Chromosome Karyotyping and Immune Testing

Or, as I think of the addition of these tests onto our infertility resume, Doom and Hopelessness (in either order) because they usher in so many new and scary questions and scenarios.  And what I feel is doom.

We could have dressed quickly, left immediately, burst into tears in the car, made the depressing 6 hour drive home.  The replay of 5 months ago makes me sick.  Instead, I asked the RE, why is this happening again?  My affect was one of exasperation and discouragement.  The RE seemed to show these emotions as well.  The room felt kind of tense and I almost perceived annoyance. 

He asked if we would like to talk about the possibility of chromosomal issues or if we would prefer to go over next steps at a later time.  We decided to get dressed (me) and talk about next steps right then. 

Next steps include chromosome karyotyping for both F and I and immune testing for me.  The nurse brought in the lab orders.  The RE did not think genetic testing of the gestational sac would give us any real answers as to whether the embryo was chromosomally abnormal or not because there just isn't enough there to test (so I will miscarry naturally again).

We also recommend Comprehensive Chromosome Screening for your next IVF.

When you come in for your follow-up (WTF) appointment we can go over the results of the tests and talk more about CCS.  Our genetic counselor is available to explain things in more detail.

In 3 months we went from, "There is no reason to think that this FET will not result in a successful pregnancy," to the very real possibility that any embryo F and I make together may all be abnormal and result in miscarriage.   It is like opening the door on a tornado.  Our trajectory suddenly changes.  We chose to do a shared risk plan because it made our choices and trajectory so simple, not to mention our payment.  We also qualified for the program because on paper nothing seemed to prevent IVF from working for us.  After the ultrasound, the director of nursing actually came in to tell us that they have never encountered recurrent pregnancy loss in their IVF refund program.  They have never ordered karyotyping or immune testing for shared risk patients.  Normally, the situation in which we have found ourselves would be a disqualifying factor for the program (but how would anyone know beforehand?).  They will actually have a team meeting about how to proceed.

It is hard to believe that after two cycles our prognosis is so grim.  Would our file actually look better if neither resulted in pregnancies?  Did we misunderstand something?

We are truly sorry for your loss; we will proceed by kicking you out of the shared risk program.

What she really said was that they would not 'kick us out' of the program but would need to discuss the situation.  So, on top of the already overwhelming new information about our infertility, there is that to discuss at our next consult.

But back to the genetic and immune factors.   This is the place I did not want to find myself in, ever.  My worst fear about infertility, actually.  Worst case scenario.

After the ultrasound and after talking in general about next steps and recommendations, we went right over to have blood drawn for karyotyping and immune testing.  

Questions.

If the sole cause of our infertility were something like a translocation or genetic disease then wouldn't we be able to get pregnant naturally?  Recurrent pregnancy loss would occur, but as is the experience of other couples I have read about, they seem to get pregnant naturally.

The immune factor is so daunting to think about and so expensive and controversial to treat that I don't even know where to start with questions.   When I handed the lab order to the phlebotomist I realized that I didn't even look to see what tests from the Recurrent Pregnancy Loss panel were being run.  She asked how my day was going.  Ha.  I replied, "Not great, actually."  She asked, "Well, have you had lunch yet?  I bet you will feel better after lunch."  I didn't say, "Look at my lab order."  When she was filling the tubes with my blood I had tears in my eyes.  She asked if I felt okay.

This may sound naive, but could it be that we have just had very bad luck thus far?   I have read that a blighted ovum rarely happens more than once.  And the first ultrasound did show a yolk sac, not a blighted ovum.  Could a chemical pregnancy, an early miscarriage and a blighted ovum all within 18 months be nothing other than really bad luck?  Bad luck would at least leave hope that we can mature the right egg to make a genetically healthy embryo that will develop into a baby.

Will CCS accomplish this for us?  I don't really know.  We had 5 blasts from IVF #1 and two transfers of those blasts.  Two implanted but stopped growing.  One didn't survive the thaw and one didn't implant.  Only one remains frozen.   Perhaps CCS would have eliminated one or even both of the transfers?   The scenarios may be different but would the outcome?  Another point to consider is how CCS will affect the way the shared risk program works (3 fresh and 3 frozen cycles)?  That would mean no more fresh transfers.  I guess this is what they need to discuss in their team meeting.



For now our plan is to wait for the test results, set up a consultation with the RE and possibly the genetic counselor, and proceed with IVF #2 with CCS as soon as possible.

Oh, but first I have to wait to miscarry again. 

Are you as overwhelmed as I am?  Thanks for reading this long post.