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help 3 failed cycles ICSI but good embryos

1 posts on this thread and the last post was on October 18th, 2006 2:14 PM by Dr Smith

gilmot - October 18th, 2006 1:27 PM

Dear Dr Smith

I am hoping you can offer some advice. We have done three cycles of ISCI in a year and they have all failed we can only afford to do one last go and must give the last one the best possible chanc

I will give you our treatment history and I hopefully you can advise our next best option.

Iam 38 in nov and hubby is 33. Our problem is male factor.

I have also had inhibin B test done june this year result: 28.6 pg/mL.

March 05 FSH 5.6 LH 3.8
June 06 FSH 6.3 LH 3.7

Naturally i have a luteal phase defect 28-30 day period but when do ovulate is on day 17,18 or 19

on all cycles sniffed synarel once in each nostril am & pm.
All cycles have been at same clinic.

I have always had to carry on a few more days with stimming till follicles ok for e/c.

1ST CYCLE
startened sniffing synarel16th aug 05. bleed came 10 days after started sniffing.
Day o scan 13th sept
started injecting 225iu Gonal F 14th sept & still sniffed till HCG injected.
Day 10 scan 23rd sept
Day 13 scan 26th sept - 17 follicles
HCG injection Pregnyl 5000i.u x2
Egg collection 27th sept - 12 eggs
Embryo transfer 30th sept - 5 had fertilised x2 grade 2 4 cell transferred.
Luteal support - Crinone Gel am & pm
RESULT - Had bleed on day 9 tested Negative 14th Oct

2ND CYCLE

Started sniffing synarel 21st feb 06 - blled came on day 12
Day o scan 7th march 06
Started injecting 8th march 3 amps menopur & continue to sniff till HCG
Day 10 scan 17th march
Day 14 scan 21st march - 7 follicles
HCG Pregnyl 5000i.u x2
Egg collection 23rd sept - 5 eggs
Embryo transfer - all 5 fertilised (x1 grade 2 4cell, x1 grade 2 3cell, x2 grade 3 & x1 abnormal.
Transfered grade 1 & 2.

Luteal support - Cyclogest 400mg am & pm, Duphastom 10mg am & pm

RESULT - test date 8th april had bleed 2 hours after tested. brown discharge had stated on day 13 of 2ww

3RD CYCLE

Prior to cycle started to take 75mg baby aispirin 1st aug
DHEA started 25mg 3 times per day from1st June

Started sniffing synarel 18th aug 06 didnt get bleed till day 16 of sniffing
Day 0 scan 12th Sept
Start injecting 5 amps menopur 13th spet & sniffed till HCG
Day 10 scan 22nd sept - 6 follicle right none on left
Day 13 scan 25th sept - 6 follicle right & 4 on left (10mm - 23mm)
HCG Pregnyl 5000iu x2
Egg collection 27th sept 8 eggs - x3 good, x4 immature, x1 shell only
Embryo transfer 29th sept - 3 fertilised x1 grade 9 out of 10 4 cell, x1 grade 8 out of 10 4 cell, x1 not good only 2 cell no nuclei.

Luteal support - Cyclogest & duphaston 3 times per day

RESULT tested 13th oct Negative and brown discharge had started.

I so hope you can help. Especially as that has just taken me ages to type all in.

I so look forward to your reply.

Thankyou very much

Mr & Mrs Booth

Dr Smith - October 18th, 2006 2:14 PM

Fertilization was lower than expected on cycles 1 and 3 and the number of eggs retrieved on cycle 2 was lower than cycle 1 and 3. The results of the stimulations are inconsistent and do not show any kind of pattern. I'm as confused as you.

The fertilization issue may be explained by a severe sperm problem, but fertilization is generally not the issue following ICSI. So... that leads me back to egg quality and maturation. The cycles seem long enough to allow adequate cytoplasmic and nuclear maturation, but some cycles have a higher than expected number of immature eggs. This may be reflective of disynchrony in follicular growth (i.e. a couple big ones and the rest small). Again, no pattern is clear. The embryo growth seems O.K., but Day 2 transfers don't give you a lot to go on as far as embryonic developmental potential. I'm going to have to admit I'm stumped here. Sorry, especially after you took so long transcribing your medical records. I guess I can't be a know-it-all this time.

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