Ask Dr. Marc: Multiple Rounds of IVF

Dear Dr. Marc,

 

I’ve had three failed rounds of IVF.  The last one was a chemical pregnancy.  Some people say I should keep trying and other people say I should look into adoption.  IVF is so expensive but I want to keep trying.  How much IVF is too much IVF?

 

Dear IVF times three,

First, I think it is worthwhile to acknowledge the amount of hard work it takes to go through 3 IVF cycles.  Each cycle is grueling and definitely takes an emotional, physical and financial toll.  Clearly you are determined to make this work and I believe that your determination will pay off!

In terms of how many IVF cycles you should attempt, it depends on several details specific to your situation.

  1. Age- We know that younger women have a greater chance of conceiving with their own eggs than older women.  Therefore, younger women tend to warrant more cycles than older women.   Additionally, women who are 43 years of age and older have especially low live birth rates with their own eggs.  In this age group, some believe that multiple cycles of IVF is inappropriate.
  2. Your prior cycles- Did your prior cycles go well?  Did you make many eggs?  Was the embryo quality good? If the cycle went well, there is reason to consider trying again, if the cycle did not go very well, are there things about the cycle that can be changed which would give you a better chance in the future?
  3. Other factors- What other factors contributed to the failures?  Are there problems with the sperm that can be corrected?  Is there a uterine factor?  Are there environmental issues that could be affecting your chances? Sometimes, you have to think a bit “outside to box” to come up with fresh ideas.

The bottom line is that there is no specific number of IVF cycles a person should undergo.  For you, I believe that if there are changes that can be made for your next cycle, you should consider trying again.   If however, you are over 43, or are a very low responder despite different stimulation cycles, you may want to consider some alternatives.  Those alternatives include natural IVF, donor oocyte IVF or adoption.

Ultimately, the decision to pursue another cycle is an individual one.  As long as you make the decision based on realistic expectations and honest counseling, I don’t think you will go wrong.

Good luck, and hopefully the fourth time will be a charm!

Dr. Marc

Share Your Story: Murphy Lives Here

Merryl Polak is the author of Murphy Lives Here, a story about her struggle with the pursuit of motherhood. After struggling with infertility for almost 9 years, she is finally a mother and now has a lot to say about that topic!

 

When the birth parents might change their mind…

 

My heart sank before she even uttered the next sentence, which was; “The birth parents were not ready to sign the papers today.”

 

Although the previous nights had been sleepless due to a child in need of food and diaper changes, this night was sleepless for additional reasons. William and I kept staring at each other with complete despair. We watched the clock tick by all night and the following morning. We barely moved and we did not eat. We tried to memorize every detail of the beautiful baby in front of us fearing the worst, but William assured me that the birth parents would never renege on all of the promises they made not only to us, but also to the baby girl before us.

 

“They don’t have a pot to piss in,” he reassured me. “They don’t have jobs, they don’t have cars, and they don’t have any financial way of providing for her. They want more for her, that is why they pursued adoption in the first place and nothing has changed.”

 

As true as that statement was, financial security was not the only requirement to parent. Of course, as true as that statement was, anyone pursuing adoption would not be considered without stable financial resources. This is what angered me. Adoptive parents have to prove that they are capable of raising a child in a million ways, but biological parents never had to prove a thing. Adoptive parents were insignificant and retained no rights. People who are loving and kindhearted and financially stable who for whatever reason cannot procreate are punished multiple times.

 

They are punished with infertility. Perhaps they pursue IVF or other invasive treatments like we did, which punishes an infertile couple’s wallet, and in my case, physical health. If that fails, as it did so many times in our case, they must jump through hoops to be approved for adoption. Even when that is over, someone must actually choose them as being worthy to parent their child. And still, when you think you have jumped every hurdle, birth parents have to stick to their word and still follow through and allow you to raise their biological child.

 

I found myself contemplating, what was the magic of genetics? Somehow, being genetically tied to someone gave a person superior parenting rights. For this, I have no explanation. Whatever the reasons are, they seem misguided. Perhaps it is because of the position I sit in, but perhaps, it is because it is also true…

 

Merryl has a happy ending to share…but you’ll have to visit her blog and pick up her book to get to the end of this story.  And don’t forget to find her on Facebook!

Ask Dr. Marc: Acupuncture and IVF

Dear Dr. Marc,

Does acupuncture actually increase success rates for IVF?  Are there acupuncturists who specialize in infertility?

Thanks,

IVF Hopeful

 

Hi IVF Hopeful,

The most truthful answer to your question of whether acupuncture really increases success rates for IVF is…I don’t know!

To understand the reason I don’t know, you need to understand a little bit about how doctors answer any clinical questions.  We use a variety of tools including personal experience, med school teaching and clinical studies.  These studies can be broken down into 3 different types:

1.  Case studies- a report of a few cases in one doctor’s experience.

2.  Retrospective studies- a structured review of prior clinical experiences over a pre-determined period of time.

3. Prospective studies- studies designed with the data collected in a prospective manner usually with some sort of control or placebo.

Of these, prospective studies are clearly the most reliable.

With this in mind, there have been literally hundreds of studies written on the topic of acupuncture and IVF.  Unfortunately, most of these are case series or retrospective studies.  Amongst the prospective studies, many are poorly designed and or poorly executed.  For this reason, their results must be rejected or, at least, taken with a large grain of salt.

When one looks at the small fraction of these studies that are prospective, and well designed and executed, the outcomes are quite conflicting.  Some show convincing benefit to acupuncture, while other studies show no benefit at all.  This pattern is frustrating, because, while it hints at a benefit in some groups, we cannot determine who, if anyone, is most likely to benefit.

Although the literature is inconclusive as to a benefit for acupuncture and IVF, it has established that acupuncture is safe.  This point is very important because there are many alternative therapies that patients consider without knowing safety data.  Many thousands of documented acupuncture sessions have been recorded in the literature with very few serious side effects.

Furthermore, it is important to recognize that acupuncture clearly does have real physiological effects.  For example, acupuncture is used as the sole source of anesthesia during major surgery in some countries.  Further, the fact that acupuncture has been used for 2-4 millennia definitely gives it some credibility!

With these things in mind, I often recommend acupuncture to my patients.  In fact, if I were going through IVF I would use acupuncture.  At worst, it won’t have an effect, at best; it may just be the thing that helps you get pregnant!

Lastly, choosing an acupuncture practitioner is very important.  You definitely want someone with training in the treatment of infertility.  The best source for this is the American Board of Oriental Reproductive Medicine (ABORM.org).  ABORM practitioners complete a rigorous curriculum of training and must pass a comprehensive board exam.

Good luck, I hope I have made a clear POINT…(sorry, I couldn’t resist the pun!)

Dr. Marc

 

 

Share Your Story: Things I Really Want to Say

I get a lot of email from fellow infertiles that just need to vent.  These women have stories to tell, but nowhere to tell them.  Sure, they share them in bits and pieces with their partners and loved ones along the way…but sometimes they have some feelings to share that aren’t so share-friendly in large groups.  I’m so glad these infertiles have found me and trust me and feel safe within the pages of Clomid and Cabernet.  Because, honestly?  That’s the whole reason I started this site.  Today a fellow infertile has a few things to say, and I promised to share them on her behalf.  I’m sure many of you can identify with her…

 

“Things I Really Want to Say”

 

-Anonymous

 

This cycle seems to be incredibly difficult. It is just my third IUI but with new drugs (and this being the last IUI before IVF), the snark fills my brain constantly. Whatever coping mechanism works, right?  I bite my tongue and just try to make it through to the end of the infamous two-week wait.

 

But secretly, this is what I’m saying in my head…

 

To my childless and not trying friends: Please stop using the word “breeder” to refer to parents. I know you seem to think that because I am also childless, I find babies and toddlers and kids grating. I don’t; I desperately want one. I can’t share in your diatribes.

 

To those who find out: Yes, yes, if I would just relax my ovaries would somehow magically produce 24 follicles each month. Why didn’t I think of that?

 

To those who complain about other’s fertility treatments: Selfish? Wasteful? Shut the frack up.

 

To the other women in the waiting room: We are all here for the same reason. Each of you, every time I see you, make me feel better, make me feel less alone. The diversity of you – the thinner and the heavier, the younger and the older, the married and singles, the gay and the straight – help me give myself a break on the self-blame. Maybe, just maybe, we can muster up a good morning while we do our third day of blood draw and ultrasound this week.

 

To my best friend: Thank you for making me laugh. Thank you for listening to way too much detailed information about side effects. And thanks for responding to reports of blue discharge with the ever-important question, “Are you having an affair with a Smurf?”

 

To my partner: I wish I could make you understand how much I wish I did not snap at you at the littlest things when my emotional health is on the verge due to extraneous hormones. Thank you for holding my hand when the substitute doctor refused to use a smaller speculum. Also, the high five after the sperm count announcement might be superfluous…

 

What thoughts run through your mind when you’re feeling down about infertility?