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sandy - June 9th, 2006 9:03 PM

Hi Dr Jacobs,
Hello,
I am 38 years old. Never pregnant. My fsh levels at day 3 blood tests are low but i am responding poorly to stimulation drugs/shots. Done 2 iui's-both failed. For my 1st ivf i produced 4 follicles and had three immature eggs, with icsi they all fertilised at 8, 7, & 6 cells with grades of B's&C's. The 1st ivf failed. For the 2nd ivf, I produced 5 follicles and 5 immature eggs. I am currently in my 2nd ivf 2ww. For this 2nd IVF, there were 3 embryos icsi'd with 2, 8-cell grade C's and 1, 6-cell embryos with C's. My RE took my estrogen levels at 200 for 5 follicles which were at 20mm leading when I took my hcg shot (ovidrel for both iui's and both ivf's).

My questions for you are:

What can my RE do differently next time around? We have an unexplained infertility. We tried naturally (timed) for 12 months before we consulted an RE. My husbands sperm volume 20/mil but not anything else such as morpholoy/motility, etc. was the cause of the icsi but I'm wondering if it was because of the immaturity of the eggs.
How can I ovulate without having immature eggs? What protocol is recommended?

Thanks a lot.


B. Jacobs, M. D. - June 9th, 2006 9:20 PM

The vast majority of my patients over the age of 37, doing IVF stimulate best on a microdose flare protocol, as opposed to a long Lupron protocol.
Good luck.


sandy - June 9th, 2006 9:55 PM

Dr. Jacobs,
This 2nd ivf cycle was done with lupron flare with 9 or 10 days of stimulation. Still the immaturity of the eggs. The embryologist in this website suggests using another hcg trigger shot. He's seen two attempts at ivf with both immature eggs.
Is this something I should discuss with my doctor?
Thanks so much,


B. Jacobs, M. D. - June 10th, 2006 1:52 PM

The second injection of hCG may be useful if eggs are not retrieved. If the eggs which are retrieved ar immature, the follicles need to be grown another day or 2, if not more.
Good luck.


sandy - June 10th, 2006 5:18 PM

sorry, but I meant a different type of hcg trigger (different to ovidrel) which may affect me differently. since my re was extending my follicles one additional day from the last ivf cycle based on the sizes of my follicles and my estrogen levels. For 5 follicles with a 20mm leading and estrogen levels of 200, my re thought that this was sufficient for triggering ovulation. my re was stunned that all of my 5 eggs were immature.

so, would a different type of trigger shot (urinary?) affect some people differently? have you come upon anything like this or is this just a matter of extending the amount of days stimulated?


B. Jacobs, M. D. - June 10th, 2006 8:37 PM

If eggs were retrievable, the hcg did its job. If the hCG were not effective, you wold not have had eggs retrieved. You might try a urinary product, but I don't know it will be of much benefit.
Good luck.


jacki04 - June 11th, 2006 10:39 PM

Dr. Jacobs
Could you explain why the flare protocal is best in this case that was explained? What are the distinct differences between the regular protocals which include BCPs, lupron, ovidrel and Gonal-F vs. this flare protocal? Would you suggest the flare protocal for a person who responded well with the traditional protocal forestated above but who failed the 1st IVF at 39 y/o?

Thanks
Jackie


B. Jacobs, M. D. - June 12th, 2006 6:41 AM

The micro dose flare protocol I use is for poor responders. Using it for someone who responds normally can cause her to over respond. Lupron can desensitize ovaries to FSH, after a week, but its initial effect is t cause the pituitary to dump all its FSH & LH. The initial response is a "flare" stimulation of ovaries. There is another collection of flare protocols, which had some popularity a few years ago, but I do not use them, anymore.
Goof luck.


sandy - June 20th, 2006 3:28 AM

Dr. Jacobs,
So, I had my blood drawn with hcg at 11 post transfer. Three days later, hcg levels went down to 9, an early miscarriage. This is my second ivf and both cycles - immature eggs. After the 2nd time however my re said that at least I can get pregnant. Is this a positive thing? Yes, I've never been pregnant and this time I was.
What can I do next time to have a baby. Went through 2 iui's and 2 ivf's; and probably all of these times I had immature eggs. Knowing what we know about my immature eggs, can we try iui for the next go or do you think we should continue with ivf. Help. My re has really bad bedside manners.


B. Jacobs, M. D. - June 20th, 2006 6:40 AM

If you have immature eggs at IVF, you may benefit from a different protocol. Without evaluating you and your husband, I cannot provide meaningful medical advice.
Good luck.


sandy - June 22nd, 2006 2:18 PM

My re just told me that instead of unexplained infertility which is what my husband and I were initially diagnosed with, we now have an issue with my eggs. Since they were immature both times of ivf despite the second ivf to go a little further with the sizes. Have you encountered anything like this? My re says that this doesn't mean that we won't get pregnant but both times of ivf, the immature eggs matured overnight and became embryos; but not very good quality ones.
Have you encountered anything like this? If so, what did you do?


B. Jacobs, M. D. - June 22nd, 2006 7:18 PM

Yes, and it seems to be the stimulation that contributes to the problem. Also, if your thyroid hormone level is low, that could contribute to the problem.
Good luck.


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