First of all, I want to thank everyone in the RPL blogosphere for all your support and prayers over the past couple weeks. Thank you also to my family and friends. All your love and support has been my lifeline through this entire process. I apologize for not updating all of you sooner. I have to admit, I was feeling pretty lost. I really thought our one good embryo would take, so it was a complete shock when it didn’t. Even with our 2 negative betas (and 3 negative HPTs), I kept thinking it must have been a mistake and somehow I was still pregnant, but my period arriving with a vengeance yesterday put those diffusional thoughts to rest. It’s done. I accept that now, but I refuse to accept that this journey is done for us. I just can’t be.

We met with Dr. J on Wednesday to discuss what happened and talked about our options. They weren’t great, but there still are some options, so thank God for that! He had no explanation for why our embryo didn’t take. She was only a moderate grade embryo which could have been an explanation, except that we did PGD, so we know she was chromosomally normal, so the grading doesn’t apply here. Dr. J also said that the grading system doesn’t always mean very much. He’s transferred lower grade embryos that resulted in healthy babies and high grade embryos that didn’t implant or resulted in miscarriage. So the grading system really doesn’t count for anything and PGD is by far a better indication of embryo quality. So then why did our embryo not take? No one can give us an explanation. Dr. J said my lining was perfect, so there really isn’t anything he can point at and blame for this failing. I also asked him if we would have benefited from assisted hatching and he explained that all PGD embryos are already hatched. Apparently, they have to break the hard outer shell of the embryo before they take the biopsy for PGD. I didn’t realize this, but it makes sense. So again, if our embryo was already hatched, why on earth didn’t she take? Without any real answers, I find myself wondering if I should have taken it easier or done something differently, but Dr. J adamantly told me there was nothing I could have done to make or not make this happen. I’m having a hard time believing him, but since it won’t change the final result, I’m trying to let it go and move on and forward to the next plan.

So what is the next plan?

Dr. J presented 3 options to us:

1. Go back to trying on our own and hope for a good egg
2. Try IVF with PGD again, but with minimal stimulation meds and batch eggs over several cycles before testing
3. Donor eggs

Option 1. Try on Our Own Again
Dr. J explained that trying on our own wasn’t a bad plan for us because we don’t need IVF to get pregnant. We’ve been pregnant 4 times on our own with only a few months of trying each time. And even more encouraging, we had a chromosomally normal child. Our son was so sick because of severe prematurity, not because of a genetic abnormality. So at least 4 years ago, we know I had some good eggs in there. Also, even with all the stimulation and damage we potentially did to my eggs with all the stimulation meds, I still had 1 good embryo, so we know I still have some good eggs now. Though 1 normal embryo out of 11 isn’t very encouraging. However, Dr. J said we can’t really calculate it like that because the entire IVF process was pretty hard on my body and he believes the high level of stimulation I had to use to get enough eggs may not have been the best thing for my already pretty messed up eggs, and they may have been lower quality as a result. So by going back to trying on our own, we may have a better chance of catching a good one. And we would be saving ourselves another round of really expensive procedures for really only one outcome: PGD. This all sounds good, except we have to ask ourselves, how many more losses will we have before we do catch that good egg? The thought of having several more miscarriages really scares me. I’m not sure I can handle it. And because of this, my husband doesn’t want to try on our own anymore either. Neither one of us wants to keep having miscarriages, and he especially doesn’t want me to go through it again.

Option 2. IVF and PGD Again with Clomid
Dr. J indicated that it would be reasonable to try another attempt at PGD, but with a much lower stimulation approach this time. Last time we took a really aggressive approach, and I did high doses of injectable meds to get the 11 embryos we had. He does not recommend doing this again. As mentioned above, he believes the high stimulation meds may have messed up my eggs even worse then then were. There really isn’t a good formula for why this works for some people and not for others, but Dr. J believes it has something to do with how our bodies respond to the stimulation and that there’s an impact on the egg quality when you have to force it to really happen, and because we really had to push my body to produce the numbers we got, it likely didn’t help my egg quality. So the next time, he wants to try a minimal approach and do several retrievals to get the numbers we need for PGD. He recommends trying Clomid which will only give us a couple of eggs per cycle, but will be much easier on my body so it will hopefully not damage my eggs too much. The thing with Clomid is it’s typically used for IUI or timed intercourse to help couples conceive. We actually have a 90% fertilization rate (the number of eggs that fertilized after our last round), so we don’t need it for that, but what it does do is help the 1 or 2 (or more if we’re really lucky) good eggs to mature properly and it will give us something to retrieve and batch so we can still do testing. That’s our goal in all of this, to know which embryos are good before implantation and lower our odds of having any more losses.

Option 3. Donor eggs
In the past, every time I’ve heard donor eggs mentioned, I’ve done a mental recoil. The very idea of donor eggs scared me. I felt that if we went with donor eggs, then we were giving up on me, on my eggs, and my ability to have a child that is genetically mine. This idea is still really hard for me, but I’m becoming more resolved to it. I’m not saying I want to jump to this solution immediately, but I’ve been giving it some serious thought for the first time these past few days, and if it comes down to a choice between adoption and donor eggs, I actually think I’d rather do the donor eggs. Even a month ago, I would have said the opposite, but the more I think about it, I’m not sure adoption is the best back up plan. I know some people who have adopted and have had a pretty smooth process and have found the entire experience incredibly rewarding, but I also know others who have had to wait for years and have eventually taken their names off the wait list because it was too hard. I honestly don’t think I could go through years of waiting after all we have already been through. Also (and this is maybe the most important thing), any children we have from donor eggs would have half my husband’s genes. I would be able to look at those children and see him. I’d also probably see someone else too, but we can find someone who matches me genetically and physically, so it might not be so obvious. Furthermore, I would still get to carry and deliver the baby. I would share my body, my blood, with the baby, so there would be that bond as well as the bond of delivering and breastfeeding. Lastly, it would be less costly and more of a guarantee then adoption. Our fertility clinic has a shared donor program that sounds promising. It’s exactly what is sounds like, you share one donor with another couple and you get half the eggs and they get the other half. They expect a young donor to get abut 16 eggs so we would get about 8, and the clinic guarantees a minimum of 2 embryos to each couple. Furthermore, with my husband’s apparent super sperm, we should have a high fertilization rate, so we may even get lucky and have a few more embryos than just the two and have more chances at a successful outcome. The only con to this is you would be sharing your child’s genes with another couple, but there are no guarantees that an individual donor won’t donate again in the future anyway or have her own children at some point, so we just have to accept that there may be other children with the same genes as our child. As weird as that concept is, we would just have to move on and forget about it. And the major bonus of the shared program is it’s half the price of using an individual donor. Since we really can’t afford any of this, any savings we can make along the way are a necessity. Another thing about donor eggs versus adoption is that the egg donors are screened extensively for infectious diseases and genetic disorders. With adoption, you can’t always find this out in advance so you could have a very sick child.

So what did we decide?

We’re going to try Option 2 first. Well more specifically, we’ll try a cycle with Clomid and see how I respond. If I only get one egg, we probably won’t do a retrieval as it’s a lot of work for only 1 egg. If that happens, Dr. J will send us home to try timed intercourse and hope for the best. If this happens it will be option 1. However, if we get 2 or more eggs from Clomid, then we’ll proceed with batching. It will likely take us about 8 months from beginning to end as we’ll likely only get 2-3 eggs per cycle and  have to take a cycle off in between each round. Once we have enough eggs, we’ll send them all for testing again and pray for more than one good embryo this time, and for a successful transfer. I’m waiting to hear back from the clinic with our reduced repeater fee breakdown to do this again, and Dr. J wants me to take one cycle off. So we’re back to waiting, but hopefully we’ll be able to move forward soon. Keep your fingers crossed that they give us a big break on the cost. We’ve already spent so much money on this!

If this all fails, then we’ll consider options 1 and 3. I asked Dr. J, how long of a window I have to consider donor eggs as our back up plan, and he said until I’m 55. I know women do this, and I mean no offense to anyone in that age group who is trying to conceive right now. I wish you the very best, but for me, I know I can’t keep doing this for the next 18 years! I know I’ll give up on all of this long before then, but it does give me some reassurance that we still have time. When I first heard I had poor egg quality for my age, I thought I had run out of time and this gives me the back up plan I didn’t have when we started all of this 6 months ago. Dr. J. indicated that my uterus is good. We know I can carry a baby, and my hysteroscopy showed that despite a C-section and 3 miscarriages with 2 D & Cs, my uterus is in really good shape, so I’m an ideal candidate for donor eggs and should be for many, many years. I haven’t completely talked all of this over with my husband yet, but I’m thinking if option 2 doesn’t work, and we find ourselves still without a child in a year, I’d like to try again on our own (even with the high risk of more losses) until I’m 40. If we still don’t have a child by the time I’m 40, then we’ll do donor eggs. That’s where I’m at today. Who knows how I’ll actually feel in 3 years or even tomorrow, but for today, this is the plan I’m comfortable with.