Next steps??

J&D2007 · April 2014

I am at a complete standstill, but still getting older. I can't begin to decide what to do next and I could use your advice. I've been through 4 Ivfs (2 in my book didnt really count in my book because I was over suppressed on lupron and had very few eggs), next one had 13R but only 1 at day 5, then ccrm 13R and 1 left at day 5 that wasn't normal. We have no official diagnosis still (AMH was a little low at 1.2). We've spent close to $100,000 and still have a credit card maxed out. My first question is, should I do an exploratory lap? No RE has ever suggested it (no endo indications), but my gyn brought it up and thinks it should have been done. Second is, I really don't know if I'm wasting my money using my own eggs and if I should go to DE. Looks like for $20,000 I could do 2 OE cycles through an Attain program or one DE ivf. I wasn't really thinking of another ivf, but found that my new health insurance had IF drug coverage?! It makes me think of trying again... I know I'm rambling, but I really need advice! Tia!

Mrs.McIrish · April 2014

Hi sweetie, A few thoughts: I don't think you will qualify for Attain after 4IVFs. So check that out first. On the last two cycles: what cell numbers were the embryos? Did they degrade between day 4 and 5 or before? If day4-5, I'd lean towards sperm more than egg. Hate for you to do DE and have it happen again. I don't think the lap would hurt. Well, pain wise yes but good for more info. Hugs. I hate that it's so hard.

sorrellam30 · April 2014

I hate the money aspect of infertility

. It's so unfair. My advice is to look into every single option you have (even beyond what you're only interested in). It helps put in perspective what you are really willing to try. GL! Keep us posted

luvboston · April 2014

I would do the lap just to cross it off. What I would really do is more blood work including an entire panel for implantation failure. Have you ever had an Ana Titer? Also has DH had the frag test?

JSM0801 · April 2014

Hi J&D! I don't have any advice for you, and I so wish you didn't have to be making these tough decisions, but I just wanted to say it's good to see you back here, and I'm happy you are thinking of moving forward with next steps. I'm always rooting for you!!!

J&D2007 · April 2014

@mrsmcirish, thanks for your thoughts. I looked at a new clinic (the only one that participates with my insurance now) and on the website there are 2 different attain programs. One said there were no medical criteria, but its not a refund program. Basically 30% off of 2 cycles ($18k for 2 I think). I actually don't know when our embryos typically poop out. I know they usually have a great report in the a.m. of day 3, then by day 5 we have very few left. I don't really understand how that correlates? I thought the egg took over on day 3 or 5 for embryo nourishment?? Any advice there would be great. The Lap just sounds so extreme to me without any endo history or symptoms. I just figure if it was recommended, one of the RE clinics would have at least mentioned it? Maybe not though!

J&D2007 · April 2014

@luvboston, thanks for the advice. I don't know if I've had b/w specifically for implantation failure. I did have an implanted fetal sac for 8 weeks so I think that initially at least ruled out additional testing. Interestingly, my derm recommended (sort of) an ANA because I've had some vasculitis type inflammatory bumps on my fingers... Maybe I'll do that. So, say the Ana comes back a little high. Then what? I get put on an immunosuppressant during a cycle? DH had a normal sperm frag test. His swimmers according to testing are perfect. I was actually shocked at first about that because his dad and older brother had a lot of difficulty conceiving. Thanks for your help.

Mrs.McIrish · April 2014

The egg is responsible for growth day 1-3. Sperm kicks in day 4-5. Did DH do a sperm frag test at CCRM?

J&D2007 · April 2014

Mrs.McIrish said:

The egg is responsible for growth day 1-3. Sperm kicks in day 4-5. Did DH do a sperm frag test at CCRM?

Oh. I thought it was opposite?! Yes, he did a sperm frag test. It was 6%. All other sperm numbers were well above normal as far as number, motility, etc, etc.. Is there any studies or info you know of about this? Thanks!

hmz819 · April 2014

I'm so sorry you have to make these difficult decisions.

I really have no advice for you. I had a lap 2 years ago and had mild endo diagnosed. I had it removed and I didn't get a take home baby from it so having the lap didn't help me. I did a lot of research before having the lap and the if community seems to be split on whether removing the endo helps or not. One camp says it does and the other camp says ivf bypasses the endo so no need to remove it.

luvboston · April 2014

J&D2007 said:
@luvboston, thanks for the advice. I don't know if I've had b/w specifically for implantation failure. I did have an implanted fetal sac for 8 weeks so I think that initially at least ruled out additional testing. Interestingly, my derm recommended (sort of) an ANA because I've had some vasculitis type inflammatory bumps on my fingers... Maybe I'll do that. So, say the Ana comes back a little high. Then what? I get put on an immunosuppressant during a cycle? DH had a normal sperm frag test. His swimmers according to testing are perfect. I was actually shocked at first about that because his dad and older brother had a lot of difficulty conceiving. Thanks for your help.

If your Ana is 1.160 you call an ri
I would suggest doing Nks, TNF and APA regardless of the Titer.

Prednisone might be good to try if u decide to cycle without any other testing. It doesn't work below 20mg a day.

luvboston · April 2014

J&D2007 said:
@luvboston, thanks for the advice. I don't know if I've had b/w specifically for implantation failure. I did have an implanted fetal sac for 8 weeks so I think that initially at least ruled out additional testing. Interestingly, my derm recommended (sort of) an ANA because I've had some vasculitis type inflammatory bumps on my fingers... Maybe I'll do that. So, say the Ana comes back a little high. Then what? I get put on an immunosuppressant during a cycle? DH had a normal sperm frag test. His swimmers according to testing are perfect. I was actually shocked at first about that because his dad and older brother had a lot of difficulty conceiving. Thanks for your help.

If your Ana is 1.160 you call an ri
I would suggest doing Nks, TNF and APA regardless of the Titer.

Prednisone might be good to try if u decide to cycle without any other testing. It doesn't work below 20mg a day.

J&D2007 · April 2014

luvboston said:

@luvboston, thanks for the advice. I don't know if I've had b/w specifically for implantation failure. I did have an implanted fetal sac for 8 weeks so I think that initially at least ruled out additional testing. Interestingly, my derm recommended (sort of) an ANA because I've had some vasculitis type inflammatory bumps on my fingers... Maybe I'll do that. So, say the Ana comes back a little high. Then what? I get put on an immunosuppressant during a cycle? DH had a normal sperm frag test. His swimmers according to testing are perfect. I was actually shocked at first about that because his dad and older brother had a lot of difficulty conceiving. Thanks for your help.
If your Ana is 1.160 you call an ri I would suggest doing Nks, TNF and APA regardless of the Titer. Prednisone might be good to try if u decide to cycle without any other testing. It doesn't work below 20mg a day.

Thanks much. Now I have to figure out how to get these tests ordered since I currently am not seeing an RE. My last one is now out of network and I bet a new one wouldn't order them without going over everything else again!

luvboston · April 2014

J&D2007 said:

luvboston said:

J&D2007 said:
@luvboston, thanks for the advice. I don't know if I've had b/w specifically for implantation failure. I did have an implanted fetal sac for 8 weeks so I think that initially at least ruled out additional testing. Interestingly, my derm recommended (sort of) an ANA because I've had some vasculitis type inflammatory bumps on my fingers... Maybe I'll do that. So, say the Ana comes back a little high. Then what? I get put on an immunosuppressant during a cycle? DH had a normal sperm frag test. His swimmers according to testing are perfect. I was actually shocked at first about that because his dad and older brother had a lot of difficulty conceiving. Thanks for your help.
If your Ana is 1.160 you call an ri
I would suggest doing Nks, TNF and APA regardless of the Titer.

Prednisone might be good to try if u decide to cycle without any other testing. It doesn't work below 20mg a day.

Thanks much. Now I have to figure out how to get these tests ordered since I currently am not seeing an RE. My last one is now out of network and I bet a new one wouldn't order them without going over everything else again!
The dermatologist can order them or your PCP

brooklynesque · April 2014

I know you didn't have a good experience at CCRM, but did you do a WTF and get any insight or ideas from the RE there?

Not sure if I would do a lap unless I understood the end game -- i.e., what the RE would do differently if you were found to have endo. I guess the long course of Lupron depot would be an option but I'd have to know more about how much that tends to improve egg quality.

Personally if I were you my next step would be a consult with a really good urologist, because as others have said if embryos poop out after day 3 the conventional wisdom is it's a sperm issue. Though I don't think this is always the case.

If you still end up with a mystery, you might want to try OE IVF again, or if you really want to maximize your chances and just have a baby already, DE IVF -- either way with half DH sperm and half donor sperm. I know donor anything is a big step, much less double-donor, and takes some getting used to. It just depends on how much longer you want to keep doing this.

Sorry, being essentially unexplained is really rough.

J&D2007 · April 2014

brooklynesque said:

I know you didn't have a good experience at CCRM, but did you do a WTF and get any insight or ideas from the RE there?

Not sure if I would do a lap unless I understood the end game -- i.e., what the RE would do differently if you were found to have endo. I guess the long course of Lupron depot would be an option but I'd have to know more about how much that tends to improve egg quality.

Personally if I were you my next step would be a consult with a really good urologist, because as others have said if embryos poop out after day 3 the conventional wisdom is it's a sperm issue. Though I don't think this is always the case.

If you still end up with a mystery, you might want to try OE IVF again, or if you really want to maximize your chances and just have a baby already, DE IVF -- either way with half DH sperm and half donor sperm. I know donor anything is a big step, much less double-donor, and takes some getting used to. It just depends on how much longer you want to keep doing this.

Sorry, being essentially unexplained is really rough.

Thanks Brooklyn, c.crm called after to say there was nothing to transfer and I asked her what she would do differently. She said all she would do is add hgh at the end. As for the lap, I assume they would take care of any findings with laser while they were in there, then I would cycle right away? Possible with depot lupron if I waited? Not sure. The urologist idea is a good one. Not sure what else they look at though? If all other testing on the sperm is normal, what other tests would we do? Thanks!

hmz819 · April 2014

I had to wait 3 cycles after my lap to make sure everything healed.

As for tests, like LuvBoston said your pcp could order. If you want all RPL/immunology tests run Beer Center will consult with you over the phone and send you orders for all testing you need. They list their prices for consults on their website.

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