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.

He also told me there is nothing you can do to improve egg quality... is this true?

No. DHEA can improve egg quality. You can only get it on prescription in the UK so I bought it from USA. After 9 weeks of being on it, I am now 12 weeks pregnant. I had previously had 2 early miscarriages. My AMH is low at 3.3 and I am 40.

from it starts with the egg

OP I had 10 years of IVF (x8 cycles, x5 miscarriages).

My last cycle with PGS (abroad) was successful.

It might be worth having some counselling, we found that with the limbo grief anxiety hope and despair That we couldn’t think clearly.

Alternatively a second opinion might help you.

I wish you all the best.

Hi OP, sorry you are going through this. I do agree that after 40 the IVF success rates drop through the floor, yes over-40s do get pregnant but less so and they do have more miscarriages. I have been through several rounds of IVF and my eggs were found to be dreadful at the age of 36, thankfully as I'm in a same sex relationship we managed to conceive two DC using my partner's eggs, even though she is older than me. It really does vary so much.

If you won't consider an egg donor, you could definitely throw everything at it in terms of supplements, ubiquinol is something we tried and apparently does help many people. You would have to take them for a few months before you tried again. Also perhaps try endometrial scratch before the transfer. Choosing a clinic is a personal thing, if money is not an issue I would definitely go somewhere else and give it another shot.

Also OP, I am a member of two facebook groups for women 40+ TTC. They have been a great support.

I am 35 and have low amh, we are looking to have another round now after our last cycle resulted in a baby boy who was very sadly tfmr for severe fetal abnormalities (not genetic). You can help your sperm and egg quality by making dietary changes and taking supplements. It starts with the egg is a good book and has a chapter for make fertility. We had a consultation yesterday and the doctor recommended the same supplements as it starts with the egg book. Ubiquinol 600mg for you, 200mg for him, vit d, folate for both, N acetyl cystine 600mg for you, r-alpha lipoic acid for both l carnitine for him, high quality high strength omega 3/DHA for both (I'm taking the Zita West ones). Medittereanian diet, no red meat, fish a few times per week.

Does anybody think my doctor has given up too easily?

No. I can't really add anything different to what has been said, and I agree that the doctor is just being honest with you. He obviously does have a moral and ethical code, and isn't just taking your money for the hell of it. This is why I and most people have voted YABU.

You aren't unreasonable for being disappointed, but you are unreasonable for expecting the dcotor to give you good news when he clearly doen't have any.

I'm sorry you are going through this

I do think he was just being honest, there isn't really any positive evidence, such early miscarriages could most likely be due to serious abnormalities.
I think it actually shows him in better light that he told you it all how it is, its invasive and costly and it must be emotionally very difficult, he can't encourage you to do that again without understanding the chances.
I would do another cycle, and genetically test the embryos, and if they're no good I'd either use donors or just get DHs vasectomy reversed and see if you get a miracle but stop trying.

Also I forgot to say that i don't believe embryo grading is particularly good, they are only looking at the cells not the DNA. My only living child is from a poor grade embryo that the clinic would have discarded if I had any higher grades. None of my A grades implanted, not even the hatching blastocyst. Both my b grades did implant in frozen cycles buy one ended in miscarriage and the other poor sweet very unwell little boy who was tfmr. We won't be wasting anymore c grade embryos in any further cycles. We are hoping to do a freeze all unless we have cs in which case they will be transferred and if they fail any higher grades will be a FET a cycle or two later.

OP when I was going through IVF I tried very hard to ignore what other people thought regarding my chances. As long as the clinic allowed me to have treatment, I disregarded the impressions the doctors gave of chances of success. I know that may sound ignorant, but I had my own personal turmoil to deal with, and I really didn’t have the energy to dwell on negative opinions. Like I say, until they actually refused me treatment, I worked to my own agenda. I’m not stupid, and I think I would have known when it was time to call a halt to it. So I went back time and again, for treatment after treatment. My consultant clearly thought I was a glutton for punishment ! He couldn’t believe that after each failed cycle I was straight back on the phone wanting to try again. In the end I lost count - I think I had 10 IUIs and maybe 5 full IVFs, and a couple of FETs. It cost me a fortune and took years but I now have 2 kids so I’m glad I stuck with it.
I guess what I’m saying is, whilst it’s important to keep your feet on the ground, you need to try not to take to heart the negative opinions. I think you’ll know yourself when enough is enough.

Thank you so much for each and every reasonable opinion.

My heart is sad. Just been shopping and pushing a trolley and thinking about why I’m sad. This process itself is such a heart wrenching one. You most want the end result which is a healthy child but each step in the process is such a pain in the arse. I spend each drive to the clinic feeling angry that I have to pursue this route to motherhood and almost having to convince myself to walk into the clinic because it’s such a shitty way to have a child!

I felt the same. I was so angry that other people could make babies in a fun, free and private way, just by going to bed with their nice warm partner and having a nice time and I was having to go through endless injections and invasive internal scans. I was a poor responder to the drugs, it took me three weeks to get to egg harvesting stage and then very few eggs.

I’m sorry you’re going through this x

OP it is a very difficult way to have a dc.
It is stressful and uncertain.
I also read Zita West's book and found it useful although it was over ten years ago now.

Doctors are quite blunt about your chances after our successful births aged 32 I was told if I wanted more dc I needed to come back before I was 35 and my age became an issue.

That doesn't mean that older woman don't have success stories just that the odds are more stacked against them.

I remember looking at everyone else seemingly having dc without problems and it really hurt. I hope you find a good way forward.

I’m so sorry you’re going through this. But the doctor has a duty of care to be realistic.

The combination of your age, poor quality sperm, poor quality embryos and several failed cycles makes the chance of ICSI working quite slim. It’s a very expensive procedure so if your doctor acted optimistically about it working, would you not be concerned he was just trying to extract more money from you?

He’s likely seen many couples in your situation and is trying to be realistic.

Have you explored other options like egg and/or sperm donation?

Were you given too much hope in the first place, Op?

Were you told that your eggs might not be "good quality" & the same for your husband's sperm due to him having had a vasectomy?

I’m so sorry, I have been where you have and it was a very dark time for me. I felt that there was no point to my life. I had 3 rounds of IVF from the age of 40/41. We paid for it and I would never have given up if I had had the choice. The desire to have a child was so strong.
After the third failed attempt, the consultant told us more or less what yours has said, however he also added that we were bringing the clinic’s success rate down and I feel that was a big factor in his decision.
You have been pregnant twice and that would have given me the encouragement to continue. As a previous poster said, progesterone suppositories are very important to support a healthy womb in the first few months. I would find another clinic and keep trying.

You said that your embryos were frozen at 3 days. That isn’t usually done as basically if they don’t make it to blastocyst (5 days) they are not going to be successful anyway. So I think you’ve been a misled up until now. They didn’t wait to see if your embryos developed into healthy blastocysts as they knew there was a good chance they would not do so.

@Circusoflove

You said that your embryos were frozen at 3 days. That isn’t usually done as basically if they don’t make it to blastocyst (5 days) they are not going to be successful anyway. So I think you’ve been a misled up until now. They didn’t wait to see if your embryos developed into healthy blastocysts as they knew there was a good chance they would not do so.

No. They were frozen at 1 day and then thawed and transferred at 3 days. The one embryo that actually resulted in a miscarriage was transferred at 1 day as part of a fresh cycle.

The option going forward would be to leave them to get to blastocyst at day 5, genetic test and freeze pending the result.

OP I guess the doctor was trying not to give you false hope but have you asked what kind of odds you are dealing with? A 10% chance may still be worth taking to you but the doctor might see it as not worth your while. Don’t let one doctors pessimism get you down.

I know you and your husband have decided against sperm donation already- but would this be something you can speak about again if it would increase the chances of success?

Did he have a vasectomy due to having children?

No. They were frozen at 1 day and then thawed and transferred at 3 days.
The one embryo that actually resulted in a miscarriage was transferred at 1 day as part of a fresh cycle.

I really don’t think this is done in the U.K. anymore. Embryology advances mean that there is no benefit transferring at such an early stage.

That doesn’t sound standard. Usually they observe until day 3 and if enough were progressing normally leave until day 5.

I would double check they are using vitrification to freeze them. If they are using older techniques this may affect the outcome.

In the UK 40-42 would expect 19% success rate per cycle.

If you can say which country you are from people might be able to suggest alternative clinics.

@Westnorwood

If you can say which country you are from people might be able to suggest alternative clinics.

I’m in the KZN Midlands in South Africa. Clinic is in Durban

It’s just something my DH and I agreed on from the start. No adoption and no donors. It’s probably a bit of an immature unexplored mindset but it was one of the limitations we set ourselves beforehand and probably why I’m so devastated that this may be the end of the road.

I don't think that navy people, in an ideal world, think that donor gametes is in their game plan.

However, for many and now you, there comes that crossroads, where you have to move on with your thinking. Do you want to potentially be a parent or forever more live with that gaping hole that you could have explored other options, be that donor gametes, surrogacy, adoption, fostering etc.

There are literally thousands of couples with a child, as a result of a donor. Be that donor egg, sperm or both.

It is, ultimately, a cell, given by another that you grow, nurture, love and birth.

Are you really, at 41,when you know your options are already reduced, going to not consider this now you've reached this point because when you made a decision you were still in the fertility treatment honeymoon bubble?

Surely you owe it to yourself, especially, as you have no biological children, to at least research and look into the other options now you're at this point before you rule it out?

Can I ask your concerns?
Not being related by blood? Child tracing donor? Not wanting to tell the child or others? Honestly, whatever it is, I promise you there are millions of couples who have thought this through before too...There are websites and forums that specifically deal with these situations and offer non judgemental advice. Do message me if you want further information.