10 years rescues the quality. Our embryos are poor. The chances of genetic abnormalities are high. Our track record of 3 failed cycles leaves such a small percentage of success in the future. It’s costly.

We told him that money was not an issue (that sounds pretentious but we have enough to do another few cycles)

I’m just so disappointed in his atttitude. It’s like he doesn’t want me to do another cycle. I thought this whole process was about hope and that these doctors would be able to try and try. 3 cycles seems very little compared to what I’ve read and I’m surely not the only 41 year old who is seeking fertility help when there are 41 year olds falling pregnant naturally?

I don’t know what to do.

I fear he was giving you the brutal honest truth that in his opinion, he doesn't believe there's much chance of there being a successful outcome (a healthy baby born more or less at term) for you both

They are optimistic or pessimistic based on facts. First time, your statistic were probably good. Sadly, it didn't result in the expected good outcome and that means that the chances of it is much lower thus time taking into consideration these facts and adding the 2 years which can make a huge difference.

I had a scan at 39 that showed my ovaries to still have a decent amount of eggs. Blood tests confirmed this and reasonable quality. Yet I started the perimenopause only 3 years later.

Saying all that, my friend was told she was in the peri stage yet got pregnant and had a healthy child at 43, so again, statistics are one thing, miracles an another.

They were so optimistic in the beginning.

IVF is one of those things where you gain information from each cycle. In some cases everything looks hopeful, but then every part of the process fails to have a great outcome, and the odds change greatly.

My main concern with private IVF is that it is a license to print money by carrying out expensive and invasive treatment with a very low chance of success. In many cases honesty would be better, if hard to hear.

Having said that, medical opinions differ. If you feel that he was unduly negative or was casually brushing you off without really focusing on the options available, you might get a second opinion.

I’m so sorry. I think he was being objective and realistic, trying to manage your expectations. It’s going to be different for you because of the huge emotions. Gentle unMN hugs.

@mikkyr

It’s crazy. For anybody who has been through ivf will know that hope is what gets you through this. I just always thought your doctor would be the one providing it through confidence. Possibly even give us some good news stories. But honestly I feel like he was trying to tell me not to do it anymore. Surely there are these women that do 10 cycles? Do they do it on their own will in the face of adversity from the very person you are hoping is going to make it happen for you? I’m devastated.

Sorry, OP, hope is important, but the docs have to be realistic. With your age, known issues, and three failed ivfs, your chances are very slim for a successful round and it would be unethical of them to boost your hope with the rare success stories in your circumstances. They need to make sure if you decide to go forward with more rounds, you're doing so fully informed that your chances are low. I'm sorry, it's such a hard thing to digest. For the few stories you see online of successful ivfs after 3+ failed ones, you're not seeing the many who weren't successful. Most of those who are eventually successful will likely be younger, which inherently gives a better chance (sorry, I'm just being honest, but I know that's hard to hear). It's not giving you a fair representation of your chances. Again, that's not to say you shouldn't try again, but I would recommend deciding on a final point where you can draw a line under IVF if any further cycles aren't successful.

"Our embryos are poor. The chances of genetic abnormalities are high. Our track record of 3 failed cycles"

It doesn't sound like there is anything much to be positive about. This is risky and a lot of strain to be putting yourselves under.

I'm sorry you didn't hear what you were hoping for, however, wouldn't you rather a medical professional was honest with you rather than filling your head with unicorns and rainbows?

I'm very sorry, that's obviously not the nicest thing to hear, but ethically I think they have to manage your expectations, for your sake and the sake of the embryos.

If one did take, it would mean the chances of having a life with abnormalities or disabilities which could be painful to live with, and may mean a life of caring for you.

If it didn't take then you would be absolutely heartbroken after being filled with hope. You might even have misplaced anger and grief.

So sorry you've had negative news. I think the doctor is giving you the hard facts so you can be realistic about your choices.

Would you consider getting your eggs frozen so using donor sperm in the future may be an option? Having friends who've done the years and years of IVF they all wish that they'd done this. Also everyone I know who has used donor egg/ egg/ embryo have no regrets at all.

Try another consultant.

I was left devastated after being told by one clinic I had no eggs left at 35.

A year later I went to another clinic and was told completely different and went on to three rounds of ivf resulting in two dds.

Have you got frozen embryos ready to go or do you have to start the cycle from scratch?

If frozen push on with it
If starting from scratch find another clinic.

Can I ask which clinic you were at? We used Care Fertility. They have a very active message board

@ClementineWoolysocks

I'm sorry you didn't hear what you were hoping for, however, wouldn't you rather a medical professional was honest with you rather than filling your head with unicorns and rainbows?

Unnecessary.

Have you tried PGS? This might help weed out some of the poor embryos. Maybe look at changing clinics.

Whilst yes chances might be lower IVF does seem to be a numbers game.

I’m just so disappointed in his atttitude. It’s like he doesn’t want me to do another cycle. I thought this whole process was about hope and that these doctors would be able to try and try

Did you really think that? On what basis?

The dr has the ethical responsibility to tell you the truth, they can't do otherwise. They can't let you think there is more hope than there is, they can't let you keep trying when in their judgment its unlikely to happen.

Don't you think you're projecting your disappointment about the prognosis onto the Dr? It isn't his "attitude" that is at fault. He's done his job.

I’m not in the UK
Last frozen resulted in the previous failed cycle.
Would have to do another egg retrieval.
Have considered going for a 2nd opinion but then worry about transferring husband frozen sperm from one clinic to another.

We have decided that donor eggs or sperm is not an option for us.

In that case, if it were me I'd get your dh's vasectomy reversed, do everything you can possibly do to improve egg and sperm quality (ubiquinol etc for you, zinc, selenium etc for both, fertility diet, moderate exercise .. lots of books on subject), track your cycle with best methods possible (Ava bracelet etc), keep in mind older women tend to ovulate earlier in cycle, have fun and see if nature works for you.

Be aware that early pregnancy testing may show chemical pregnancies that may well not become a true pregnancy.

Apparently natural conception is more likely to result in a successful pregnancy because your body had selected the better eggs and fertilisation would be less likely to happen with a poor quality egg. Obviously means far fewer pregnancies but higher chancing of one sticking, as it were.

Fwiw I know three women off the top of my head who fell pregnant naturally at 45 (and the dads were older too).

After all the bad news my husband has said that if we decide to do another round we would definitely do genetic testing before another embryo transfer. It comes at such a huge cost but like someone before has mention a life with a disabled child also comes at a huge price.

Am I reading this correct, you have had 3 IVF cycles, two of which resulted in pregnancies, which you unfortunately miscarried. and 1 failed IVF?

If that is the case, I would not give up hope yet.

I had 6 failed IVF's plus several failed FET's before I finally was successful on my 7th. I never saw a BFP until my 7th IVF. Maybe consider changing clinic, that is what I did ,and was successful on the 2nd IVF cycle at the new clinic.

They were so optimistic in the beginning. Basically that I was a fit healthy relatively ‘young’ women and that the only obstacle was my DH vasectomy which on biopsy had ‘lots of good moving sperm’!

Was it the same doctor?

It sounds like they've changed their tune and are now giving it to you straight whereas they should have done so in the beginning.

That’s very kind of you.
Sounds like you were in the consult room with me hearing every word the doctor said.
Definitely me projecting.
Have you ever had ivf?

@Zug2

Am I reading this correct, you have had 3 IVF cycles, two of which resulted in pregnancies, which you unfortunately miscarried. and 1 failed IVF?

If that is the case, I would not give up hope yet.

I had 6 failed IVF's plus several failed FET's before I finally was successful on my 7th. I never saw a BFP until my 7th IVF. Maybe consider changing clinic, that is what I did ,and was successful on the 2nd IVF cycle at the new clinic.

Yea you have read correctly. One chemical, one miscarriage and one complete fail. Ie no implantation at all. The first one was miscarriage and they only transferred one embryo. 2nd two transfers were two embryos each.

If you are in your 40s and doing IVF your chances are always low, in fact at all ages they aren't great.

The question is whether you look at the stats. Even before they did these three cycles, your chances were low. Now, on paper at least, they may be a bit lower. But realistically, you probably always knew nothing was for sure and were doing this so you give it every possible chance. Even a low chance is a chance, so every couple has to decide how long they can keep going. It sounds to me like you are ready to keep going, and I think as long as you know the stats/on paper chances, it's reasonable to do that. It might work.

It would be bad to go into it thinking you had a 50% chance, but if your decision about how much mentally/physically/financially you can give is based on a realistic understanding, then it can still be right to go on.

I would consider changing doctor as even though he may just have been giving you the stats, you will probably feel more positive with someone else now.

Unfortunately the doctor has an ethical obligation to be honest with you.

I’m sorry it wasn’t better news.

I agree the doctor was being factual but unfortunately the facts aren’t particularly nice to hear.

I think the advice to decide on what your limits are is actually really helpful (though devastating). You’re putting up a good fight but you do have to consider that the eventual outcome won’t be in your favour and start to work out how you’re going to accept that if that’s what comes to pass.

I wish you all the luck in the world with your attempts

If the dr really thinks that you have little to no chance of success, would you like them to lie to you and have you do several more cycles?

I think getting two positive tests from the first three cycles is actually pretty encouraging, and every cycle you ended up with transfer.