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Infertility

Experimental Immunotherapy Helped Me Get Pregnant After 6 Years of IVF

After three rounds of egg retrievals, 11 embryo transfers and numerous miscarriages, Sarah feels both elated and guilty about her pregnancy. Find out why.

Experimental Immunotherapy Helped Me Get Pregnant After 6 Years of IVF

Credit: Sarah Attia

Sarah Attia always knew she wanted to be a mom. What she didn’t know was how long, difficult, exhausting and expensive her pregnancy journey would be. Despite her certainty, she says “I also had this feeling pretty early on that we were going to have a hard time.”

Following their 2015 wedding, Sarah and her husband, Ivan, started trying for a baby—or at least not avoiding it, she says, recollecting those early, carefree days. After about a year, that changed.

Sarah’s parents struggled for years to conceive her in the 1980s, when in vitro fertilization, or IVF, was in its infancy and out of reach for most families. So she wasn’t totally surprised when she didn’t get pregnant in those first couple of years.

Dealing with unexplained infertility

In 2017, the Attias visited their first fertility specialist and the couple was diagnosed with unexplained fertility. “That was a tough pill to swallow,” says Sarah, 31 at the time. “We were two healthy young people, and no one could tell us what the issue was.” But their doctor was confident IVF would work for them. Sarah and Ivan applied for provincial fertility funding—the Ontario government covers the first round of IVF. When it was approved about a year later, they got started.

Sarah Attia sitting in a hospital bed waiting for a round of IVF Credit: Sarah Attia

The often harsh realities of IVF

Sarah underwent her first egg retrieval in 2018. Fifteen eggs were collected, 14 of which were mature. Of those, 10 were fertilized. Three days post-retrieval, they were all developing well. But by day five, only one egg had reached the blastocyst stage—the ideal stage at which an embryo can be transferred to a patient’s uterus. Sarah was shocked by the drop-off in numbers. Her doctor hadn’t prepared her for that. “I remember dreading each phone call from the clinic.” But the next call brought better news—by day six, they had seven blastocysts.

In November of that year, Sarah and Ivan did their first embryo transfer. It failed. Sarah was devastated. “We had friends who got pregnant after their first transfer, and I naively thought it would be the same for us.”

They did a second transfer in March 2019, which also failed, and another in November that resulted in a chemical pregnancy. Sarah’s frustrations were mounting and she felt her doctor was dismissive of her concerns and reluctant to change anything in her protocol. “But we’d done three transfers the same way, getting the same negative result, so I started self-advocating more.”

A positive test and a pandemic miscarriage

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She pushed her doctor to transfer two embryos together, which her team was hesitant to do given her young age. Sarah got her way eventually. They did the transfer—her fourth—in February 2020. Her first beta tests, a measure of the level of beta-human chorionic gonadotropin, or hCG, in the blood, were positive.

Sarah went in for an ultrasound on March 11, 2020. Early COVID restrictions were starting to take effect, so Ivan had to sit in the waiting room. Alone in the ultrasound room with the technician, Sarah knew something was wrong. “The technician wasn’t saying anything, and she was taking a long time to do the scan.” Eventually, the tech told her there was no heartbeat. Sarah had miscarried.

Sarah Attia and her husband Ivan standing outside wearing masks and holding up an ultrasound picture Credit: Sarah Attia

Finding support online

“That was probably the toughest point in my journey,” says Sarah. Because of COVID restrictions, she couldn’t see her parents or anyone in her support network. “It was a very dark and lonely time.”

That’s when Sarah started joining online fertility support groups for women and couples. “My mom and my best friend were great, but they couldn’t really understand what I was going through.” It felt good to connect with people, even online, who were in the same “lousy club,” particularly at a time when the outside world felt so isolated.

Making difficult decisions

They transferred their final embryo in September 2020, and that one failed too. Despite misgivings about her doctor’s protocol, which didn’t leave much room for Sarah’s thoughts and concerns, the couple did another egg retrieval at the same clinic, this time privately funded.

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That retrieval was followed by four more failed transfers, three of which were with tested embryos and shown to be genetically normal preimplantation. At that point, Sarah and Ivan started having some difficult conversations—the toughest of their relationship. “We both felt really defeated.” Ivan was tired of seeing Sarah’s body go through so much pain. He just wanted to walk away and try something different.

Sarah Attia and her husband Ivan in scrubs waiting for an IVF procedure Credit: Sarah Attia

Trying immunotherapy for IVF

“I felt like I had to keep going,” says Sarah. “It felt almost like an addiction. Like if I just kept at it, eventually I’d hit the jackpot.” The conversation went back and forth for months, during which time Sarah started researching immunotherapy, a side course of treatments that can sometimes improve IVF outcomes. She convinced Ivan to try again, but at a new clinic—Markham Fertility Centre.

The clinic was more than an hour’s drive from the couple’s home in Burlington, but it’s one of the few in the country that offers immunotherapy. Their third retrieval yielded 14 eggs, five of which fertilized. None had made it to blastocyst stage by day five, but one had made it by day six, which is when most clinics stop tracking development. Markham kept watching, and on day seven, the other four made it to blastocyst.

To get ready for transfer, Sarah’s new doctor agreed to start her on an immunotherapy protocol involving intralipids and steroids. Despite a lack of obvious immune conditions, she’d had success in the past with similar cases. Sarah and Ivan even participated in lymphocyte immunotherapy, or LIT, an experimental therapy which involved injecting Ivan’s white blood cells into Sarah’s forearm. “That burned like hell—it was one of the most painful things I’ve ever experienced.” It took roughly six months of immune treatments to get her body ready.

On the day of the transfer—their tenth in all—Sarah remembers feeling intense pressure, given everything they’d gone through to get there. “I was sobbing in the chair,” she says. The transfer failed. Sarah finally felt like she was finished with IVF. They had embryos left from their latest retrieval, but she just wanted to get to whatever was next—surrogacy or adoption, both of which she’d been actively exploring—on their journey to creating a family. She’d do those final transfers, then move on, she told herself. But she wanted to take a break. Her doctor, on the other hand, urged them to proceed immediately, given her body was optimized from all the treatments.

Sarah Attia wearing a mask outside Credit: Sarah Attia

One last try

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Their final embryos—two of them—were transferred on October 26, 2023. Sarah remembers being uncharacteristically calm that day, mostly because she was already thinking about what was next. “I wasn’t crying. I wasn’t nervous. We didn’t even take our usual transfer-day selfie.” Her team reported that the embryos looked good—frozen embryos shrink, and then hopefully re-expand ahead of the transfer. In the past, hers never really had. But in this instance, one had fully re-expanded, and the other had re-expanded to 75 percent. Still, she wasn’t expecting a positive outcome.

Fast-forward to November 4, 2023. It was Sarah’s birthday, and, thinking about having a glass of wine with dinner, she took a pregnancy test. It was positive. “I’d seen positive tests before, though, so I didn’t think much of it. But I didn’t drink wine that night, either.” She went in for her first blood test a few days later, and her beta-hCG levels were higher than they’d ever been. Then they just kept going up.

Sarah—accompanied by Ivan, whose presence in the room she advocated for—went in for an ultrasound in late November. Together, they heard their daughter’s heartbeat for the first time. “It was the most incredible sound in the whole world.” She couldn’t believe one of those “third-round, day-seven embryos no one had hope for” worked. All prenatal tests and genetic screens have come back clear, and Ivan and Sarah’s baby girl is due this July.

Sarah Attia standing in her baby girl's nursery holding her pregnant belly Credit: Sarah Attia

Survivor’s guilt

Sarah is ecstatic to finally be pregnant after such a long journey: seven years, three egg retrievals, 11 transfers, and nearly as many failed implantations and miscarriages. But she also has pain for the people who are still going through it. “It’s a bit like survivor’s guilt,” she says, “like I’m abandoning the community.” She knows what it feels like to be left behind when it seems like everyone else is succeeding and moving on. “I was there for so long,” she says. “And I was happy when people got pregnant, but I was also jealous all the time.”

Sarah’s advice

When asked what she would say to those still in the thick of it, Sarah knows what they don’t need to hear: never give up. “I think that can actually be quite toxic, and it puts a lot of pressure on someone who might want to give up.”

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There’s no right or wrong path, she says, whether it’s exploring adoption or donor embryos, or living child-free. She urges people to tune into what they’re feeling and what they need—which might be boundaries. “I was invited to so many baby showers and first birthday parties over the years,” says Sarah. “I didn’t want to miss those milestones, but when I was at my lowest low, I just couldn’t.” She was upfront with friends about having a hard time, and people usually understood.

As to what she’d say to those who don’t have to go through this? “I’ve had a lot of people say stupid things to me over the years, like ‘just relax’, or ‘enjoy being able to sleep in while you can’,” she says. “So just do more listening than talking.” Most often, she just wanted someone to be there with her. Following one of her miscarriages, a good friend dropped off a self-care package of candles, tea and bath salts. “That was so thoughtful,” she says.

Throughout her journey, Sarah started sharing her story on Instagram. She was surprised by how many people—including men—reached out to say they were going through the same thing. With both Sarah and Ivan working from home through much of their experience, she could hear how open he was about their struggles as well. Sharing made them feel less alone, but also like they were contributing in their small way to reducing the stigma, shame and silence that continues to shroud the topic. “Talking about our fertility struggles was probably the best thing we ever did.”

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