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

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[quote=Anonymous][quote=Anonymous]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. [/quote]

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!
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