WTF appointment... more decisions to make (update in reply)

alpCRNA

For those who aren't familiar with me here is a little background.  IVF#1: antagonist protocol, stimmed for 9 days, 13 R, 9M, 8F.  Day 3 8 "good looking" embryos, day 5 transferred one grade1cc blast and 1 morula (had 2 extra morulas that did not make it to freeze).  Full period came 9dp5dt despite progesterone suppositories.

I had my WTF appointment today.  They did not have an explanation for why we had "poor" quality embryos.  She said everything looked normal until day 5.  They are recommending switching to the long-lupron protocol simply to make a change and starting with higher dose stims to try to get more eggs.  She also recommends pre-genetic testing IF our embryos make it far enough to qualify.  She thinks it is a good idea since we have an "unexplained" IVF failure.  She also recommends adding assisted hatching if we have to do a day 3 transfer.  I also have to switch to IM progesterone.

After listening to their recommendations, I asked about my weight.  I know that I have a very unhealthy weight and fall into the "obese" category by BMI calculations.  She did tell me that there are studies showing higher success rates with decreasing BMIs until the healthy weight.  BMI>35 has lower rates than BMI 30-35, and BMI 30-35 has lower rates than BMI<30.  I would have to lose 20 lbs or 50 lbs to reach those BMIs.

We applied for the shared risk program and will find out something within a week.  I also applied for a loan, but am about $5000 short of being able to pay for the shared risk with meds and genetic testing.

So, here are the two things I can't decide.  Should I take 1-1.5 years to try to loose weight before IVF#2?  I kind of wanted to try at least once in 2014 so I will meet the 10% required for tax deduction as we are just a few thousand short.  Second, should I try one more time without genetic testing?  I am only considering this option since we have been approved for a loan that would give us enough to pay for the shared risk and meds for 1 round.  

Sorry this is so long.

AMShark

You have some tough decisions, and only you (and maybe DH figures in here too) can really make them.  That being said, according to your signature, you look like you have time on your side, so a break does seem like it could be feasible, if that's the way you are leaning.

I thought I was going to ask for genetic testing after an m/c ended my IVF#1 - but in the end, we decided to try once more before moving on to testing.  If you have reason to suspect that you're dealing with a genetic disorder, maybe now is the time to test.  If you have no particular reason to believe there is a genetic disorder, I might wait one more cycle before testing.

Justone13

Tough decisions ahead. Like @AMShark‌ said only you and your oh can make those choices. Take some time to think about it all. GL.

jencity9

This is a hard decision. I'm afraid the PGD discussion might come up at our next consult as well based on our embryo qualities. I guess for me it would depend on exactly how much your RE thinks the weight could have been a factor and your age (I am mobile so I can't I see your siggie). And I totally understand wanting to do one more in 2014.. Is your RE leaning any way about it being one thing more than the other possibly? If it were me I would probably do one more in 2014 for insurance reasons... As for PGD I would probably do everything I could do afford that too (then again I don't actually know how much the actual cost is). The only reason I would not so that is if I absolutely could not include that cost.

Hope that helps in any way. Good luck with your decision!

ExoticAntibiotic

My experience: we had no indication of an issue, my embryos from IVF #1 were all 4AA/4ABs. After 3 BFNs from 4 embryos, we did PGS with the 2nd IVF and discovered a huge egg quality issue. I would recommend PGS based on my experience, it was $1850 and saved us from 2 FETs at $4,000 a pop.

Aimothy

Our first IVF had poor quality embryos (only one made it to early blast, two morulas; none to freeze; BFN) on the long lupron protocol.  The second time, we switched to the antagonist protocol and had much better quality embryos (5 blasts, three frozen; BFP). That said, we definitely have gone with the recommendation of the RE, whom we trust.  As the previous poster said, spending $2000 could save you a lot more money if there are egg quality issues. Definitely a discussion that only the two of you could decide. There's no easy way to make the decision here.

As for the losing weight, I had to lose 70 lbs before I could start IVF1.  I HATED having to not move forward, but as I sit here 70 lbs lighter, I absolutely am so thankful for my RE's requirement.  I actually did better when I had a deadline, so I went ahead and made an appointment with the RE for 6 months out, because then I knew I HAD to lose the weight before then.  Decide how long it will take you to lose the 20 lbs and have that as your goal. Good luck with whatever you decide. 

gnl42

These decisions are not easy! 

I have a hard time being patient, so I would probably try again in 2014 (especially if it makes sense with the tax deduction). I would also try to do the testing if that is feasible to improve my chances. If it is one or the other, then I would try once more in 2014 without the testing, then try to lose weight for 6 months, and then proceed with the testing. The BMI categories are good for categorizing and doing studies, etc. but you have to figure that you don't need to absolutely fit into a category. It is good to have a goal to help you along, but any amount of weight loss is probably a healthy move and would theoretically improve your chances based on the information above. Taking 6 months off seems much more tolerable than 1-1.5 years! But, like I said, I'm not very patient. Best of luck with whatever you decide!

alpCRNA

We are still waiting to find out if we qualify for the Refund program.  If we do it covers 6 fresh and unlimited frozen cycles.  So, this is what I am thinking about doing.  Trying to loose weight and doing a fresh IVF w/ICSI with NO pre-genetic testing in November or December.  That way I loose some weight before the IVF#2 but also meet the tax deduction requirements.  As far as the pre-genetic testing goes, it cost $2000 to the clinic and $2500-$4500 to the lab.  There is no way for us to be able to afford that by the end of the year.  RE recommends it since we don't know why we had poor quality embryos, but we have no risk factors for having genetically impaired embryos.  If IVF#2 is a bust I will wait 4-6 months before moving to #3.  That would give me time to loose more weight and maybe get a tax return to help pay for PGD.  If that was a bust I would continue to to wait 4-6 months between cycles until I reach an optimal weight.  Thoughts?

alpCRNA

For those using mobile and can't see my siggy, I am 27.

Twinkie0612

A few thoughts...

First you said that you are close to the 10% threshold for tax deductions.  You really need to spend 10% plus the standard deduction ($12,400 I believe for married filing jointly) to make itemizing worth while.  If not you are better off just taking the standard deduction.

As for weight, I am actually working towards getting back into the normal BMI range as was recommended by my RI (reproductive immunologist).  Luckily I only have about 10 more lbs to go, as I have already lost about 15 lbs.

I think genetic testing of the embryos is really a personal call.  We have not done it because we usually have so few embryos by day 5, it just didn't seem worth the extra cost.  My RI actually did not recommend genetic testing for us.

alpCRNA

Twinkie0612 said:

A few thoughts...

First you said that you are close to the 10% threshold for tax deductions.  You really need to spend 10% plus the standard deduction ($12,400 I believe for married filing jointly) to make itemizing worth while.  If not you are better off just taking the standard deduction.

As for weight, I am actually working towards getting back into the normal BMI range as was recommended by my RI (reproductive immunologist).  Luckily I only have about 10 more lbs to go, as I have already lost about 15 lbs.

I think genetic testing of the embryos is really a personal call.  We have not done it because we usually have so few embryos by day 5, it just didn't seem worth the extra cost.  My RI actually did not recommend genetic testing for us.

Maybe I need to look into the tax laws in more detail.  I thought I just had to spend more than 10% of our combined income.  Even if I have to spend 10% + $12,400, the shared risk program would put us over that as well.  Thanks for the information.