When All You Have is A Hammer, Everything Looks Like a Nail

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When my husband and I moved to Seattle we needed to establish care with a new fertility clinic.  We selected our doctor because she is an expert in treating recurrent miscarriage. 

I was stunned when I entered the lobby of the our new clinic.  It’s located on the 10th floor of a medical tower which faces south east, so I walked into a perfect view of Mount Rainier in all her glory.

I have found there to be a marked difference between private fertility clinics and university clinics.  Our doctor in Chicago worked at a University and was a researching clinician.  Her facility was decked out with all the best equipment – hi-def ultrasounds, doppler imaging, etc.  But the rest of the clinic was sparse; it felt understaffed, it wasn’t inviting, and it wasn’t comfortable.  It was functional.  The two private clinics I’ve been to were the opposite.  The waiting rooms were chic with comfy sofas, nice views, free teas, and candies.  They dripped with support staff… and color coordination… and branding. I want to be clear that I received excellent care in both settings, they were simply different.  One clearly prioritized the science, the other the patient experience. 

Anyway, after checking in for my appointment, I remember being led back to a small, shaded office.  I was by myself, because I’d accidentally scheduled the appointment for the same day we were supposed to move into our house.  But, since it takes months to get a first appointment with a new fertility clinic, rescheduling seemed out of the question.  The lights weren’t on because the sun was beating in through the windows, and the blinds were slightly drawn.  When my doctor arrived, she drew them down further, telling me that after seven years in Seattle, she’d turned into a vampire.  I don’t know why this stuck with me, but it did.

I remember thinking she seemed nice.  She was young, but older than I was, which seemed important at the time.  We went through my medical history, each of my losses, my prior test results, and my family building desires.  I told her I was exhausted.  I confessed that I had little hope I’d ever be able to deliver a child and wondered openly if it was time to move on to other options.

To my surprise, she told me there was nothing in my test results to indicate to her that I wouldn’t be able to carry a child and encouraged me to give it more time with a new approach.  She suggested I try IVF.  As we hadn’t tested the tissue from any of my prior pregnancies, she hypothesized that our problem may have been poor egg or sperm quality.  She explained that IVF with genetic prescreening could eliminate those variables and potentially increase our chances of success.  I told her I would think about it.

I think it’s a bit of every patients’ fear that as soon as you enter a fertility clinic, you’ll be prescribed IVF.  I mean, that’s what happened to me.  But, at the time, her logic made sense.   And after trying naturally and getting nowhere, I was willing to give anything a try. 

In retrospect, I have mixed feelings about my decision.  IVF was expensive, hard on my body (both mentally and physically), and ultimately unsuccessful. I’m sure I’d feel differently had it worked.  Since it didn’t, I’m a bit salty.  But that’s the risk one takes when agreeing to a non-standard or experimental course of treatment…

The theory – which has been validated in some data – that IVF with genetic prescreening decreases the risk of miscarriage is based on the fact that most miscarriages are a result of “aneuploidy” (the embryo having the wrong number of chromosomes).  This can be due to poor egg or sperm quality or be a result of random errors during cell division as the embryo forms.  These types of losses are considered “sporadic” and may account for as many as 50-60% of early miscarriages.   By prescreening embryos before implantation, you largely eliminate the aneuploidy risk. 

But here’s the rub, the more miscarriages a person has, the less likely it is that they are a result of sporadic errors.  It’s basic math – its statistically unlikely to get the same roll of the dice over and over again.   If aneuploidy is the cause of someone’s losses, statistically, if they keep trying, eventually, they’ll stay pregnant.  They actually studied this at Stanford.  They compared the live birth rate between couples who’d had unexplained recurrent miscarriages and continued with “low-tech” approaches (trying naturally) versus those who used “high-tech” approaches (IVF).  The life birth rates were similar.  On the flip side, if aneuploidy was not the cause of someone’s losses, IVF probably wouldn’t help anyway.

I don’t know if aneuploidy was the reason for our initial losses. As I said, we never tested. I decided to do IVF because I was pretty hopeless, and it was something new to try that gave me a bit of hope. It was like getting off a jammed highway onto surface roads. It may take longer to get to your final destination, but it’s a more satisfying drive when you feel like you’re making forward progress.

I will write about the full IVF process in more detail later, but we retrieved 27 eggs, of which 22 were mature, 13 were fertilized, 10 grew to the blastocyst stage to be genetically screened, and 7 came back normal. There are many women who would do anything for numbers like these. Some women endure multiple egg retrievals to get one usable embryo. My immediate response to my doctor was “so I guess egg quality wasn’t our problem then.” Please read that as an indication of how desperately I wanted an explanation for my losses, rather than as a complete lack of gratitude. I do appreciate what good news I was receiving, it’s just that the news didn’t bring me any more hope.

My doctor has since told me it was a poignant moment for her as well because it helped her understand the psyche of an RPL patient.  We are small subset of fertility clinic patients.  Mostly fertility doctors are met with excitement at a successful retrieval or a successful transfer.  Not with the RPL patient, or at least, not with this RPL patient. My excitement was tempered.  I would not be fooled. 

For me, IVF proved an unsuccessful exercise.  We got pregnant, but we still miscarried.  Twice.  The only good thing I have to say about it, is that it allowed our surrogacy process to move slightly faster since we already had frozen embryos. It also enabled me to stop trying without shutting the door to pregnancy completely.  My fertility is now frozen in time.  I still have eggs in my basket, and I am grateful for this. 

End Note: I want to caveat this post by saying that I think IVF is a remarkable procedure. For many women, it’s the only way to achieve a successful pregnancy.  But it is not a silver bullet. It’s not the answer for every woman. It was not the answer for me.  

The Author

Megan is an amateur blogger and a professional businessperson. She is the co-founder of Recurrent Pregnancy Loss Association, which is dedicated to funding research into the causes of and treatments for repeat miscarriage. (rplassociation.org)

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