Chromosomal issues and poor ovarian reserve
11 Replies
faith2006 - April 6

Hello Dr.

I have had 1 failed iui (chemical) and 3 failed ivf. Although my fsh is 5.4 and I think my estrogen is kind of high at 70. In the ivf cycles I was able to retrieve a maximum of 6 eggs. I only made it to transfer once. All 3 times the eggs were badly fragmented.

I’ve done the long lupron protocol with repronex and gonal f, stop lupron with repronex and gonal f and flare lupron protocol with gonal f. All along I thought excessive LH was the reason for the fragments but after consultation with my RE yesterday, he said the reason is that my ovaries have aged and I’m having chromosomal issues. He said it is not genetics so I don’t need genetic testing and there is no treatment for chromosomal problems. He said never say never but my best option is donor eggs. I’m not ready for donor eggs so I’m trying iui once again since I got a chemical once.

I have other issues like pelvic scar tissues from fibroid removal, right tube is open although displaced in the gutter. Left tube was partially blocked but was opened during lap, it’s also adhered to the abdominal wall.

Can you give me a brief analysis based on this short description? Is your recommendation also donor eggs?

Thanks
Faith

 

Barry Jacobs, M. D. - April 6

Without evaluating you and reviewing all the clinical data, I cannot give you a valid recommendation. From your description, you probably do have poor ovarian reserve. After the age of 37, the rate of successful, healthy pregnancy decreases dramatically. For women between the ages of 40 and 44, IVF embryo implantation rate is 6.1%. Given this information, you may be able to make your own decision about donor egg. From what you relate, it may be a good idea.
Good luck.

 

faith2006 - April 6

I forgot to mention that I'm 34. Does this make any difference?

Thanks
Faith

 

Barry Jacobs, M. D. - April 6

At the age of 34, you would not be expected to have an increased percentage of eggs with an abnormal complement of chromosomes. In our patients with recurrent miscarriage, at any age, there is an increased incidence of one member of the couple having an abnormal arrangement of chromosomes (balanced translocation). Therefore 3/4 of the eggs or sperm would have an abnormal chromosome makeup. As far as ovarian reserve you are less likely to have a problem at the age of 34, but it is possible to run out of eggs prematurely.
Good luck.

 

faith2006 - April 6

Thanks for all the info.



 

faith2006 - April 7

Dr Barry - So in a situation where you've tried long lupron with gonal f (150) and repronex (150), stop lupron with gonal f (225) and repronex (75) and micro dose lupron flare with gonf f (300 2/day) and still you get the maximum of 6 eggs at age 33.

What will be your next protocol since you don't use antagon?

Thanks
Faith

 

Barry Jacobs, M. D. - April 7

In our hands, pregnancy rates with Antagon produce very poor prenancy rates. For my microdose flare protocol, I start the microdose Lupron twice a day on "cycle day 3" (pill day 28). At the same time, I start FSH 150 units, twice a day.
Good luck.

 

faith2006 - April 7

Dr Barry - Does it matter if its 10 units or 5 units with the micro dose lupron (diluted)?


If you don't respond that well to maximum dose like 300iu twice a day of gonal, can you still respond well to 150iu twice a day?

Thanks
Faith

 

Barry Jacobs, M. D. - April 8

Please understand that there are variations of every protocol. Your RE will use the variation that he/she has had the most success. I cannot second guess your physician.
Good luck.

 

faith2006 - April 10

Dr. Barry - I understand that and I would not even try changing a prescribed protocol even if I feel my RE does not know what he is doing. He knows my history more anyway.

I am not even on a lupron protocol right now, I was just trying to get a feel for what other RE might do in my situation before making a decision on my next cycle.

So if you don't mind could you tell me if someone that did a higher dose of 300iu of gonal f twice a day and did not get more than 3 mature eggs out of 5 follicles can respond better to a smaller dose like 150iu twice a day?

And on a diluted lupron micro dose flare protocol, is 5iu twice a day sufficient or is 10iu twice a day better for a poor responder.

I'll really appreciate your opinoin.

Thanks
Faith

 

Barry Jacobs, M. D. - April 10

There are data ion the literature indicating that higher FSH dose does not improve pregnancy rates, but if you require more, your chance for pregnancy declines. The 5 units of Lupron is certainly adequate for a microdose flare protocol.
Good luck.

 

faith2006 - April 10

Thanks I appreciate your help.
Faith

 

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