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Being Positive

Welcome back.

Well, as some of you may have guessed the previous story has a happy ending. While weighing her options Sheri became pregnant. 9 months ago she had a girl, and all is well.

I talked to Sherri about the whole ordeal. She reminded me that she had done many IUIs and 4 IVF cycles. She believes her success was aided by sticking with trying the old fashioned way when not in a medical/IVF cycle.

She is resistant to sayings like, “it’s easier to get pregnant once you stop with our doctor”. And she did want people to know that she did not change her diet or add any holistic therapies, it just happened. (Just a note about this. Of course I believe in the benefits of life-improvement techniques, but they may work best when used in conjunction with conventional therapies Using unconventional therapies alone has some, but limited benefit, and counting on them as you are aging is not recommended. If two groups of 41 year olds try holistic vs holistic plus fertility treatments, both groups will have pregnancies, but there will be more in the second group).

So what are my comments? Every infertility patient has a built in “on-your-own” pregnancy rate. People do get pregnant without treatment. For some the rates are very low, but as long as there is at least one tube and some sperm, the rates are rarely zero. Sheri had an edge; she produced an excellent number of eggs during her ivf cycles and this meant the overall status of her ovaries was well above average. Plus we all understand the Sheri is an exception, not the rule. The fact is, most women her age with a longstanding history of infertility do not get pregnant using their own eggs, even with the most aggressive treatments.

But when it happens it’s wonderful. Plus, in her case to get through the increased risk of miscarriage that goes along with being 43 is a big relief.

But why and how she did it may not be the most important point here. I think we should take time out to celebrate and hope that everyone has the potential to be successful as quickly and as easily as possible.

I’ve had a few other surprises in the past months. I have had my share of patients who responded poorly to the medications causing us to cancel their IVF cycles. With the few eggs that we had, we did an iui “just in case”. Sure enough, 3 women became pregnant and they are all doing well.

Two years ago I had a woman in her 40’s get cancelled from an FSH iui cycle. Her estrogen did not budge after 10 days on drug. Four weeks later her home pregnant test was positive and she had the baby. Apparently, her normal cycle started the day she stopped the injections and without even knowing she ovulated, and without monitoring or exact timing, she became pregnant.

And on the IVF side, I have one woman whose pregnancy is doing well despite her having her retrieval at age 45. Plus, I have had a slew of women whose embryos did not look very good at all, but went on to be successful.
And just yesterday I did a pregnancy ultrasound on a woman who did absolutely nothing except try. I met the couple about 3 months ago. He had a few medical problems that were resolving. Things turned around and they were successful on their own.

One point here is that busy infertility doctors, who promote surgery, fertility drugs, inseminations and in vitro, have many patients who get pregnant without their help. We suggest IVF to some who decide to do iui instead, and some of them get pregnant. We have older patients who have failed many cycles. We may ask them to consider other options, but they persist with IVF, and a few do get pregnant. We have women on our donor egg list who call to come off because they became pregnant.

I don’t want to confuse the luck of a few with the harsh reality of many. But I think it’s important to hear about the potential positives that do exist among people who did not have the best chances. Will being positive up your odds? Some say yes. If not, at least it will give you more strength as you continue on your difficult path.

Another person needs to be very positive, and that person is your doctor. I think most are. You need a doctor who is honest and can communicate the reality of your situation and the odds of success. If you and she believe it’s in your best interest to initiate or continue treatment, then she needs to be behind you 100%. Unfortunately, there are some doctors who do not have the correct mindset to be positive and an advocate for women whose odds are low. No one can really predict who will or will not get pregnant, so why not go in saying it will work. Your doctor should work with everyone as if they will be the one. Again, I think most infertility doctors are very good at this, but if yours is not, try another.

I don’t know if Sheri became pregnant because she was always positive. But I like using her as an example of how good things do happen to people who have one or more factors hindering their chances. Most infertility patients are not optimal candidates for success. Most patients have some barrier, known or unknown, to getting pregnant. Work with what you have, and good things may come your way.

Thanks for reading,

Dr. Licciardi

Update on a Past Story

Hello everyone once again.

Last week I received some new information about an old story, going back to August 2009. Here is the reprint of a past blog. Read it through, and soon I will post the follow-up information.

Dr. Licciardi

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