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The first thing that comes to mind is the timing of the hCG shot. It needs to be given 36 hours before the retrieval. Taken later than that, the eggs will be immature. The next question is - are you sure you took the shot correctly? Did they check the level of hCG in your blood the day before the retrieval? We do this routinely to determine if there is a problem with the hCG injection timing, dose, etc. Next, keep the box with the lot number of the hCG. It is possible that that particular lot of medication may be biologically inactive. Ask your doctor to call the pharmacy it came from and ask if there have been other calls about that particular lot. If so, he must fill out an "Adverse Reaction Form" for the FDA. Finally, some patients do not respond to recombinant hCG and require urinary derived hCG or vice versa. If they monitored ovulation for the IUI's and you ovulated in response to this type of hCG, that rules out the varied response problem.

That's all I can think of.

Thank you very much Dr. Smith.

I contacted my doctor. She said my progesterone level was 2.9 and my hCG level was 277 approximately 7 hours after two Ovidrel shots. I also took the shots at the exact time as instructed and have taken them properly. She says everything looked good. My doctor is suggesting reducing follistim amount from 225 to 150 and extending the stimulation cycle. We were not convinced that next protocol would work either. I think I should have had some mature eggs. Does it worth going for another ivf cycle?

Yes, it is definately worth trying another cycle. All the numbers and facts you reported sound fine. I agree with your doc that extending the stimulation may help in allowing the eggs to mature in the follicles for a longer period. The stimulation should be a minimum of 9 days to allow adequate egg maturation. In your case, you may need even longer.

Stimulation is a learning experience for the RE and we tweak it a bit with every cycle.

Thank you very much Dr. Smith. It is very encouraging.

My doctor mentioned there was a couple of cases like this at their clinic. And for both cases, they ended up using donor eggs. That really concerns me. Hoping it is because of my short stimulation period. - My stimulation was only 8 days, not 9 days. (I am assuming stimulation cycle is when I am taking follistim.)

How long should we wait until the next ivf? My first retrieval was done on December 1st. My doctor says it is OK to start the pre-cycle in January and retrieval in February. Does it give enough time for my body to rest?

Another thing is I took Leuprolide 10 units throughout the stimulation period. The clinic’s typical dosage is 10 units for 12 days, then start the stimulation period with 5 units of Leuprolide. I did not respond well so the doctor waited two more days before starting my stimulation period (14 days on Leuprolide) and kept me on 10 units dosage throughout the stimulation period. Does it affect the outcome of the ivf?

That would be really helpful if you could tell me anything we should as my doctor or should keep in mind.

Thank you so much for your advice.

Sincerely,

mm

I'm going to forward your question to Dr Jane Miller, the RE I work with. She's more qualified to answer your question. She will post a reply as soon as she is able.

Thank you very much Dr. Smith.

Dr. Jane, can you please give an advice?

Thank you very much.

mm

Hi mm,

I know you addressed your question to Dr. Jane, but as a fellow IVFer, I just wanted to share my experience, and offer my 2 cents (take it for what it's worth).

My first IVF was a disaster -- 7 eggs retrieved, 5 immature, only 2 fertilized, and those 2 were the worst quality embyos you've ever seen in your life. Even I could tell in the photo that the cell division was completely uneven, and that there was tons of fragmentation.

2nd IVF -- Minor change in meds. Completely different results -- 16 eggs retrieved, 15 mature and fertilized. Embryo quality still not great across the board, but did have 1 grade 1 and 1 grade 2 embie. Got PG with twins.

Soooo, that's a long way of saying you should ABSOLUTELY try again. Everyone responds differently to the meds, and only a minor change in meds can make a big difference. There is a lot of science behind IVF, but since each patient is different, unfortunately, there's also a lot of trial and error.

Since your RE has a plan for how to change the medication, it's probably worth giving it another go. If you are concerned, get a second opinion.

As for how long you should wait, I started BCP again when my period started after my failed cycle, and then started lupron after 3 weeks of BCP.

Best of luck to you, and don't give up yet!

Cristina

Hi Christina

Thank you so much for your encouragement and congratulations on your pregnancy. Twin? That is so exciting! How many months now? It is great to hear success stories.

What kind of med change did you make? My doctor will keep me on the same medications, but changing the dosage of the med.

I was going to give it up if I did not hear from you and Dr. Smith. It is very hard to cope with failed IVF, especially I had a miserable result. If I had at least one mature egg, I may have felt differently. But I guess we do not know from only one try.

Thank you so much!!
mm

Please don't give up!! I agree with Dr. Smith that you might do better with urinary HCG instead of recombinant. Also - at least a 9 day stimulation and, in your case, I'd delay ER until 37 hrs. post HCG injection. that might allow your eggs more time to mature. I am surprized at the progesterone level 7 hours after HCG. With as many follicles as you had I would expect a prog. level of around 2 - 2.5 before the HCG injections. That low number after the shots was a tip off that the eggs might be immature. Your doc may have had a good reason for keeping you on the 10u of Lupron. If anything it did you no harm - the downside of too much Lupron is oversuppression and failure to respond to the stimulation. This as not the case with you.

Dr. Jane

Thank you so much for your information. I just set up for the next ivf cycle. It looks like my retrieval will be sometime mid Feb. I will ask about the urinary HCG. Also, I am planning to try acupuncture this time. My nurse said if started pre-cycle, it is very effective.

Thank you so much again and I cannot thank you enough for all your support. I will let you know the result.

Sincerely,
mm

Just wanted to share my story. I had my second IVF in Sep 07. But this time, I did acupuncture and took Chinese herbs for 4 months prior to the procedure. (My Chinese acpuncturist/doctor was just great!) My doctor also reduced the follistim to 125 and extended the stimulation by 2 more days. This time, they still collected 18 eggs and 17 were mature. 11 fertalized. My doctor said this was like night and day compared to the horrible result from my first try. They transferred three embryos and I am now 24 weeks pregnant!

When I had all immature eggs from my first ivf, I was devastated and searched for an answer. But I found it was very difficult to get a definite answer. I think every woman responds to medication differently. In my case, the medication was too strong. I think the doctor has to try and see how each patient's body respond to the dosage. Also Acupuncture really works! After 4 months of treatment from a great acupunctualist, I had great (I think 7 eggs) baseline to start with.

If there are someone who are going through the same experience I went through, I hope my story may help.

Congratulation MM!!!!
So glad you didn't give up and have a great news to share with us. Wishing you a healthy pregnancy and a healthy baby!
I have a friend who is going to her first failed IVF and having doubts about the next step. She also needs to hear more stories like yours.
All the best,
Inna

Hi MM,

Thanks for sharing your story. If you don't mind, can I ask what was your med protocol (with dosage) for the two IVF's that you did?

Thanks a lot.