In Which We Have A Conversation With The RE

Right around the time I went to see my OB/GYN in September because my PCOS was causing weird bleeding and fierce acne, I also found myself unable to quit thinking about the two embryos we still have in storage. I had/currently have zero desire to be pregnant right now. At the same time, I kept wondering what the real possibility of a second pregnancy would look like or if there even was a reasonably good possibility of that happening.

Part of the issue is that out of three pregnancies, I’ve had zero normal, term deliveries. Each subsequent pregnancy has required more and more medical intervention. My first miscarriage was sad but routine. My ectopic required follow-up blood draws and monitoring for over a month, and even then I was really pretty lucky when it comes to ectopic pregnancies as I miscarried “naturally” without needing metho.trexate or surgery. The third pregnancy, of course, required a total of 4 ER visits, 2 brief admissions to L & D, innumerable office visits and ultrasounds, 17P shots, specialists, a 55 day hospital stay for me, a c-section and a D&E for retained placental fragments (not to mention the lengthy NICU stay for E).

In other words, it’s not prudent to do things that require actual planning and serious time/financial/emotional commitment such as applying to start my master’s degree until I’m truly done with pregnancy. So after talking with my OB/GYN, I went over to the RE’s office, which happened to be in the same campus and made an appointment to see Dr. E. We had questions about the quality of the embryos, the possibility of scar tissue in my uterus, and what came next. I also needed to know how the embryos were frozen and whether we would do one transfer or two. There’s obviously a financial difference and we needed to know ahead of time so we could plan savings.

We met with Dr. E a few weeks ago and set up the outlines of a plan. Much to my surprise, the quality of the two embryos is quite good. “These are the two best embryos you’ve made,” Dr. E told us. He also told us that the embryos were frozen as individuals, not as a pair.

Dr. E concurred with both the perinatologist and my OB/GYN that while I’m always going to be a high risk pregnancy because of my history, the subchorionic hematoma (SCH) was most likely a one-time thing. There’s no reason to think that another pregnancy necessarily would be dangerous or that I’d wind up hospitalized with a premature birth again. Then we got down to the details of what a transfer would look like for us. “Definitely one at a time,” Dr. E said. “I’d even go so far as to say that given your OB history, this is a medical necessity.”

“Because I’m already high risk and twins are an even higher risk?” I asked.

“That’s part of it,” Dr. E said. He had a theory about my SCH. The causes of SCHs are mysterious and not well studied. There’s some thought that blood clotting disorders can be a factor, but due to my infertility and miscarriage history, I’ve had a number of the work-ups for blood clotting issues and we’re reasonably certain that wasn’t my problem.

I’ve had a total of five embryos transferred. We know for a fact that four of the five implanted (blighted ovum, the baby I lost at 9 weeks, the ectopic, and, of course, E). Dr. E told me that it is somewhat unusual to have such a high implantation rate in IVF. When we did the ultrasound with E and saw only one gestational sac, we all figured that the embryo we’d transferred with E had just stopped developing and not implanted.

Dr. E thinks it’s a possibility with my track record of implantation that that embryo did implant and try to grow briefly, there was a vanishing twin that never got far enough to see on the ultrasound, and that this may have caused the SCH to develop. Dr. E stressed to us this was merely a theory, but when he said it, it made a lot of sense.

We also talked about the state of my uterus. While Dr. E said he couldn’t be certain until he actually did the imaging, he’s reasonably confident that I won’t have extensive scar tissue. Apparently having the D&C or D&E shortly after giving birth makes the risk much higher for scarring but mine was far enough out from my daughter’s birth that the risk was lower.

All in all, it was a good conversation. The current plan is to consider transferring sometime in the fall of 2016, but that depends on how E is doing and how Arthur and I feel about it at that point. We’re done with fresh IVF cycles. At least we have answers to our questions and can make fully informed decisions going forward.

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3 thoughts on “In Which We Have A Conversation With The RE

  1. I have some insights based on my own experience and what my doctor has said. I oddly remember that you transferred a day-5 morula when you got pregnant with your daughter, and a lot of the complications associated with IVF they now theorize are the result of poor synchrony between the lining and the embryos. Now that I have this ERA result that says my lining is behind, it makes the SCH of my own pregnancy seem like a side effect from an embryo that implanted but not quite right…if that makes sense. Amidst all this lining dysfunction I had 2 ectopics, several chemicals, and I just wonder how much was rooted in the mismatch. Anyhow, I don’t mean to be an armchair RE, but it’s just good for thought from my own ruminations, esp since microbes in the stagnant blood of your SCH could quite possibly have caused the PPROM, no? Maybe a little tweak could eliminate a lot of the risk.

    • That is so, so interesting…I appreciate you letting me know this. It’s most definitely something to bring up to my RE. I hadn’t even considered this as a possibility for the SCH and it makes a lot of sense. Thank you.

  2. It sounds like you are thinking through your options very carefully and asking all the right questions — I am so glad that the remaining embryos are good quality and frozen separately. It sounds like you have a thorough doctor, which is so helpful. So much to sort through. I wish you all the best in your decision-making and ruminating up until Fall 2016!

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