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morsecooper - December 12th, 2006 11:23 PM

Hello - My history is as follows.

My husband and I naturally got pregnant after 1 year of trying and miscarried that baby about 6-7 weeks after we had seen a heartbeat at 5 weeks. After another year of trying we did not get pregnant so went to a IVF clinic in Reno Nevada.

My doctor ran all the gammett of tests and all that was wrong is I had irregular ovulation (not ovulating on day that supposed to and had a25 day period as opposed to a 28 day period) and my husband had low motility but nothing that they were too worried about.

He advised us to try IUI with CLOMID and we got pregnant on the second time. We miscarried that baby as well - a blighted ovum.

We did a second round of IUI's with CLOMID and got pregnant agan on the second time. We miscarried that baby as well around 7 weeks after we had seen a heartbeat.

As the doctor could not explain why I was miscarrting (3 miscarriages) he advised IVF with PGD do that we could see if there was a high percentage of embryos with chromosonal disorders and to pick the best ones to transfer.

I was put on Menopur and Bravelle (2 amps 75 ach). On cycle day 6 they tested my estradiol and told me it was low and put me on 3 amps (75 each) of bravelle and 1 amp of menpur (75) twice a day. On the day of egg retrieval they retrived 8 eggs (bye the way I had an anesthesia complication - threw up while I was under and got fluid in my lungs - had to be hospitalized overnight).

I was told the next day that 6 fertilized. However on day 3 I had only 6 cell fertilized eggs (as opposed to 8 cells). He said not enough to do the PGD as would compromise the embryos. By day 5 he said they had all arrested and that he had seen some asymetry and they were only grade 2 and grade 3 eggs (no good eggs like grade 1) before they had arrested.

Then he told me that basically my eggs are bad, he has no idea why they are bad as I am a 33 year old women, and suggested egg donation. He did not really give us any other options except for maybe trying lurpon in case I might have endometreosis. Also I was hysterical and could not really talk so we probably need to schedule another meeting.

What are your thoughts. It is hard to believe that all my eggs are bad? What about another drug protocal? What about embryo co-culturing. Any ideas?

Dr Smith - December 13th, 2006 12:47 PM

I'm going to forward your post to Dr Jane Miller, the RE I work with as many of your questions are of clinical nature (recurrent miscarriage, etc).

With regard to egg/embryo quality is is hard to draw conclusions from a single cycle. We can assume that you had genetic problems with the eggs on this cycle, as the embryos did not make it to the blastocyst stage. Your previous early miscarriages may have been caused by genetic abnormalities or other factors. Since genetic testing was not performed on the products of conception, we will never know. From the three miscarriages, we do know that these embryos made it to the bastocyst stage, implanted and continued to develop for a short while. I would not give up on your own eggs just yet. I think, and Dr Miller will probably agree, that you should be tested for other factors that may have contributed to your miscarriages. These factors may be treated. I would try another cycle of IVF. If the embryos arrest development again or result in an early miscarriage, I would suggest you move on to donor egg.


Dr Jane - December 13th, 2006 2:39 PM

Hello,
Dr. Smith and I are on the same page about this. It is premature to give up trying with your own eggs but more information is needed.
As he wrote, the pregnancies that miscarried were blastocysts before they implanted. I would suggest only blastocyst culture for your next IVF cycle. I would also suggest that you and your husband get genetic tests on yourselves - karyotyping - to see if there is a translocation that is being passed on and causing you to miscarry. Finally I would suggest autoimune testing for antiphospolipid antibodies and natural killer cells which, if present, may cause early repetitive miscarriage. The IVF cycle that you had may hve just been a "bad crop of eggs". Another try is warranted.
Good luck.

jennt - December 13th, 2006 5:16 PM

Hi, The Reno RE recently gave me very similar news (edometriosis and all). I know how hard it is to hear, especially when you aren't really given any real answers. We will give it another shot to rule out the egg factor. I would ask these helpful doctors about your stim protocol. Maybe you should ask the Reno doc to beef it up alittle next time to get more follicles (not too much though because I was overstimmed and it was not fun and may have been the factor to my egg quality, although the Reno RE says that it is not a trade off, quantity for quality.
Anyways- Good Luck.

morsecooper - December 14th, 2006 11:44 PM

Thanks Jen - Are you in Reno. Are you going to do the IVF again? Are you going to do a different protocol? We are going to take a few months off and try to de-stress before we decide what to do.
Lisa

morsecooper - December 14th, 2006 11:55 PM

Dr. Smith & Dr. Jane - Thanks you so much for your replies. We did the karotype testing and we both have normal karotypes. Also my doctor said that he ran ALL possible tests on me - are the natural killer cell and the antiphospolipid antibodies standard tests that all RE's do on their patients?

Thanks again,
Lisa

Dr Jane - December 21st, 2006 8:57 AM

No Lisa,
The NK cells and the APAs are not standard tests but it is more common for docs to do the APAs. I believe that you should do both before embarking upon another cycle. And - only blastocyst culture and transfer in a program that is proficient at doing it. I am always wary of programs that routinely transfer cell stage embryos but tell patients that they"can go to blast" in some situations.
Good luck!!
Dr. Jane

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