QuestionQUESTION: Hello:
In the last year, I have had three IUIs and one IVF and have been pregnant three times. But, all three pregnancies have failed. Through my second IUI, I became pregnant for the first time. There was never a heartbeat at seven weeks, so it was diagnosed as a missed miscarriage that resulted in my first D&C;.
The second time I became pregnant was a natural conception, which was a chemical pregnancy. I just had a late period; no procedures were required.
The third time I became pregnant was through my first IVF cycle. It was diagnosed as a blighted ovum and I had to have another D&C to remove the pregnancy. At the same time, they found a 20% septum and removed this. In this IVF cycle, the doctor retrieved six eggs and three fertilized. He transfered all three, which appeared to be of excellent quality. I was on the estrogen priming protocol. The highest my HCG got to was 6973.
My doctor is optimistic and thinks I have every reason to try another IVF cycle with my own eggs. I am 41 and scared about trying again with my own eggs. I am worried that I will just miscarry again and I don't know if I have the stamna to go through it again. In your medical opinion, should I move straight to donor eggs or try again with my own eggs?
Thank you!
ANSWER: Hello,
Thank you for giving me your age. That is probably the reason for the miscarriages, as there is an increased risk of miscarriage with increasing age. This is because the "age factor" is due to old eggs that have become weakened or debilitated. It therefore leads to genetically abnormal embryos, which either don't implant or lead to miscarriage. Miscarriage is natures way of making sure that you don't have an abnormal child.
So, you have to make a decision. Do you want a genetic child or do you just want a child. If you want a genetic child, then you have to keep trying. The fact that you have gotten pregnant before is a good sign, and with repeated attempts you probably will be eventually successful with a successful pregnancy. But, you need to be prepared for more disappointments.
If you don't mind not having a genetic child, want to increase your chances of a successful treatment and decreased risk of miscarriage, then donor eggs is the better way to go. There is still a risk of a miscarriage but it is much less because the eggs will be better quality. Also you chances of pregnancy with IVF increase to almost 70% versus 25% currently.
I hope this helps,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
check out my blog at http://womenshealthandfertility.blogspot.com
---------- FOLLOW-UP ----------
QUESTION: Hi Dr. Ramirez,
Thank you for your answer. I now have another question. I had a D&C (and septum removal) about 4 1/2 weeks ago. Right after the D&C, I bled for about a week and then stopped. I had nothing for two weeks, then, this past week, I've been lightly spotting on and off for about a week. Is this normal? I'm still having a positive pregnancy test 4 1/2 weeks past my D&C.
By the way, all of my blood tests for clotting have come back normal. We had the tissue tested and it was trisomy 16.
I'm in San Francisco.
Thanks so much for your help.
AnswerHello again,
I am surprised to hear about the septum. You should have had a hysteroscopy to check for that before your IVF, and I will usually do it as part of my basic infertility evaluation before any treatment.
It sounds like the septum did not have an affect on your ability to become pregnant, though, since the genetic testing was abnormal. It was consistent with what we find from the "age factor."
The bleeding and continuing bHCG levels are normal. They should be followed down to zero. It can take up to 6 weeks to resolve and 4-6 weeks after than to have a normal period.
Good luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF program
www.montereybayivf.com
Monterey, California, U.S.A.
Check out my blog at http://womenshealthandfertility.blogspot.com and twitter with me @montereybayivf.
