infertility/miscarriage Q

august8080 · January 2012

I'll prob DD this later, just so her business isn't out on the web......

My BIL (DHs brother) and SIL have been TTC for 2-3 years now. In the last 21 months, she's had 3 miscarriages, 2 of which happened at 10 wks and have been confirmed via testing to be due to chromosomal abnormalities--they told her back luck and age (she's 35 now).

They spent 2011 doing IUI. They start IVF this month because their insurance has quit paying for IUI (she has a whole host of other issues--doesn't ovulate....I don't know all of the things), even though really they could keep on with the IUI since she does get pregnant with it, just doesn't keep the pregnancy.

I asked her if the drs had a plan in place that was any different from what they had been doing during the IUIs to help her stay pregnant with the IVF. She said no, they just told her the chromosomal abnormalities were due to bad luck and age and that while they could screen the embryos before transfer, they'd need to be screening for something(s) specific, not just random abnormalities.

Here's my follow up question that I don't want to ask her because I don't want to hurt her feelings....isn't there more the doctors can be doing to prevent her from miscarrying again due to the same reasons??

DH and I just hurt for them so much to have a baby and I know our family/fertility situation can't be easy for them and they've been really great about it, save for a few minor-ish incidents. I don't want to ask too many questions because I don't want to inadvertently hurt her feelings in doing so.

Wanted to see if y'all have any knowledge or experience with this. Thanks!

L L CG · January 2012

In my experience, no. It sounds like she has the same problem I had- she is able to get pregnant (maybe with meds to make her O) but she has just had some bad luck. I had a miscarriage due to chromosomal defects, a chemical, and an ectopic. All were just bad luck.

The good news -- and never, ever, EVER say this to her-- is that she can get pregnant. That's the really hard part. My OB told me that he's never had a patient who was able to get pregnant not go on to have as many children as she wanted. Never. It may have taken years and a really hard road, but it will happen. You might tell her what my OB said. It was Seeker and it was very comforting to me.

abh1977 · January 2012

L L CG:

In my experience, no. It sounds like she has the same problem I had- she is able to get pregnant (maybe with meds to make her O) but she has just had some bad luck. I had a miscarriage due to chromosomal defects, a chemical, and an ectopic. All were just bad luck.

The good news -- and never, ever, EVER say this to her-- is that she can get pregnant. That's the really hard part. My OB told me that he's never had a patient who was able to get pregnant not go on to have as many children as she wanted. Never. It may have taken years and a really hard road, but it will happen. You might tell her what my OB said. It was Seeker and it was very comforting to me.

Pretty much this, unfortunately. And I wholeheartedly agree - don't say to her "at least you can GET pregnant." I heard this so many times, and it's not comforting. It just makes you feel defective in a whole different way. I know how bad you must feel for them; I'm going through a similar issue with a cousin right now. Her baby passed away about a year and a half ago, and she has been unable to sustain a pregnancy since then, despite fertility treatments. I feel so guilty when I see her or talk to her, and there are no words to say, really. I just hug her and let her know I love her and am praying for her. It's a type of survivor's guilt that I didn't even think about when I was struggling to get pregnant. Lots of luck to them, and to you - I know how hard it is to be in both positions.

austxgrl · January 2012

If they are going to IVF as the next step I would recommend that they talk to their RE about PGD IVF. PGD will test the chromosones of each embryo before transfer. Thus, hopefully, weening out most embryos that have chromosonal defects. I did PGD and we retrieved 18 eggs; 16 fertilized well but out of the 16 only one was a healthy (no chromosonal defects) embryo for transfer (1 did not provide a reading). So we chose to only transfer the one. I did miscarry but my RE was never able to establish exactly why. Most REs will recommend PGD for anyone over the age of 35 who has had multiple miscarriages as a way to further assist with the sucess of the IVF. Given her age and the number of miscarriages and that they were able to identify that the miscarriages were infact caused by chromosonal defects, I would not go through IVF without doing the PGD. My case is very very rare (the PGD doctor in PA actually said that the results were "remarkable" - and he was not referring to that in a good way) and I really feel that they would have different results. I have a ton of information on the PGD and would be more than happy to talk to them if they would like. Feel free to email me for more info lainaustin at yahoo.

brideonjuly8 · January 2012

I guess I'm the odd one out, but knowing that I COULD get pregnant (and carry a healthy baby) is the only thing that's kept me going and not completely breaking down. Could be because I already have one, I dunno. I agree though, don't say that to her. I think they should do what austxgrl said and so that genetic testing on the embryos.

L L CG · January 2012

brideonjuly8:
I guess I'm the odd one out, but knowing that I COULD get pregnant (and carry a healthy baby) is the only thing that's kept me going and not completely breaking down. Could be because I already have one, I dunno. I agree though, don't say that to her. I think they should do what austxgrl said and so that genetic testing on the embryos.

It did for me, too, but ONLY when Dr. S said it. If anyone else said it I would have ripped their face off. It made me feel like the baby I lost didn't matter.

AustinBride06 · January 2012

If they believe that the chromosomal abnormalities were the main reason, then I agree with austxgrl... screening with IVF should eliminate that concern.

Just as a side note, there's been evidence that acupuncture on the day of the transfer has been proven to help the odds for a successful IVF. That's really the ONLY thing that the medical community has said in favor of acupuncture for fertility so in my book, that's huge.

Mrs.Talala · January 2012

austxgrl:
If they are going to IVF as the next step I would recommend that they talk to their RE about PGD IVF. PGD will test the chromosones of each embryo before transfer. Thus, hopefully, weening out most embryos that have chromosonal defects. I did PGD and we retrieved 18 eggs; 16 fertilized well but out of the 16 only one was a healthy (no chromosonal defects) embryo for transfer (1 did not provide a reading). So we chose to only transfer the one. I did miscarry but my RE was never able to establish exactly why. Most REs will recommend PGD for anyone over the age of 35 who has had multiple miscarriages as a way to further assist with the sucess of the IVF. Given her age and the number of miscarriages and that they were able to identify that the miscarriages were infact caused by chromosonal defects, I would not go through IVF without doing the PGD. My case is very very rare (the PGD doctor in PA actually said that the results were "remarkable" - and he was not referring to that in a good way) and I really feel that they would have different results. I have a ton of information on the PGD and would be more than happy to talk to them if they would like. Feel free to email me for more info lainaustin at yahoo.

An RE can do either PGD (preimplantation genetic Diagnosis) or PGS (preimplantation genetic Screening). ?Technically PGD is testing an embryo for a specific genetic disease that is running in the family (example:? Huntington disease or spinal muscular atrophy).? In order to do PGD you have to have a known mutation or mutations in the family. ? ? PGS is a way to Screen embryos for chromosome anomalies prior to transfer. ?PGS is used in families without a specific diagnosis of a genetic syndrome. ?Chromosome anomalies can happen to anyone but the risk does increase with age. ?With PGS the lab can look at the embryos for a certain number of chromosome anomalies prior to transfer.? Some labs look at all chromosomes; some labs only look for a certain number of common chromosome anomalies. ?I have researched PGS in the past and the idea is that if you only implant embryos with ?normal? chromosomes then you should sustain a pregnancy. ?However, if you read the published literature there are many studies that show that the actual rate of a successful live birth is not that increased over IVF with out PGS. ?Now it may be that we just don?t have enough data to prove that PGS works but I?m not sure I would say this is standard of care at this point in time.? The other reason it is called as screen is because its not 100% accurate. ?Most PGD/PGS labs recommended confirmatory testing with CVS or Amnio. ? I think PGS is an option but I just think its important to know that it is a new procedure that is still being studied and success rates are still murky.

agran · January 2012

Who is her RE? Even with my one loss my RE has been all over testing for chromosomal defects so we don't have to go through a loss again.

Plus doing IVF she'll be on progesterone supplementation that can help prevent miscarriage but not if they are chromosomal. I'd definitely ask about PGD.

AustinBride06 · January 2012

L L CG:
brideonjuly8:
I guess I'm the odd one out, but knowing that I COULD get pregnant (and carry a healthy baby) is the only thing that's kept me going and not completely breaking down. Could be because I already have one, I dunno. I agree though, don't say that to her. I think they should do what austxgrl said and so that genetic testing on the embryos.
It did for me, too, but ONLY when Dr. S said it. If anyone else said it I would have ripped their face off. It made me feel like the baby I lost didn't matter.

This. My little sister said that to me and maybe it was the way that she said it (somewhat flippantly) and it made me pretty angry. Especially since it was right after the loss. At that point you don't care that you can try again... you just want THAT baby back.

august8080 · January 2012

Thanks for the thoughtful responses, everyone.

I have not said to her "at least you can get pregnant" although DH and I have said it to each other. I try my hardest not to say anything hurtful or offensive so I'm usually sticking to: I'm sorry, We're praying and hoping for y'all, etc. I'm sure I've failed at that somewhere along the way.

I appreciate all the suggestions on things they can do/ask their RE. They live in a big city in the NE that rhymes with Austin so I don't know who her RE is. Unfortunately, I don't think we have the kind of relationship where I can make suggestions about what they should/shouldn't do/ask. We get along great and really like each other but only see each other once, sometimes twice a year and occasionally email throughout the year (some years are better than others). We've known each other a long time-like 10 years-but the distance keeps us from having a real relationship. If you disagree with me and think there's a way I can tactfully suggest it, I'm all ears. We'd LOVE for them to have a baby!!

I do know that she's doing accupuncture once a week because we talked about it over Christmas.

Thanks, y'all!

esbeek · January 2012

My acupuncturist's life work, according to her, is gathering data to show that acupuncture helps reduce miscarriage due to chromosomal abnormalities. She's Kirsten at Texas Center for Reproductive Acupuncture. I know you said your SIL is going to acupuncture already, but I thought I'd mention it in case she wants to talk to someone specifically interested in this topic. And if she winds up at TCRA, tell her to see Mandy for treatments. In my experience, Kirsten is a brilliant researcher and diagnostician, but Mandy is most effective with the needles.

august8080 · January 2012

esbeek:
My acupuncturist's life work, according to her, is gathering data to show that acupuncture helps reduce miscarriage due to chromosomal abnormalities. She's Kirsten at Texas Center for Reproductive Acupuncture. I know you said your SIL is going to acupuncture already, but I thought I'd mention it in case she wants to talk to someone specifically interested in this topic. And if she winds up at TCRA, tell her to see Mandy for treatments. In my experience, Kirsten is a brilliant researcher and diagnostician, but Mandy is most effective with the needles.

Thanks. I know she's seeing and acupuncturist who sees about 75% of her clients for reproductive issues and was recommended by her RE. As I mentioned in my reply, above, they live in the NE, so things here aren't an option.

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