This Time Even I Got a Little Mad

It wasn’t supposed to end this way. We all knew going in that nothing was guarantied, but we felt good and optimistic about starting. Together, we believed that if we just obeyed the rules and had faith, that good things can happen to good people. We anticipated sacrificing time, emotion and money, for a process that was logically the most reliable way to go. We figured it was the best option, and we were “all in” to work towards success.

Shari was 41 when we first met and she was already at it for more than a year. She was very smart and informed. Shari understood the small details of each treatment, but didn’t dwell on the negativity. She was super practical. The plan, which she started at 39, was to start with iui, and move to IVF if nothing happened. She eagerly and compliantly stuck to the plan, and had 2 IVFs under her belt by the time she first saw me.

At our consultation I definitely saw hopeful signs from her previous cycles. She made 15 eggs the second time. Plus her embryo quality was very nice. I explained that 3 things really help when you are trying to get pregnant with IVF at 41; a high egg number, good looking embryos and chromosomally normal embryos. We knew off the bat that she at least had 2/3. More eggs means more selection. We all know that a large percentage of embryos have bad chromosomes, so if you have more embryos, you are increasing your odds of at least one of them being normal. And if they look nice, all the better.

Wow, she called to tell me she got pregnant on her own. Sweet. But there was no heartbeat at 7 weeks, and she needed a D and C. This caused her to pause, and logically concluded that maybe FSH iui could work. So she tried to no avail.

Doing more IVF cycles was not an easy decision. She had some infertility insurance coverage, but that was all gone, so she had to pay for anything else, including the medications. But she weighed the options and decided to proceed with more IVF based on her good response, recent pregnancy and advancing age.

So off she went into her 3rd and 4th IVF cycle with me. Each time producing eggs and very good embryos. We changed the protocol a bit, but in the end she had cycles that most other women could not achieve.

Except for the two negative pregnancy tests.

And that’s the end of the story.

When we last spoke she was again very practical. She just didn’t see the value in going into a 5th IVF cycle. She could not afford donor egg. She was very kind, expressing her gratitude for the treatment she received. But this was it; she was done. She had ended her quest for a baby. Stated differently, she was probably not going to have a baby.

So why am I bringing this story to you, as this is not the first tale of woe in the infertility world.

I think this one was tough for me because she had to stop, but I still had some hope in the chest. For many, stopping becomes the best option because multiple attempts have given me information saying that it really may not be worth continuing. Few eggs, very poor embryo quality, advanced age etc. When younger women have to throw it in, I can at least feel that with time their situation will change, and although it looks like the end now, they may get another shot later on. It’s also easier when the best option is donor egg, and donor egg is agreeable and affordable to the patient.

Now every doctor does get very disappointed every time a patient has a negative pregnancy test. But the story about Shari just left me hanging a little more than usual. Many eggs, nice embryos, and my sense that if she could just do more cycles her time would come. Maybe. The thing was, I couldn’t tell her it would happen, and that always makes it tough. And I couldn’t lay on the optimism thing, even though had some. After 4 cycles, the energy and drive to continue has to come from the patient.

But I will continue to have hope for her. Maybe she will fall into an insurance program that will get her at least one more cycle. She doesn’t have much time for that. May be her financial situation will change and she will get to donor egg. This she has a little time for. And maybe, she will get pregnant on her own, which is not out of the realm of possibilities.

Thanks for reading, and Shari is a substitute name.

Dr. Licciardi

36 responses to “This Time Even I Got a Little Mad”

  1. jenicini says:

    Your thoughts about S teared me up, and I don’t cry very often. Thanks for being a doctor who cares enough to get a little mad at the situation.

  2. Misty Dawn says:

    Reading your story on Shari reminds me of my own story. Recently I gave up or quit TTC after 5 yrs due to the emotional/financial strain it was causing on my marriage. We just couldn’t take it any more and decided to walk away. With 5 m/c’s under my belt and only 3 FSH IUI’s w/great response(5 others that we choose not to do an IUI or they were cancelled, i.e. 8 treatment C’s w/RE). The stress and burden of going through these treatment C’s month after month and constantly getting your hopes crushed is unbearable. While I may only be 27, things could change but I doubt SC will start covering IF. I’m very proud of your patient for walking away, even though its the hardest thing to admit that you will live the rest of your life childless. I can see how its frustrating for you.

  3. Mrs. Chief says:

    It is comforting to know that there is a doctor that cares enough to get mad. I have had 4 miscarriages with different doctors and have gotten the “these things happen
    attitude from all of them.

    I am 28 years old, but I already have thoughts of not trying again. At what point do you stop? I haven’t been offered any hope that the next time will turn out any differently and I know that I can’t spend the next ten years doctor/answer shopping. The emotional/financial strain would ruin my marriage. And at some point we would have to make the decision to stop and adopt.

    My question for you is what other tests or factors should my doctor’s be looking for? I have no problem getting pregnant, but have had 4 early miscarriages. I have never seen a heartbeat and have had 2 D & Cs since my body wouldn’t take care of it on it’s own. I do not have a clotting disorder, I’m hetero for MTHFR, I do have a positive ANA, and my progesterone is generally low. For my last pregnancy the doctor was confident that we had everything figured out. I was on Clomid to raise my progesterone level, baby aspirin and Lovenox for the MTHFR and ANA, and extra folic acid for the MTHFR. When I still had a miscarriage the doctor said that we had to look at this as the first miscarriage when I was back to normal and miscarriages still happen to normal people.

    So his only suggestion is to try again, and he said he wouldn’t change anything this time. I did go to a hematologist for the MTHFR and he gave me a prescription for Metanx (which I have been taking) but my OB/GYN doesn’t think it will make any difference. Is there anything else that should be looked at for my situation?

    Thanks!

  4. Anonymous says:

    Wow. This reminds me of my story, although I went through “only” 2 IUIs and 2 IVFs. I responded well, most eggs fertilized and we made good looking embryos. For some reason, I never got pregnant. We can’t continue w/ another IVF. It’s not b/c I don’t want to or don’t have the will. It’s not b/c there’s a medical reason. It’s b/c my insurance doesn’t cover fertility treatments, and after incurring over $30,000 of debt, we just can’t do it any more.

  5. Anonymous says:

    Very, very sad situation. As a PP said, thanks for caring not about your success numbers, but for the patient herself!!! I wish there were more doctors like you!!

  6. Angie says:

    It is always nice to hear from a doctor that sincerely cares. Your story about Shari reminds me a lot of myself because I am currently at the point of asking myself, “When do you say when??” I’m not sure there is any right answer but when you are mentally and financially tapped, I guess that is as good of time as any.

    One quick question before I go – do you do mini-ivf or do you have any thoghts about it? Someone just reccommended it to me since we have no infertility coverage, I ovulate on my own and produce 2-3 follicles on 50mg of Clomid. I am 32 years old. We’ve TTC for three year and ahve done 5 IUIs with no success. The only thing we’ve ever been diagnosed with is low morphology. We have one child, conceived naturally and are on the brink of quitting. I’m not even sure our clinic does mini-IVF but I would be interested in any thoughts you have on the subject.
    Thank you for caring.

  7. Anonymous says:

    We too can’t do IVF because of insurance issues.
    My insurance pays for sterialzation and all that even
    Gastric Bypass. My theory is the cost of abortion and fertility
    Treatments should be switched.

  8. Anonymous says:

    Dr L,
    Thanks for writing this story. While it is sad and I can surely relate; having had over 10 pregnancy losses. There is an option for Shari and other women..get tested to rule out why you are having miscarriages. This is an area that many IF clinics do not believe in or actually do. For the lady with low P4, did your doctor put you on P4 supplementation other than Clomid, which we know thins the lining?

    The other option, of course, is donor egg and there are many exellent programs around including NYU. Save up for a few years and get a proven donor. It is expensive but it is a great option. Have yourself worked up for any isssues that may cause implantation failure before you start; that includes your husband. But do go to a good doctor that does not just throw expensive tests at you but one that has a genuine interest in helping you find the cause.

    I personally have been at this for eight years and I refused to give up..I turned every stone and it looks like it may have been worth it.

    I was lucky to be at a great clinic for DE but it was all of my many doctors who worked together and still do to help me achieve my goal.

    Thanks Dr. L.

  9. Anonymous says:

    Age 43, after 4 failed IVF and 1 failed DE IVF, I have been offered frozen donor eggs (eggs, not embryos) to use with my partner’s sperm, any thoughts?

  10. Anonymous says:

    I love your articles. Reading thoughts from doctors perspective is enlightening to say the least.
    you are amazing and your patients are lucky.

  11. Mrs. Chief says:

    Follow-up:
    My doctor said that Clomid was the best to raise your progesterone level because it raises it before you’re acutally pregnant. He said we could do a progesterone supplement, but you can’t start that until after you know you’re pregnant and usually it is too late by then to do any good.

  12. Kami says:

    A sad story. One that hits close to home. We also had 4 failed IVF cycles with good looking embryos (well, at least one top grade blast) and between 10 and 20 eggs / cycle. Our miracle pregnancy (severe MFI that no RE would do an IUI with) after an unmedicated IUI ended in neonatal death.

    Fortunately, while we mortgaged our future and cashed in our retirement, we were able to move on and be successful with DE.

    I hope your client will find an alternate way to be a parent as well or at least finds peace in living child free.

  13. Anonymous says:

    Mrs Chief,
    You can start progesterone right after ER..You do no and should not wait for a confirmed pregnancy test. That is incorrect information. Even on a natural cycle, you should start right after a confirmed ovulation, which you can do by taking a LH level. Good luck.

  14. Anonymous says:

    If you had a 48 patient who had been unsuccessful with two egg donors but whose embryos had all been of high quality would you be suggesting a surrogate at this point? We have three embryos in the freezer created with our 24 year old proven donor. We were looking to do one last cycle with them and then we’ll be done TTC. But a 39 year old friend who has an almost 8 month old of her own has offered to be our surrogate. She was on femara herself to conceive resulting in one miscarriage and a blood clot during her pregnancy. Would you consider her as a surrogate?

    Thanks, P.

  15. Anonymous says:

    Why dont you give her a free IVF? She paid for 2….buy 2 get one free? 🙂

    Wouldnt it be great if there was a charitable organization that donated to things like this?

  16. It was wonderful to hear the doctor’s side of the story. Beautifully written. Thank you for being so caring. Your patients are lucky to have you.

  17. yes really wonderful and informative article…….

  18. Jen says:

    How about only charging her you actual cost and using donated meds or encouraging her to use donor/adopted embryos?

    My doctor is starting a low cost IVF program where he makes a small amount each cycle but not the extreme amount most doctors charge.

    Just my opinions!!!

    Jen

  19. michelle says:

    I am trying to become pregnant via IUI using frozen sperm. I am 35. My fertility tests were in normal range, except for marginally low progesterone in the luteal phase. As a result, the plan was unmedicated IUIs based on OPKs. My first try was about 18 hours after the positive OPK, and it failed. My second “try” never actually happened. My positive came Saturday afternoon, and the dr’s office advised Monday morning for the IUI. An ultrasound on Monday showed no measurable follicles, but also no “free fluid” indicating recent ovulation. The next day’s ultrasound was the same, but a progesterone blood test revealed very recent ovulation. We agreed on ultrasounds beginning Day 10 of my next cycle, and a trigger shot, when appropriate, the trigger shot being to make sure we get the timing right, given that we apparently can’t rely on the OPK timing.

    Two questions:

    1. is this a reasonable plan?
    2. is it true that this brings no additional risk of multiples? most of what I read indicated that the shot releases only the eggs that are already there, but the Ovidrel prescribing information does indicate an increased risk. What I can’t tell, since I’m not a doctor, is if the increase is just b/c the shot is usually used in connection with the fertility drugs that do increase egg production.

  20. Darla says:

    and it’s stories like this that we are reminded that we are not in this battle alone, but together, as one. You are perfect for the profession that you choose…or did it choose you? Thanks for your story!

  21. angela says:

    Thats a great story, its good to hear the good and the bad.
    If you don’t mind I have a question, we have been trying for over 2 years to get pregnant ( our 3 year old daughter was conceived with no problem). It turns out my husband has poor motility and morphology and lowish numbers. For the last 5 cycles we have been doing IUI and the last one with clomid. However each one I am getting more and more painful and crampy right after IUI, after sex in that 2 week post ovulation period and for the 1 st 2 days of my period. It has gotten so bad that I am reduced to crying and groaning on the floor. It even hurts to go to the bathroom, walk, stand up straight etc. The last time I ended up needing to take vicodin as nothing else touched the pain.
    I told my Dr this yesterday and he still wants me to do another IUI with clomid. To be honest I think its my bodys way of telling me to back off and take a rest. Can this be a complication of IUI or clomid? My Dr didn’t seem to take me seriously with the pain or my concerns.

  22. Anonymous says:

    Just recently found your blog. Thank you for sharing your patient experiences. I feel for S! It takes a lot of courage to walk away.

    Just wondered what advice you might have. I’m 41 1/2. My husband and I have a healthy 19 month old that we conceived naturally after one month of trying. I was nearly 40 when I delivered.

    This past Jan (just before turning 41, got pregnant again naturally, resulting in a 7 week m/c.)

    In July on the advice of OB friend, I started Clomid and headed for RE. We decided to do IUI. This resulted in 2 follices measuring 18mm and 26mm. (my FSH was 10). Got pregnant again, everything looked great at 6.5w and 7.5w scans, but FHT gone at 8.5weeks. Just had D&C few days ago and awaiting chromosome results. Common things being common at my age, I’m expecting abn chrom.

    All things considered, RE thinks my chances of having live birth vs m/c is 50/50. Rest of w/u is normal except for a small fibroid that did not impact this pregnancy.

    My question is should I skip FSH IUI altogether and go straight to IVF? Would be grateful for any advice you might have.

  23. ifcrossroads says:

    Dr.L – I just found your blog today – thank you for what you do! I’ve read almost a year’s worth of posts and have learned SO much!

    I have a question. I’m 29 and was dx’d w/Stage 3 Endo via Lap. We’ve been TTC for 16 months. Husband has hypospadia and we were encouraged to move to IUI. We’ve done one 50mg. Clomid cycle w/timed intercourse which was negative and caused 2 cysts. After a break cycle we did 1 Clomid/FSH IUI with only one follicle at 18mm which resulted in a negative beta. I’m willing to do an all FSH IUI but then I think it would be time to move to IVF. What are your thoughts?

  24. Anonymous says:

    Doesn’t this tell you that ART (IVF) doesn’t work for this woman? Her only pregnancy was “on her own”, not even by IUI.

    Also, doesn’t this “failure” merit more exploration, for example, clotting disorders or other underlying causes?

  25. Elizabeth says:

    This comment has been removed by the author.

  26. Cate says:

    I know we’re all willing to try ANYTHING when we get to this point. Shari’s story gave me pause, and reminded me that sometimes, for some, enough is enough. I have used guided imagery in my life and have heard from many that it helped in their journeys toward parenthood. My favorite titles are found at wwww.healthjourneys.com. It can’t hurt!

    – cate.

  27. Amanda says:

    Dr. L. your blog is literally an answer to my prayers. My hubby is in law school and I’m a school teacher (i.e. we’re poor). We’ve shelled out over $3000 in fertility testing thus far (poor insurance coverage) and were literally one month away from IUI but the dr. wanted to do $700 more in testing (post coital test, progesterone test, ultrasound, and endometrial biopsy). After that we were going to try IUI ($650/pop).

    With mounting tuition costs, and after much prayer, we came to the decision that though we were quite close to actual treatment, it’d be best to instead save that money for adoption and, God willing, we’d get pregnant on our own someday (I’m 29 and he’s 36). Though I felt at peace about the decision, I’ve still wondered if I made the right decision. . . when I read this post tonight it was truly an answer to prayers, that yes, it is okay to move forward.

    Your comments about being young and hopefully being able to conceive naturally brought me hope (we’ve bought a fertility monitor and are going to try it until we’re approved for adoption). In addition, maybe once my hubby’s done with law school we’ll have more money/better insurance and be able to get to actual treatment in the future.

    Thank you again. You are doing such a great work.

  28. Sprudeln says:

    My RE also thinks that we just need to “wait for the right embryo”. I’ve just turned 35 (we started this all because of MFI when I was 32), produce between 7 and 11 eggs per cycle, all look good at transfer time, and 3 of my 4 cycles have ended in miscarriage.

    I’m awaiting the results of the 5th cycle, and I still don’t know if we can walk away after this.

  29. Anonymous says:

    Dear Dr. L. Thanks so much for your blog! It is good to know that you really care about your patients. I got pregnant on my third IVF cycle only to lose the babies at 20 weeks from a freak accident. Life really challenges you sometimes.

    We are now back in the game using frozen embyros from our previously successful cycle. If it hadn’t been for our RE’s encouragement we may have just given up. It isn’t easy to go back to IVF after suffering a loss like this.

    Thanks for all the encouragement on your blog.

  30. I guess each one of us has our own path to walk on.
    Since IVF is so expensive, why isn’t alternative methods, such as stress management, relaxation techniques, etc offered before IVF. Afterall we’ve all heard of stories of couples who finally gave up IVF, adopted a child, and then got pregnant on their own!

  31. JOdi Miller says:

    This is similar to my story. I am 40. We can only afford two more ivfs so we will end at 4 cycles.

    Our first cycle was an ivf transfer from an IUI. Last month on a low dose of puregon I had 21 eggs which reduced to 3 embryos. Two were transfered in. One frozen. I had a chemical pregnancy.

    One of the reasons why we are doing ivf is that we need icsi. My husband’s sperm count is low AND in the petri dish the dr discovered that his sperm is NOT interested in my eggs. (nothing happened after 24 hours)
    So, my question is:
    Would we have a better chance with a sperm doner?
    Thanks

  32. linda says:

    Great post.

    I, too, gave up after a number of IVF cycles due to cost and swore that I wouldn’t try again unless I had insurance.

    The universe answered with the best IVF coverage my docs have ever seen.

    So, here I am, nearing my 45th birthday, and going into IVF cycle #5. My FSH is decent (8.0) and I make 8-10 follicles a month and usually have 100% retrieval/maturity/fertilization rates. Decent embryo quality. It’s just that nothing implants. (I’m an immune patient w/APAs, NKs, MTHFR).

    So I keep on trying until the money runs out, again.

    I so feel for S.

  33. Sonya says:

    Couples should be aware that 80% will conceive within a year and 90% within two years if they don’t use contraception and have regular intercourse…Cialis Online

  34. sasha says:

    here i love to share about tubal reversal is a surgical procedure that restores fertility to women after a tubal ligation

  35. MedWriter says:

    Is there perhaps an implantation issue that using a surrogate would help with?

  36. Fukuoka says:

    The average couple will need 3 or 4 attempts before obtaining a pregnancy through IVF, all depending on your real problem. Some couples will have unexplainable cause of infertility , which doctor will give the only choice , IVF the only realistic option for achieving pregnancy.
    Stress can have a huge influence in your hormones.
    What ever treatment you take don’t get upset, it won’t help. And make sore you take balanced nutrients dally.
    No doubt is affordable and good for your heath.

Leave a Reply