When should the donor cycle be cancelled?
1 Replies
Stacey Espinoza - March 14

Dr Smith,

I'm a 41 years old, and in excellent health. My husband and I just finish our third cycle of IVF. After two failed attempts using my eggs we selected to use a donor. This was her third cycle at a very reputable clinic in our area. The clinic's standard operating procedures for a failsafe donor cycle are unknown, at this time. Their policy for when to call a cycle ‘failed’ was not discussed. After the donors egg retrieval the doctor called to inform me that there were 22 follicles but ,oddly only 2 eggs were mature enough to fertilize. He was able to retrieve 6 or so others but they were all very immature. Over night one egg didn't make it, so that leaves one. On day two, all looked well, 4-5 clean cells. on the day of transfer, the embryologist calls to inform us that the egg doesn't look so good. There are 6-8 cells, but he can't see the nuclei in each one, and there is a lot of fragmentation. He went so far as to say, it looked like there was something wrong with the protoplasm. On a descending scale of 1 to 5 it was a grade 4. The doctor stated at the visit that it had a better chance of making it to blastocyst in me than in a Petri dish. After reading some of the other replies you've posted to other topics I find that hard to believe. Ultimately, she put the final decision in our hands as to whether or not we move ahead with the transfer or to wait and see if it cultured to blast. Of course, given the info at the time, we proceeded. And another failure ensued. Looking back on the cycle, there were several things that I question. I know this is long and drawn out, but I have a couple of questions.
When should the cycle be stopped by the doctors?
The doctor who performed the retrieval tested the donors’ blood for hCG and it was there but only in trace amounts. They are blaming pharmaceutical error. The donor was responsible for the administering of the hCG.
It is most likely human error. By chance do you know much about quality control checks with fertility medications? Needless to say, the donor has been released from the program. Our follow up appointment is tomorrow, I called ahead with questions I need answers to, and hopefully they will have some for us.
Your answers and input would be a great help.

Thank You, Stacey

 

Dr Smith - March 14

First of all, infertility treatment is elective, so you (not the doctor) are in charge. After all, its your money. I think they should have cancelled the cycle when the hCG came back low. We use 100 mIU/ml as the cutoff in our program. Below 100 and yer outta here! When the hCG is below 100, it is very likely that the donor didn't take the hCG properly or not at the right time. It is probably not a problem with the hCG product itself. When we've had similar problems, we looked into the quality control processes for the companies that make the hCG and were satisfied that it is highly unlikely to get a single "bad vial" of hCG. When we "interrogate" the donor, they often admit they screwed up.

When the doctor didn't cancel the cycle when she learned about the low hCG value, I think you should have been given the option to cancel the cycle after the retrieval. 2 matures eggs is simple not enough for a successful cycle - period. They should have told you that and with that information, you could have cancelled. Its time to discuss a free cycle (except for the donor fee) with your doctor.

I'm sorry that things turned out this way, but if its any consolation, we've had trouble with low hCG values on a few donors as well. Some of these young (immature) women just don't get how important this is to the recipient.

 

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