After all our bad news lately, we have been talking a lot about what is next for us. We’ve been talking, thinking, crying and even laughing. We see 5 options before us right now.

1. Try Again with the full treatment plan

In many ways, this would be the ideal solution, because Mr. MPB and I already have some idea what we would be getting into. But, we both know that it is unlikely to occur for us. Based on our current diagnosis expectations, it is unlikely we will be able to afford the full treatment plan. We fully expect that once we receive the full treatment plan from Dr. B, this will trigger the official end of our RPL/infertility journey after almost 2.5 years and 5 lost babies. I am sure that this will take us on another emotional roller-coaster as we come to grips with our new reality, but I am confident we will figure out how to live with this.

2. Try Again with a partial treatment plan

This is probably not going to happen for us. We chose from the onset not to tell Dr. B about our financial constraints. We wanted him to design us the full package (i.e. we want the Porch with all the bells and whistles and upgrades). We want to know what he would recommend without any constraints to know what will give us our best chances.

Once we see that, we can then start to look at downgrading and what the lesser options will do to our budget and our chances of success (i.e. will we just be designing the ford pinto which will allow us to drive it until it explodes and kills us all). That said, I suspect both my husband and I are prepared to walk away from trying again if we cannot do everything on Dr. B’s list – neither of us want to go through another miscarriage, and if we cannot afford the best, we might just not be willing to take the ride. Honestly, for me, right now, it was one thing before to be willing to try again when we didn’t know the cause. But now, knowing my body is unknowingly reacting negatively to each one of our babies and ultimately ending each pregnancy, I’m not really interested in trying if I cannot at least give them a better chance at survival. I don’t see how I would be willing to try again both because I don’t want that to be my child’s short life. I also don’t believe that I can experience another loss. I’m not sure I can emotionally play the game anymore when the risks are so high and the chances of success so unbelievably low. If we cannot afford the full treatment plan this will likely be the end of our pregnancy journey.

All of this said, we will not make any decisions until we know and understand the final diagnosis and treatment plan options and chances of success.

3. Surrogacy / Gestational Carrier

This may be one of our best options moving forward. We have been spending a lot of time discussing and researching this option. We will undoubtedly also be spending a lot of time in the future discussing the same.

There are definitely some pros and cons for this solutions.

Pros include:

  • Having our genetic child. But, we don’t really care about the genetic link, it’s not the most important thing for us.
  • We will know the full family medical history.
  • We will know with some certainty that no alcohol or drugs have been consumed by the carrier.

Some negatives include:

  • Finding a carrier in a country that does not allow payment for such arrangements.
  • Costs of potentially travelling internationally to pay for a carrier.
  • Health risks of international IVF and premature births.
  • Myself going through IVF – I feel like I’ve already had enough physical torture with 5 failed pregnancies, and I’m not sure I am even willing to go down that route.
  • The emotional investment in the process – the uncertainty of a TWW. I honestly don’t know if I have it left in me to do this again. I’m afraid another loss would destroy me.

4. Adoption

Right now, deep inside my heart, I believe this will be our final route to parenthood. As we have been researching adoptioon for months now, I have written a bunch about adoption in the past multiple times (and I’m I will continue to). We have a lot of concerns, but we also have a lot of knowledge about the process and the risks.

Ultimately, we both know that if we want to have children, adoption is the most certain way to get there. We know if we choose to adopt, that with some time and patience we will end up with a child. There is something to be said about certainty. There is something to be said about loving a child in need of parents.

5. A life without children

This will likely not be our outcome. We have talked about this at length over the last year, and even more so in the last few weeks. While not having children would enable us to travel more, take greater risks, have less financial worries, go out for fancy dinners more frequently, and really do whatever we want (as I have discussed), we both know this choice would also mean something will always be missing in our lives. And, as my husband so eloquently put it the other day, if I have to choose either adoption or not having children, I’d rather take the small health risks related to adoption.

Once again, he is so right (I knew there was a reason I married this amazing man). For us, at the end of the day,

We want children to be part of our lives, and we will love and care for any child that comes into our lives regardless of how they arrive. We have too much love in our hearts to not share it.

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Based on our initial consultation with Dr. Braverman we have been seeking out information about the potential treatment options available locally. No thanks to our RE we were very fortunate to get a last minute cancellation appointment with an OBGYN who reviewed Dr. B’s findings and suggested treatment with us. Here is what we have learned:

  1. Endometriosis Surgery – we will not find a surgeon in this province who will do the surgery based on what Dr. B found.  Here, they rarely do endo surgery at all, so it’s very unlikely they will do it for someone who is not showing any traditional symptoms.  The one local OBGYN who has specialized endo surgeries would be incredibly unlikely to go near me given the complete lack of traditional endo symptoms (i.e. I have pain free periods). It is our understanding that the reason for this approach is not because of the limited resources in a public health care system, but because they work really hard not to do unnecessary surgeries both on the medical oath to not do harm, and due to liability risks of doing a surgery that does not appear as being a necessity.
  2. Endometriosis and RPL – Further, based on the prominent literature in Canada, endo is typically viewed as a leading cause of not being able to get pregnant, not a cause of RPL. This means, no local doctors will be influenced to do an endo surgery for us in hopes of improving our changes, as they do not see a link to our RPL situation.
  3. It was again reinforced to us that we should start taking it 4 days after ovulation.
  4. For a doctor to order IVIG locally, it is very complicated. First, they must have hospital rights. Second, it requires approval from Infectious Disease. Third, the only time IVIG is for pregnant women who contract chicken pocks. It has never, and will likely never be approved by Infectious Disease for our situation.
  5. While it is unlikely Dr. B will recommend we use interlipids, we will not be able to get interlipids here. We already knew this based on discussion with our RE and my local immunologist. It is not a product that is utilized here, so we simply cannot get local access to it. In fact, 2 of the 3 doctors have not even heard of interlipds.
  6. Absolutely take a low dose prednisone.  Here it is common to use prednisone on someone who has lupus or sever morning sickness.  There is a slight risks of cleft palate, which is correctable should it occur. Therefore, the potential benefits outweigh the risks.
  7. Restricted blood flow to my uterus.  Here they don’t do doppler sonograms until 20 weeks, and only for people who have a history of preeclampsia or past low birth weights.  Knowing the blood flow issue, the best approach would be a low dose heparin. There are no guarantees it would make enough of a difference, but it won’t hurt so it would be worth a try. .
  8. Poor pre-implantation lining. Estradiol (I think), may help my body develop a better lining prior to implantation. This may be something to consider if we try again. The drawback of this is that an RE will have to monitor my cycles to see what happens.

So, while we continue to wait for the final diagnosis and treatment plan from Dr. B, we have learned a few more things about the treatment that will be available to us locally. Probably the most important things we have learned are that a local endo surgery is completely off the table. Secondly, we will virtually need a miracle to get IVIG locally. Thirdly, we will not get interlipids in our province.

Honestly, we aren’t even upset with all this news. If anything, we are just happy to have more knowledge on our local treatment options. We are no worse off today than we were a week ago. So, really we are not upset by this news as it doesn’t change anything for us. And, if anything, we are relieved to know this now so that we will not get our hopes up, just to have them crushed in a few months.

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