February 2011- My husband and I are both really excited to finally started trying for a baby! We had been ready to start a family for a couple years, but we decided to hold off while I went back to school to get my masters degree. I had a sneaking suspicion that I had lean polycystic ovaries syndrome and was a bit worried by how light my periods were. My cycles proved to be relatively normal with ovulation tests showing an LH surge each month. Almost a year later we were still eagerly waiting.
March 2012- First consult with RE at local fertility clinic. Initial blood work prescribed for both of us, a hysterosalpingography for me, and a semen analysis for DH.
April 2012- My initial work-up comes back normal apart from a thin endometrial lining. DH’s semen analysis comes back with low count, poor motility, and 7% morphology with a borderline high multiple anomalies index (Rx: hypospermia, moderate oligospermia, necrospermia, asthenopermia, and teratospermia).
May 2012- DH meets with andrologist. 2nd semen analysis prescribed for June to confirm diagnosis of male factor infertility.
June 2012- Severe male factor infertility confirmed. 2nd semen analysis worse than the first: low count, poor motility, 1% morphology with a high multiple anomalies index.
July 2012- DH diagnosed with a grade 2 varicocele. Varicocele embolization scheduled for September 2012.
July 2012- DH starts taking vitamins based on a protocol I found on the Cornell University Institute for Reproductive Medicine website.
August 2012- I start a new job on the other end of the city from our current fertility clinic and we start looking into changing to the clinic next to my work.
September 2012- DH has varicocele embolization surgery. Semen analysis scheduled for December 2012 to see if the surgery has helped the numbers go up.
October 2012- DH starts acupuncture.
December 2012- Semen analysis post-varicocele embolization shows slight increase in count and motility, morphology still low (2%) with a high multiple anomalies index. Based on the results our RE recommends going straight to IVF ICSI.
December 2012- Change fertility clinics, to a clinic that I can walk to from work, in preparation for IVF #1. Sorry to say goodbye to my RE at the first IVF clinic.
December 2012- Test cycle to see if taking oral estrogen will help thicken up my lining. Lining appears to respond reasonable well. IVF #1 planned for February.
December 2012- I start acupuncture.
February 2013- IVF #1 (GnRH-antagonist cycle to avoid ovarian hyper stimulation: Menopur, Orgalutran, Decapeptyl, Utrogestan + meds for lining- Vitamin E, Endothélon (grape seed extract). 29 eggs retrieved, 24 fertilized with ICSI, elective single Day 3 embryo transfer (8 cells, grade A), 7 Day-3 embryos frozen (8 cells, grade A) = BFN. We would have liked to have grown our embryos out to blastocysts, but day 5 landed on a Sunday and our laboratory is closed on Sundays, so day 3 it was.
May 2013- FET #1 (Puregon, Ovitrelle, Utrogestan + meds for lining- baby aspirin, Vitamin E, pentoxifylline, grape seed extract). Thin lining, 6.8ish mm. Elective single embryo transfer (Day 3)= BFN
June 2013- FET #2 (Hormone replacement therapy- Provames/Estrance, Utrogestan + meds for lining- baby aspirin, Vitamin E, pentoxifylline, grape seed extract). Thin lining, 7ish mm. This cycle we opted to unfreeze 4 of our remaining Day 3 embryos and grow them out to Day 5 blastocysts. Three survived, one was transferred and two were refrozen. Elective single embryo transfer (Day 5 balstocyst)= Chemical pregnancy (Beta #1- 38, Beta #2- 66, Beta #3- 17).
September 2013- FET #3 (Hormone replacement therapy- Provames/Estrance, Utrogestan + meds for lining- baby aspirin, Vitamin E, pentoxifylline, grape seed extract). Lining made it past 8mm after 21 days of oral estrogen. Elective single embryo transfer (Day 5)= BFN. We unfroze the two remaining Day 3 embryos and grew them out. One survived. We have 2 refrozen Day 5 blastocysts left.
October 2013- FET #4 (Hormone replacement therapy- Estrogen patches, Utrogestan + meds for lining- baby aspirin, Vitamin E, pentoxifylline, grape seed extract). J-12 endometiral biopsy. Thinish lining, 7mm. Elective single embryo transfer (Day 5)= BFN. One refrozen Day 5 blasto left.
Nov 2013- FET #5 (Hormone replacement therapy- Estrogen patches, Utrogestan + meds for lining- baby aspirin, Vitamin E, pentoxifylline, grape seed extract). Thin lining, 6.5mm. Single embryo transfer of our last frozen blast from IVF ICSI #1= BFN
Nov 2013- Hysterosonography shows normal uterine morphology, but thin uterine lining (5mm on Day 13).
Feb 2014- Hysteroscopy and luteal phase endometrial biopsy (MatriceLab) to look at NK cell activity. Lab unable to analyse biopsy due to insufficient size of biopsy sample. Basic biopsy results show that my endometirum appears to be in the luteal phase, but lagging behind where it should be.
April 2014- IVF #2 (GnRH-antagonist cycle: Menopur, Cétrotide, Ovitrelle, Utrogestan). 9 eggs retrieved, 6 fertilized with IMSI, 2 blastocysts transfered on day five (4AA, 2AA) = BFN. Two 4AA blastocysts vitrified.
May 2014- Second opinion appointment with RE at the big public hospital in town. The RE said he doesn’t think the NK cell and other experimental biopsies are worthwhile. He said that our problem was likely still purely male factor infertility and that we needed to just keep trying and potentially consider donor embryos. This plan of action is far too passive for me at present. If we have to proceed with FIV #3, we might consider seeing this RE from the public hospital, but in private because he guaranteed that I could have appointments before work (7am), after work (6pm), and that he was always on time. Not having to wait 1 to 3 hours after my appointment time for every appointment is extremely enticing.
June 2014- NK cell endometrial biopsy, Endometrial Receptivity Array biopsy, and more blood work.
The NK cell biopsy showed insufficient immune activation due to a diminished recruitment of NK uterine cells.
The treatment strategy aimed at increasing local endometrial reactivity:
1) Endometrial scratch in the mid-luteal phase of the cycle prior to the transfer, 2) FET with minimum or no stimulation rather than a transfer after egg collection, 3) HCG booster after the transfer if natural cycle, 4) Sexual intercourse pre and post-transfer.
The ERA biopsy concluded that my endometrium was pre-receptive after 5 full days of progesterone suppositories and recommended a second ERA biopsy after 6 full days of progesterone.
The blood work came back mostly normal: Active protein S (slightly low, but need to retest during a natural cycle because the test was done during a hormone replacement cycle), Anti-cardiolipine antibodies (normal), Lupus anticoagulant (absent), Factor V Leiden/Prothrombin G20210 (absent), Complete Blood Count (normal).
July 2014- Doppler ultrasound to look at endometrial blood flow and 2nd ERA biopsy after 7 full days of Progesteron.
Endometrial blood flow appeared to be normal on the Doppler.
The 2nd ERA biopsy concluded my endometrium was receptive after 7 full days on progesterone (P+8). The recommendation is to proceed with a transfer of a day 5 blastocyst after 7 full days on progesterone.
August 2014- Natural cycle with luteal phase endometrial scratch prior to FET. Simple dating biopsy concluded that my endometrium appeared to be in-phase. Wondering if the late window of implantation detected by the ERA biopsy is due to how my body reacts to the hormone replacement cycles.
September 2014- FET #1 (Hormone replacement therapy- Provames/Estrance, Utrogestan). Lining at 7.5mm after 21 days of oral estrogen. Transfer of a 5-day blastocyst after 7 full days of progesterone (P+8)= BFN. We have one wee day 5 blastocyst waiting for us.
October 2014- I need to call to schedule yet another WTF appointment.
December 2014– FET #2 (Hormone replacement therapy- Provames/Estrance, Utrogestan). Lining around 7mm. Transfer of a 5-day blastocyst after 7 full days of progesterone (P+8)= BFN.
January 2015- Change IVF clinics to work with a fertility specialist who has lots of experience and is always on time for appointments (yes they do exist). Never knowing how late my first RE was going to be and having to typically wait 2 hours for 10-minute appointments was becoming increasingly stressful, tiring, and difficult for me to manage with work.
January/February/March 2015– IVF #3 (Synarel, Gonal F, Ovitrelle, Utrogestan). Lining at around 8mm. 9 eggs retrieved, only 5 mature, 5 fertilized with ICIS/IMSI, 2 blastocysts transfered on day five (4AA, 4AA) = BFN. No blastocysts vitrified. By far the most challenging cycle for me emotionally.
March 2015– WTF appointment. RE suggests using the exact same protocol apart from reducing the dose of Gonal F. For IVF #3 we had the fewest number of eggs retrieved, the highest proportion of immature eggs, and the fewest number of blastocysts out of all our previous cycles. For past WTF appointments with our first RE, I usually came out feeling like I had somewhat of an understanding of and faith in the proposed treatment steps. Walking out of this WTF appointment, my predominate feeling was still WTF.
July 2015- We decide to take our time before IVF #4 in order to get a few more medical opinions about our infertility.
-Appointment #1: I meet with an endocrinologist to see if my PCO could be contributing to our difficulties to conceive on top of the severe male factor issues. I’m thin, so most doctors just brush my PCO aside. The endocrinologist took the time to listen, provided a pertinent analysis of our situation, and was just lovely overall. I’ll be doing some more Day 3 blood work to determine if my PCO needs to be addressed.
-Appointment #2: I meet with an RE who prescribes more blood work and a hysteroscopy with a very specialized doctor during the first half of my cycle since the others were all done during my luteal phase for the NK cell biopsies. The RE wants to wait for all of the test results before making any recommendations for our next cycle. She seems to be an up and coming star in the world of REs here, so I’m really interested in her opinion. But the fact that she is so overbooked makes me a bit nervous.
-Appointment #3: I meet with another RE who has a lovely presence. He prescribes a FISH exam (Fluorescent in-situ Hybridization) for my husband. I didn’t realize this exam was available where we live. If the FISH exam is abnormal we would qualify for PGD, which is only legal in very specific cases where we live. He says he could follow us for our next cycle, but that he wouldn’t be able to offer much more than the treatment we have already received where we live. He recommends going to Spain for our next cycle because he feels the labs there have much better technology and might help us get closer to our dream of having children.
September 2015: Bloodwork and hysteroscopy for me and the FISH exam + full semen analysis for my husband. Hoping this will give us some direction.