Little FISH, Big FISH

After much gentle prodding we finally got Steve's FISH results late Friday afternoon.

The envelope please....

ahem...

oh, look at that! my hands are shaking! John Tesh, you had better take a peek....

GASP!

Steve is 34% abnormal. Or, if you prefer your nutsacks half full, Steve is 66% normal.

!!!!

This is good news. Nay, great news. Surprising, of course, what with all the miscarriages, but cause for rejoicing. Just think, with a large enough sample size of pregnancies, two-thirds of them should work out. If I could only get pregnant, like, 40 times we could expect to have 26.4 children. O! Just imagine the hijinks!

Perhaps more to the point we are well within range for IVF with PGD. It doesn't mean it will work, of course, but his numbers (contrary to previously held beliefs) do not automatically disqualify us. As the beginning of a new cycle (5 weeks to the day, again, post D&C) coincided beautifully with the arrival of the FISH results I decided to celebrate Steve's relative normalcy by going in for a Day 3 blood draw on Saturday (Day 2, alas, but what can you do?)

We had left it with the local RE that we would wait to see if Steve's sperm was better than 50% normal (yes!) I would then do the Day 3 tests (FSH, e2) and wait for two full cycles following the D&C before scheduling a simultaneous mock transfer/ HSG. So that was the plan and I decided that wherever we wind up they will want to see Day 3 numbers for me. Thus, I went.

Hey, want to hear something funny? I wasn't sure what tests he had ordered so I asked the lab person as she drew my blood. She told me about the FSH and e2 and said he had also ordered a test to check for anti-sperm antibodies. I thought this was amusing. I mean, I haven't exactly been The Great Wall of Vagina when it comes to repelling swarming hordes of killer sperm from the west. Steve and I joked about sperm strapped with TNT wearing false mustaches and carrying passports with names like Kill R. Semen getting waved right on through the cervical checkpoints: "OK, this checks out! Bon voyage! Enjoy the Fallopians!"

Feel free to enlighten me if I just don't understand the antibodies test, but could I get pregnant so often if that was the problem?

Speaking of Steve we are having a little... not disagreement... um... well, ok, it's not Steve. It's me. Steve feels that his numbers are so good we should try one more time on our own. He hastily added that he would completely understand if I was not up for it and wanted to move right to IVF. He is fine with that. He supports that. He practically started handing me wads of cash as a sign of his good faith. So good, but....

The problem is that all I needed was the slightest nudge to start me wobbling*.

Steve gave me that nudge by saying he would like to try again unassisted. Then I talked to my brother and he said, Jules (I like the name Jules, by the way, it is what my brother always calls me) I STRONGLY recommend that you try one more time before IVF. STRONGLY.

What does my brother have to do with anything? Well, he is one of my very best friends and I trust him. He also has his doctorate in immunology and he is the closest we get to a genetics expert around here. He thinks that we have a good chance, solo.

I wish I could do fancy little charts, but let me try to break it down for you and then you can tell me what you think I should do.

Unassisted: I have a good likelihood of getting pregnant on my own but that also brings a high probability for another miscarriage (or worse.) Statistically it now looks like a 34% miscarriage rate but historically it works out to 88%. I KNOW. I KNOW I should not add them together like that but… ok. 88% of my pregnancies have ended in miscarriage, is that better?

Assisted: I have been quoted a few different numbers for my chances of conceiving with IVF after PGD. Let's say 18% on the low side and 40% on the high side. BUT if we do conceive the chance of miscarrying drops to, I don't even know, something really low.

So on the one hand I will probably get pregnant on my own but there is a that biggish chance I would miscarry; on the other I probably would not get pregnant but if I did it would likely stick around. Oh, and cost about $15,000 whether it worked or not.

Maybe someone has The Answer or at least knows how to clarify the question for me? I am utterly muddled.

Your views (be they based upon your personal IVF experience, your statistical genius, the goodness of your heart or your psychic abilities) are most welcome. Wellkommen. Bien venue.

PS Do not think I am not grateful that I even have this choice to make. I am. Exceedingly. Wheeee! I CANNOT believe that Steve has more genetically normal than abnormal sperm. It’s like an early Halloween present.

------------------------------------------------
*The Wobble courtesy of Getupgrrl, all rights reserved

Comments

[Mollie]

Happy, of course, that you haven't gotten some horrible, dream-crushing news, of course of course, but also sorry that the MEN in your life (who have never miscarried, I'm guessing) whom you love and trust are treading on your excitement about moving on to what looks like a more inspiring landscape (at least from your perspective).

I've only miscarried once, and I never did IVF. But if I multiply my experience of miscarriage by a male factor of eight and subtract adoption, I get IVF with PGD, Honey.

It's fine and well for those guys you love to have their "druthers." But if money is not an issue, and you know what you are most comfortable with, I'd say it's your turn to have the "druthers" trump card.

[Mollie]

By the way, I am stealing "great wall of vagina."

*stuffs words under coat*

[Crystal]

I couldn't do it. With the availability of cash, I'd go for science, not roulette.

But let's not forget I'm the wimpy-ass chicken shit who jumped of the procration boat at the first mid-pg loss.

I only needed to live that hell once, thankyouverymuch.

And frankly, Lee and I were both very happy about adoption (well, Lee needed to do some serious thinking, but it took him all of 2 months.).

I still... Look, if you told me that from now on I'd have nothing but girls, but I had a high risk of another m/c? I'd get a tubal. I don't do loss well.

Really, only you can make this choice. How well can you tolerate another loss?

And does the current knowledge, and the fact that the PGD is there mitigate the problems of a loss any? I'm not sure for me it would, I'd still grieve *that* child. But for some, it might, especially given the genetic issues you're dealing with.

I dunno. Hell, Julia, it's not a choice I'd be grateful for at all. It smacks of the dreaded "be glad your Mother died quickly" when frankly, I wish she'd never had cancer at all, and was still here with me. But whatever. I'm greedy that way.

[Cathy]

Hi Julia,

I would go with the IVF myself. I'm pretty sure that the abnormal sperm must have some selective advantage. It's hard for me to believe that you could have been so unlucky in the past, given those FISH results. Maybe the abnormal sperm are faster due to having less mass or something, like Y chromosome-bearing sperm. Do you know where the breakpoints are?

Cathy

[Izabela]

Weeell, in my stats it adds up to IVF. Had three miscarriages, would have to scrounge for $15,000, would go for it in a shot. Guys don't really know.
Good luck.
Izabela

[Sanorah]

Our problem is male factor. The little buggers are just bad all around and we were given a less then 10% chance of ever conceiving naturally. That being said, the doc has had Poke on meds for the last couple of months to try to improve the quality of his sperm. He went in Friday for another SA to see if there has been any improvement.
This weekend he asked me “IF” his sperm happen to look a lot better would we back off of doing this upcoming IVF and try naturally again. (we tried naturally for 3 ½ years).
No only did I say NO WAY but I started bawling on the spot. I know he was just trying to save me the pain of going through this IVF and a few thousand bucks, but the thought of trying to do it natural now… after it failing for so long was just to painful. I have to do this IVF or I will feel like I am doing nothing at all.

So… I guess you could see that my vote is for the IVF. At least this way they can clean out the obviously defective sperm and pick the cream of the crop (pun intended) to put together with your eggs.

[Julie]

No! More! Miscarriages!

No! More! Miscarriages!

A vote for another miscarriage is a vote for anarchy, Lunchables, and George W. Bush. So you know which side of the fence I fall on.

[meredith]

Sorry to spend your cash willy nilly, but I think I'd be heading for IVF, as well. I have had 3 m/c and I can't imagine risking another. Your problem doesn't seem to be implantation, so I think your personal odds of IVF are higher than other people's (though I'm ignorant to the real reasons IVF success rates are rather low..my guess being that most of those people were unlikely to ever get pg anyway)But for you, IVF is not the 'end of the line'. If you do it, and it doesn't work, you can always try again on your own. If money isn't an issue, I'd go with science.

I don't know why I agree, but it seems that the bad sperm have some unfair knowledge of how to get to your eggs before the good guys. Perhaps that's where the phrase 'Good guys always finish last' comes from!

Meredith

[Slim]

Well, of course, this is a deeply personal decision, and it's your body, and only a Republican would tell you what to do with your body, and . . .

No, sorry, I've just got to vote for IVF. I'd vote for anything that might get you off the fast train to Miscarriageville, pop. vast and all still grieving.

But I'm not telling you what to do. (Yes, John Ashcroft, I know you're reading this, and I am not a Republican.) I'm just saying if I knew $15K could help me avoid a miscarriage, boy, I'd be filling the sacks with cash right now, instead of jabbering to a stranger's blog.

And like Cathy, I wonder if the evil sperm are in fact wiler, better able to lure your wholesome, innocent ova into unholy alliances with their smooth but unbalanced blandishments.

[Michelle]

A note of caution on the IVF -- you have to be reasonably sure you can produce a good crop of eggs, 10-12 or so, for the PGD to select enough to implant. One of the things they dont tell you is that PGD can destroy the embryo so they like to have lots to work with.
If they have a way to select out the "good" sperm maybe you could get away with an IUI.
Despite this, I still think IVF makes better sense than trying on your own. I would worry that another loss would mess something up permanently.

[Laura K.]

Yahoo!!!!! That's wonderful, wonderful news, Julia! 66% is GREAT!

Sperm antibodies - yeah, I don't think that's your problem but I really don't know for sure.

Are you staying with the last RE you met with, then? Do you think he was just trying to downplay things since he didn't really expect Steve's guys to be so good?

Oh, and I say that the person who has had the most physical trauma holds the cards in the decision-making process of IVF vs. natural. Besides, since Steve's sperm are only about 2/3 normal, does that meant hey should only get 2/3 of a vote on this, leaving you to outnumber him? Yes, I think so. ;) But, bottom line, it really does come down to you. There's the risk of miscarrying if you go at it on your own, which you are mentally prepared for but have also suffered a lot from already. There's the risk of being disappointed if the IVF doesn't work, and I guess you would need to decide which one would be harder to handle right now.

If that doesn't clear things up for you, I don't know what will - ha ha!

Take care,
Laura

[KellyH]

I haven't had a miscarriage, but I'm a woman, wife, mother, and faithful reader. I also say IVF.

I'm hoping desperately that this next step, whatever you decide, will work out for you.

[Kristine]

First of all, CONGRATS on some better-than-expected odds! Now...
Good God. I can't believe I'm in the VAST minority. And as a gal whose had my heart ripped out and stomped on by three miscarriages...perhaps it is the now 28 week burgeoning belly speaking through me here...
After the 2nd miscarriage I swore it was the last time I would try. But, like you, I would find myself hanging on to some shred of hope at ovulation time- and whammo! I was back in the saddle again! And after the third...yup. Did it again. I SWORE this was the last time we were trying. Positively. And it took. I'm due in January. I guess I'll never know (but always suspect) how full of shit my declaration of halting was.
I also, like you, have one child already. And would spend a lot of time looking at her and thinking "I know we can do this...we've already did it once..."
So I guess I see where you're coming from with the difficulty in making this decision. For me, the money would also be an issue, possibly even a deal-breaker, as coming up with $15K would mean some pretty major lifesytle changes for us- probably even downsizing our house. So there's that.
It's quite possible that I'm a hopeless Pollyanna and you should cut a check to the IVF folks promptly...I also did not excel in statistics, but it seems to me that a new pregnancy would simply have the 34% chance of miscarriage. And statistically, since you're at 88% loss, aren't you due to get a good guy past the gates?
Ok- I could be all messed up here. Bottom line: only you know what you're willing to go through.
So I help not at all. But thanks for the diversion from the piles of papers on my desk.

[dish]

That's funny...they tested my husband for anti-sperm antibodies before IVF...never tested me.

It sounds like you're well informed on the issues and stats, now it's just a matter of pondering the risk scenario you're willing to face. Not sure what I would do in your shoes, but I'll be keeping you close to heart as you make your decision.

[Bwc]

My vote is a resounding I.V.F. with P.G.D. if you can afford it.
I.V.F, especially with P.G.D. is going to yield a lot of information about the quality of embryos that you and your husband are making (this can be good and bad depending, and I've seen it go both ways) This fact alone makes it a better option, not to mention the fact that that if you get some good embryos to transfer you'll have a very good chance. What's to be learned from another miscarriage? You know that you can carry a pregnancy but all those D and C's can cause scarring, it's not worth the risk.
Miscarriages suck. I could go on and on..
Good luck deciding!
Ms Blunt

[Annie]

IVF! IVF! IVF!!! Don't risk it again! I want to see you succeed and give Patrick a sibling! IVF! IVF!!!!

Good Luck!
Annie

[Lisa]

Julia, I would do IVF. I don't understand Steve's desire to try again, and risk putting you through another loss. We have male factor, and were advised that was our best shot right away, and we did it and it worked on the first cycle. I know we're lucky, but honestly. It isn't a big deal. I would do it again in a heartbeat and I will, without question, when we're ready for #2.

[Libby]

Julia,

I often feel uncomfortable commenting on these specific matters (read IF or miscarriage) because I am one of the "fertiles" and have no experience with them(thank God). However, I been reading about your struggle since your days at iParenting and well, I care. So I can't keep my mouth shut.

My first instinct was to tell you to try solo once more, but isn't having all those miscarriages and D&Cs bad for your body (not to mention your soul)? What about scarring? that can make it even harder to ge PG in the future IVF or not, right?

I don't know, it is a very hard choice and you are the only one that has the key to the awnser. Like I said, I don't know much about these things, but I care about you and your family and I am hoping for the best.

[Andrea]

I've never posted before but love to read and wanted to say CONGRATS on such greatly unexpected numbers!

And wow...what a hard decision to make. I'm not sure what is best for you in the very next couple of months but I'll tell you my experiences. It took us 3 years to get pregnant for the very first time and this was finally through IVF. Sadly, we miscarried that little one at 6 weeks. But we got back on the train, thrilled that I had actually gotten pregnant and tried again using our frozen embryos. It worked again and from the bottom of my soul I'm blessed to be sitting here pregnant with a boy. We never figured out our "problem" except that I didn't ovulate on my own but always did beautifully with a little help from meds. When we did IVF, my body responded incredibly and we got 23 eggs. We did not do PGD however but still ended up after 3 days with 15 healthy embryos.

All this to say that I can't understand why the docs say your chances of IVF aren't higher? To me, it seems like you would have an incredible chance at creating great embryos with the help of filtering out the bad sperm. From everything I have seen with IVF, I would bet your chances are great for a successful pregnancy. I would think your body would respond very well to the meds and you would have plenty of eggs to draw from. And you've seem to have created a very nice home for your little embryos since they do like to stay..if sadly, even for a short time.

The other thing I thought of is that if you do end up with several "good" embryos, would you freeze them for the future? Then the $15,000 doesn't seem like a one-time-only. You'd have more little embies to try and coax into life :-). I can't tell you how wonderful it is to know that I have embryos waiting for us after this little one is born. I no longer worry about the what if's...I know I have several chances waiting for me and for now I can rest in that thought.

It is a lot of money, but for me and my husband, it was greatly worth the risk. I realize our situation is different because we couldn't get pregnant at all without the IVF. But it was a scary risk none-the-less. Because if it didn't work, where would we go from there?

I can't even begin to imagine the pain you have felt from all your losses. You're future odds of a healthy pregnancy via the "good ole fashioned" way do seem encouraging....but I also understand that your past experiences weigh heavily on you. Whether you do try on your own, one more time or not....I really believe IVF will be a positive experience for you.

Good luck and I hope you can weed through all the info and comments to help with your decision!

Andrea

[Summer]

Wow. I am thrilled -- and surprised, frankly -- to hear that Steve is so normal. Anything that suggests that better reproductive luck is coming your way is good news to me.

I've probably told you too many times about that one Benadryl-enhanced psychic vision I had (that thing about psychic abilities was for me, right?) but the sum total of the information I gathered from that vision was this: you're going to have a daughter. You're going to name her Anna. She's going to have curly hair like yours and skinny legs. She's going to make you take her to ballet lessons, but she'll never be the star of the recital. That's all that I'm "certain" about. I got the feeling that she was the product of an unassisted conception, but that could just be my Hope Addict speaking, and we all know that her psychic abilities are for crap.

Julia, I can't tell you what to do, but I can promise to support you unconditionally, no matter what happens. I wouldn't be surprised if you get pregnant before you could arrange an IVF, because I know just how easily Steve can sweet-talk you out of your Long n' Lean jeans, and because I know your vaginal bouncers are willing to lift the velvet rope for any spermatazoa who says he knows Steve. (I've also got to say that I love Slim's idea that your ova are like me, circa 1990, always interested in the bad boys.)

Give us some more good news to celebrate around here, willya?

[Brad]

Jules -

"Above and beyond the call of duty," remember? I-V-effing-F

And I call you Jules just to counteract your brother's luring you away with your favorite nickname.

Also, I'm glad to hear you won't have to tread any farther down the donor sperm path. It didn't seem to be heading anywhere good.

[Laurie]

I've had one m/c and I've got to admit that once was enough for me. I simply don't see how you do it, as I'd be blubbering away in some mental hospital by now. So, in case you haven't guessed already, my vote is for IVF w/PGD. I agree with a previous post that said (something like) maybe this will yield valuable embryo-quality info. Good luck with your decision.

[Menita]

Hurray for the good news on Steve.
About the other question: if the worst happens again, can you bear it? Because if it (god forbid) happens, you will be no closer to an answer.
My vote is for IVF with PGD. I understand about your brother's expertise, but he's never endured multiple miscarriages, has he?

[Karen]

Here's another way to look at things.

I agree with everyone about going to IVF/PGD now.

Tell your brother and Steve that if $15K doesn't get you a baby, you can always try it nature's way, later.

Curious question tho: I've heard & read that PGD is not 100% accurate. Is that old news? Has the science gotten better? Is it lab-dependent?

How great that the FISH results are so encouraging. Go you!

[Sara]

I think the men in your life are thinking with their own -ahem - reproductive organs in this discussion.

Some percentage of EVERYONE's gametes are not right. So his are not the only ones in this scenario. Sure, he's only got 34% wonky, but you have some percent too, and you have to combine those probabilities -- one of his good sperm have to meet one of your good eggs -- and that egg has to let only *one* of his sperm in.... and .... and.... and... Its not as simple as "well, we've got a 66 % chance the next one will work out" like the men (thinking that sperm are all it takes) are thinking.

The men in your life may love you deeply - but they aren't the ones who have the miscarriages. Go for what YOU need in this.

[shannon]

I think you've had more than enough miscarriages for, oh, is it 8 people?
I understand the cool headed boys and their statistics and economics, but here's the thing, it's worth 15,000 of Steve's dollars to ME that you not have any more miscarriages. Sorry, I just couldn't bear it. Get thee to the ATM and take Steve's money to the doctor's office. That's less than $2000. per miscarriage so far. It's the least he could pay you for all that hell.

Congrats that so many of the boys are healthy.

[Emily]

IVF. The heartbreak of miscarriage is just too hard, why risk it? Maybe your odds of naturally are just as good as assisted, but why not have the peace of mind of knowing the next pregnancy is the one because you've done the tests. I'm all about peace of mind and could care less the cost. If someone told me that in order I'd be guaranteed a baby if I eat glass, I'd smash every single piece of my great grandmother's crystal amd make soup. You may not be guaranteed 100% with IVF, but it will spare you the possibility of another heartbreak and if it doesn't work, then nature's way is always available.

Glad to hear the results were good.

[Christine]

Wow - you're starting to scare me now. Are we separated at birth or something? Had two m/c, then my son - now 2 1/2yrs. That was three IUI cycles with Gonal-F. Since him, I've had five m/c, the last being ectopic. So, I'm behind you by one m/c, but I'm willing to skip it if it's okay with you.

The RE says she wants us to move up to IVF/PGD to see if that answers the recurrent m/c question and to help ensure placement of a non-ectopic embryo. We are almost two months out of the last m/c and she wanted me to wait two full cycles, then come in for HSG and to discuss the next plans.

I was lucky enough that my husband cancelled his two week business trip to China that was scheduled to start three days after the first methotrexate shot. Although, if it weren't for the risk of rupture, I think things would have gone the way of your Steve.

We had a lot of trouble deciding what to do next. The money is a huge issue since I quit my job two months ago (smart move in retrospect - shoot). But, after a long sit-on-the-porch-and-drink-lots-of-wine discussion, we decided to go for it. We actually just talked about seeing if there's any chance to cycle in December since my mother is very clear about being opposed to the ethical issues of IVF and won't babysit for us and my husband has a lot of time off htat month for babysitting.

Last week I had another period - 13 days after my last one. I said I wanted to see if they'd just put me on BCP until we do IVF if they're going to do that anyway. DH's reaction? "But shouldn't we try again on our own first?". Where the heck has he been? Why do they throw these curve balls when we least need them?

No advice for you. I want to move on to IVF/PGD simply because I can't take the statistics of only 50% pregnancy after ectopic and 25% of those being recurrent ectopics. I'm terrified to try again on my own and risk that.

Just wanted to let you know you're not alone. I can't wait to see how things turn out for you and hope we both have good luck.

Chrsitine

[Judy]

Shit, I don't know why, but I don't buy those FISH results. 66% normal? Either the test was wonky, or something else is going on in addition to the translocation.

I have no advice on how to proceed. But, when I'm at a loss I flip a coin, and while the coin is in the air I usually come to a decision (i.e. what I hope the coin will land on). I do agree with above posters that this is your decision (more then Steve's), and if you prefer to try IVF then that's what you should do.

[Ninotchka]

Congrats on the results, Julia! Better news than expected is always welcome, huh?

Re: IVF vs. "one more cycle" -- that's a doozy.

I'm leaning toward IVF because it just seems like better odds. Overly simplistic but you've already been through so much with the multiple m/c's. One more cycle just seems like one more cycle too much. How about IVF and if (Heaven forbid) that's not successful, then back to unassisted for another cycle(s). You know? If IVF = Better Chance, then go for that first. You *deserve* a better chance at this!

[ValleyGal]

I think both Summer and Karen are right.

First, if you do IVF with PGD, given the fact that you ovulate well, it seems to me that you have a high likelihood of having more than one or two "good" embryos. In that case, you'd have enough to transfer the first time as well as extra to freeze and then you could lower your miscarriage risk for multiple pregnancy attempts.

In addition, each time you miscarry "naturally" you raise your risk for developing scar tissue and/or Asherman's, which could negatively affect your ability to carry a pregnancy in the future.

Finally, trying naturally is free both now and in the future (unless either you or Steve plan to start charging admission).

If I were you, I'd be scheduling a round of IVF with PGD.

[barren mare]

Great news! And a tough call as to the next step. It makes me think you have really been spectacularly unlucky thus far, which makes it hard to weigh up, but I gotta say, I'd be inclined to the IVF route. As others have said, only you can decide, but the emotional cost of another miscarriage seems punishingly high. Only you know what you can endure, but the thought of you even having to contemplate another miscarriage makes me want to weep, not to mention crawl under the desk, rocking back & forth.

[Mandy]

Pregnant infertile here with no experience regarding IVF.....only trying on our own and IUI's.

Go with your instincts. If you feel uncomfortable trying one more time without IVF, don't do it. It sounds as if there is nothing standing in the way of IVF other than the requests from these two men in your life who would like you to reconsider. And it sounds like they both are leaving it up to you - this is where they show their intelligence, but recognizing that it is your choice.

Whatever you decide, you have the support of many.

[persephone]

I'm so happy the numbers came back so good!

I honestly don't see what the downside is to IVF. I mean, apart from the money, which you've said in the past Steve is more than willing to throw at problems to make them go away. I think this qualifies. The only other reasons I can think of not to do IVF are the injections & procedures & stress involved. And I'm willing to bet that to you, all that will seem like a piece of cake compared to what you've already put yourself through.

Why are they trying to talk you into another go on your own? Why would a pregnancy achieved that way be preferable to one achieved through IVF? Especially if the IVF one is more likely to stick? It's not like we're talking about Steve's sperm versus a donor. It's not like you don't already have plenty of medical involvement in your reproductive life. I'm really bewildered as to why anyone would urge someone in your situation not to do IVF. Unless you're not sure you can afford it.

I'm surprised that you've been quoted IVF success rates as low as 18%, though. Is that because you're most likely going to have to discard some embryos, either due to abnormalities or due to PGD itself?

[Christine]

Me again. Adding a link to the ASRM web site with a paper on IVF/PGD in recurrent pregnancy loss (versus same procedure for failed IVF or advanced maternal age). Thought you might like to add a few more stats to your worksheet - "In the RPL group 63.6% of the patients who had PGD became pregnant, significantly more than the 37.5% in the control group who became pregnant.  More than 68% of the embryos examined for the RPL-PGD group were abnormal."

So maybe we could raise the odds of IVF being successful a bit?

http://www.asrm.org/Media/Press/genetictech.html

[Gretchen]

All right Julia, I've been torn on this one for a while. I read this post several hours ago and have been stewing on it before responding. I came up with what I feel are two valid arguments...

My first thought was that I have no right to advise you either way, as I have not been through IVF myself. However, if we had the money, I probably would have done at least one IVF cycle by now. I think that my biggest point of frustration in my TTC journey was near the end of my second injectables cycle when my RE told me that he wouldn't do an IUI because I had too many follicles. He did point out that I would be an excellent candidate for IVF, though. All I could think of at that point was $$$, and how hard it had been to financially manage just an injectibles/IUI cycle, and how there was no freakin' way we could scrape together $10,000 - $15,000. So I say that if you have the funds, then do the IVF.

My other thought is how difficult/painful/dangerous a miscarriage is. I've only had one m/c, and it did a number on my head. I'm pg again, and it wasn't until my 19 week sono that I really started to believe that I wasn't going to miscarry again. Also, I can't imagine that your uterus appreciates all of that interference. I'd hate for you to have to contend with uterine scarring in addition to Steve's "special sperm". I know that IVF doesn't guarantee a positive outcome, but I have to think that starting off with known genetically compatible embryos would increase your chances dramatically.

So my vote, as long as money is not an issue, is IVF. I don't envy your position, though. Good luck!

[chris]

I'm in a similar boat. Get pregnant very easily, lost them very easily. After my last D and C (3 weeks ago) I decided that we should move on to IVF with PGD. My husband, being a financial not-genious, said sure. But the more I think about the financial aspect of it all, and the scary odds given that I will be 40 in December, I'm leaning heavily toward trying natural one more time.

Good luck.

[Jen P]

Julia, whatever you decide, I really hope it works wonderfully for you. Best Wishes!!

[Toni]

If I were you (then who would I be then?? hmmm...), I do the IVF. I've been through only 1 m/c...and it still hurts...I couldn't imagine going through another one. I'm doing EVERYTHING I possibly can to avoid it this time (glucophage b/c it's supposed to reduce the m/c rate in PCOS from 45% to 8%, extra follate, etc). And since I'm you...I'd do the same thing - do anything to avoid that pain again.

Since I'm you - would you be me? My Steve would be lonely without a 'me'.

[Annie]

Julia--

When I read your post, there's something I notice. Your men seem to have an idea that these are cumulative odds, that you've had so many miscarriages that you'll be bound to have another viable pregnancy soon. Like a slot machine, except with sperm! To me, it looks more reasonable to suppose that at each unassisted pregnancy, you have a 1 in 3 chance of having a miscarriage.

Make what you like out of those odds.

[Jessica]

Opinions? Hell yes, I’ve got an opinion!!! Not a very qualified one, I’m afraid, since I’ve never had a miscarriage, nor done IVF. B-U-T you said anyone with psychic abilities, and that’s me. Errrrr, anyways. Let’s break this problem down into three separate categories:

1) Psychological (can you tolerate the pain of yet another miscarriage?)
2) Finanical (Would the house, the cats, and the family silver be have to be sold in order to afford IVF?)
3) Physical (are there any physical dangers in trying again on your own vs IVF?)

Ahhem. To 1) Amateur psychology alert: Yes, you seem stable enough psychologically. Because if you weren’t, there would be no “wobble” – every nerve ending in your body would scream NEVER AGAIN. So, I’m just going to assume you could handle the pain of yet another miscarriage. You also said you had a gamblin’ heart. So: Psychologically: trying again would work.

2) Financially? You’d be able to afford the IVF without major inconveniences to your lifestyle. At least, that is what I understand, so correct me if I’m off.

Now for 3), the most difficult part. Miscarriages are always an infection source, and multiple D & C’s can cause Asherman’s syndrome. Not really what you want. You’ve had quite a few so far, so you don’t really need more scarring. I mean, it could be corrected by surgery, but why go there.

Sooo, 1) would be on the “try again” side, but 3) is definitely in favour of IVF. If it were me, I’d weigh 3) more, and go ahead with an IVF. Just my 2 cents, for what it is worth. We’ll support you no matter what you decide is best for you.

[Tertia]

Can't read all the comments, too long, can't....

Jules, (going to call you that all the time now)

DO THE IVF!!!!!!!!!

Txxx

[Liz]

What great news about Steve's 'numbers'! Am way too tired (not to mention clueless) to provide any useful advice. The thought of you experiencing another miscarriage is absolutely devastating. But it's a toughie - I can understand your Wobble. Whatever your decision, I'll be cheering you on from afar.

[LauraN]

Julia,
this is going to be long!

When you toss a coin you have a 50-50 chance of getting either side, but you could have a string of 3 or 4 of the same side, so if you only toss the coin few times you may get a 20-80 in favor of one side. But if your number of tosses is high enough, statistically you will get a 50-50 percentage. Although you had 8 miscarriages (right?), from a statistical point of view the number may be not significant to give you a 33-64% pregnancy success rate. In other words, if you keep tossing this coin you probably will have another normal child, like you did with Patrick and this is what your hubby and your brother are thinking. However, this is not a black and white situation, or a simple coin toss. Like other suggested, what happens to your uterus or hormones when you have all these losses and D&Cs? Is there an advantage to the abnormal sperms so they will fertilize the egg first? I would like to know what the abnormality is, so could you e-mail me? Have you talked to a geneticist who explained the abnormality well to you? Another piece of information....most miscarriages in women with NO IF problems are due to chromosomal abnormalities that occur during division of the egg (texts put that number as high as 20-25% of pregnancies are lost due to chromosomal problems). So if you didn't have your miscarried embrios analyzed, it could as well be that one of them was lost for something other than Steve's chromosomal abnormality, thus giving you a statistical number other than 34-66, like the 88% you wrote. Does this make sense to you? I am sure your head is spinning now ;0)

I would also consider other underlying causes that may have not been excluded yet. I assume that you have already been checked for Rh-, progesterone levels and other problems that can cause early pregnancy losses, correct? These things will be really controlled during the IVF cycle.

I would have consider the odds of IVF with PGD. How many eggs do you need in order to be able to have PGD? If Steve's sperm is 64% normal can you calculate how many embryos you can expect to have after the procedure, assuming an average egg retrieval? If there is a average number they can predict. Assuming that some will be lost because of the PGD, you will need a good number to work with, right? Because you clearly don't have a problem with your eggs, most likely you will have a good response to stimulation so you will probably have many eggs to work with. Are they going to try the highest number of eggs because of the PGD?

I am not sure this all makes sense to you. I am not sure what I would do if I were in your shoes. Eight miscarriages seem like a huge number to me. It is not like you had so many that you are used to them by now so one more will not be a big deal. The pain increases each time, and there is no statistical number that will tell you that if you miscarry one more time the next one will be a live baby. I hope your DH and brother will understand this.

I would say, research this IVF with PGD really well, what the odds are, etc., be informed and then make a decision.

I don't mean to be totally rational about this, but this is my response as a Biologist. I am sure emotionally you want to jump on the IVF rollercoaster immediately. I am really sorry about the pain you have been through, I cannot even begin to imagine it. I just hope that we all helped somehow in this difficult decision.

Best of luck,

LauraN

[Allisun]

I’m green. I don’ know a FSH from an e2 from a hole in the wall. Not true, actually, I’m clever enough to establish the hole. My advice, or shall I call it, what would I do, comes from my heart. Gut, if you will.

IVF.

Let’s say 34% are abnormal but manage to lay claim faster than the 66% normal ones. What about that statistic from God knows where that states one in four normal pregnancies will end in miscarriage?

Most of this entire magical miracle is so entirely out of our control, I would be desperate and hopeful enough to do everything I could to stack one more odd in my favor. Even if it was for a single odd. Even if I had to borrow to pay for it. Even if it would have worked otherwise.

Months and tries are so so valuable, you'd give anything to get them back. The means are there. That you’ve been marked a good candidate; it’s a big, fat, good sign, no? Steve, your brother, the fan club, we’ll support you with bated breath no matter what.

It’s the way you haven’t yet tried. Maybe after, like a baby after, you can go back.

Allisun

[Summer]

Hi, it's me again, did you miss me?

Last night, Vince and I spent our entire dinner (some crazy spicy chicken curry from the Jamaican carry-out) discussing the latest twist in your situation. For the record, he didn't see any reason that you shouldn't do the IVF, but I thought of two points that I don't think have yet been raised.

1. IVF with PGD wouldn't just spare you the high risk of miscarriage, it would spare you the ten weeks of emotional agony as you wait to find out a) if the baby will last long enough to make to CVS testing, and b) what the results will be. I think you've said something about lying curled on the dining room floor, chewing the legs of the table during that time period. Honestly, it's been hard enough on me to wait out the beginning of your pregnancies, and I'm separated from you by most of the continent and thousands of miles of DSL cable.

2. PGD, if you had beaucoup embryos, would give you the chance to transfer only genetically normal embryos. I know that a healthy carrier baby is WAY preferable to an unbalanced, will be lost baby, but given the choice, wouldn't you rather spare your child this reproductive trauma? Actually, what I'm really saying here is this: have you thought about whether you would transfer a healthy carrier baby?

I'm so glad that you have this decision to make, but man, I do not envy you. You ARE going to have another baby, soon. I can't wait to take up the challenge of finding a baby gift for you as thoughtful as the one you sent me.

[Moxie]

Not to be a follower, but I'm with the crowd voting for IVF with PGD. All I know about it is what my SIL's gone through, but here's the way I've puzzled it out in your case:

1. I'm with Judy above who says that 64% normal but 8 miscarriages just doesn't add up. There's something else going on. A natural pregnancy (and probably m/c) won't tell you what that it, but IVF with PGD might.

2. What if one more D&C finally does your uterus in? How much can one uterus take, anyway?

3. You seem to have no trouble producing eggs, so you may very well end up with enough healthy normal embryos after the PGD to do an FET round or two or three if the IVF doesn't work the first time. FET rounds are easier on your body and your wallet. So it's not necessarily just a one-shot deal with the IVF, and the PGD is a sunk cost over the IVF round but also any future FETs you do with other embryos you produce.

And, frankly, I don't think Steve gets one single effing vote in this, since he left you after your last D&C to go away with friends for the weekend. He clearly has no idea what the experience is like for you (it sounds to me like it scares him too much and he feels too guilty to hang around for the aftermath). And your brother is looking at this as a scientist.

[e]

Big fish, small fish, Swedish fish, lutefisk.....I see it like that. Swedish fish, there are NEVER as many in the bag as you'd like, they seem to disappear so quickly, and even then sometimes they are too chewy, but yet they call to you and make you want to keep trying them because you KNOW they can be SO good. But lutefisk.....bleh.....it creeps all over your plate, sliding into your meatballs and lingonberry sauce. You can't seem to get away from it no matter how hard you try. It swells in your mouth and it smells bad and it ruins a perfectly good holiday meal. Even Aquavit can't take the flavor away. Why would anyone ever soak their fish in lye??

IVF is my vote.

[Linda]

J~

I've got no opinion here (that I'm sharing at least), but I'll say that I didn't find IVF to be horrible. Of course, I only had a few complications and then a positive pregnancy test so who am I to talk? But from your post I'd say you're heading towards one more try in the casino, hoping to beat the house this time. Man, I hope you do.

[Robyn]

Julia,

When I read your entry a couple of days ago, I was going to post but I was afraid my opinion would have been slammed. I was even thinking about posting in the cowardly way with no name.

Anyway, I agree with most everyone here that you should go with the IVF. Although I never have miscarried, I know from your experience that it is one of the most gut-wrenching things that can happen to a women. And I know your brother and Steve mean well but they are not women (at least I hope not) and really could never understand what you have been through.

Take care, dearest. Let us know what you decide.