I wrote about my other female cousin who lost three pregnancies in the last year. She consulted with a reproductive immunologist who recommends doing a hysterosalpingogram and hysteroscopy to rule things out. If those two tests and her partner’s sperm test check out, she recommends my cousin to try naturally with Clom.id for baby number one and IVF to bank embryos for number 2. I shared her information with Dr. E, my own reproductive endocrinologist, to get an idea of what she thinks the most sensible next step should be. My cousin is now 41. Dr. E thinks that the most logical thing to do is IVF with PGS. She said that chance of a healthy pregnancy with IUI at 41 is 5%. Chance with IVF at this age will be around 15%. She said that if my cousin waits and does IVF when trying naturally doesn’t work, the window of having a healthy pregnancy may have closed. Dr. E tells every woman over 40 to realize that she may not have a healthy egg left and that’s normal and to be expected. She said that having a miscarriage (getting pregnant naturally like my cousins does) doesn’t mean you have a higher chance of a healthy pregnancy. I told my cousin all of this. She said she’d wait until the tests are done. My cousin got her HSG done. Her tubes were open. Her hysteroscopy showed some inflammation and spots that may or may not be endometriosis. Her uterus has a slight septum so the next step is to do a surgery to remove the septum. It may or may not prevent her from having a miscarriage but it is to make sure that the uterus would not be the reason for a miscarriage if she had one. I reiterated Dr. E’s recommendation to my cousin. Maybe IVF is a bit out of reach for her right now financially? She is going to try Clo.mid like she had planned. Since she got pregnant all three times she “tried” (and the first time she didn’t even try), she is quite confident that she will get pregnant again very soon. She feels like once her uterus is fixed, she should be able to get pregnant and hopes to remain pregnant. She will continue trying naturally until her next miscarriage. If she miscarries again, she will pursue IVF in Europe instead of here for the fraction of the cost. From talking to her, I can feel her innocence that comes from not having been on this journey for too long. She thinks that she will get pregnant quite easily. The only thing she needs to do is to keep the pregnancy. I don’t think she worries about the egg quality. It sounds like she thinks that she will make some good embryos for transfer if she has to do IVF. I know from experience that even if you make many follicles and eggs, at age 41, the chances of making good embryos (even PGS normal ones) that would stick are quite low. And I have seen so many people having embryos that don’t make it to day 5 or 6. I just marvel at how differently she and I look at the situation. That’s not surprising right? She’s pretty new to trying to conceive and I have already come out of the other side having supported many and knowing all the heartaches that could result from failed cycles and more miscarriages. She could be a poor responder to meds. She could make a bunch of embryos that don’t survive til day 5 or 6. She could get implantation but go through the beta roller coaster. Going to Europe for IVF may mean she’d have to go back repeatedly for more cycles. Many things could happen. I hope that she never has to learn the harsh reality of infertility. I wish that her innocence can live on, which means that she’d be able to bring home a baby relatively easily. I really hope so. I don’t wish my journey or her sister’s journey upon her.