Persistence Can Pay Off

The sun is out and DrG's fingers have defrosted enough to allow me to add a new post to the blog. Camping is great but it was about 7 ° F on early Saturday AM. I have not ever been quite so cold as I was at 2 am, huddled like an animal inside 2 sleeping bags. My son was quite warm but he had the winter weight sleeping bag and a new fleece liner while I had the light-weight bag with a fleece liner...When we woke up it was snowing INSIDE our tent as the moisture from our breath had frozen on the inside of the tent!

My son announced to his mother that I would probably come home early. I had thought about leaving by making up some excuse until another parent (a woman on her first campout) announced what a great time she was having and how fun it was to camp out! Well, this Eagle Scout was not going to wimp out so I hung in there and drew upon my pioneer ancestors to get me through to the end of the campout. Ultimately, my persistence paid off as we had a great time and my son appreciated the time we got to spend together.

Sometimes persistence can pay off in terms of fertility treatment as well. Here is such a case.


Clinical Vignette #3: Persistence can pay off (patient PH)

The age related decline in fertility is a factor in many of our patients. Although it is inequitable, a woman’s age matters more than a man’s age when considering fertility treatment and success. Over the age of 35, a woman’s fertility begins to decline and the rate of pregnancy loss increases leading to lower odds of success. Unfortunately, there is no test that can predict what percentage of a woman’s eggs are healthy (able to produce a healthy child). However, persistence can pay off in such cases and in this light let us review the case of PH.

PH was about to turn 41 when she and her husband of 6 months came to see me as a new patient. After routine testing revealed no clear etiology to their infertility except PH’s age of 41 the couple elected to pursue an aggressive path of treatment with IVF.

IVF #1 resulted in 10 eggs and 5 perfect day 3 embryos were transferred and 3 cryopreserved. The pregnancy test was negative.

IVF #2 resulted in 15 eggs and 5 high quality day 3 embryos were transferred. The 3 cryopreserved embryos were thawed but none were of sufficient quality to transfer. The pregnancy test was negative.

IVF #3 resulted in 18 eggs, 8 excellent quality embryos were transferred on day 3 and 8 were cryopreserved. The pregnancy test was positive. Initially there were 3 gestational sacs but 2 were empty with no fetal pole inside. PH delivered a healthy 8lb 15 oz girl at full term.

But the story doesn’t end there…last year PH returned at age 44 for a frozen embryo transfer (FET) of her remaining embryos. These had been frozen on day 3 so we elected to thaw all of them and transfer the viable embryos on day 5. PH had 5 blastocysts and one morula transferred and again the pregnancy test was positive. Although initially there were 2 sacs, only one contained a fetus with a heartbeat and she was sent off to her OB Gyn for pregnancy care! Just last week I got a wonderful card with photos of her new baby.

This story clearly demonstrates the impact of age upon fertility. It took 33 eggs to find one good one for PH’s first pregnancy. However, it is amazing that the 3rd IVF cycle went so well including the fact that the frozen embryos yielded a dividend a few years later. Sometimes good things happen to nice people and PH was an excellent patient, asking appropriate questions but understanding her options clearly.