sharedjourney home

You are finally in the right place. Congratulations to the OB who sent you to a Reproductive Endocrinologist. I have not prescribed Clomid in at least 15 years. Please see the information on our web site, <www.texasfertility.com>.
Good luck.

Dr Jacobs,

Which is better? Day 3 with assisted hatching, or day 5 blasts?

My clinic does not do assisted hatching on blasts and I have found myself having to make this decision. I know blasts are ideal but i have not success in the past w. fresh blast cycle and frozen blast cycle. Ideally, i'd like an assisted hatched blast but i'm being forced to make this decision....what are your thoughts?

Assisted hatching seems to only provide a benefit if the zona pelucida (clear protein coat arround the egg and early embryo) is too thick. Since not all day 3 embryos which look good are actually good, by waiting to day 5, we let many of the less good ones identify themselves.
Good luck.

Hello Dr,
I am 34 and DH 43. He was 2 kids from previous marriage. We are TTC from 2 and 1/2 years.

I have a history of endometriosis. I have a nodule of endometriose located close to my rectum. I had a surgery on Dec/06 to remove it. During the surgery the doctor found out that my left tube was too much demaged and removed it. The nodule was to far behind and could not be removed without damage my uterus, so the doctors decided to not remove it. They said that everything else looked good.

I did 3 unsucessful IUIs when we finally decided go to IVF. Prior to the IVF I did the Antra follicle count and it was low - 7. The doctor also saw that my last ovary does not produce eggs, probably because was damaged during re removal of the tube.

Anyhow, we decided go to IVF anyways. I took Lupron, Gonal-F, Menupor and Progesterona shots. I was able to produce 7 follicles, all on the right side.

From the 7 eggs, only 3 were mature anough. They're fertilized and became 2 8B and 1 10B. Verify good quality said my doctor.

Following docs recommendation we implant the 2 8bs (I regret that later) and froze the 10B.

The IVF failed. Doctor recomended then do a frozen cicle with the 10b. DH and I decided not to due to the cost and considering the low chances of 1 frozen implantation.

Doctor requested a office histeroscopy, before next cicle of IVF.

What do you think of all that? Any suggestions? We did so many tests and nothing else was found (beside my low followcle count). Anything that we cound be missing?

I am looking for any type of advice.

Thanks in advance.

I do not know what purpose a hysteroscopy would serve, if your uterine cavity has already been evaluated. I evaluate the uterine cavity with an X-ray study - HSG. For more information, please read our web site, <www.texasfertility.com>.
Good luck.

I have been trying to start a new thread and it has not been working - not sure if it's even available.

Anyway - I have a question regarding protocol and trigger shot. Currently - my husband (43) and I(41) have been TTC for 11 months - we have 2 beautiful children - 3.5yrs & 15months. Both conceived and delivered naturally using OPK's. Had 3 unsuccessful IUI's and just completed my first IVF. I think I was triggered too early but would love a second opinion. I am including my protocol for your review -
07.05.08 Saturday   Base Blood/US      Day 2
    &nb
sp;    Start
75 IU - Repronex-pm (Glute)
    
     Sunda
y
am – 225 IU – Bravelle (Back of Arm)
     
;    Estrodia
l
      77
 
        
Progesterone      
.08
       
;  LH     &nb
sp;   6
   &nbs
p;     FSH  &
nbsp;      7
&n
bsp;       &n
bsp;75
IU Repronex (Sunday pm)
      Monday (am) 225 IU Bravelle
  &nb
sp;   Monday
(pm) 75 IU Repronex
      Tuesday (am) 225 IU Bravelle

07.08.08 Tuesday   Blood/US  
       Day
5   (Possible Egg ret. Sun. 07.13.08)
    
     Increas
e
Repronex to 150 IU (Glute)
    
;     Add
Garinelex – pm (Abs)
    &n
bsp;    22
5
IU – Bravelle (Arm- Wednesday -am)
    
     15
0
IU Repronex (Wednesday –pm)
    &n
bsp;    Ganireli
x
(Wednesday –pm)
    
;     22
5
IU Bravelle (Thursday – am)
     
;    Estrodia
l
      251
 
;        
;Progesterone      
;
1
     &nb
sp;   LH  &nb
sp;      
;
2
     &nb
sp;   FSH  &n
bsp;     &nbs
p;
11

07.10.08 Thursday   Blood/US  
;       Da
y
7
    &n
bsp;    22
5
IU – Bravelle (Arm) am
    &nbs
p;    Repronex
to 150 IU (Glute) pm
    &nbs
p;    Garinele
x
– pm (Abs)
Estrodial       362
 
;        
;Progesterone      
;
0.6
     &n
bsp;   LH  &nb
sp;      
1
     &nb
sp;   FSH  &n
bsp;     &nbs
p;
12

07.11.08 Friday   Blood/US&nb
sp;     &n
bsp;     D
ay
8
    &n
bsp;    225
IU – Bravelle (Arm) am
    &nbs
p;    Repronex
to 150 IU (Glute) pm
    &nbs
p;    Garinele
x
– pm (Abs)
    &nb
sp;    Estrodial
      585
 
;        
;Progesterone      
;
0.5
     &n
bsp;   LH  &nb
sp;      
>1
     &
nbsp;   FSH  &n
bsp;      
13

07.12.08 Saturday    Blood/US  &nb
sp;      Da
y
9
225 IU – Bravelle (Arm) am
    &nbs
p;    Repronex
to 150 IU (Glute) pm
    &nbs
p;    Garinele
x
– pm (Abs)
    &nb
sp;    Estrodial
       827
     
;    Progesteron
e      
;
0.7
     &n
bsp;   LH  &nb
sp;      
1
     &nb
sp;   FSH  &n
bsp;     &nbs
p;
13

07.13.08 Sunday   No Blood/US     &nbs
p;    Da
y
10
225 IU – Bravelle (Arm) am
    &nbs
p;    Repronex
to 150 IU (Glute) By 6pm
    &nbs
p;    Garinelex
– (Abs) By 6pm
    &
nbsp;    HCG
12:15am

07.14.08 Monday    Bloodwork Only       Day 11
     
;    Estrodia
l
       1549
    &nbs
p;    Progestero
ne     &nbs
p;
6.6
     &n
bsp;   LH  &nb
sp;      
4
     &nb
sp;   FSH  &n
bsp;     &nbs
p;
12
    &n
bsp;    Beta
    &nb
sp;    
150
    
     N
o
Shots
     
;    Increase
Fluids
    &nbs
p;    Nothin
g
to eat/drink after midnight

07.15.08 Tuesday   Egg Retrieval – 9am       Day 12
15 eggs
7 mature
4 fertilize normally w/ICSI
Freeze till next cycle for PGD

We are starting another IVF cycle this August - Dr. says same protocol but maybe stim for a few days more - what do you think? Any thoughts are appreciated.
Thanks

There are an umber of different protocols for stimulating ovaries for IVF. Your physician must use the one(s) he/she is comfortable using. We find that, starting stimulation on nominal cycle day 3, if we give hCG to start maturing eggs before cycle day 12, fewer of the eggs we obtain are mature.
Good luck.

Thank you for your quick response - it is appreciated!

I do have one more question...

Due to my age-41-I think the stimulation went fairly well - I had 13 follicles greater than 13mm and 11 that were less than that. Dr. was able to retrieve 15 eggs.

The upcoming cycle Dr. indicated he'll watch my numbers w/blood & u/s - what are good numbers to indicate the HCG trigger for bloodwork? Should my Estradiol have been a little bit higher than 1549? Not sure how the bloodwork gives indication of when to retrieve.

I just want to make sure I do not over stimulate, but I think I should go a little longer before retrieval in hopes to get a few more mature eggs.

Thank you again for your time - it is appreciated.

Each practice hs its own protocol and set of criteria for administration of hCG. Please rely on the judgement of your RE.
Good luck.

Dr.Jacobs,maybe my question silly,but it seems like in my clinic have a hard time to coordinate their answers and even harder to get hold of a doctor.
So,anyway,I had a transfer yesterday and in a few days I'm supposed to start using Vivelle pathes 2mg endd replace them every 3 days.I asked the nurse if I could use Estrase 2mg tablets left from my unsuccesful FET instead(I have about 90 pills left and if this is the same thing ,I don't want to waste it,i paid $200 for that medicine).But ,of course,I'll do whatever is the best.
I just dont understand why it is so hard for them to give me an ecxact answer.So,my quiestion is:
can I take Estrace pills 2mg/day(orally or vaginaly)?
and what's the difference-why they preescribe Vivelle(or Estraderme) for thr fresh cycle and Estrace for FET?
Thank you doctor.

I really cannot interfere with the instructions your RE gave you. If he/she is OK with your using Estrace, then that is the answer. In truth, it probably does not make a real difference.
Good luck.

I was unable to open a new thread so placed my question over here.

I'm seeking a bit of your time and talent and suggestion. I'm 32 years old with stage III endometriosis, adhesions. After excision surgery in March 2002 and laprosocpy in 2006 for removal of cysts and endometriosis, and 2-3 cycles of clomid then, we started IVF in November 2006. My first fresh cycle produced 8 eggs--transferred three in a 3 day transfer in December, ending in a chemical pregnancy. The second cycle i responsed very poor and turned out to IUI and The second IVF cycle in 2007 oct and transferred two again that resulted in BFN. Three were transferred in our third cycle, 2008 in June. it was unsuccessful with BFN from thrid cycle included several acupuncture sessions. Throughout all three cycles both doctors and nurses said though I am poor responder , everything looks perfect. As you can see, I'm certain this is not perfect.What should be my next step, Is it time for testing, immune or other and if so, what should we be looking for?

Thank you in advance for your help. I look forward to your reply.
PS-- I'm being treated by doctors at FCI chicago and the dr is Laurence A. Jacobs.

For poor responders, I use a microdose flare protocol. Your endometriosis is another problem. It can iterfere with production of an adhesion molecule in the endometrium, which seems to be important for embryos to implant. even if all the visible endometriosis was removed when you had surgery, you still have microscopic endometriosis, which may respond to medical treatent. For more information, please seeour web page,<www.texasfertility.com>.
Good luck.

Thank you for your response.
the last 2 periods which I had faced a bad cramping which is out of endometriosis I think.
Is it good to go out once again for laprosocpy to clear the endometriosis and adhesion's if any.
I am confused and just making sure what to do before i proceed to next ivf cycle.

There are only 2 reasos I operate on a patient to treat endometriosis. One is to try to relieve painful periods. The other is to try to restore production of a molecule in the endometrium which seems to be important for embryos to attach to the uterine lining.
Good luck.

I started my infertility workup 12/07, at that time my FSH level was 9.6 and Estradiol level 39. I had a HSG which revealed blockage on the left but right tube was opened. I underwent bilateral tuboplasty 2/08 both tubes were discovered to be blocked, however the M.D. was successful at unblocking the left and questionable on the right. Per the report, "both distal ends of the fallopian tubes were patent and methylene blue dye spill was confirmed from the left fallopian tube, but not the right." Was advise by my doctor if we did not conceive to return for another HSG to check patency of tubes. Had that done 8/08 which revealed the same thing, left is open and right no spillage noted. My doctor is now recommending IVF. I am not sure that this is the right route to take. I question my FSH levels and the use of Clomid but the doctor does not think that is the right route to take given my age and tubal problems. I am 38yrs old, my husband's sperm count is good. I'm considering seeing another doctor to try some medications firsts. What do you think? We have only been trying since 2/08 after the tubal surgery.