Our IVF Journey — What we learned after 9 failed IVF transfers — Part 1
Disposable embryos, PGS Testing, the ERA test, Uterine lining, Natural versus Medicated Cycles, Donor Eggs, Thyroid Levels, Sperm Quality
Introduction
9 unsuccessful IVF cycles!
Over 200K in personal savings, 8 long years and a serious toll on Mom’s health.
That’s what our journey took.
The unfortunate thing is that we could have success on our very first cycle (and subsequent cycles), had we known the things we know today.
We were misguided (by one of Austin’s top IVF specialist, no less).
We were a little too trusting of doctors and spoke up too little, too late, among a slew of other mistakes.
If this post can help you avoid even a single failed cycle (and end up with a successful implant), I will consider the effort worth it.
We would not want anyone to go through the heartache that we went through — especially knowing that most of it was avoidable.
Key Takeaways
This post will discuss the following key areas- and what we would do differently were we to do this again.
- Multiple Embryos — what does it mean to your specialist? (The all important ERA test)
- Pre-Genetic Screening of Embryos
- Medicated versus natural cycles
- Thyroid Levels
- Donor Eggs
- Sperm Count and the Male Partner’s Success Rate
Success at Last — In India
We did have two successful cycles.
No specialist shared the information that I am sharing here.
We discovered these through IVF forums, pregnancy forums and such.
We also consulted a trusted family friend — who is a top OBGYN in India.
We were fortunate to have access to the top IVF doctors and top OBGYNs in two different countries, and it turned out to make a huge difference in our journey.
More than one good embryo? Doctors will treat them as disposable.
This is still painful for me to write about.
If you have more than one good embryo (make sure they are PGS tested — even if you are young and healthy), IVF Specialists believe that you have the luxury and time to go through multiple cycles.
A top Austin IVF specialist went through 4 perfectly good, screened embryos before recommending a test (when we were down to our last embryo).
We were only informed about the ERA test, after we were 4 embryos and 4 IVF cycles down!
And that too, only after I had done some legwork research to see if this might be the issue with my wife’s multiple failed cycles (long story short- this WAS the issue, we DID get pregnant — though not with the help of this top Austin specialist).
When asked about why he did not recommend this important test up front — when were on embryo number one, his response was…..
‘oh — if you have more than one embryo left, we don’t normally do this test. Only if all those embryo fail, do we advocate the test’.
In other words, they would rather do unsuccessful transfers with perfectly good embryos, than perform the test prior (the test costs little — and the gains far outweigh any cost).
Our recommendation — get the ERA test done early — even if you don’t have a good reason to (actually, what reason would that be?).
Keep in mind that 80% of women are normal receptive — meaning that without the ERA test, and with just the regular 5 day embryo transfer, they have a high chance of implantation (as long as other factors, such as uterus lining and thyroid levels are all within range).
However, it is still important to know whether you are in the 80% — or the 20%.
The cost of not doing the test far outweighs any financial cost!
Receptivity of endometrium — The ERA — And the change in ERA after missed abortion
The exact date and time of the embryo transfer (and thus, of your successful implantation) is dictated by the results of your ERA test.
There is some debate in the medical community about whether this test is truly valid or not. For us, there was no debate.
Both our successful implants occurred after ERA test results were taken into account.
The first ERA result actually resulted in a successful implant — but eventually a missed abortion.
This missed abortion actually calls for a second ERA test — because any abortion has a high chance of shifting your receptivity timing (I know — so infuriating right?).
Thankfully, our India IVF specialist, realizing that we were down to our last embryo, decided to repeat the ERA test.
A slightly different ERA result — as predicted (due to the shifting from the missed abortion). And another successful pregnancy — this time leading to us becoming first time parents!
It is noteworthy, that the results of the two ERA tests were different — and yet, BOTH ended in successful implants based on calculations from the ERA results.
Natural versus Medicated Cycles
This top Austin IVF specialist insisted that my wife’s uterine lining would not reach it’s mark until we took strong hormone doses (medicated cycle).
He never bothered to check the natural lining size during the menstrual cycle.
My wife, in spite of being in her 40s, was forming perfectly good linings —both size wise and desired-pattern wise — each cycle around!
She also lacked any serious medical condition except for a mildly elevated thyroid (something that is easily fixable —see thyroid section below).
The medicated hell that the IVF specialist put her through, actually destroyed her gall bladder ( a known effect of overdosing with hormones). She ended up in E.R. requiring a gall bladder removal.
We swore off that doctor after that date.
To our shock, our next specialist informed us that we never needed those medicated cycles. Her natural lining was strong enough — and had the perfect pattern — to perform a transfer!
This is called a natural cycle. And we stuck to this for all our successive implants (both of which were successful).
PGS testing of embryos
Here’s the rub. If you are over 40 (female), your eggs are on a downhill trajectory. Both quality wise and quantity wise. My wife was still producing LOTS of eggs — but the quality was unknown. You would only know the quality when you tried to form the embryo and the formation succeeded or failed. Even then, embryos were ‘graded’ — based on their quality.
Long story short — Always get the pre genetic screening test on your embryos.
It is a little expensive, but not as expensive as finding out 6 weeks down the road, that your successful implant wasn’t successful.
It saves a lot of time and heartache down the road.
Donor Eggs
Donor Eggs, if that is something you are okay with, are almost guaranteed to be a lot healthier (younger female) than your own. With that in mind, if we had to do it all over again, we would have probably just gone with donor eggs from the start.
Pro Tip — Even with embryos formed from donor eggs, get the pre genetic screening done! There is NO DOWNSIDE to the screening — except the cost (which is minute compared to the actual IVF cycle cost). The reasons I would advocate the pre genetic screening of embryos is :
- You don’t know anything about the donor’s genetic disposition. Even if it is young, healthy female, there is still an unknown genetic factor involved.
- There is certainly a chance (though smaller) of genetic defects coming from the male partner as well (especially if the age is over 40). Simply getting a young female donor doesn’t guarantee a perfect embryo.
Pro Tip — If you do go the donor egg route, look for a young (preferably under 28 donor ) — who has had a successful pregnancy in the past.
Thyroid Disease and Thyroid Meds
As you would be well aware (if you are trying to conceive), your thyroid levels need to be under control (ideally TSH under 4).
My wife wound that her levels were high to begin with. She was given a fairly high dose of Thyroxin medication (up to 200 mcg — which is super high). For weeks, she took that dose — only to find her levels mostly unchanged.
This was a surprise, as we had managed to get her levels down before.
She consulted an endocrinologist in India. That doctor advised her to simply switch to a name brand and keep the same dose going.
Within a matter of days, her levels were down from 12 to under 3!
Now, typically, when we all take generic versions of brand name medications, we are not so concerned about the difference in effectiveness. And in most cases, it really doesn’t make much of a difference.
However, for the Thyroid gland, there’s apparently a WORLD of difference between generics and brand name meds.
Not sure why — but we learnt the hard way, to always pay for brand names. And also, try switching medicines if one isn’t working.
The six week test (Fetal heartbeat) and The Second Genetic Test (3 months into pregnancy)
Post a successful implant, there are still a couple of milestones to cross. A fetal heartbeat (6 weeks into pregnancy) and a genetic test (3 months into the pregnancy). Our experience shows that there are ways you can significantly improve your chances of clearing both these milestones.
Most importantly — the odds are in your favor if you had your embryo screened genetically (see the section above on pre genetic screening of embryos).
In addition, the younger the egg donor’s (or wife’s) age is — the better the chances of making it through these two milestones.
If you do go the donor egg route, look for a young (preferably under 28 donor )— who has had a successful pregnancy in the past.
This does not mean that if you are in your 30s and 40s — and are using your own eggs, that you will face any issues. It is just that younger donor eggs do have an advantage.
In other matters, like the actual capacity of the uterus to hold a successful 9 month pregnancy, age makes less of a difference. Uteruses can stay healthy a lot longer — and even post menopause.
There are cases of implants in 50 (and 50 plus) year old women, that have successfully delivered babies.
For the Male Partner — Sperm Counts and getting good embryos
Low sperm counts can still work well with IVF cycles.
However, even with low count samples, there are ways to improve the number of embryos that can be generated from your sample.
The standard is to wait for 3 days (3 day gap) between ejaculations — to provide your doctor with your IVF sperm sample.
I did a few cycles using this, and then came across a medical publication, which claimed that a ONE DAY gap — was actually better.
Better in terms of getting more good sperm — and hence more potential embryos.
Believe it or not — this simple hack had us generate 3 good embryos from the single sample I provided (earlier samples would do 1 or 2 at most). My embryologist in India agreed that this was a well researched topic — and the 1 day gap could make a difference.
Summary
There’s a lot more that we learnt along the way. However, this post contains all those things that we learnt the hard way — and that not a single specialist told us — until WE asked them about it!
We are happy parents now, but it could have gone either way.
Had we not persevered and kept hounding those specialists for tests that were not on their radar, we might have never had success.
I hope this helps prospective parents out there. I hope you do not have to go through a journey like ours. Best of luck and happy parenting!
