Sixth Time's the Charm - IVF Failures & Success
I met Anne through our mutual friend Bethany. We attended fertility yoga together and encouraged one another on our simultaneous fertility journeys. Throughout Anne’s journey, I was struck and impressed by her calm and patient perspective. Anne and Kyle’s journey is a story of judicious decision making, persistence and grace.
Anne and her husband Kyle met in college where they both ran track. They became college sweethearts and got married during Anne’s final year of her graduate physical therapy program. Both Anne and Kyle spent the next few years engaged in their work and focused on career growth. Kyle, an engineer, established himself at a local firm where he would later become a partner, and Anne started taking on a management role in her PT practice. In January of 2012, a couple years into their marriage, they decided to start trying to have a family.
By fall Anne went to her OB for a standard annual visit and after discussing her cycles and the irregularity in the duration of each cycle, they decided to do some fertility labs to check things out. Anne’s OB contacted her to share the lab results while Anne and Kyle were vacationing in Hawaii. Anne remembers her OB telling her that based on her numbers, it appeared that Anne may not be ovulating. As soon as Anne returned home, at the recommendation of her OB, she started taking Clomid, a common infertility drug used to induce ovulation, particularly in women that are not consistently ovulating. Anne experienced severe headaches and felt overly emotional taking Clomid, but despite the side effects, she kept taking Clomid for 5 or so cycles with no success.
When Anne and Kyle were about a year and a half into their journey, Anne sought out a therapist that one of her friends had recommended. Anne explained that the therapist “helped me think about what another story could be for me. I knew [having a family] is kind of what I pictured and what I imagined, but the therapist asked what life could look like if this doesn’t work out or the timing doesn’t work out. I think, looking back at high school, I got into the college I wanted to get into, I did well in college, I knew I wanted to go to PT school, I got into the PT school I wanted to go to, I got a job right after PT school, and was successful all along the way. This is really the biggest thing in my life that just didn’t happen the way I wanted it to happen. It was a really tough thing for me, getting over that, that I wanted this so badly but it just wasn’t happening the way I wanted it to.”
From an OB to a Reproductive Endocrinologist: Fertility Drugs + IUIs
After their unsuccessful cycles trying naturally and on Clomid, their OB referred Anne and Kyle to a reproductive endocrinologist in the winter of 2014, 2 years into their journey. The clinic performed an infertility assessment and diagnosed Anne with PCOS (polycystic ovarian syndrome) due to numerous small cysts on her ovaries. Women diagnosed with PCOS may also have anovulatory cycles, cycles in which they don’t ovulate at all. To try to remedy this, the clinic recommended Anne start taking Femara, also known as Letrozole, in conjunction with performing IUIs (intrauterine inseminations). Femara/Letrozole have been found to be effective for some women who have not had success taking Clomid, and their reproductive endocrinologist hoped this would be the case for Anne. However, cycle after cycle the combination of IUIs and Femara did not result in a positive pregnancy test.
I was an acquaintance of Anne’s during her fertility journey, and one thing that struck me was the sense of patience and peace Anne had throughout her journey. I asked her how she and Kyle handled the uncertainty, waiting, and monthly disappointments privately, and she explained that Kyle was her steady and stable support which helped keep her calm. Anne also said, “Travelling became our default coping mechanism. It would either be a celebration or a way to get away.” Anne recalled a handful of vacations that were clouded by her getting her period or negative news from the clinic, but she said the travel helped to keep them going and engaged in other things outside of their fertility journey.
Anne remembers, “As we went through the IUIs we kept saying, nope, not ready for IVF”, and they would move forward with another IUI. After a number of cycles with no success, including a cycle incorporating the trigger shot into the IUI process, their clinic laid out the statistics for IUIs versus IVF (in vitro fertilization), and being a numbers guy, Kyle looked at the numbers and they both agreed that they were ready to move onto IVF. I asked Anne how much finances played a role in when they decided to initiate IVF, and she explained, “We had already exhausted our infertility insurance lifetime max during the IUI process. We were very fortunate that the financial piece was there for us.”
During this time Anne sought out community in her fertility journey and started attending an 8 week fertility yoga series. followed by weekly drop in classes. The workshop covered holistic therapies, nutrition, stress management, self care, and non toxic living. Throughout the workshop Anne started to understand the importance of work-life balance, self care and making time for herself.
“Those first couple years of us trying, both of our stress levels were really through the roof, which who knows how much that affected things. I look back and I really had nothing to help me relax. Now I think about what prior commitments I can say no to and that’s something that I figured out through all of this.”
IVF: Cycles 1-3
In June of 2014, two and a half years after Anne and Kyle started trying to have a family, they moved forward with their first round of IVF. They were extremely successful in their retrieval, with over 30 follicles, 26 of which were successfully fertilized, and the vast majority of them were well rated. Anne and Kyle felt very lucky to have such a successful and prosperous retrieval. Anne responded well to the hormones, which alleviated any concerns about her PCOS diagnosis, and they moved forward with their first IVF cycle using a fresh embryo. Unfortunately, the cycle did not result in a positive pregnancy test. By fall, Anne and Kyle decided to move forward with a second IVF transfer, their first using a frozen embryo, that October. To their disappointment, it did not result in a positive pregnancy test. At the end of that year, Anne and Kyle decided to try another frozen transfer, their third IVF transfer, which again did not result in a positive pregnancy test. Anne remembers feeling exhausted and in need of a break physically and emotionally following the three unsuccessful transfers.
“I think it was super helpful for me to talk to other people and open up to people around me. I knew these are people that are going to be there for me if it doesn’t work. There were times that I couldn’t emotionally tell [friends and family] before a transfer, but I found if I didn’t tell them, it was harder to tell them that it didn’t work.”
After trying to process the unsuccessful transfers, Anne and Kyle discussed their options with their reproductive endocrinologist, and they unanimously decided to do chromosome testing on the remaining embryos. The chromosome testing was done in batches of 8, so they sent 8 embryos for testing and held the others. Anne explained that the testing seemed like the natural next step for them based on how well their transfers had gone with no clear explanation for failure.
“The day that they were thawing them to do the chromosome testing, I had this weird sensation. I felt like I knew something was happening with these embryos.”
The chromosome testing findings were favorable, revealing 7 of the 8 embryos were normal. Anne recalled, “By the time we hit the chromosome testing we just didn’t understand what was going on, there was no reason not to try again because everything looked good.”
IVF: Cycles 4-5
And so, with positive testing results on their side, Anne and Kyle decided to try another frozen transfer. To date, Anne and Kyle had transferred one embryo each cycle. As they were preparing for this transfer, Anne felt compelled to consider transferring two. She called the clinic and asked if they could look at their data to see if they had better odds transferring two. The clinic reviewed their data and based on similar populations to Anne and Kyle, their recommendation was to only transfer one embryo. And so, in August of 2015 they moved forward with their fourth IVF transfer using one of the confirmed normal chromosomal embryos, but the transfer did not result in a positive pregnancy test.
“All of the transfers went perfectly, the embryos were all good quality, they just didn’t work. The reproductive endocrinologists were also frustrated that they did not have an answer.”
Throughout their journey, Anne had tried a number of holistic therapy approaches to infertility. After learning that their embryos were chromosomally normal, she decided to dig deeper into some of the practices. Anne sought out private holistic fertility health coaching from the same instructor she had for her fertility yoga 8 week series a few years prior and started a 6 month elimination diet. She also started going to acupuncture regularly, had mayan abdominal massage work done, and started seeing a physical therapist that specializes in visceral manipulation.
“I was skeptical about many holistic medicine and self care techniques, especially with my physical therapy background, but you get to that point where you‘re ready to try the next thing, that you didn’t initially think you would do. Now, I am starting to incorporate these practices into my PT practice. It’s pretty remarkable.”
After news that their fifth IVF transfer didn’t work, and with the support and prompting of Anne’s close friend Bethany, Anne, Kyle and Bethany attended the RESOLVE Family Building Summit. Anne was starting to consider the idea of a gestational carrier and they were able to learn more about it at the conference. It opened their eyes to what a carrier could look like and the general process. The summit also offered 15 minute time slots to meet with a reproductive endocrinologist, which Anne and Kyle took advantage of. They wanted to meet with a doctor from a different clinic to see if they had any other ideas or recommendations - basically a way to get a quick second opinion. Anne said they told the doctor everything as efficiently as possible and then he sat there, his wheels were spinning, and eventually he listed a number of recommendations to try. Anne asked if, in his opinion, they should stop pursuing IVF, and he said, “No, absolutely not, I wouldn’t be done trying if everything has worked, there’s no reason to stop.”
“I think it was helpful for Kyle to be there and to be surrounded by other men and couples going through this. To convince Kyle to go to this was kind of a stretch. I think in the end he got more out of it than me.”
Anne and Kyle felt re-energized and hopeful coming out of the RESOLVE conference. They discussed the recommendations from the reproductive endocrinologist at the conference with their clinic and made of number of changes to their prior strategy. By spring, Anne had been on a strict elimination diet for months, was attending acupuncture weekly, and was deep into her holistic fertility program in preparation for another round of IVF.
IVF: Natural Cycle 6
In April of 2016, Anne and Kyle decided to try another frozen transfer. In addition to the holistic therapy additions, Anne took Heparin, a blood thinner, along with baby Aspirin, and they did a natural IVF cycle. Normally, a woman preparing for IVF would go on birth control for 2-4 weeks before a frozen cycle and the clinic would monitor her cycle and have her take estrogen to align with the thickening of the uterine lining until it is ripe for implantation, at which time the transfer is done. In the case of a natural cycle, Anne followed her cycle, tracked her basal body temperatures, used an ovulation predictor kit, and called the clinic when she got a positive ovulation test and went in the following day for the IVF transfer. This time, on their sixth transfer, Anne and Kyle received news that they had a positive pregnancy test, their first and only positive test in four years. After much anticipation, that December Anne and Kyle welcomed their daughter Chloe Rae into the world.
I asked Anne what she learned and how she changed during her journey to fertility. She said, one thing she is continually reevaluating is her work-life balance. She stressed the importance of a good work-life balance for her and her husband Kyle, especially now with a one year old daughter. Anne also reflected on her marriage and their life as a family, and said, “I think Kyle and I have a stronger relationship because we went through all of that together. If it would have happened right away we would have a very different life than we do now. It happens for a reason, not easy to hear that when it’s happening, but at this point I’m glad it happened when it did.”