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pappy2b - June 30th, 2008 4:11 PM

My wife and I have just completed out first IVF cycle, with a poor outcome. Of the 14 eggs retrieved: 2 degenerated from ICSI, 2 did not fertilize, and 10 fertilized. On day three the embryologist found that all 10 had stopped growing, the largest was a 3 cell embryo. Our doctor has double checked everything and none of our tests would indicate this happening. He did say the eggs had a little thicker shell, and some had more compact cumulus cells, but that he has had great results with these conditions being present. We're trying again in a month with a different protocol, hopefully with different results.

History:
Wife: 31 yrs
No prior pregnancies
good ovarian reserve

Husband: 31 yrs
sperm ct. 12-22 million
motility: 42-60 percent
morphology: 12 percent Kruger

Protocol:
Day 0: 1st menstral day
Days 1-6: 225 units Bravelle
Day 7: 150 units Bravelle, 10 units low dose HCG, cetrotide
Day 8: 225 units Bravelle, 10 units low dose HCG, cetrotide
Day 9: 225 units Bravelle, 10 units low does HCG, ganirelix
Day 10: HCG trigger
Day 12: Retrieval and ICSI
Day13: 10 fertilized eggs
Day 15: all embryos arrested


Our Doctor says he cannot tell us what happened for sure. We'd just like to know what possibly went wrong and if we can change something to get a better outcome? Should we keep trying, or is it a lost cause?
I've read that if embryos arrest before becoming 4 cells it is likely a cytoplasm issue. Is it possible that my wife was stimulated to quickly and her eggs did not have sufficient time to mature before retrieval? Or is it more likely to be something genetic that we cannot overcome? The above protocol seems very fast to me. Would we have a better chance with a longer protocol? If so, how long? Thanks.

B. Jacobs, M. D. - June 30th, 2008 4:46 PM

Your problem is likely an egg issue. A laboratory problem is a possibility, but if other embryos in the lab, at the same time did well, the lab is probably OK. We find we get better quality eggs and embryos if we do not give any LH or hCG during the stimulation. Also, if we get very rapid or high rise of estrogen, the eggs are of lesser quality. There is a dys-synchrony of maturation of nucleus and cytoplasm of the eggs.
Good luck.


pappy2b - June 30th, 2008 4:56 PM

Does this mean that if my wife was stimulated too fast, to catch-up to the other patients in the batch, that all of her eggs would be immature?
Is this something we could overcome with a longer protocol, and without LH and HCG, as you said?
Or does the fact that all 10 had the same problem mean that this is the likely outcome no matter what we do?
What does thicker egg shell and cumulus cells indicate?
Thanks

P.S. others in the batch had success, so I think we can rule out laboratory problems

B. Jacobs, M. D. - July 1st, 2008 6:40 AM

I cannot know with certainty what caused the problem or how to resolve it. It may be woth trying a different stimulation protocol.
Good luck.

Calley - July 1st, 2008 8:51 AM

Hi

Question for a friend, who is planning on starting IVF next month. Her husband is a casual pot smoker - 1-4 times a week, he has had 3 semen analysis over the past three years, two had poor morphology, the lastest was normal. He feels that becasue they are doing ivf, this is not an issue, should they proceed?

Thanks

Calley

bosox9teddy - July 1st, 2008 12:18 PM

What is the difference between a long Lupron protocol and an antagonist protocol? Just how long is a long Lupron protocol? And which do you prefer?

B. Jacobs, M. D. - July 1st, 2008 6:41 PM

Calley, If your friend has poor sperm morphology, they may have to inject his sperm into eggs to create embryos.

I use either a long Lupron protocol for my patients I expect to respond briskly and a micro dose Lupron flare protocol for my expected poor responders. I have had poor pregnancy rates with the antagonist analogs.
Good luck.

bosox9teddy - July 7th, 2008 11:18 AM

How soon after doing an IVF cycle can we try again?

B. Jacobs, M. D. - July 7th, 2008 5:54 PM

The answer to your question will depend on the judgement of your Reproductive Endocrinologist. The earliest I do a repeat cycle for my patients is after at least 2 weeks of birth control pills following onset of menstural flow.
Good luck.


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