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.

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

Isn't that the pregnancy rate, not the live birth rate? Not many people would consider a miscarriage at 12 weeks a success, but it would be under those statistics.

Have you had a child before?

I was 39 when I tried for my second one. It took 18 months and we looked at IVF. We even started a cycle and then I found I was pregnant but they said that as I was proven to be able to take a child to term that made the stats much better.

Like you I wouldnt consider donor eggs. We had one child already and that would have been fine but I agree with PP. They wouldnt be doing the right thing inflating your hopes. Your age isnt in your favour, you DH's situation isnt either and the cycles that didnt work is telling everyone something but please dont think you can go to 10 cycles or even 20 plus. What does your DH think?

When we did ICSI my consultant told me she would always be honest on my chances and that she wouldn't ethically be doing her job if she didn't lay out what she felt our chances were.

@Hardbackwriter

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

Isn't that the pregnancy rate, not the live birth rate? Not many people would consider a miscarriage at 12 weeks a success, but it would be under those statistics.

This is true, my mistake. Live birth is the better metric.

14% per cycle
16% per egg collection
18% per embryo transfer (42% of those being blastocysts)

They have to be realistic.

Even if you were young your chances of success are still very low (around 30%), add your age and your DH’s sperm into that equation and you’re looking at very unlikely odds. And then if you factor birth defects in as well which might mean you would terminate a pregnancy the chances of you having a baby now are very slim.

The clinic isn’t just about giving hope. It should never be hope at all costs, and tbh there does have to come a point where you call a halt. There’s no point trying cycle after cycle after cycle with no chance of success. This is just going to make things even harder for you.

If adoption and donor eggs/sperm aren’t something you want to pursue (I wouldn’t have either) might it be worth seeking some counselling to help you come to terms with things.

I would also say if you can afford it then keep going, it’s no ones business as such

It's very much the drs business.

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

That's very much an average. For an individual, it could be 5%. Or 0%

I'm so sorry you're going through this. Do you think the doctor was trying to (in their view, not necessarily mine) be realistic about your chances and thought they were being kind by preparing you for it not working?
You should maybe ask to have someone else handling your care tbh. I've been through this process and it's much harder when you don't really trust the person trying to help you. We had to change consultants and while our second was brutally realistic (we were given something like a 10% chance of IVF working) he always used to say things like 'where there's life there's hope' and 'the thing about statistics is you always have your outliers, those that beat all the odds'. I found it strangely comforting. Anyway at 41, after 2 failed pregnancies, we conceived twins via IVF, they're now 2 and they're great. Good luck, it's a hard journey and not everyone gets a baby at the end but you'll give it all you've got any try your best regardless of the chances. I'll be thinking of you xx

Change clinics OP nothing worse than cycling with all that negativity I didn't use my free nhs cycles because I couldn't take the negativity. Id say your doing pretty well to get three transfers out of one round of ivf. The odds were really against us and we knew it but we're still happy to throw everything we had at it our consultant was honest 10% chance of success over a three cycle package but at no time was he ever negative. We were successful after 6 rounds of ivf. I would also go for the vasectomy reversal at the same time so you get to try naturally as well x

I’m sorry you’re going through this OP. I was very glad to have a straight taking Dr when we were doing our IVF. She was very clear after round 3 that it was very unlikely that using my own eggs was going to work. Like you, DH and I had discussed before the first round what we would do if things didn’t go well and decided that what was important to us was having a family, however that was to be achieved. We looked into adoption and spoke to a few local authorities but it didn’t look good where we lived and also they wouldn’t see us so soon after failed IVFs so we went the donor egg route which resulted in our son.

I don’t think it’s an IVF specialists job to give false hope. They need to be the ones without emotion as it’s impossible for the patients to do that.

Going into our first round of IVF we were filled with hope as sometimes a problem can’t be anticipated until they see how a cycle goes. It was heartbreaking for us when it failed. I really hope you get to have your family.

Are you in Ireland? If so, drop me a DM. I've been through more than one clinic and might be able to share some useful information. My story is very different, but I do know a thing or two about different consultants and different approaches.

Sorry, just RTFT, and see you're not.

@SoloMummy OP has said that they have ruled out donor gametes. That is their decision. Why are you trying to talk her into it?

I'm sorry, I think he's just trying to be realistic and not give you false hope.

I’m so sorry, OP. It’s brutal. As others have said, if you afford it, and feel resilient enough, you could try again.

It Starts With the Egg has a lot of advice on improving egg quality. I was also advised to take DHEA.

Oh OP that sounds awful. I think they only being honest with you though. I'd rather someone be realistic then give me false hope.

Change clinics OP nothing worse than cycling with all that negativity I didn't use my free nhs cycles because I couldn't take the negativity.
I presume you mean realism / honesty??

I went to see a prominent professor after suffering multiple miscarriages in my early 40's. She was very clear that it was likely to be the quality of my eggs. I was devastated. . What it did, was focus my mind on what I could do which was go down the donor egg route. We had 2 cycles and now have 2 amazing children. Although I didn't want to hear what she had to say in retrospect she gave me the opportunity to achieve my dream of being a mother and probably saved me the heartbreak of more miscarriages. Your Dr may not have had the most empathetic way of telling you but I assume he/she was sharing the statistical probability of future success if you decide to.repeat the process. It is hard news and I am sorry.

@Tipsylizard

I went to see a prominent professor after suffering multiple miscarriages in my early 40's. She was very clear that it was likely to be the quality of my eggs. I was devastated. . What it did, was focus my mind on what I could do which was go down the donor egg route. We had 2 cycles and now have 2 amazing children. Although I didn't want to hear what she had to say in retrospect she gave me the opportunity to achieve my dream of being a mother and probably saved me the heartbreak of more miscarriages. Your Dr may not have had the most empathetic way of telling you but I assume he/she was sharing the statistical probability of future success if you decide to.repeat the process. It is hard news and I am sorry.

Similar story here. I really, really didn’t want to use donor eggs, to start with.

My only regret is that we didn’t do it sooner.

I would be tempted to find another clinic. I had 3 failed ivfs in my late thirties with no transfers at two different clinics, before getting pregnant twice at a third. The difference was immune testing and treatment. This wasn’t even mentioned at the previous clinics.
I wish you all the luck in the world, I know how all consuming and devastating this journey can be.

Sorry op, that must have been really tough to hear. I think he has a duty to be honest with you about this to spare your health, money and heart as much as possible if the odds aren’t what you hope. Take stock for a few days and let your thoughts settle and talk it through with your dh. What are his thoughts following this last appointment?

@Tipsylizard

I went to see a prominent professor after suffering multiple miscarriages in my early 40's. She was very clear that it was likely to be the quality of my eggs. I was devastated. . What it did, was focus my mind on what I could do which was go down the donor egg route. We had 2 cycles and now have 2 amazing children. Although I didn't want to hear what she had to say in retrospect she gave me the opportunity to achieve my dream of being a mother and probably saved me the heartbreak of more miscarriages. Your Dr may not have had the most empathetic way of telling you but I assume he/she was sharing the statistical probability of future success if you decide to.repeat the process. It is hard news and I am sorry.

Me too x

OP I would try the infertility board for your post- you’ll also get some good support there. Good luck.

Dhea ASAP with a blood test. Then if not consider donor embryos. It's about 2k and they're amazing quality. I have 4x donor embryos on ice and it's the best decision I ever made.
Just make sure you tell the child so it doesn't find out later in life that everyone they love lied to them.

I became pregnant through ivf on my third cycle at 40.5. I think if I were you I would try again.

OP - I should mention that I changed clinics (to abroad) for my last two cycles. Different protocol. And the PGS on top.