First doc appointment

So, things went so well at the appointment with the doc that I'm thinknig about cancelling the other appointment.  I mean, what are hey going to tell me that the first doc didn't already tell me? 

I like this doc's more aggresive style.  AND, my biggest concern about this doc was that because he was a smaller outfit that their embryologist wouldn't be able to do the day 5 blastoderm biopsy that I would want to do for the PGS.  (There's a whole school of thought on what day to take out a cell to run the testing on it.  Here:  http://www.genesisgenetics.org/pgs.html  if you want to read all the studies.  Personally, I found them fascinating, but I'm wierd like that.) 

What it comes down to is that there's a certain amount of mosaicism that naturally occurs in splitting embryos.  Mosaicism is when the egg has one cell that split incorrectly, but all the others are normal.  The egg does a pretty good job of pushing the bad splitter to the side and continuing to develop the baby from the good splitters.  From the outside, you can't tell which eggs have split chromosonally well and which haven't.   So, the embryologist will take out one cell from a 3 day embryo (there are only 8 cells at this point, so the embryo can only afford one) and 2-3 cells from a 5 day blastocyst (which has over 100 cells at this point).  And, the embryologist can take the cells from the trophectoderm which is the part of the cell that will become the placenta. 

So, then the lab can look at those 2-3 cells and decide if there is mosaicism present and we can make a judgement call at that point.  Also, if they happen to take the day 3 cell that has the "bad" mosaicism, the whole embryo will be graded as bad.  Whereas if you wait, the embryo may have stopped dividing that cell and all the other cells are normal and you'll only get normal cells at day 5. 

BTW, studies show that about 1/3 of embryos have some mosaicism. 

But, the point of all this is, is I asked the doc how he felt about the ability of his embryologist to do a blastomere biopsy and he stated, "Frankly, we'd have the lab come out and do the biopsy.  They're more experienced and there the ones taking responsibility for the cells.  They like it that way."  And, so do I!  I'm always super impressed with someone who can see their own limitations and find a way around it.  So, right now I see no reason why we wouldn't go with this doc. 

Why?

So, for anyone who doesn't know the details, this is my current theory on why I've been having all these miscarriages. 

This article sums it up well:

  http://www.livescience.com/22706-super-fertility-recurrent-miscarriages.html

Essentially, the theory is that some women have a uterine lining that is "too" receptve to embryos.  While as a "normal" woman will have a uterine lining that will reject low quality embryos, some women ahve a uterine lining that will let anything implant.  This leads to a shorter time to pregnancy than average (me) and a greater number of miscarriages than average (me) because the body fails to reject the low quality embryos. 

So, hopefully, IVF can help to preserve any fertility I have left and with PGS I can pick only the good chromosonally sound embryos to put back. 

The story

HHHHhhmm    I'm new to this whole blogging thing.  So, I thought "A Little Background" would be the name of this post, not my whole blog....  But, maybe it's appropriate...

So, here's the story.

DH and I were married in 2005.  We decided to start a family after about a year and after one time on the first try (we were on a camping trip with DH's family!) we were pregnant.  Well, that was easy.  A beautiful son was born 9ish months later in 2007.

We decide to try for #2 and, while still nursing ds, after 3 months we got pregnant again.  9ish months later dd was born in 2009.

We decide to try for #3 (I'd always wanted 4 kids) and while still nursing dd, 3 months later, we're pregnant.  This was early 2011.  Well at 11 weeks we find out it was a blighted ovum.  We opt for expectant management and the miscarriage finally happens at 14 weeks.  The doc is following the HCG down to zero and the HCG is only falling very, very slowly. 

This is just a fluke thing so, of course, we try again.  3 months later we're pregnant again before the HCG gets back to zero.  So, now the doc sees the numbers start to go back up again.  But, they're rising very, very slowly.  At about 6-7 weeks I start to bleed.  Nothing is seen in the uterus.  The numbers are still rising and I decide I need to see a Recurrent Pregnancy Loss (RPL) doc, Dr. Mary Stephenson.  By then the numbers have finally started to fall again.  (Again, the numbers are falling very, very slowly.) 

The doc starts all the RPL testing including a hysteroscopy, endometrial biopsy and endometrial function test and all of the conceivable blood tests.  Everything comes back normal.  (Which isn't surprising because we already had 2 successful pregnancies.)  We prevent during all of this testing, but start trying again in early 2012.

We get pregnant in May 2012 and we're excited to find out it's twins!  But, they're monoamniotic identical twins.  Around a 50% chance of making it to birth.  We find out at the 13 week appointment that we are not in the winning 50%.  We opt for a D&C.  (Genetic testing reveals 46XX. Chromosomally normal girls).

Just try again, they say.  The odds are in your favor.  We try again and find out we're pregnant 2 months later.  Again the numbers are low and slow and between 6 and 7 weeks I start to bleed again.  So, that brings us to today.

But, I'm tired of beating my head against the wall.  I'm tired  of doing the same thing over and over again and expecting different results.  (This is the very definition of insanity.)  So, we want to do IVF with PGD, specifically CGH.  PGD is pre-implantation genetic diagnostics and CGH (comparative genomic hybridization) is a specific type of PGD which looks at every chromosome to make sure the embryo is chromosomally sound. 

I've met with my RPL doc (Dr. Jennifer Hirshfeld) who states that it's not what they recommend, but she can certainly see why I would want to do it.  She states they don't do PGD in her office, but she gives me the names of 2 clinics that do.  I'm going to research them today and make an appointment with one of them.  Also, I found another clinic that does it and I have an appointment with them for early January. 

Update - The second appointment (from one of the recommended docs) is now set up for late January.