What's in store?

One of the main questions people tend to ask when dealing with infertility is, what's in store if I undergo a treatment cycle. This is not an easy question for us to answer because the truth of the matter is, we don't know either. Of course we try to educate patients as much as possible about their different options and what each option entails but we don't know the outcomes and reasons for certain things that may happen during a treatment. There are still so many unknowns in our field and if anyone claims to know exactly how a cycle is going to go, they should not be trusted. Now, there are cases where the treatment goes as planned and everything is as expected but we also see many cases where things just don't seem to be working for reasons that we cannot explain. These are the cases that are frustrating not only for the patients but for us as well. There's still a long way for our field to go and for us to be able to answer every possible question. Some patients may have to complete several cycles without a definitive explanation as to why they are not having success. We have cases where the number of eggs collected is good, fertilization rate is good but only 1 or 2 embryos if any develop properly and they may not lead to a pregnancy. As an embryologist, I wish we had the answer as to why these things happen but we don't know what is going on inside the embryo and why it may stop developing. We also don't know all of the different events that occur inside the body that may lead to failure of implantation or miscarriage. When I first reached out to Nicki (@myfertility_hope) on instagram and heard her story, I was inspired. Even though her journey has been a tough one, she and her partner have been able to cope with the ups and downs.

Ever since they began their relationship, they always talked about starting a family but wanted to wait until they were married. At the time they got married, Nicki's sister was going through her own fertility struggles and so they decided to not start trying until her sister had gotten pregnant. The December after their wedding in 2012, her sister's treatments had been successful and she was finally pregnant. This was when Nicki came off the pill and they began trying to conceive. All through 2013, her periods were becoming more irregular and so she decided to have a check-up. After some tests, she was diagnosed with PCOS in 2014. She began clomid for 6 months along with follicular growth tracking. Sadly, she was told that the clomid would not work and they would need to go through with IVF and so they were referred to a fertility center. They went through some preliminary tests and she was scheduled for her first egg collection in January 2015. From this cycle, she had 12 eggs collected, 8 of which had fertilized. On day 3 of development, she was called in to have a fresh transfer because the embryos were not progressing too well. Unfortunately, it was unsuccessful. She was not offered a follow-up appointment after that and was not given any explanations. They began another cycle in October 2015 in which she got 18 eggs collected, 12 of which had fertilized. Following her egg collection (after 2 days), she contacted her clinic with signs of bloating, high temperature, shortness of breath, diarrhea and a lot of pain. She was told to monitor the situation and call back in 2 days if things had not resolved. That night, she was sent to the hospital by an out-of-hours GP. She was tachycardic, hypertensive, had a fever, her respiratory rate was low, she had chest sepsis and moderate OHSS. Due to her situation, her 2 embryos were frozen with no fresh transfer. Understandably, she was not happy with the clinic and how they had misread her OHSS symptoms, she expected to have been better taken care of. In March of 2016, they had their first transfer which was again unsuccessful. They decided to take a break at this point until they were both ready to start treatment again. They wanted to give each other some time to recover before going through the whole thing again. Their next transfer was done in January 2019 which was sadly unsuccessful. At this point, they had used their 2 NHS funded cycles and had to move onto private cycles. Her next egg collection was scheduled for November 2019. They changed her medication and planned for a freeze-all cycle. She had 24 eggs collected, out of which 15 had fertilized. Again, the embryos were not developing as well as expected and on day 6, they were informed that they only had 1 embryo. They recently had their consultant appointment this month and are planning an FET soon and if unsuccessful, they want to continue with another round of treatment. They were also told to consider donor eggs. She also mentioned how they were told that some women just need to complete a lot of IVF before they get pregnant and sadly, Nicki was one of them. Her main advice after dealing with such a long journey is to not put your life on hold as you don't know what this journey has in store for you.

As I mentioned previously, every person's body responds differently to treatment and we don't have all the answers. This does not excuse not explaining things or not following up after treatments with the patients. We are obligated to ensure that patients fully understand what we know and any known risks that are associated with treatment. We also have to be available for patients to reach in case of any questions they may have. This way patients feel more at ease going through treatment. I really appreciate Nicki's advice of not putting your life on hold. Of course we all agree that this journey is anything but easy and so trying to take things as they come and not worrying too much will definitely help in coping. There will be both physical and mental challenges along the way and not fixating on them will be an important way to ease the process. Reaching out to others who have been through fertility issues is definitely helpful, but it is important to keep in mind that everyone's journey is different and everyone responds differently to treatment so don't compare your journey to others. Each journey, each treatment, each person is different and it is not easy to predict what will happen. However, most specialists are very knowledgeable, compassionate and able to provide great care for patients so don't feel too disheartened and try not to worry too much.

Please get in touch with me if you have specific questions about certain treatments.

Image by Nick Morrison