Failed IVF Cycle: Help Dr. Jacobs
9 Replies
Bmorrison - February 4

I am 37yo and hubby is 50. Male factor, had varicoele repair, IVF with ICSi still suggested by RE. My FSH 5.5 and Estradiol 27. Here is how my stim went: OCs 11/26-12/24/07. Started Bravelle and Menopure 150 IU x 7 days, Bravelle 112.5 and Menopure 75 IU x 1day, Bravelle and Menopure 75IU x 1day, Centrotide x 4days and triggered with Ovidrel 250mcg. Started Stim injections on 1-3-07. Had first u/s and blood on 1/8 (E2 level 1310 and 13 follicles) 2nd u/s and blood 1/10 (E2 2154 and 20 follicles) 3rd u/s and blood 1/11(E2 2763 and 25 follicles) 1/11 lead follicles 23, 10, 19x2, 18x2, 17x4, 16x3. Was never monitored again after 1/11. RE office called that day and said to trigger at 8pm on 1/12 with retrevial set for 7am on 1/14. At retrevial only 6 eggs were obtained, only 2 fertilized with ICSI. Had 3 day transfer with grade 1 -(7 cell) and grade 3-(6 cell). Failed IVF cycle. The real kicker is I had a 1 time only chance on my insurance. Any advice on what should have been done differently and what questions should I ask my RE? Why only 6 eggs? Do you think my E2 was too high? should they have monitored me after 1/11 and before 1/14?

 

B. Jacobs, M. D. - February 4

The protocol you used is quite different from what i use for my patient who ate 37 or older. Each program has a set of protocols they are comfortable using. I use only FSH, and no the products like Menopure, which contain LH. I am in the minority in that regard. I do not use Cetrotide, but, instead use a microdose flare protocol. Also, please note that the stimulation protocol may not have been the problem. The fact that you are 37 and not 27 is very important.
Good luck.

 

Bmorrison - February 4

Dr. Jacobs

Thank you for your quick reply. My question is this: How could I have had so many follicles, but so few eggs. Were my E2 levels rising too quickly? In my inital post I included my follicle sizes and E2 levels. Should I have been monitored after my last u/s on 1/11 before retrevial on the 1/14? According to my RE the problem was that I did respond like a 27 year old, not like a 37 year old. I am a nurse, and it just seems to me that I produced many follicles too quickly. The size range I included were from the last u/s taken the day before my trigger.

 

B. Jacobs, M. D. - February 5

I really do not know why more eggs were not retrieved. The best person to try to answer that question is the RE of did the procedure.
Good luck.

 

misty_RN - March 31

Dr. Jacobs,
6 years ago my husband had a vasectomy, but since coming home from deployment to Kuwait has changed his mind and wants to have a family. He is 40 years old. I just turned 36. I'm wondering: Is our best option to try a vasectomy reversal or to try a testicular retrieval and do IVF with ICIS? I want a baby so much! (I always did. I just didn't want to choose between him and a baby.) I've waited soooo long for this but I'm afraid we may have waited too long. Can you give me your opinion regarding what you think is our best option....

Much Thanks,
Misty

 

B. Jacobs, M. D. - March 31

I use a different protocol than does your RE. I do not add any LH to the stimulation, and for my patients over the age of 35, I use a microdose flare protocol.
Good luck.

 

bcs19 - May 11

Hi Dr. Jacobs,

I had done my first IVF cycle. I had 13 eggs retrieved and produced 11 good quality embryos (9,8,7 cell count and a couple 6). I had 2 fresh transferred and 7 were frozen (2 months ago). As a result, I got pregnant but miscarried very early. I was scheduled for my FET transfer yesterday but got an am call that all 7 of my embryos did not survive thawing. I am very confused..even my fertility Dr. said this is very unusal with that many good quality embryos. The embryologit report said they started to degenerate as soon as they were thawed.....Why and how often does this happen?

 

bcs19 - May 11

Hi Dr. Jacobs,

I had done my first IVF cycle. I had 13 eggs retrieved and produced 11 good quality embryos (9,8,7 cell count and a couple 6). I had 2 fresh transferred and 7 were frozen (2 months ago). As a result, I got pregnant but miscarried very early. I was scheduled for my FET transfer yesterday but got an am call that all 7 of my embryos did not survive thawing. I am very confused..even my fertility Dr. said this is very unusal with that many good quality embryos. The embryologit report said they started to degenerate as soon as they were thawed.....Why and how often does this happen?

 

B. Jacobs, M. D. - May 11

bcs19,
I cannot know why none of your embryos survived the freeze-thaw process. There may have been technical problems during the freezing which allowed ice crystals to form within the cells. We do have the occasional isolated loss of an embryo, but our embryo freeze-thaw survival rate is about 90%. I hope you are more fortunate with your next effort.

 

twinkletoes - May 28

Hi,
I am 43 yrs old and just had my 2nd ivf transfer.

1st ivf:
11 eggs retrieved, 9 fertilized. Transfered 5 grade 1 8-cell embryos, froze 2 grade 1 7-cell, 1 grade 1 6-cell and 1 grade 2 7-cell.

Resulted in chemical pregnancy

2nd ivf:
15 eggs retrieved, 12 fertilized:

5 grade 1 8-cell
1 grade 1 9-cell
2 grade 1 7-cell
1 grade 1 6 cell
1 grade 2 9-cell
1 grade 2 6-cell
1 grade 2 3-cell

Because of my age, we decidided day 3 transfer of 9 embryos, froze the other 2. the 3-cell is not good enough for the transfer and my RE said will probably not be good enough for freezing. I know that at 43, most of my eggs are chromosomely abnormal. Do you think we should have transferred all of the embryos including the 4 frozen from my 1st cycle? I had my transfer on 5/25 and in my 2 ww. If this does not work, I will try to do FET with the 6 frozen embryos. I asked about donor eggs before starting my 2nd ivf but my RE said that inspite of my age I still respond good with the stims and will just try to transfer more next time, thus the transfer of 9 embies. Do you think that if this doesn't work, to go straight to donor embies on the 3rd ivf? Is is possible to combine donor and my own frozen embryos in one transfer?

Oh, my insurance does not cover IVF so this is all out of pocket. It is physically, financially and mentally stressfull for us to do this but we are still praying for a miracle.

 

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