Let's Read Non-Fiction: "Unexpected" Infertility, Miscarriage and IVF Failure Explained

When a thing was new people said it was not true. Later, when the truth became obvious, people said it was not important. When its importance could not be denied, people said it was not new. William James, 19th century philosopher

Is Your Body Baby Friendly? I just finished this medical text by Dr. Alan E. Beers. This was going to be my January Read of 500 pages but I inadvertently thought it had 500 pages when I picked it out only to find one third of the text were notes or references to medical journals and studies. So I skipped ahead and this has become my April non-fiction selection in February. Also I wanted to read this text of immune tests and treatments prior to my appointment with Dr. Foong later this week where she will explain what may have gone wrong and hopefully what we can do next time to improve.

I was surprised after our textbook quality embryos, hope from doctors for a successful cycle and gleeful nurses to have a failed IVF cycle. Likely these tests or treatments recommended by Dr. Beers will not be available at the Regional Fertility Program in Calgary.  Immunological testing has not yet been entirely accepted by the medical IVF community. There have not been enough blind studies completed with placebo subjects despite the success rates of 85% Dr. Beers has achieved with his patients who come to him after several failed IVF or miscarriages.

"There is an anecdote about an engineer who visited a factory to view a marvellous new machine churning out widgets.  He turned to his host and said, " I see it works in practice, but does it work in theory?""

We fixed the lack of ovulation with IVF now to fix the implantation issue and/or ability to maintain a pregnancy. This may not be easy.

I wonder if I have one or more of the categorical immune issues identified by Dr. Alan E. Beers.

There are five categories.

• Category 1: Tissue Type Compatibility
• Category 2: Blood Clotting Defects
• Category 3: Immunity to Pregnancy
• Category 4: Antibodies to Sperm
• Category 5 A: Natural Killer Cells
• Category 5 B: Antibodies to Hormones and Neurotransmitters

I wonder if I have category 2 as my father also has blood clotting issues and several members of my father's family take blood thinning medications. I also have a clotty cycle. I was prescribed baby aspirin in my past cycle and I think that may have helped along with acupuncture. It is likely I also have category 5 issues as Polycystic Ovarian Syndrome is discussed within this section. It has been confirmed by several doctors that I have PCOS and I have also seen it on the ultrasound monitor. 

"Women with polycystic ovarian disease and ovarian cysts have a higher incidence of autoimmunity of the type that leads to insulin resistance (high fasting free insulin levels), autoimmune thyroditis and recurrent pregnancy losses.

Elevated levels of insulin lead to poor endometrial development , which can prevent the embryo from implanting. Other fertility problems can manifest themselves as failure to ovulate, irregular periods and poor egg/embryo quality. 

Furthermore, an excess of insulin can interfere with normal blood clotting balance, leading to restricted uterine blood flow. It also reduces glycodelin output. Glycodelin (also known as placental protein 14" or PP14) is an immunosuppressive protein found in the uterine lining with inhibits NK and T cell activity. Therefore, low levels of this key protein can increase the chance of miscarriage. For women with untreated PCOS, these category 2 immune problems combine with those of Category 5, can increase the risk of miscarriage between 30% and 50% during the first trimester. "

We were told we had good endometrial lining likely due to the doctors being able to control my hormone levels of estrogen, progesterone and testosterone. During the 2 week wait I was not monitored but I was taking progesterone supplements orally. So I am curious to learn what Dr. Foong suggests may have gone wrong.

I think I will also ask to go back on Metformin. I am not looking forward to the side effects again but think it is probably best to try to get my PCOS under control even if I never am able to carry a baby to term to mitigate against stroke, heart attack, diabetes, and weight gain.

"The most effective treatment for PCOS is metformin hydrochloride, the same drug that is used to treat type 2 diabetes. Metformin increases the body's sensitivity to insulin and allows it to be used more efficiently. It also reduces the amount of glucose produced by the liver, and the amount of glucose absorbed by food from the stomach. By controlling levels of insulin, metformin helps to elevate levels of glycodelin, which regulates the NK cells, thereby lessening the risk of immune mediated infertility and miscarriage. Metformin can even correct blood clotting problems to a degree."

I was initially perscribed Metformin when the doctor suspected I might have PCOS when my pap tests came back with abnormal cells in 2010.  Instead at the time we were focused on determining if I had cervical cancer and so I did not think at the time, once the tests finally came back normal from the cancer board after several painful laporoscopy and biopsies, to ask to continue metformin for infertility. And as such we had given up after my first miscarriage on even conceiving and were focused on adoption.

I did not know much about metformin or PCOS then and I think was initially in denial that I even had PCOS and did not even want to take metformin because somehow in my head I equated that with diabetes. I thought I could manage my weight and insulin levels with diet and exercise. Obviously I am not doing the greatest with that as I am not as diligent as I once was with monitoring my insulin levels. In my twenties I was aware I had some issues with insulin as I used to have a strict diet of 21 grams of protein, 7-9 of fat, 28 grams of carbohydrates for every meal along with two snack of 3 fat, 7 protein and 9 carbohydrates daily. Then it was to lose weight and was the only method I found successful to lose weight. When I was successful in organising my food intake I was at my lowest adult weight of 122 lbs.  Impossible to maintain on an ongoing basis if you have family or friends or stress.

But perhaps with a return to metformin, a change in my lifestyle and a renewed focus I can lose some weight. I am currently at my heaviest at 170 lbs. I have been here several times before and this is generally my ceiling before I kick it into high gear and revisit exercising and cutting out sugar in earnest. I have to wise up to the fact that PCOS is not only causing me infertility it could in fact shorten my life. It is a full time job really managing one's insulin levels.

And so my challenge is this. Hopefully metformin, cutting out sugar, exercising, taking baby aspirin daily along with a multivitamin with folic acid, reducing stress, losing weight, getting daily vitamin D and cutting my favourite vice- coffee will improve my chances for a successful IVF cycle. If not then there is always the Alan E. Beers Center in California. The Centre for Reproductive Immunology and Genetics.

I checked out the website where the laboratory testing is done.

Testing is done if there is:

(a) two miscarriages or two IVF failures after age 35 or three miscarriages or IVF failure before age 35,
(b) poor egg production from a stimulated cycle (less than 6 eggs),
(c) blighted eggs,
(d) idiopathic (unknown cause) infertility,
(e) previous immune problems (ANA positive, rheumatoid arthritis, and/or lupus),
(f) previous pregnancies that have shown retarded fetal growth, and
(g) one living child and repeat miscarriages while attempting to have a second child.



Half of the battle will be finding a doctor in Canada who will agree to be a collaborating doctor and support the protocols recommended. I learned on the Reproductive Immunology Support group that possibly there is a doctor at the Victoria clinic and also in Ontario or there is also a clinic in Las Vegas that takes Canadian patients. The testing is $1200. The treatment costs identified depend on the testing results. Some could be expensive as they may be required several times during the course of a pregnancy.

I am hopeful for a successful FET cycle but I am also reserved.

Here's to hope. Again.

I hate losing the innocent joy that comes with infertility. The innocent joy when we first thought we would like to think about having children and were just having fun trying, then our first chlomid cycle which ended in miscarriage which led to several other chlomid cyles without positive pregnancy tests. Then when we first fell on adoption and thought this would be the answer to our infertility and thought we would have a healthy baby within two years. Then finally our first IVF cycles. Holding that picture with the perfect blastocyst I felt so much joy.

Here's to joy. Again.

I wish the universe recognized our efforts.  My friend S shared with me this past fall when I was picking up medication to begin my IVF cycle that she and her husband were excited to try to have a baby. Then after my unsuccessful IVF cycle we met again for lunch and she shared with me that they had a miscarriage. Just this past week L and I went over to play some games and were enveloped in their joy that they were pregnant and due in August on their first try after their miscarriage. I was surprised and happy for them but that evening tears slipped from my eyes and I wondered when me? will it ever be me? how is this fair? where is there justice God? are you not compassionate? merciful? how long have I prayed for this? can you not fix me?

The purpose of science is to change belief. If you believe that infertility, IVF Failure, recurrent miscarriages, prematurity, and low birth weight are 'God's will' which is not testable scientifically, you will never try to find effective treatment."  Sir Peter Medawar (Nobel laureate)

Here's to joy. Here's to hope. Here's to science. Again.

Help us God.

In other adoption news all is not a loss for our imminent move to SK. While we may have to lose our Taiwan adoption I have found a a sliver of hope with an agency in BC that works with SK to arrange adoptions from the USA. One of the USA adoption agencies they work with I think would be a great fit for us. So where to begin with all of that again.... the whole process is very daunting.

Daunting though this is; it will not stop me. Someday I will have a baby either by infertility treatment or adoption.