Would you move to IVF after terminating for chromosomal abnormality (T13)?

[Anonymous]

I had a trisomy pregnancy at 36, then a normal, naturally-conceived pregnancy at 38. Talk to a geneticist to be sure, but I think your chances of recurrence are low. Good luck.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:IVF has higher risk of ectopic and higher risk of C section.

I would make the decision based on whether or not I could manage another 2nd trimester termination.

What’s the source for this? Correlation doesn’t imply causation. There are infertility factors (age, weight, infertility causes, other health or anatomical issies) that would make one more susceptible to ectopic pregnancies or c sections to begin with.

DP. There is a slight increased risk of ectopic pregnancy from embryo transfers (I learned this the hard way), but I've never heard of an increased risk of c section tied solely to IVF and excluding other risk factors.
Anecdotal, small sample size, I know...but I was part of an infertility support group, with roughly 20 women who had gotten pregnant from IVF. Most of us had vaginal deliveries. The majority of those who had c sections had other risk factors (multiples, history of surgical removal of fibroids and endometriosis, etc). There was one lady who had a c section due to failure to progress during induction, and one who had a breech baby.

The increased C-section rate comes partially from moms tending to be older, but also partially because they want the baby out on the due date, which means more inductions. Also speaking from experience, conceived naturally, had a vaginal birth, followed by IVF pregnancy, failed induction, C-section with ongoing complications years later (80% due to medical negligence but that story would take 10 pages to explain). There is also an element of "precious baby" syndrome and women opting for elective Cs. There's other risks, abnormal placentation, subchorionic hemorrhage, several others. The risk to the infant is not fully elucidated. There are some differences, like more asthma in IVF pregnancies, but it is hard to say how much of that is due to the actual IVF and how much is due to the older mom/infertility factor. Long story short, IVF pregnancies *are* more medically complicated.

Overall 1 in 3 pregnancies end in a C, 1 in 2 of IVF pregnancies do. I really wish there was better informed consent. I was not aware of any of this before I learned it the hard way.

[Anonymous]

At 38 there are high odds of having another trisomy pregnancy or trouble conceiving. I'd start the IVF process because it can take a year. But keep trying.

I was done with trying naturally when on loss #5 (chromosomally normal, yes IVF doesn't solve everything) I almost lost my life / uterus from complications. I wasn't willing to risk another abnormal pregnancy.

[Anonymous]

Hi OP, I know it has been a few months since you posted, but just another mom who experienced a baby with Trisomy (T18 in my case). First, I just want to say how sorry I am for your loss. It still guts me a year later. We worked with an excellent MFM and genetics counselor (Dr. Kelly at VHC) in the course of the testing they were able to say that it was not inheritable and therefor unlikely to occur again in a future pregnancy given the extreme unlikelihood of it having happened in the first place. I was 42yo when it happened with a previous healthy straight forward pregnancy behind me at 38yo and they suggested that IVF would potentially be the way to short cut the line for blighted ovums, or other testable reasons that would make it more likely for a pregnancy to fail. We (more so my DH) did not have the emotional strength against the ticking clock of being older to try again, so I don’t have a happy ending to tell you. I do wish you the best of luck with whatever you choose and no that you are not alone in this lonely experience.

[Anonymous]

Anonymous wrote:Hi OP, I know it has been a few months since you posted, but just another mom who experienced a baby with Trisomy (T18 in my case). First, I just want to say how sorry I am for your loss. It still guts me a year later. We worked with an excellent MFM and genetics counselor (Dr. Kelly at VHC) in the course of the testing they were able to say that it was not inheritable and therefor unlikely to occur again in a future pregnancy given the extreme unlikelihood of it having happened in the first place. I was 42yo when it happened with a previous healthy straight forward pregnancy behind me at 38yo and they suggested that IVF would potentially be the way to short cut the line for blighted ovums, or other testable reasons that would make it more likely for a pregnancy to fail. We (more so my DH) did not have the emotional strength against the ticking clock of being older to try again, so I don’t have a happy ending to tell you. I do wish you the best of luck with whatever you choose and no that you are not alone in this lonely experience.

To this poster- I have read and reread your post multiple times now as it is if I wrote it, right down to saying “did not having the emotional strength against the ticking clock.” Give a huge hug to the one you had at 38. Hug yourself most of all. And hugs to all here who are going through this now.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:IVF has higher risk of ectopic and higher risk of C section.

I would make the decision based on whether or not I could manage another 2nd trimester termination.

What’s the source for this? Correlation doesn’t imply causation. There are infertility factors (age, weight, infertility causes, other health or anatomical issies) that would make one more susceptible to ectopic pregnancies or c sections to begin with.

DP. There is a slight increased risk of ectopic pregnancy from embryo transfers (I learned this the hard way), but I've never heard of an increased risk of c section tied solely to IVF and excluding other risk factors.
Anecdotal, small sample size, I know...but I was part of an infertility support group, with roughly 20 women who had gotten pregnant from IVF. Most of us had vaginal deliveries. The majority of those who had c sections had other risk factors (multiples, history of surgical removal of fibroids and endometriosis, etc). There was one lady who had a c section due to failure to progress during induction, and one who had a breech baby.

The increased C-section rate comes partially from moms tending to be older, but also partially because they want the baby out on the due date, which means more inductions. Also speaking from experience, conceived naturally, had a vaginal birth, followed by IVF pregnancy, failed induction, C-section with ongoing complications years later (80% due to medical negligence but that story would take 10 pages to explain). There is also an element of "precious baby" syndrome and women opting for elective Cs. There's other risks, abnormal placentation, subchorionic hemorrhage, several others. The risk to the infant is not fully elucidated. There are some differences, like more asthma in IVF pregnancies, but it is hard to say how much of that is due to the actual IVF and how much is due to the older mom/infertility factor. Long story short, IVF pregnancies *are* more medically complicated.

Overall 1 in 3 pregnancies end in a C, 1 in 2 of IVF pregnancies do. I really wish there was better informed consent. I was not aware of any of this before I learned it the hard way.

Most women going thru IVF, especially if multiple cycles and losses, are not hung up on the possibility of a C section. I just wanted to be able to take home a healthy baby. (I had 2 Cs, the 2nd by choice)

[Anonymous]

I would ask your RE or in a consult with a genetic counselor if having had a T13 pregnancy makes you more likely to have another and what your personalized risk would be to help you make the decision. I'm not sure of the answer, but I know a woman who had a loss due to T18 and then her next pregnancy was her daughter who has Down's Syndrome. They had a second child through embryo adoption.

[Anonymous]

What about combining IVF with PGS. I came across the article on Fertility Road and some webinars on My IVF Answers, and experts recommend this approach to boost chances.

[Anonymous]

OP I'm so sorry. I had a MMC that turned out to be T13. Heartbreaking.

Can you ask your OB/RE if they can test you for being a carrier for this, in which case it's more likely to happen again? (Carrier is not the right word but there was something they could test for via blood test, even though obviously I don't have T13 myself.)

We ended up having a healthy baby afterward naturally though it's a roll of the dice - your OB would know the stats better.

Good luck.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:IVF has higher risk of ectopic and higher risk of C section.

I would make the decision based on whether or not I could manage another 2nd trimester termination.

What’s the source for this? Correlation doesn’t imply causation. There are infertility factors (age, weight, infertility causes, other health or anatomical issies) that would make one more susceptible to ectopic pregnancies or c sections to begin with.

DP. There is a slight increased risk of ectopic pregnancy from embryo transfers (I learned this the hard way), but I've never heard of an increased risk of c section tied solely to IVF and excluding other risk factors.
Anecdotal, small sample size, I know...but I was part of an infertility support group, with roughly 20 women who had gotten pregnant from IVF. Most of us had vaginal deliveries. The majority of those who had c sections had other risk factors (multiples, history of surgical removal of fibroids and endometriosis, etc). There was one lady who had a c section due to failure to progress during induction, and one who had a breech baby.

The increased C-section rate comes partially from moms tending to be older, but also partially because they want the baby out on the due date, which means more inductions. Also speaking from experience, conceived naturally, had a vaginal birth, followed by IVF pregnancy, failed induction, C-section with ongoing complications years later (80% due to medical negligence but that story would take 10 pages to explain). There is also an element of "precious baby" syndrome and women opting for elective Cs. There's other risks, abnormal placentation, subchorionic hemorrhage, several others. The risk to the infant is not fully elucidated. There are some differences, like more asthma in IVF pregnancies, but it is hard to say how much of that is due to the actual IVF and how much is due to the older mom/infertility factor. Long story short, IVF pregnancies *are* more medically complicated.

Overall 1 in 3 pregnancies end in a C, 1 in 2 of IVF pregnancies do. I really wish there was better informed consent. I was not aware of any of this before I learned it the hard way.

Most women going thru IVF, especially if multiple cycles and losses, are not hung up on the possibility of a C section. I just wanted to be able to take home a healthy baby. (I had 2 Cs, the 2nd by choice)

Agree. We have less of an ideal way to give birth and more a desire to take him a healthy baby. I didn't care how my kid came out, just that he was healthy.

[Anonymous]

Anonymous wrote:Deciding on next steps and looking for advice. I (38F) have a daughter who just turned 3. She was born right before I turned 36 and was conceived naturally after being treated for an ectopic. Husband and I started trying for a second in fall of 2022, no luck until about a year later when we conceived in October 2023 on our second round of IUI. We had decided in advance that if three IUIs didn't work we would move on to IVF. So we were overjoyed when I got pregnant. Unfortunately we got abnormal NIPT results and confirmed via amniocentesis that the baby had full Trisomy 13. I had a D&E two weeks ago at 17 weeks.

In the immediate aftermath it seemed obvious that when I was cleared to try again we should go straight to IVF with PGT to avoid this happening again. Now that the dust has settled and I'm feeling a bit calmer, I wonder if it's worth trying IUI again. The more I think about the cost, time, and impact on my body, the less certain I feel about IVF. I understand that IVF can take a very long time and involve long periods of waiting, which I know will cause enormous stress. Part of me thinks maybe we should "roll the dice" again with IUI since we know I can get pregnant. And plenty of people have healthy babies after having to TFMR. But I turn 39 soon and if we were to have another trisomy pregnancy, I'd be heartbroken - and it'll set us back many months.

I feel like I know what the answer is and I'm just resisting it. What would you do? Alternatively, have you gone through a TFMR and then had a healthy subsequent pregnancy at advanced maternal age? I'd love to hear your story.

Before making any decisions about whether to pursue IVF or IUI again, what I would do is request follow up testing including a karotype. One of the more common balanced Robinsonian Translocations (where two of your chromsomes become attached to one another) is 13:14. This results in a carrier being totally phenotypically normal because you have a full suite of chromosomes, but having an elevated risk of trisomy because 2/3rd of your gametes will segregate in a non-genetically normal phenotype. Only ~1:1000 people are carriers of this, so it's not the most likely situation. However, if you are, it would totally make sense to pursue IVF with PGT-A testing because you have a high risk trisomy 13 or 14 happening again, whether it ends in termination or miscarriage. If you don't have this rare genetic situation, it was just a one off situation likely due to age.

If you don't have any particular genetic risk of it happening again beyond age related anuplodies, it becomes much more of a personal choice and will probably depend on other biomarkers in terms of how successful the doctors believe a retrieval cycle would be vs. IUI plus your personal preferences on how much you prefer the possibly improved odds of IVF with PGT testing vs. doing something less invasive.

Good luck!

[Anonymous]

No

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:IVF has higher risk of ectopic and higher risk of C section.

I would make the decision based on whether or not I could manage another 2nd trimester termination.

What’s the source for this? Correlation doesn’t imply causation. There are infertility factors (age, weight, infertility causes, other health or anatomical issies) that would make one more susceptible to ectopic pregnancies or c sections to begin with.

DP. There is a slight increased risk of ectopic pregnancy from embryo transfers (I learned this the hard way), but I've never heard of an increased risk of c section tied solely to IVF and excluding other risk factors.
Anecdotal, small sample size, I know...but I was part of an infertility support group, with roughly 20 women who had gotten pregnant from IVF. Most of us had vaginal deliveries. The majority of those who had c sections had other risk factors (multiples, history of surgical removal of fibroids and endometriosis, etc). There was one lady who had a c section due to failure to progress during induction, and one who had a breech baby.

The increased C-section rate comes partially from moms tending to be older, but also partially because they want the baby out on the due date, which means more inductions. Also speaking from experience, conceived naturally, had a vaginal birth, followed by IVF pregnancy, failed induction, C-section with ongoing complications years later (80% due to medical negligence but that story would take 10 pages to explain). There is also an element of "precious baby" syndrome and women opting for elective Cs. There's other risks, abnormal placentation, subchorionic hemorrhage, several others. The risk to the infant is not fully elucidated. There are some differences, like more asthma in IVF pregnancies, but it is hard to say how much of that is due to the actual IVF and how much is due to the older mom/infertility factor. Long story short, IVF pregnancies *are* more medically complicated.

Overall 1 in 3 pregnancies end in a C, 1 in 2 of IVF pregnancies do. I really wish there was better informed consent. I was not aware of any of this before I learned it the hard way.

Most women going thru IVF, especially if multiple cycles and losses, are not hung up on the possibility of a C section. I just wanted to be able to take home a healthy baby. (I had 2 Cs, the 2nd by choice)

I had my rainbow baby after my 6th loss trying for #3. He did not go head down and was born via C section with two knots in his cord. He wouldn't have survived vaginal birth and after all my losses I didn't hesitate to do the c section for him to get here alive.