Pregnant after IF

Need some reassurance **warning - loss mentioned**

Hey ladies,

As many of you know our first FET sadly ended in miscarriage.  Thank you for all the kind words you have shared.  I lost the first at 7w3d.  U/S that day measure the remaining baby at 6w6d with a heart beat of 100bpm.  4 days later the baby still measured 6w6d with no heartbeat.  I can only assume they both stopped growing around 6w6d.  I was given Cytotec to induce the second miscarriage, which I did last night.  As a side note, that went relatively well and was much less traumatizing that I imagined.

Logically, I know it is not uncommon for the first FET to end spontaneously.  However, our RE advised us not to do embryonic genetic testing because I am under 35.  So, now I am really worried that there may be a problem with all of our embryos and the next FET may end in the same way.  We have 4 embryos remaining, which would be 2 FET attempts.  I'm wondering if I should ask to only transfer 1 embryo at a time.  I was told the embryos are independent and a loss of one wouldn't necessarily effect the other.  But, I can't help thinking I'd rather have 4 chances than just 2.  We retrieved my husband's sperm shortly after a leukemia diagnosis, before he started chemo.  He is no longer a candidate to donate.  So, if 1 of these 4 doesn't work it will be the end of the road for us.  Did anyone else lose their 1st FET for unexplained reasons and have later success?

Re: Need some reassurance **warning - loss mentioned**

  • Well, I'm not a doctor, but 8 years of dealing with IF I've been around awhile and if you have the finances to do 4 transfers, I would go one at a time. Why? I know the argument for one will not affect the other, but there are numerous arguments in the other direction as well. Multiple pregnancies are higher risk, for the mother, the children and the pregnancy as a while. Hormones are generated by each embryo, so while the loss of one might not directly impact the other, a sudden hormone shift that causes bleeding might, at least early on in my opinion. I have no studies to back that up, only the fact that my losses have been caused primarily by low progesterone and a short luteal phase. They were all early like yours and my progesterone levels just weren't high enough quick enough to prevent menstruation. I know that the corpus luteum produces progesterone until the embryo takes over with the hcg and that's supposed to protect the pregnancy in the first 2-3 weeks (pregnancy weeks 4-5) but when that doesn't work you get a chemical pregnancy. When you have twins, your hcg usually goes higher faster, but when it spikes and drops really early like that, what does it do exactly? Does anyone really know for sure? I've heard of stories where one is lost and the other remains, but also plenty where the whole pregnancy is lost, and anecdotally it seems like this happens a lot more than it should even with a 20% chance of loss for each embryo. Figure that's like rolling a 1 or a 2 on a 10 sided die twice in a row - that's how often the whole pregnancy should be lost, but in what I've seen it seems like total loss is more the norm than the exception. But it shouldn't really be 20% even because that's a general risk, not just genetic issues. Genetically every couple is different, but barring any shared recessive conditions or known dominant ones that you or your husband have or x-linked conditions that you may carry if the embryos were male, these would have to be de novo mutations. Now I'm not sure how old you guys are either, and it's not like 32 or 35 are magical numbers before which you have no risk and after which you are suddenly at risk for chromosome anomalies and de novo mutations, it's actually more like a gradual increase I've read from as early as the late 20's that picks up pace at 32 and takes off again at 35 and then really skyrockets at 40, but in any case it's a limited risk. By limited I mean the chance of randomly generating 2 embryos out of 6 with such mutations and then selecting those 2 simultaneously for transfer is incredibly low. 

    Reproductive endocrinology as a field is in its infancy. Maybe when our grandchildren are having children it will all be perfected and fertility drugs will be like allergy pills and antibiotics, but right now there's a lot of guesswork and trial and error in play. You say you have 4 chances and that's it, at least for a child that's biologically yours and your husband's. All that being said, I would go as conservatively as possible, which is why I'd recommend the single transfers so long as that's financially feasible for you two. Take a break, not for the lowest time possible or the median recommended time, but with the most conservative estimate. Do everything in the most conservative way possible. It may take longer to reach your goal, but you're more likely to get there at all that way. Most people, both here and that your RE deals with, are not absolutely limited in such a way, so what's right for most isn't necessarily right for your family. That's another thing - I remember from your original post that your RE didn't answer your emergency call for more than 6 hours! If you have a feeling that you might want to do some interviews or get a second opinion before you proceed, do so. Particularly with the rest of your circumstances, you need someone who is responsive and focused on your case. Maybe that was a one time slip up and the RE's great and I'm way off base, but that's all I've read about them, so I wanted to say something.

    Again, I'm really sorry for your loss and while I do know what it feels like to suffer losses, I can't imagine what it's like to be starting with a limited number of tries. I'll keep you in my thoughts that your next transfer, however many embryos, is a total success.
  • Hi there. Again I am so sorry for your loss. I had a chemical on my second fresh transfer but my FET was successful (4th cycle).

    Do you know the grades on your embryos? Is there a reason that your re wants to transfer two at a time? My re wanted to transfer two but I said no and only did one. That one took. I think that transferring only 1 at a time is a smart idea especially if you only have these 4 left.
    SIGGY WARNING//TICKER WARNING//PAIF

    Long of the Short:
     TTC since April 2013  DH 42 y/o I'm 30  Dh had vasectomy reversal Feb 2013 after 3 months developed scar tissue 
     First Re appt was September 2013 OOP for everything minus meds  
    DH's TESE surgery December 2013
    First cycle was February 2014 BFN none to freeze
     Second cycle was April 2014 BFP ending in Chemical Pregnancy none to freeze
     Third cycle June 2014 BFN none to freez
     Fourth cycle October 30th 28 retrieved, 13 mature and 12 fertilized
    PICSI, assisted hatching and fresh sperm from my DH's TESE surgery used
    5 FROZEN from a freeze all cycle! 
    FET completed on DECEMBER 9TH!!!
    Beta #1 13dp5dt BFP!! 800
    Beta #2 15dp5dt 2100
    Beta #3 17dp5dt 3600 
    First Scan January 5th! Everything looks great! Heart rate of 121!
    Second Scan January 20th. Baby Justone13 looks amazing. Heart rate of 175!
    Baby Girl is due August 27th
    Liv Annmarie born 8/25 7lbs 6oz 21 1/2 inches long 
    image 

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  • Thanks for all the info. I'm 32 and my husband is 41. The reason we are having to do IVF is due to my husband's previous vasectomy. We had an unsuccessful reversal, so IVF was our only option. As far as we know there aren't any genetic issues that would prevent a successful pregnancy.

    It's not really possible (without a lot of drama anyway) to switch RE's at this point. As our RE has our 4 embryos in their freezer. Yes, I know they are ours and I suppose we could tranfers them to another facility, but I don't really think that's necessary. Our clinic is actually very reputable. They are number 3 in the country and I personally know 5 children that are products of that clinic. I believe the embryos we have left are three grade 3, 5d embryos and one grade 2, 6d embryo.

    However, they have completely sucked at returning emergency phone calls on several occasions. In retrospect, there probably wasn't anything they could do for me during the miscarriage, but it was inexcusable. I was very clear that I did not appreciate the treatment and they have gone out of their way to check on me since then. We'll see how things go for my follow up.

    For our first transfer I did ask about only doing one at a time. We are completely fine with only having one child. I was assured they would not effect each other and it would be my best chance of getting at least one on the first try. I agree that it seems like the hormone fluctuations and bleeding associated with one loss almost certainly had some impact on the other. Especially since I know my remaining baby had a heartbeat the day I miscarried the first. I know it measured about 3 days behind, so maybe it would've been lost anyway. But, I hate thinking that all the drama going on in my uterus caused the second loss. The first miscarriage was much more severe than the second. I don't know how anything could've survived that.

    While the miscarriage was a horrible experience, I would rather go through 4 more knowing that I have given each one the best chance.

    Thanks so much for all your advice!
  • We had to do ivf due to a failed reversal also. I think you are right in wanting to do one at a time. Plus that way like pp said you can take your time and let your body become perfect again before doing any transfers. Hopefully the next time everything works out. Sending you positive thoughts with your future journey!!
    SIGGY WARNING//TICKER WARNING//PAIF

    Long of the Short:
     TTC since April 2013  DH 42 y/o I'm 30  Dh had vasectomy reversal Feb 2013 after 3 months developed scar tissue 
     First Re appt was September 2013 OOP for everything minus meds  
    DH's TESE surgery December 2013
    First cycle was February 2014 BFN none to freeze
     Second cycle was April 2014 BFP ending in Chemical Pregnancy none to freeze
     Third cycle June 2014 BFN none to freez
     Fourth cycle October 30th 28 retrieved, 13 mature and 12 fertilized
    PICSI, assisted hatching and fresh sperm from my DH's TESE surgery used
    5 FROZEN from a freeze all cycle! 
    FET completed on DECEMBER 9TH!!!
    Beta #1 13dp5dt BFP!! 800
    Beta #2 15dp5dt 2100
    Beta #3 17dp5dt 3600 
    First Scan January 5th! Everything looks great! Heart rate of 121!
    Second Scan January 20th. Baby Justone13 looks amazing. Heart rate of 175!
    Baby Girl is due August 27th
    Liv Annmarie born 8/25 7lbs 6oz 21 1/2 inches long 
    image 

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