When do you stop doing IVF or move on to a donor?

[Anonymous]

I am a 32 year old with AMH of 1.1 (almost diminished ovarian reserve) and my husband has low morphology. In addition, I was diagnosed with endometritis (NOT endometriosis) and was treated for this. We have one 2 yr-old son conceived through IVF (our first attempt). Since his birth, we haven't been able to get pregnant. 2 failed fresh IVF, and 1 failed FET. When do we quit? Should we try a "big name" clinic like CCRM or Cornell?? Should we do egg donor? Adopt an embryo? Has anyone had success out there on their 3rd or 4th IVF?

[Anonymous]

Sorry, to hear about your failed cycles. Someone posted an article here recently (NY Times?) that talked about this issue. I think if you haven't achieved a pregnancy in three cycles, your odds go down. This is also what my RE told me. However, you are still quite young so your odds might be better. I'm in a similar situation. I have a biological two year-old daughter and I've had multiple early miscarriages probably due to AMA. I'm struggling with the idea of a donor egg or an international adoption since I already have a biological child who looks and acts very much like DH and me. Good luck!

[Anonymous]

You should definitely get tested for immune issues before moving on to a donor. Immune-related implantation dysfunction can be a common cause of secondary infertility. I know way too many women who have moved on to donor eggs only to find out later that their problem was implantation, not egg quality.

Do a consult with Dr. Abbasi at CFA. She's the only doctor in the DC area who does the tests. Other doctors in this area will tell you it's bunk but my experience has made me a true believer.

[Anonymous]

GW docs do the immune tests as well. Dr Frankfurter does ALL testing....leaves no stone unturned, sometimes too much!

[Anonymous]

My experience with Dr. Abbassi wasn't good, she is really cold and uncaring, and she didn't even listen to me when I asked about immune issues.

[Anonymous]

Personally I'd explore a few options in parallel:
- if you feel strongly about having a genetic connection, then I would schedule a consult with Cornell or CCRM (if not even do a cycle or two with them) - the level of expertise exceeds local options by far
- investigate donor eggs & embryos - look at options/costs/support groups - does it seem like something you'd want to do?
- schedule a consult with an RE or RI (reproductive immunologist - none in DC area) who will run through immune testing options. you should also do the panels for clotting disorders if you haven't already.

once you've felt out those options that might help you decide on next steps.

and if you feel strongly about having #2, DO NOT give up yet just because the odds go down - I know several couples who had success after many rounds of IVF/FET (including ourselves - we finally found success in cycle #4 for DC#1 - up at Cornell).

[Anonymous]

here is a top RI:
http://www.rfuhealthsystem.com/RMC/tabid/2651/Default.aspx

she might do a phone consult for you

[Anonymous]

Just like deciding when to get married, buy a house, have that first kid: only you can decide when to move on. We have a Plan A, B, C and D -- and talk a lot about when we're moving from one to another. Keep as many options open as possible, do lots of consults and try different stuff (tried accupuncture? Creighton model? different clinics?). You may be hesitant but you'll know when it's right.

[Anonymous]

I agree with the PP that you'll do a lot of soul searching (and in my case obsessing) and eventually you'll know what to do. We did A LOT of IVF's to conceive our kids. It took 4 fresh IVF cycles to conceive our first child. It took an additional 5 fresh and 1 frozen cycle to conceive our twins. So yes - 9 fresh and 1 frozen cycles = 3 kids for us. In between those 2 pregnancies - I had 3 IVF cycles that were either miscarriages or ectopics. Not great stats but fantastic final results.

We considered a lot of things. We did second opinions with out of state clinics to see if they thought our local clinic was missing anything.

We did have one clinic recommend the antibody testing. Not sure how things have changed in that field since we did IF treatments years ago but at the time - the bloodwork was very expensive - my insurance didn't pay for (it was over $1K). We were "locked in" to a local shared risk program that I needed to stay with (we had no insurance coverage for IVF and I could find no other IVF PGD shared risk program around).

Even if I spent the money on the antibody testing - my local RE told me up front (I told him we were doing second opinions) that he would not do anything with the results of that testing. To him, it would always show "something" wrong and he didn't believe it. I'm not saying not to do that type of testing. But just think ahead - at the end of the day - if you're unlikely to change from your current clinic for any reason and your current clinic doesn't support the antibody stuff - you might not want to spend the money on having that testing done because it can be costly if your insurance doesn't pay for it. Unfortunately our insurance considered that testing "experimental" or something.

Honestly - the best thing that we did when trying to conceive #2 was taking a long break and enjoy ourselves for the first time in YEARS. I miscarried twins (IVF #8) - keep in mind that we told ourselves that we were only going to do 2 more IVF cycles to conceive #2 and if it didn't work - we would accept our fate and move on. Anyway - we normally did cycles back to back - cancelled vacations - rearranged plans - you name it. But after that miscarriage we took 7 months off from IF - we traveled, enjoyed our child and lived our lives for the first time in years. And tried to figure out what to do with ourselves.

We had a frank discussion with our RE - we all agreed one last cycle and that was it - it resulted in twins.

It can be done. Sometimes I feel like it's a numbers game and if you try enough eventually it will work. You just need to know your limits - and don't let the "costs" of IF treatments - on your marriage, your relationship with your child, etc. overtake your lives. If you're truly meant to be done - you will know. You have options - you just need to figure out which way works best for your family.

[Anonymous]

Sorry - PP from above - not sure why my "8" turned into a smiley face? Weird - anyway - meant to say IVF # 8.

Good luck!

[Anonymous]

This is the original poster--thank you so much for your responses. We are currently seeing Dr. Gordan at Dominion Fertility and he doesn't believe in immune issues, but there has to be something wrong. We've transferred 6 good quality 5 day blasts/almost blasts with no positive result. I'll have to check out the RE at Columbia.

For the PP who tried 9 cycles, how did you stay positive and hopeful? May I ask what your diagnosis was? Did you do shared risk programs at any of the local DC clinics?

Thanks again. This was very heartening. I appreciate your support.

[Anonymous]

"We've transferred 6 good quality 5 day blasts/almost blasts with no positive result."

OP, I agree with you that something else is up. At your age, one of those should have stuck. (And an AMA of 1 isn't that bad - it shows low reserve but not low quality). I think you need to consult with someone outside DC who will think outside the box. Given that you have a DC, Cornell might not be much help because you may not need the co-culture. Look at SIRM in NYC - they do immmune issues Possibly CCRM, though they don't. I would definite do the immune testing and have your DH do sperm DNA testing.

[Anonymous]

If you are going to Columbia, I'd recommend Dr. Sacks over Dr. Abassi. He's a great doctor and will take time to answer your questions and explain things to you.

[Anonymous]

New poster here...Poster 20:12...this is one of the best posts I have ever read. Thank you so much for sharing your story. It is very encouraging.

[Anonymous]

Anonymous wrote:If you are going to Columbia, I'd recommend Dr. Sacks over Dr. Abassi. He's a great doctor and will take time to answer your questions and explain things to you.

Dr. Sacks may very well be a great doctor but he doesn't treat immune issues, which was the OP's whole reason for looking at CFA to begin with.