Upcoming 3rd Ivf cycle
3 Replies
Jo from Oz - October 12

Hi Dr Smith

I've read your previous topics - and appreciate not only your knowledge, but your upfront easy to understand delivery.

I'm 40, overwieght, no PCOS, non-smoker, No children. Possible previous pregancies: lost in early stages (luteal phase defect?). 18 months TTC. Dh is 32, normal motility etc.

We've had 2 IVF/ICSI cycles so far this year.

1st time: Standard protocol (Syrenel day 2-13; Pregnel 425/day day 3-13; Egg Pick-up day 15; Transfer Day 20)

12 follicles: 16 eggs: 14 mature: 11 fertilised; 6 growing strong. Pgd = 1 dud. 5 ok day 5; Best 2 blastocysts transferred on day 5. 0- frozen. Crinone progesterone am/pm following.Spotting say 31. Blood test on Friday day 33 HcG = 17 then >2 on Monday.

2nd time: Standard protocol (Syrenel day 2-12; Pregnel 400day day 3-12; Egg Pick-up day 14; Transfer Day 17)

10 follicles; 9 eggs; 8 mature; 7 fertlised; 6 growing strong. No pgd as by end day 2 - 3 had multi nuclei. Day 3 transferred best 2 x 8 cell. Assisted hatching, & Glue. None Frozen. Crinone progesterone am/pm following, as well as 2 x Progest shots.

Blood test day 32 was -ive. Long light period form day 33.

As you physically/emotionally/financially this becomes a drain. We are prepared to go again. Specialist wishes to do a long protocol next time. Syrenel from day 20 (next Friday) then scan day 6 next cycle followed by pregnel shots (450/day). He prefers blastocyst, Full PGD/Isci/AH. and glue. Then I presume same progesterone protocol.

Is this a reasonable protocol to maximise our chances? Why in the first cycle did I show HCG at 17, then 0? Can this be fixed. Why did the second batch have multi-nuclei? Can this be fixed? Can you suggest anything else to be done this time or the next (should we go again)?

I'd appreciate your thoughts ? many thanks, Jo from Oz



 

Jo from Oz - October 16

[quote author=Jo from Oz link=board=6;threadid=3123;start=0#26560 date=1160704267]
Hi Dr Smith

I've read your previous topics - and appreciate not only your knowledge, but your upfront easy to understand delivery.

I'm 40, overwieght, no PCOS, non-smoker, No children. Possible previous pregancies: lost in early stages (luteal phase defect?). 18 months TTC. Dh is 32, normal motility etc.

We've had 2 IVF/ICSI cycles so far this year.

1st time: Standard protocol (Syrenel day 2-13; Pregnel 425/day day 3-13; Egg Pick-up day 15; Transfer Day 20)

12 follicles: 16 eggs: 14 mature: 11 fertilised; 6 growing strong. Pgd = 1 dud. 5 ok day 5; Best 2 blastocysts transferred on day 5. 0- frozen. Crinone progesterone am/pm following.Spotting say 31. Blood test on Friday day 33 HcG = 17 then >2 on Monday.

2nd time: Standard protocol (Syrenel day 2-12; Pregnel 400day day 3-12; Egg Pick-up day 14; Transfer Day 17)

10 follicles; 9 eggs; 8 mature; 7 fertlised; 6 growing strong. No pgd as by end day 2 - 3 had multi nuclei. Day 3 transferred best 2 x 8 cell. Assisted hatching, & Glue. None Frozen. Crinone progesterone am/pm following, as well as 2 x Progest shots.

Blood test day 32 was -ive. Long light period form day 33.

As you physically/emotionally/financially this becomes a drain. We are prepared to go again. Specialist wishes to do a long protocol next time. Syrenel from day 20 (next Friday) then scan day 6 next cycle followed by pregnel shots (450/day). He prefers blastocyst, Full PGD/Isci/AH. and glue. Then I presume same progesterone protocol.

Is this a reasonable protocol to maximise our chances? Why in the first cycle did I show HCG at 17, then 0? Can this be fixed. Why did the second batch have multi-nuclei? Can this be fixed? Can you suggest anything else to be done this time or the next (should we go again)?

I'd appreciate your thoughts ? many thanks, Jo from Oz

PS _ The maximum No. of embies they transfer now is 2, except for over 40years. I'm forty - and wondered what are the chances of them all taking if I transfer 3 or 4 good blastocysts given my age. Both previous times we seem to have 3 or 4 ok embies - but tranfer the best 2 - and the left over not frozen.


[/quote]

 

Dr Smith - October 18

I agree with your doc - ICSI/PGD/Blast/AH/Glue (a.k.a. "the works").

The multinucleate embryo was genetically abnormal and was the result of a genetically abnormal egg. Nope. There's nothing that can be done about that. That's a "get whatcha get" situation.

The low beta hCG was a "chemical" pregnancy. It means the embryo attached to the endometrium, implanted, started to grow, secreted enough hCG into your blood to be detectable by the blood test and the abruptly stop growing. Usually a genetic problem with the embryo. Nature's way of stoping an abnormal pregnancy as early as possible.

Yes, go with 3-4 blastocysts if ya got 'em. At your age the chances of a high order multiple gestation going to term is very low. However, if there are blastocysts with very few stem cells, if these embryos are transferred implant, they will result in another "chemical" pregnancy or "empty sac". Better not to transfer these low quality blastocysts. They are a heartbreak waiting for a place to happen.

 

Jo from Oz - October 23

Thank you for the clarification & advice:-)

I'll discuss your information with my specialist.

Many thanks, Jo

 

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