Why am I having such a hard time conceiving a second child? A patient’s story…

Myriam consulted after trying to get pregnant for 3 years. She had given birth to a girl almost five years earlier. The time to that pregnancy had been 2 months, the pregnancy uneventful and the delivery normal.

She consulted her gynecologist after a year of trying to achieve pregnancy. The doctor’s advice was to relax. After 2 years the gynecologist did a few tests on her but when year three came around she decided to skip the gynecologist and to directly consult a fertility clinic. As she told me her story, she was discouraged but optimistic because she already had a child. She was now 41….

We prescribed the initial fertility testing and everything was normal for her age. Her husband Miguel came in for his testing. The sperm was not spectacular but he was almost 50. When we had all their results we sat down to go over them and I had to give them news that they could hardly believe. Pregnancy at 41 for a woman and 50 for a man is not as easy to achieve as the world in general portrays it to be. I told her at 41, her chances of pregnancy using IVF were around 25% but also she had to take into account that over 25% of the pregnancies achieved, ended in miscarriage. This is generally due to aging eggs although it can also be due to aging sperm. I also underlined how after 40 you are likely to have more problems during pregnancy like high blood pressure and gestational diabetes and that babies tend to be smaller or preterm.

Myriam and Miguel were shocked by the news. I explained IVF and gave them resources so they could make the decision to move forward or not. Three days later they came back and said they wanted to start immediately as I had suggested. Myriam initiated stimulation 10 days later when her period came. She responded well and we ended up with three embryos on day 3 which did not implant. I suggested a few different strategies for the future. I explained that most embryos when a woman is over 40 are abnormal even though they may look fine to the biologist, but they are genetically abnormal. Genetic testing was an option, with the objective of finding and transferring only normal embryos. They decided on the option to bank embryos so when she transferred embryos, they would be genetically normal. That means that Myriam would go through a few stimulation cycles and freeze the embryos obtained. Then when we had around eight embryos we would perform Preimplatation Genetic Diagnosis (PGD) on the accumulated embryos. PGD tests are performed on embryos at Day+3 or Day+5 for genetic defects.

Myriam went through three more cycles of stimulation and we accumulated 7 Day+3 embryos. She said she had had enough and she wanted to wait a few months and then go ahead with PGD. She was emotionally exhausted, had neglected her personal life and needed time to recuperate. So we waited four months and she came back with a very positive attitude. I explained once again that we were going to cultivate her embryos to Day+5 and biopsy at the blastocyst stage. We would prepare her for an embryo transfer and she was conscious of the fact that maybe we might not have any Day+5 embryos to biopsy and if some embryos did get to Day+5, there was also a chance of not having any normal ones.

On Day+5, there were 2 blastocysts to biopsy. The biologist biopsied and we anxiously awaited the information. One of the embryos was normal! We proceeded to transfer the genetically normal embryo. Twelve days later we had a positive pregnancy test!

Myriam had a baby girl last week. She called me to tell me the baby was born earlier than her due date but that everything was going well. She promised to send pictures when the baby came home from the hospital. She commented on how at times she had been so discouraged and had she felt Assisted Reproduction was a waste of time, but in the end she and Miguel are thrilled and with their beautiful, new baby. They now know that it was well worth the effort!


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