WTF 2

Shucks, this is so hard, I cannot begin to describe how we’re feeling right now, other than heartbroken. Yesterday we had our WTF appointment for our second failed ICSI cycle, amazingly this clinic gave us an appointment only two days after I called them, our first clinic had us waiting a torturous two months.  

I’ve tried to summarise our appointment with the consultant in the hope that it may help some of you in a similar situation and also you may have suggestions for us that we haven’t thought of yet, believe me we are at a loss right now and so all suggestions are welcome! In TTC for coming up to 3 years soon, we have never had one positive pregnancy test, with have 2 failed ICSI cycles under our belt, no frosties ever, and we have never made blastocysts before. Herein lies our problem, if we cannot make blasts then it ain’t gonna work, full stop. So why don’t we make blasts and are we wasting our time . . . are you sitting comfortably?

I thought I would be seeing the same consultant as at our first appointment, instead we saw the new guy, I was a bit sceptical at first but in the end I was pleased we saw him, he has only been at our clinic for 3 weeks, prior to this he was the medical director at The Bridge Centre in London. He sussed me out within seconds after asking me if I studied Biology at school, I held my head up high and said I studied it as my degree, ha!

On the whole our second ICSI cycle did seem to go well and just like last time after Day 3 our embryo’s pretty much deteriorate.   Here is how Cycle 1 and 2 compared:

CYCLE 1
15 eggs collected, 13 mature, 8 embryo’s. Day 5 single embryo transfer (morula not a blast), no frosties.
CYCLE 2
13 eggs collected, 10 mature, 6 embryo’s. Day 3 double embryo transfer (1 excellent, 1 good), no frosties.
 
He said the cycles in terms of eggs/embryos were comparable and he is happy with the numbers, the quality of the embryo’s this time around were better than last time, but the same deterioration happened post day 3. The sperm sample on the day was the best OH has had since we started on this journey so we think the multivitamins he has been taking and lifestyle changes may have had an effect. In essence we are told that the sperm sample can fluctuate a lot and so there is just no knowing how it will be on the day, but it is going in the right direction. Now that I have had two cycles he will admit there is a pattern forming  but it’s not possible to say whether it is the egg or the sperm (or both) causing the problem, it’s likely to be the sperm but impossible to say for certain.
We discussed Day 3 vs Day 5 transfers, his preference is to get the embryo’s back as soon as possible if there are clear front runners, if it’s not possible to choose the best ones then he would opt for a Day 5 transfer. It is possible that the embryos could form blasts within me but not within a petri dish, he has seen the poorest quality embryos work before so you just never know (I know I know, it only takes one).  However for us, if we’re not producing blasts then it’s possible there is a genetic issue.

We discussed various tests that we could do to help diagnose or influence how to do our next cycle . . . he thought there was no point in seeing a urologist at this stage, it’s unlikely they will be able to tell us anything given the improvement in OH’s sample over our ICSI cycles. We discussed chromosomal karyotyping, this is a pre-requisite for some clinics before starting IVF/ICSI, it’s unlikely this will show anything for us both as it only detects major chromosomal defects but it may be worth doing for peace of mind. With regards to other tests, DNA fragmentation and Sperm Aneuploidy, he didn’t think these were worthwhile as these figures can also fluctuate, if we were to go ahead with these we have to be aware of the limitations of the results in that they look at a snapshot of the sperm at that time, on the day of ICSI the sample could be better or it could be worse, it will not help us in choosing better sperm. This was a little hard to hear, before we saw him we were adamant that we should do this type of testing before progressing, but we can see his point, it won’t help our upcoming cycle or change our situation (as we’re not going to give up just yet) and so should we bother? He said that the results of a DNA fragmentation test will only help determine whether to do ICSI or conventional IVF, as we’re already doing ICSI it won’t tell us anything new, he asked us to think about what we will do with the results, will it stop us from doing another cycle? I guess the answer is no.
 
We also discussed PGD (pre-implantation genetic diagnosis) and CGH (comparative genomic hybridisation), these are expensive options we could do in the future, unfortunately for us though it only helps in choosing the best embryos (or eggs) so this may not be useful if we can’t also select the best sperm in the first place to make the embryo. For this the latest technique is IMSI (intracytoplasmic morphologically selected sperm injection) as opposed to ICSI (intracytoplasmic sperm injection). It’s just like ICSI but uses a higher degree of magnification to choose the sperm, it’s thought that the fertilisation and success rates could be higher for people in our situation as they are hopefully choosing sperm that is less fragmented right before injecting into the egg.  I had looked up IMSI briefly before our appointment, I could only find one clinic near us (in London) that does this, it seems to cost a few hundred pounds more which is not much more in the grand scheme of paying for a treatment cycle. IMSI is not available at our current clinic, but the consultant offered that if we decided to pursue this in the future, he would be happy to link us up with a satellite clinic abroad (possibly France) for the egg collection/transfer part of the cycle. This seems like our only option moving forward in the future. Other tests we could do are full chromosome karyomapping and SNIP technology, I’m not sure what this would tell us but it’s something else to add to our list of research for the future. We discussed immune testing briefly too but given that we can’t seem to get to the implantation stage yet (we need to make a decent embryo first) he thinks we should hold off on this for the moment.

Our first ICSI cycle was NHS funded, we are lucky enough to be in the right postcode area to have funded cycles but have a restriction of 6 months between cycles, this is why we opted to privately fund our second ICSI cycle to bridge the gap. This means our next cycle will be NHS funded which is great but means we can’t do any extra fancy stuff, so we’ll take the NHS cycle and give it another try and ramp up OH’s vitamins based on some of our own research we have done, if this doesn’t work we can then perhaps pay for an IMSI cycle afterwards.
In terms of other lifestyle factors, the amount of alcohol we have (not much) he thinks is absolutely fine, he said just be sensible, no binge drinking and advised that during treatment I don’t drink. Eat a sensible diet, have my vitamins, continue with acupuncture if I find it relaxing and the OH should try to keep his stress levels down.

So we agreed a plan:

• Chromosomal karyotyping – he will write to my GP to see if they will fund this test for us both, it’s just for peace of mind (I’m persistent).
• Change my stimulation medication from Gonal F (recombinant FSH) to one from natural sources, such as Menopur or similar, just to see if it makes any difference.
• Agreed to transfer two embryos even though it’s an NHS cycle (did I mention how persistent I am)
• Keep up the good diet / lifestyle / mind & body relaxation.

Are we filled with hope, no not really, but we have to try again and in the mean time we’ll research IMSI and simply hope for the best. We might proceed with the other sperm DNA fragmentation tests anyway, he understands that we feel helpless and just want to gather as much information as possible. In the meantime the hundreds of vitamins keep arriving through the post box!

We felt relieved after the appointment to draw a line under it and to look ahead, but it didn’t last long. By late evening, I went in to a serious meltdown when I got home, we both did, so much so that we both could not go to work today and face people. I put on a brave face about 90% of the time, it’s impossible to sustain and stay positive and pretend everything is normal, we’re so far from normal that I’ve forgotten what normal is. I don’t want to burden anyone so I find myself distancing myself more and more, who’s interested in someone going through their third cycle or however many more we might need?!

Today is a new day and we do feel a little better, but our life is the same still and we have no choice but to keep putting that brave face on and keep going. 

Apologies for my longest post ever (zzzz).