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what to do next?

September 11 2012 at 10:11 PM
Dee  (no login)

 
My recent cycle has failed, we used a 29 year old donor who was "proven" according to my clinic because she had 2 children. I took heparin and prednisone, and baby aspirin.

Several things could have gone wrong:

1) I came down w/some sore throat virus 2 weeks before the transfer, and I had to take antibiotics for a couple of days that might have reduced the effectiveness of the hormonal drugs, according to what the pharmacist told me. I was concerned about that, but also concerned about how a virus could affect the IVF outcome.

2) The week before my transfer I had some mild spotting and my lining, which had been going up just fine, started to go down some. The sonographer said it was probably due to something "hormonal". Could the antibiotic have caused this? Was told to increase my estrace dose, and my lining went back up to 11 for the transfer. I still wonder if something went wrong hormonally that affected the cycle.

3) Although donor had children of her own, she was 29 and unproven as far as the IVF process (she was a first time donor).

4) Last December, I had some minor adhesion near my cervix repaired by Dr. March, an expert in the field of diagnosing & repairing adhesions.

I have 3 frozen embryos of "average" quality. I am thinking about intralipids for the next cycle and going back for more acupuncture. I don't know what else to do.

 
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futurebeauty
(no login)

I think you did everything right

September 11 2012, 11:24 PM 

First, sorry for your failed cycle. It sucks to get a BFN after so much time, effort and money. I feel for you and I have been there myself.

Sometimes, clinics prescribe antibiotics as it can help w/ some hidden virus and some ladies have only gotten pregnant when on antibiotics.

I think that intralipids could be something to explore but it is pricy but not outrageous in costs, just another added expense.

I think sometimes we have to remember that DE only works on average 50% of the time. Of course it sounds dreamy compared to our 1-5% chance w/ OE. I really thought that I would fall on the positive side of 50% but it did not work out well for me.

I keep thinking that this is a numbers game and once we have covered all our our pre-existing issues then eventually we will fall on the good side of the numbers and have our take home baby.

Keep on going as you will get there.

Good luck,

happy.gifhappy.gifhappy.gif FB


 
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Dee
(no login)

Re: I think you did everything right

September 12 2012, 4:12 PM 

thanks, I want to keep going on, but as I'm getting older, I don't really know how many more years I have left to do this. Every time we fail a cycle, we are emotionally gutted afterward. I don't feel my clinic had the best donor available for me, age 29 with no prior cycles is not really that proven. I've been to the Czech Republic now 3 times, and have nothing but a growing collection of Matroyshka dolls. No baby.

 
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LizLA
(no login)

Sorry for your BFN. ( child ment)

September 12 2012, 6:25 PM 

I'm not going to sugar coat...

Get clinic with best results and proven donor...donations resulted in live birth.

There is no guarantee but you will have a better chance.

We also at the time consider Ukraine, especially since I speak the languagh, but I was willing only do it once. Great clinic + young 3 times proven donor= one baby. Also, we had severe male factor.

Good Luck.

 
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Hopeful in Delaware
(Login hopefulindelaware)

So sorry, Dee.

September 12 2012, 10:00 PM 

I don't really have suggestions, just wanted to say I'm really sorry to hear your result. Take good care of yourself. Big virtual hug.

 
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KerriA
(no login)

Hi Dee

September 12 2012, 10:10 PM 

Hi Dee,
I am so sorry for your BFN. They can be so soul-crushing I know. I've had 7 good to excellent blasts total transferred into my uterus of death, and none of them have stuck around. Like you, I am trying to figure out what to try different and even if I should pursue a different path. I had lots of great input when I posed this question down below. Daisy, in particular, gave a great list. Here's the link:http://www.network54.com/Forum/57451/message/1346142544/Hi+Kerri.++I+am+really+sorry+that+you+have+had+such+a+hard+%28pg-loss-m-c+ment%29

I do agree with FB - that sometimes it does seem to be a numbers game, and I think top clinic/proven donor is the best way to go.

thinking of you and wishing you lots of luck!
kerri

 
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Dee
(no login)

Re: Hi Dee

September 12 2012, 10:48 PM 

thanks for that list. I have actually had some of that testing done recently, like the thyroid test and hysteroscopy. Also was tested for ureaplasma & mycoplasma (had this test done 3 times this year and it was negative each time). I have not been tested for the NK though. I think we are dealing with faulty sperm.

 
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Zoya2
(no login)

I'm so sorry, Dee

September 13 2012, 10:10 AM 

I'm so sorry about your BFN, and I'm so sorry you've gone through so much.

As far as what else you could do, I would echo what LizLA said with a caveat. I agree that going with a clinic with a super high success rate plus a proven donor is a really good option. I did just that, and for me it was like throwing everything I possibly could at the problem. However, a big caveat is that the super high success rate clinics are very expensive for one cycle. It's great if you have frozens from your one fresh cycle - giving you the option of frozen cycles for around $5K - but it's never something you can count on no matter where you go.

Have you considered Shady Grove? If I had around $30K (plus travel cost, if applicable) to spend but wanted to have the feeling of having insurance, I would do SG's 3:1 shared risk program. The money back guarantee is pretty great. If I had around $30K (plus travel) to spend on one cycle throwing everything I had at the problem to give me my best shot in one cycle, I would go with a clinic with a high success rate.

One plus of SG over the 70-80% live birth/cycle clinics is that you can still be accepted into their shared risk program if you have previous failed DE cycles. My 70-80% success rate clinic has a guarantee program, but it's not nearly as financially attractive as SG's, and they won't offer you the money back guarantee if you have previous failed DE cycles.

Good luck, Dee!

 
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Dee
(no login)

Shady Grove

September 13 2012, 1:12 PM 

Thanks. I would consider Shady Grove if I had an extra 30K right now. I would also consider doing a split cycle that costs less (where you share eggs with another couple).

My Czech clinic is offering us one remaining free cycle with DE, since the first two did not work out. If the last cycle does not work, then I can't see a reason to continue working with this clinic anyway.

 
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Dee
(no login)

proven donors

September 13 2012, 2:11 PM 

Also, I think my current clinic has a problem with getting good or 'proven' donors, perhaps they don't pay enough fee to donors, and so many of their potential donors go elsewhere? I don't know. But 29 years old with no donation history was presented to me as being their "best" donor. I have a feeling it was just one of a handful of donors they had at that time.

 
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DeeinNYC
(no login)

So very sorry

September 13 2012, 10:36 AM 

I am sorry that this cycle did not work out. I can only add to what everyone else is saying. I would only use a proven donor that has actually cycled before and who has a good track record. I would also get a full immune work-up including a NK Assay and DQ-Alpha and HLA testing in addition to a full thrombophilia blood clotting panel if you have not done so already. I'm curious as to why you think that this is a sperm issue and what sperm issue do you think is at work.

 
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Dee
(no login)

Re: So very sorry

September 13 2012, 5:18 PM 

As it turns out, I cannot see any reproductive immunologist, because there are only two clinics in the USA that do this and I cannot fly to them. I flew out of town last year for the hysteroscopy and that was quite expensive (7,000 plus travel expenses). At this point my husband would be very upset if I spent another thousand dollars, plus hundreds more for that kind of specialized testing. And there is no reproductive immunologist in my city.

My husband has always tested as having poor quality sperm (low quantity and low quality), and that is why we have always had to do ICSI with our cycles.

 
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DeeNYC
(no login)

Re: So very sorry

September 13 2012, 9:24 PM 

Hi Dee,

Not sure where you live but if you are near a SIRM office, or even if you are not, you can get a free consult in many cases and they will order the testing for you. You can then see if your Dr will add whatever is needed. I know that many get their testing done through SIRM-Las Vegas. Also, you can look into the Beers Cenrer in California. They do not require you to come to California.

 
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Dee
(no login)

okay but

September 13 2012, 9:44 PM 

do you know about how much it would cost? If its in the thousands, no way could I do it. I do live near a SIRM (Southwest Institute for Reproductive Medicine).

 
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DeeinNYC
(no login)

Re: okay but

September 14 2012, 10:27 AM 

Hi,

SIRM stands for the Sher Institute of Reproductive Medicine. Their site is located at www.haveababy.com. You can see a list of clinics there. I did my testing at SIRM-NY and they did their testing through Reprosource which sent the samples to Rosalind Franklin labs for testing. I THINK SIRM-Vegas uses another lab. With respect to Reprosource, If you have BCBS I don't think it costs anything except a co-pay. If you have out of network coverage with most other carriers, Reprosource takes that plus when I did it, I paid $197 total out of pocket. That was for the NK Assay only. The DQ-ALpha and HLA testing is more. I think an additional $300-$400 or so. Your husband must also be tested for that test. A full thrombo panel should be next to free and covered by your clinic.

 
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Dee
(no login)

okay, I think I found one

September 14 2012, 11:11 AM 

There is a Sher location near me, looks like there is a Dr. Saleh. I have heard about him, I will give them a call. I would also love to have a consultation with him.

Many REs around here aren't interested in doing a lot of investigative testing to see why cycles fail. They just quit working with those patients who have failed too many cycles. My former RE here was not even interested in testing me for thyroid problems or antibodies. He has very high success rates and just weeds and weeds out problem patients.

 
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DeeinNYC
(no login)

Great

September 14 2012, 11:38 AM 

Ive head good things about him too. You can take a look at the SIRM message boards to get an idea about how he handles various issues. Just know that they usually will not treat you unless you are a patient of theirs so keep your plans to cycle elsewhere under your hat for now and get your testing done. Good luck.

 
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Dee
(no login)

Re: Great

September 14 2012, 4:10 PM 

OK I suppose I have to pretend I am interested in cycling with him. However, REs need to realize that not every patient is going to bring in big money for IVF. For example, a lot of patients do IUI or just fertility meds....

I am perfectly willing to pay for an initial consultation with him.

 
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Kim
(no login)

Re: So very sorry

September 14 2012, 3:45 PM 

Al.an Be.er Institute in California did not require me to go there for the testing, and I had my bw testing done locally or shipped. There are two parts to the testing - one is bw that can be done through a place your insurance carrier considers in network (like Labco.rp or Que.st Labs), and this covers the non-immune testing for the most part. Then the other part is the immune testing (only two labs supposedly do this testing), so I had to find a lab to draw my blood, so I called around and asked the lab located in the basement of my GYN's office to draw the blood for me to send off myself. They did not charge me anything for the draw, and the only problem with this part was to ship the bw to the immune testing place. Shipping costs was $70 for overnight priority. I also had my GYN do the endometrial biopsy (but not sure you have to have this done) and again had to mail the sample to the immune testing lab again - for the same cost $70+. A few weeks later the results were in and I had a phone consult with Dr. St.riker there (the consult is out of pocket at $600) to go over my results.

In all, I think the immune testing is paid out of pocket at $1,250 (I think) plus the consult fee ($600) plus the endo biopsy testing (GYN fees covered by ins for the most part plus $350 for the immune testing) plus $150 for shipping. So just over $2,000 out of pocket for the bw and consult, with insurance covering some bw done at Lab.corp and GYN cost of taking the biopsy.

By the way, Dr. Br.averman in NYC can do the same but he told me that he cannot do out-of-town testing without seeing me for a consult in NYC. DH and I did not want to travel for this testing - on top of the cost for the testing.

 
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Dee
(no login)

thanks for the info n/t

September 16 2012, 12:48 AM 

n/t

 
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