When is enough, enough?

When is enough, enough? This is often brought up as a philosophical question. And I am the first to concur that the emotional, physical and psychological toll that IVF takes on your body, your self and your relationship should be a consideration.

But the truth is, IVF goes beyond the mere emotional, physical and psychological. It is existential. I say this having had one child, the experience of birth is close to an experience of both birth and death at the same time. It is truly primal. And the journey and drivers that take us there, I think we need to acknowledge, run so deep in our psyche as to be beyond conscious, and entering both the subconscious and biological all at once.

This is not at all to say that living a life without children is not just as worthy, I’m simply trying to describe the depth of feeling that accompanies this very active choice we make to have children when that choice is subsequently met with the roadblock of biological reality of age or other bodily interference.

Now, if we accept the idea that IVF is a choice we are making which goes beyond much of what matters in a more material (e.g. as in finances) or even personal (health/wellbeing) sense, then there is maybe a logical lens that we could theoretically apply to deciding WHEN enough is enough. And I think such a lens would be a useful resource to have given how complex IVF and life decision-making can be.

With all that said, here is my own thinking around when enough is enough.

Enough is enough when…the act of continuing would require more time, and provide a less than 1 in 100 chance of live birth. At that point, the most logical act is to move down the line to the next potential treatment.

Important to note I am not taking finances into consideration here other than in suggesting that you stack all well-researched euploidy add ons sooner (those most likely to make a difference). Add ons that I haven’t included here but which you could consider based on blood tests are DHEA, testosterone gel and Ovarian PRP. But would suggest doing those as add ons in a separate cycle after adding the initial ones.

Age 35-39

Cycle 1: Move straight to PICSI as an add on which is noted by the researcher as an add on that should be considered standard treatment for 35+ age cohorts.

Cycle 2 onward if still struggling: Consider all other add ons as per 40+ and then if still struggling move to the 43-45+ option.

Age 40+

All additions as early as possible (Met* and Calcium Ionophore and PICSI)

For the addition of HGH, consider if this is right for you. If you’re already getting 5-6 blasts, may not be needed.

If you improve your euploids, keep going to bank what you need (3 = 93-95% chance of live broth and 5 = 99.98% chance of live birth so if you want two children ideally you’d want 6-10 euploids for the best possible chance at that).

Age 43-45+

Complete a single cycle with all euploidy additions stacked on top of their base protocol.

If no euploids or positive outcome (if doing a day 3 untested transfer), move straight to Ovarian PRP, wait 2-3 months for AMH and follicle improvement (as it usually goes down before it goes up), and then go straight to Maternal Spindle Transfer in Albania which appears to have the best success rates at the moment - able to achieve 91% fertilisation, 50% blast and 66% euploidy up to 60 years of age if you are capable of producing follicles still.

Costs I’m still trying to determine, but I believe it’s around $20k per cycle because it has to include the cost of donor eggs where you do NOT use their genes, you only use their cytoplasm (their mitochondria). In your home country or while there, you need to either freeze your own eggs or freeze at day 1 which most clinics don’t do. A day 1 freeze is ideal though because it reduces the losses on thaw.

For everyone else…if you’ve done everything you can to improve euploidy and still no euploids, then move to MST as early as possible while you still have follicles. The older you get the less follicles are produced and then all you’re doing is depriving yourself of the choice if that time comes after waiting too long.

I also need to say, you don’t have to pgta test in order for these add ons to work, but I do think having a baseline and comparison would be ideal, especially if you’re someone who produces a lot of embryos which would then waste significant time transferring whole chromosome aneuploids which have an extremely low rate of live birth.

So that’s it. If you don’t want to go down the donor path (where donor means having a child that is not genetically yours, not the same as a child where they have the mitochondrial dna of a donor which has no impact on their personality or phenotypical traits), this is the most ideal decision making pathway based on age.

One thing I do not believe this is (despite many people saying this in forums), is a numbers game. Well, it is, but not in the way people normally mean it. If you’ve done 2-3 cycles with zero euploids or even mosaics - so they are ALL whole chromosome aneuploid…then continuing to do what you’re doing is a gamble of epic proportions with an upside of less than 1%. You’d need to transfer 150 embryos to potentially get a live birth. You’d be 70-80 years old before this…and that’s assuming you transferred every single month, 5 at a time. This is my personal definition of futile. Why go for another round (assuming you have also already tried these euploidy add ons) when you could go to MST—and if you are capable of creating at least two blasts, almost guaranteeing yourself a euploid?

I appreciate all this has to come with a caveat of cost, and that in Australia we are covered by Medicare so cycles cost only about $5k each. But $5k on futility is still $5k on futility.

And in the US there is insurance coverage which often doesn’t cover add ons nor out of country IVF procedures, but again if we’re comparing the idea that $60k out of country on MST could mean x3+ euploids vs doing the same thing that got you no euploids or mosaics before while hoping for a different outcome, this is a big, big gamble. Why hope for a miracle if you could buy one?

Another caveat here, if you’re getting one euploid per cycle and it only costs you $5k per cycle, clearly doing four more cycles locally to get 4 euploids is still a better option that MST. So a lot of this is defined by your current stats, not anything more amorphous such as overall statistical likelihood.

I wanted to cover this topic because I know how fraught with difficulty and so many unknowns this decision making process is and there’s lots of info about things you “could” do, but not “how” you could approach decision making on your next steps.

I’d love to know if these thoughts resonate, or help provide you with a decision making framework you’d like to use at all.

❤️❤️❤️