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Topic: First IVF (Read 719 times) |
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curiousgal
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Dr. Smith -
I had posted back in March on the 101 boards with the results from my tests and Dr. Jacobs said that he didn't see why I was doing IVF. This is what happened with our first IVF:
We did our first IVF retrieval on 5/12 on 5/9 my stats were e2 1602, lining 9mm, on my right 1@18, 2@16, 1@15, 2@14, 1@11, 4-5 <10 on my left 1@13, 1@11, 3-4<10. on 5/10 my b/w came back with e2 of 2282 and they told me to trigger - I didn't have another u/s but they said they were growing at 2 per day. So I triggered and they only got 3 eggs on 5/12. 1 was no good - the other 2 they did ICSI on - one didn't make it and the other today is at 3 cells with some fragmentation on Saturday - on Sunday - the day of the transfer (of course they didn't want to wait to Day 5  ) they said it was a 6B - I don't know what that means.
my protocol up until trigger was 225 iu twice a day of follistim and then they added antagon to it. do you think that some other protocol would have helped with getting more eggs and possibly better eggs?
And is 6B really bad - I haven't been able to find any information on grading systems that go up to 6 - I know different clinics use different systems - but when there isn't any info on systems going to 6 - I'm worried. I know that there is only a very small chance this one will work out - I'm asking the questions so I will be better informed for next time.
Thank you Again!
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Dr Smith
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The "6" refers to the number of cells as in "6-cell" and the "B" refers to the quality with "A" being the best grade. They transfered a 6-cell stage embryo with a moderate amount of fragmentation (i.e. average quality).
You were on a standard protocol, so the protocol was fine. However, when they triggered you, you only had three mature follicles. They could have waited a little longer and allowed the smaller follicles to develop a little more. You might have had more mature eggs and more embryos to choose from.
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curiousgal
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Thanks Dr. Smith! I was thinking the same thing... and I appreciate your breaking down the 6B! 
I truly appreciate your thoughts -- it is so important to understand what is going on especially when you don't get to talk to the doctor who is treating you! I felt pretty lost and in the dark this weekend and you've just made me feel 1000X better!!! 
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curiousgal
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Hi Dr. Smith!
We are meeting with the RE for a followup today. Our 1st IVF failed. It wasn't that big of a shock for me given the research that I did and your helpful insight.
I plan on listening to what he has to say and seeing if it jives with what I think (too short of stim 8 days, trigger too early, only 3 mature follies at trigger, and no form of suppression prior to stims, day 3 transfer). I wanted to thank you again and will probably have some questions after our followup with him.
Have a good day!
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curiousgal
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Hi Dr. Smith -
Our meeting with the RE went "ok". He said that he never expected to only get 3 eggs from me based on all of my tests. He said that on the day of retrieval there was 1@20, 2@18, and 1@17... he said that they triggered at the right time. He said that suppression wouldn't have helped because that is mainly used for "timing" purposes.
He said that he would like to try a micro dose / flare protocol including reprenox (not sure of spelling). He also said that donor eggs would be another option - but that he'd like to give it 150% to see if they can get more eggs for me. He also told me that my embie was very good - not excellent - but very good and that had we had 2 of them, my chance would be 50%.
I'm not sure if you're the right person to ask or if it is Dr. Jacobs - but I'm not sure if I should give it another chance, change clinics (do you guys do people from out of state?). Based on my stats/tests - dr. jacobs said he was "hard pressed" to see why I needed ivf in the first place when I posted to him a few months ago. Everything is out of pocket for us and I just want to ease my mind and really know the reality of the situation. Iwish I hit the powerball....
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Dr Smith
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I disagree with your RE that if you had two 6-cell grade B embryos it would give you a 50% chance of success. It is not clear whether or not the embryo was capable of developing beyond the 8-cell stage, a critical factor in the assessment of embryonic developmental potential. Secondly, the only patients who could expect a 50% success rate from a Day 3 transfer of only two embryos would be under age 35, and the embryos would have to be perfect 8-cell embryos. If you are over 35, a 50% chance of success from a two embryo Day 3 transfer is very unlikely.
Lupron is used for scheduling of patients, but it also has the added benefit of facilitating synchonzation of folliclular growth. You had significant dissynchrony in follicluar growth, with many of the developing follicles less than 16mm in mean diameter at the time of the retrieval. It is no surprise that only three eggs were retreived. The eggs in the smaller follicles had not had time to adequate mature and were therefore still strongly attached to the inside wall of the follicle (i.e. un-retrievable). Even if they had been retrieved, they would have had a low fertilization rate and poor developmental potential.
Although the micro-dose flare protocol uses Lupron, it is used in a different way and does not have the same synchonizing effect. If fact, dissynchrony in follicle growth is actually worse when using the flare protocol.
Both Dr Jacob's program in TX and the one I work with in NJ accept patients from out of state. If you would like to speak with Dr Jane Miller, the RE I work with in NJ, give her a call at 201-871-1999.
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curiousgal
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Thank you for your reply!
I'm am having a very difficult time through what I've been reading (here & other places) - and trying to understand what the microdose/flare protocol is. One thing for sure is that I'm thinking I don't have confidence in my current RE - he doesn't explain things very well and doesn't seem to take the time to give us information for us to make an informed choice/decision.
I will give Dr. Jane a phone call. I think it is time for a second opinion & change!
While I know that there is no guarantees of anything in this ttc world - at least I feel that there may be some hope for us. Thank you for giving me that! 
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