Input appreciated
12 Replies
aebdmd - October 7

New to infertility. Just going through 1st IVF cycle. Had 8 total follicles. RE said prior to retrieval that three were very small, but five appeared ok in size. Upon retrieval Tuesday, got 6 eggs. One was cracked, leaving 5. On that day, she explained that eggs didn't look of great quality. 24 hours later, Wednesday, no fertilization occurred. ICSI performed. 24 hours later, Thursday, signs of fertilization on all 5 eggs. 24 hours later, Friday, all 5 early embryos. 24 hours later, today Saturday, 3 arrested at 2-cell stage, of remaining 2......1 is at 4 cell stage, other at 6 cell stage. Planning to do PGD today at noon. RE says the 3 arrested ones are to be disregarded. What do you feel about the remaining two? Planning so far to do transfer on Tuesday a.m. Will this be blastocyst stage? Can I request blastocyst transfer? Seems that I would want blastocyst from everything I have read. Very depressed right now, never dreamed it would be this hard. Any input would be appreciated. Husband's sperm analysis fine.

 

Dr Smith - October 10

This cycle went very poorly. Unfortunately, my response will come too late, but the PGD was a waste of time and money. By now, you already now that the remaining embryos did not progress to the blastocyst stage. In fact, they probably arrested shortly after the PGD.

Rescue ICSI (ICSI performed after a failed fertilitation by conventional IVF insemination) simply does not work. There's a reason that eggs do not fertilize in the presence of good sperm. The eggs are developmentally incompetent and this is nature's way of ending things early. If you force the issue and perform ICSI the day following the failed fertilization, the embryos may divide a couple of times and but then they will arrest between the 4- and 8-cell stage.

As far as what went wrong?? The ovarian stimulation may need to be tweaked to get better egg maturation and hence, better embryo development. Alternatively, it is posible that you have a serious problem with your eggs. IVF is also be diagnostic. It can provide an explaination of "unexplained" infertility. In any case, discuss what happened with your doctor and come up with a game plan for the future.

 

aebdmd - October 16

well, you were basically right. Of the two remaining, pgd was performed. The next day, both of those had "recovered". This was day before transfer. Going in on day of transfer, the larger one (8 cells showing compaction) arrested. I thought that would be the one to be transferred. However the embryo that was 4 cells following PGD tested normal and was by day of transfer showing signs of compaction. So it, alone, was transferred. What do you think? We'll see how it goes, but not optimistic.

 

Dr Smith - October 18

It is possible that this embryo may implant, but very unlikely. PGD tests for a few chromosomes, but not all and does not detect subtle gentic abnormalities that can result in failed implantation, chemical pregnancies, etc. Compaction is a good sign, but as you found out with the other embryo, embryos can arrest in the process of compaction - especially rescue ICSI embryos. Bottom line: I don't hold out much hope.

 

aebdmd - November 1

Of course, no pregnancy. With the first cycle resulting in such poor numbers, my RE wants to try antagon on the next try, no lupron. Do you agree with this?

 

Dr Smith - November 7

What the doc is suggesting is SOP. Go ahead and give it a try. Keep us posted (no pun intended).

 

aebdmd - November 9

I'm sorry, SOP?

 

Dr Smith - November 9

You know how we love our acronyms in this field: ART, IVF, IUI, ICSI, etc. Sorry, I shouldn't have used an acronym. SOP stands for Standard Operating Procedure. In other words, acceptable medical practice.

 

aebdmd - December 14

Hi, me again. Just wondering, started day 1 of cycle on 12/12 pm (7:30 pm). Had bloodwork this morning (14th) at 7:30 am. Wondering what you think of todays results and my RE's response.

LH 5.79
FSH 9.02
Estr. 25

RE wants to put me on BCP's starting today before next IVF cycle, not sure when the IVF cycle will be, Jan or Feb. Do you agree with this, for my results?

 

Dr Jane - December 21

Hello,
As you FSH is - annoyingly - approaching the ominous # 10- your doc want to try to lower it if possible to enable a greater follicle recruitment next time. We do this frequently in IVF. It won't enable you to develop many more eggs but even 1 or 2 extra means just that - 1 or 2 extra attempts. Your FSH wil always go up several years before the LH does - hence your normal LH. Your E2 is also apropriate for day 2 or 3.
Good luck!
Dr. Jane

 

aebdmd - January 16

ok 2nd cycle. follistim and menopur. Day six ultrasound shows 2 follicles on left ovary, 5 on right ovary. I can tell by the way my RE talks, she doesn't think this is going very well since it is a numbers game. My question is this: why are my numbers so low? Where do I go from here? Please refer to my previous message regarding the first cycle for history. Again, just day 6 so maybe there is still hope? Thank you so much for your time.

 

aebdmd - January 17

Just sending again, anxiously awaiting your thoughts on this second go around. Should I continue with this cycle? What next?

 

Dr Jane - January 17

Seven follicles is low - I agree with your RE - and it just isn't fair!! Your baseline FSH of 9.02, however, is in keeping with this. It is telling us that your "ovarian reserve" is low and, because of that, you are not likely to develop more than 7 or 8 follicles on afny one cycle at this time. About 80% of the follicles that mature will contain an egg and only about 80% of these will fertilize. As you know, fertilization is just the first hurdle. Correct sequential culture of your embryos to see what - if any - make it to the blastocyst stage is indicated. Then your question "where do I go from here?" can be answered. If you were to have cell-stage embryos transferred again and you got px. - that would be great. However if you didn't get px. you would not have any answers. In our program we see patients who have had 6, 7 , even 8 cycles!! They keep cycling because they have no answers. I agree w/Dr. Smith that PGD is not indicated in your case fopr the reasons he stated.
Yours,
Dr. Jane

 

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