Dilemma/decision making

[Mtntn]

Hi there,

I was hoping to get peoples thoughts/opinions.

I have done two rounds of IVF with PGS and three FETs.  My first IVF resulted in no euploid embryos, my second resulted in six euploid.  I felt so lucky after getting the six as I had always wanted to have the opportunity to go for a second child if I was lucky enough to have a first.

Anyway, fast forward 7 months, I have done three FETs with euploid embryos which have resulted in 1 chemical and 2 early miscarriages. 

My doctor has a few concerns/suggestions:
1. Potentially I have a translocation (currently awaiting karyotyping results) - if I this is positive, his suggestion is to do more IVF with a different donor (I'm single using donor sperm)
2. Potentially the medicated FETs are not working for me and I'm not absorbing synthetic progesterone, therefore he has suggested going straight into another natural FET and if it works, hope that that has been the problem all along, and hope that 2 remaining euploid embryos is enough if I want to try for a 2nd child when I'm 43 or so.
or 3. Potentially I'm not a good match for the donor (donor does have other families) - suggested do more IVF with different donor

My dilemma is that I'm 41 now.  If the karyotyping comes back positive, I know I will definitely have to do more IVF with PGD as that that point it is trying to find one that doesn't have an abnormality therefore there is no dilema and I just go ahead and do it.

However given translocation is quite rare,  if it comes back negative, I have to decide if I go ahead and do a natural FET and if it works, hope two remaining euploid embryos are enough if I try for a second down the road, or alternatively just go ahead and do another round of IVF to bank more embryos since I haven't been that lucky to date before trying a natural cycle. 

He also said if the karyotyping is negative and I decide to do another round of IVF to bank more embryos just so I'm not worried about having enough, he has suggested using a different donor.  The embryologist said there is no reason to but he advised it.  The issue then will be if I do bank embryos, then try a natural FET and it works, I'll have two remaining embryos from one donor and maybe a few from another. 

Anyway, I know I should just be worried about getting pregnant once let alone worrying what happens down the road, but I feel with all this fertility treatment I'm having to think a head all the time.  Just so torn and it is so hard to have to make these huge decisions on my own.

I hope I have explained my situation okay.  Would love to hear anyone's opinions, ideas. I really appreciate it.

Thank you!
Mtntn.

[FertilityFriends]

[Tincancat]

Hi Mtntn
I'd say early miscarriage and CP with apparently genetically normal embryos suggests uterine environment isn't right.  Now as for progesterone it's not normally a problem if taken by injection but can be if you are only using pessaries as some ladies don't absorb it.  This is easy to resolve by doing a dummy cycle with full medication but not having transfer instead just testing your progesterone levels.

Other things to optimise uterine environment might be level 1 immune tests looking for issues such as clotting problems which can be easily treated.  It might be helpful to refer yourself to Professor Brosens and Quenby Implantation Clinic at Coventry Hospital for a second opinion.

It might be worth doing another IVF cycle with a different donor and freezing them all to give yourself a few more embryos to try with once you have looked in to your implantation issues

TCCx

[cosmopolitan4112008]

In addition to the previous comment, check your thyroid. Should be  between 1-2. Also, no cells should be checked as a part of the immune testing. Gl!

[Mtntn]

Hi Mtntn
I'd say early miscarriage and CP with apparently genetically normal embryos suggests uterine environment isn't right.  Now as for progesterone it's not normally a problem if taken by injection but can be if you are only using pessaries as some ladies don't absorb it.  This is easy to resolve by doing a dummy cycle with full medication but not having transfer instead just testing your progesterone levels.

Other things to optimise uterine environment might be level 1 immune tests looking for issues such as clotting problems which can be easily treated.  It might be helpful to refer yourself to Professor Brosens and Quenby Implantation Clinic at Coventry Hospital for a second opinion.

It might be worth doing another IVF cycle with a different donor and freezing them all to give yourself a few more embryos to try with once you have looked in to your implantation issues

TCCx

Dear Tincancat,

Thank you so much for your great response. I'm quite new to this forums so it seems I haven't set up my notifications properly as I have just found your response. So sorry.

Thank you for your comment.   

I'm still awaiting the karyotyping tests.  If these are normal, then definitely think you are right and its a uterine environment problem.  I have had a full thrombophilia screen done and also immunes.  My clotting was normal, but do have high NKC and also TH1:TH2 ratio. This last FET I did high dose omega 3s before the transfer to try reduce my TNF alpha and also did a few rounds of Intralipid. 

I'm guessing if the karyotyping is normal, I might end upping my immune meds e.g. humira/ivig.  I'm going to talk more to my doc re: the progesterone levels too.

It is such a hard road. 

Again, a huge thank you and so sorry for the delay,
Mtntn

[Mtntn]

In addition to the previous comment, check your thyroid. Should be  between 1-2. Also, no cells should be checked as a part of the immune testing. Gl!

Thanks so much cosmopolitan4112008

Again, my apologies for the delay. I have my notifications sorted now.  Thanks for your message.

Thanks for the suggestions.  Thankfully my thyroid has behaved throughout all of this and is between and 1-2. 

Thank you so much!
Mtntn