It’s not me—it’s you [embryos]

Okay.  I had an eye-opening conversation with my RE.  (And I thought my eyes were already pretty open.)

I should start by saying my RE is not a bull-shitter, and he does not like to speculate.  (Two things I like about him.)  So when he tells me things, I believe him.  I’m not saying he’s always right, but I think that he tells me what he really thinks.  So, here we go…

He thinks the fact that our last two cycles were quick implants and losses suggests that there is something wrong with the embryos.  Because they were tested, we know they had a normal number of chromosomes.  But that does not tell us about the actual genes.  Combined with the fact that we have had seven pregnancy losses, most of which were early, he thinks that we produce a large number of (while chromosomally normal,) genetically abnormal embryos.  And it might be that there’s something with my genes that is wrong but not fatal (I’m okay) and same with my husband, so we can produce normal embryos (our kid!), but we also produce a lot of bad embryos.  Maybe in 10-20 years doctors will be able to sequence the actual genome (and freak everyone out with the prospect of designer babies), and we will be able to tell at that point which embryos were wonky.  Now, we just have to keep putting embryos in and hoping one is okay.  (He also indicated that this was not a common affliction, and that if his theory is true my husband and I could have gone on to have no issues with other partners.  Crazy!)  We know that our last three chromosomally normal embryos that failed were all female, so maybe it’s something just with girls?  Who knows!

Now, this is just his theory, but it would explain why we’ve had so many early losses.  And it could explain our blighted ovum and even our anencephaly pregnancy. 

That theory made me feel much better.  I’ve been beating myself up over and over again that there was something wrong with my womb (clotting disorder, thin lining, immune issues! – I’ve been calling it the bat cave) or something wrong with my actions (not enough folic acid, too much exercise, etc!).  But maybe it’s not me at all…. it’s the wonky embryos!  And if that’s true—we produce some normal embryos, but a lot of abnormal ones, and it’s nothing we can test for—well, it’s just a numbers game.  How many times are we willing to do this?  And if I’d known that was the score from the beginning, I might’ve come to the same decision we find ourselves having made at this point: put ourselves through two fresh retrievals, and use the embryos from those (9 total embryos) and be done.  BRUTAL, of course, but at least we would know what we were in for. 

He and I talked more about dexamethasone.  He said it was a steroid that lowers white blood cells (inflammation), which could cause implantation issues.  He said that less than 5% of his patients go on dexamethasone, and the ones that do are the ones who have later repeated first trimester losses suggesting potential immune issues.  He puts patients on 0.5mg dexamethasone and then tapers them at 6 weeks.  He said he did not have any concerns about impact on the developing fetus.  He noted that dexamethasone was more frequently used during the egg retrieval cycles, as it could be used to decrease cycle cancellation and increase egg retrieval.  (I have a friend who has done several retrieval cycles at CCRM and she told me she had been on dex for all of those cycles.)

He said that he really does not think we have an immune issue, but at this point he’s willing to try a steroid.  We talked about prednisone as well.  He said his lab has only used dexamethasone, but he would consider other steroids.

We also talked about antihistamines.  He said that theoretically they could have an impact, but he would not want to put a patient on both steroids and antihistamines.

The average patient at my clinic with a chromosomally normal embryo has about a 70% chance of getting pregnant.  Based on our history, and his theory that we have chromosomally normal but genetically abnormal embryos, he gives us a chance of 50% with our B2 boy, 40% with our B3 girl, and 10% with our untested mystery embryo.  Okay, those are not great odds, but we’re not totally out of the game!  Based on his opinion of our chances of success, we’ve decided to stay the course.  Our next transfer we will continue to do a selective single embryo transfer, even though we’ve had SIX failed SETs in the last two years.  Yes, we are thrill seekers.  (If we implanted two embryos, they worked, but then something went wrong—it would be one of my greatest regrets.)  IF the next one does not work, we might transfer two for the last cycle, because the chances of the both the last one and the “wonky” one working, considering our history, is incredibly low.