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’m so sorry you’re feeling so demoralised. Whilst I think the doctor was being realistic and trying to manage your expectations, the truth is that ivf is very rarely straightforward. The only real indicator is the statistics because every single persons’/couples’ circumstances are pretty unique. In your shoes, I would give it another go as I think you’ll regret it otherwise. That was one of my benchmarks. Is there anyone else you can talk to at the clinic?
At my clinic, going back a few years now, we had to drink 2 litres of milk per day during stims to help egg quality by increasing protein.

I haven't read what you have written as the doctor telling you not to have another go or that there is no chance - he has just been honest about the odds

Poor egg quality - your last transfer I'm assuming you were 38, so assuming your eggs will be older and from what I've looked there's a a drop from 50% 'normal' ie 'good' eggs at 38 to approx 30% at 41 - however if you were told you had a 30% chance of something happening you'd still have a good chance

Frozen sperm - the thawing process does loose about 50% of them and they don't last as long as fresh - however you only need one and if having IVF they are in control of the time scale

The chances of a chromonal abnormality at 41 (the previous frozen embryos were considered to be age 38 no matter what your age was) is 1 in 53 - that's less than 2% but some people will consider that high

In short the doctor is right that there is LESS chance than there was 2 years ago when you did your first cycle however not trying again would mean you have NO chance

I'd take less chance over no chance

You may well find that once you have made your decision that your doctor is very supportive and positive - just trying not to give you false hope entering into it

Things that can help with egg quality are DHEA and CoEnzyme Q10 - the former especially.

If you are trying again, try DHEA and make sure your vitamin D levels are good.

Ivf Veteran here.
Doc being realistic not necessarily negative.
On genetic screening- what the research is increasingly showing is that the success rate of genetically viable embryos is much higher than just transferring blind.
To put it another way- there’s little point transferring a non Genetically viable embryo- most likely is it won’t implant, or you will miscarry, or be faced with a TFMR, or a severely disabled child.
On the other hand if you transfer a genetically viable embryo your chances of a viable pregnancy are well above 50%.
So if you do go ahead with another round I’d highly recommend genetic screening if you can afford it.
FYI- we did 3 egg retrevial cycles to get 1 genetically viable embryo. Always had loads of eggs- but it turned out they were genetically bad embryos. Our viable embryo is nearly 2 now. And I was 40/41 when she was born.

Op I've been through Ivf though I feel incredibly lucky that my infertility was diagnosed at 27 and I had ivf at 28 and conceived first time. When we went to try again 5 years later (aged only 33) my egg quality was so bad I knew I wouldn't even try as I couldn't put myself through the process and potential disappointment. I realise that my situation is different in that I had one child but either way it's still a big decision to walk away.
I hope you get the result you want or find peace. It's incredibly difficult and heartbreaking. Good luck

[quote CounsellorTroi]@SoloMummy OP has said that they have ruled out donor gametes. That is their decision. Why are you trying to talk her into it?[/quote]
I'm not trying to talk her into it. But that blanket decision was made when things looked rosier. That's not the reality.
So now they need to decide. No children ever versus could still be parents.
It's OK to then decide not for them, when in possession of the facts, not solely an uninformed ideal of "not for us".
How many donor recipients do you think would have thought similarly beforehand?

Op this is hard for you but the doctor needs to behave in an ethical manner, he needs to clearly explain to you your chances, and what may likely occur, and then you need to make your decision from that position of knowledge. It would be terribly wrong of him to just give you hope ans confidence.

These people urging you on are not really doing you any favours, I think they are just trying to give you hope back, but that’s not necessarily the right thing to do.

My sil went through this and as much as I was an onlooker, I could see how devastatingly hard it was, for both of them.

I think you need to sit down and simoly think this through, look at the odds, the risks, discuss with your husband and both make a decision, and proceed from there.

Good luck whatever you decision you make💐

@Mumbum2011

Op I've been through Ivf though I feel incredibly lucky that my infertility was diagnosed at 27 and I had ivf at 28 and conceived first time. When we went to try again 5 years later (aged only 33) my egg quality was so bad I knew I wouldn't even try as I couldn't put myself through the process and potential disappointment. I realise that my situation is different in that I had one child but either way it's still a big decision to walk away. I hope you get the result you want or find peace. It's incredibly difficult and heartbreaking. Good luck

Same story, although I continued and it failed. Now in mid 30s im struggling with if I try again. The cost and mental trauma is just horrible, but I can totally sympathise with those who keep going to try and get the result they want. Infertility is so cruel.

I do think some doctors are much better at conveying things than others. It sounds like this one was very poor on the communication front.

Bluntness 100 we are not ‘urging her on’ but passing on information with the best of intentions. If I had not come across immunity testing on a forum I would not have my children today. I want to share this just in case it’s something the op has missed as it could, possibly, make the huge difference for her that it did for me.

Ah that’s a very shit and sad day you had
I’d assume all the risks he gave were actual rather than perceived
And we know other women of your age have managed both naturally and via IVF despite such hurdles
I’d not take it personally but write down every risk he mentioned and ask for second meeting and if he could give you the detail

Personally the genetic abnormality risk would need further details

And rationale behind every single
One ?
I’m sorry ☹️

It doesn’t sound like the doctor has said they won’t let you try again, just wanted to make sure that you had realistic expectations. I would sooner trust that doctor/clinic than one that told me what I wanted to hear just to get my money.

I had 3 cycles with my own eggs at a similar age and was spurred on by an early miscarriage in my first go. I also said I wouldn’t want donor eggs - but who would by choice? But when given the stark chance of a live birth from my own eggs of 5% vs 45% from donor eggs it seemed like a much easier decision. I now have 2 DDs and wish I had had donor eggs earlier as would have tried for a 3rd.

Are there tight regulations on IVF where you are? Transferring embryos on day 1 is very uncommon in these days. Certainly in the UK most embryos are cultured to D5 to select the ‘best’ embryo. Before you go ahead with another cycle I would compare your clinic’s transfer policies and success rates with others in your country.

Good luck - it’s a hard journey.

Have you tried other clinics with better success rates, especially for those who are older. I couldn't recommend the ARGC more and they have the best success rates for over 40s in the country (or did a few years ago).
They are very honest and if they said the same I would believe them but they can work miracles. Their approach is different to other clinics - very pricey but if you can afford it at least go for a consult.

I also recommend the ARGC, they are more progressive than other clinics imo. Their success rates are also higher. I would have a chat with them if you haven’t already, before making any decisions.

Sad as it may be, you need to understand how poor your odds are.

There are women conceiving naturally in their 40s, but statistically it's a vanishingly small %, even lower % of women who haven't had a successful pregnancy before. Being "young" & fit in terms of your external appearance has no correlation with reproductive age, alas.

Yes, there are people who persevere through 8,9,10 cycles and eventually get a baby (a relative had 8 before having her son) but for all the success stories, there are far more sad stories for women your age. The dr is being decent by being realistic about your prospects.

By all means keep trying if you need to do that to feel you've tried everything, but I think important to be aware how easy it is to get trapped into an addictive cycle of "just one more try".

Hi, have you looked into immune testing - might answer why early miscarriage?

Really wishing you good luck - I know what it feels like, I hope your outcome is as positive as mine was x

Donor sperm seems worth a try, as you're 41.

@Calmingvibrations

Hi, have you looked into immune testing - might answer why early miscarriage?

Really wishing you good luck - I know what it feels like, I hope your outcome is as positive as mine was x

All immune testing done as standard protocol here. Thyroid issues discovered which had to be corrected before clinic would do transfer. Thanks anyway.

I have said you are being unreasonable because I don't think that the doctor was wrong to be honest with you. Though you will understandably want to hear words of hope, I am firmly of the view that to sugar coat and give people hope irrespective of the facts can be more cruel than telling them how it is in reality. That said, I don't think you are at all being unreasonable for feeling as you do and for wanting to have heard more positive encouragement to continue. Infertility issues are bloody hard. I know. I also know that you will want to continue for as long as you can even if the odds are against you because sometimes it can still work. Try to hang on to that hope but balanced with protecting yourself from the potential of an end game which isn't where you would want to be by taking heed of some of the advice you were given. Don't stop trying but be realistic is what I mean. I really truly hope that you get a happy ending

I had the same conversation at a clinic after some failed ivf. We had Male factor problems but no problems with me and bloods were all good with regular cycle etc. I was so angry at the conversation I left the clinic and went to another. One of the best in the country and had all the immune treatment done and even tried donor sperm. It didnt work and cost loads and I put my mind and body through so much. Eventually we went to a third clinic and used donor eggs and sperm which worked. I remember the 3rd clinic telling me they would use my eggs but I said no. I was 41 and I was nearing the end of my ability to keep going and the success rates were so low.

I wish i had listened to the doctor at the first clinic. I wish I had switched to donor sperm then.

I didnt agree with that doctor because I didnt want to hear it. Looking back though I wish maybe I'd had some counselling to accept the news.

The odds are low at 41 especially with a Male issue. We always think we will be the 10% it works for but that's statistically unlikely. I took the view that as long as I was happy I had tried everything then I could live with myself if it didnt work. Now I have 2 wonderful donor children. But I'm still damaged from the trauma of 8 years trying to have them.

Good luck x

Your DH already has biological children, you don't. I'd go for donor sperm - surely he'd understand? Or seriously reconsider donor eggs and sperm. At the end of the day, YOU are missing out on motherhood.

Also most clinics wont do IUI if your over 40 even with donor sperm.

Sorry to hear what you’ve been going through. IVF is really hard. I guess it’s their way of trying to let us be realistic with our expectations. For us, we had 6 fresh cycles in the end. Hope does get you through them as you always think that this time will be the one. I found the consultant in our appointment after our first failed cycle and he was so negative and I left feeling very despondent. We tried for 14 years so was in my late 20s when we first started trying. I had 4 negative cycles, one chemical pregnancy with own eggs at almost 41 so decided then to move onto donor eggs as realised that my chances were probably quite low. We went on a waiting list for 8 months and were really lucky as I got pregnant on my first donor cycle and we now have an almost 3 year old.

Wishing you lots of luck in whatever road you go down xx

Anybody still on this thread that I can fact check a couple things my doc said to me?