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Topic: Varied response to stimulation (Read 494 times) |
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PR
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I have learnt a lot from this site and i like this site.
I just turned 40.
My day 3 E2 level was normal. They did not measure my FSH level. I was told if my E2 Level was normal it is most unlikely that my FSH level will be high.
Is this normally the case?
I am going through IVF/PGD.
I was on lupron for 10 days. My 11th day E2 level was 32 and I was asked to do Gonal F 225 units twice a day = 550units for 2 days with lupron and then lower my dose to 150 units twice a day for 2 more days. My E2 level after 4 days was 120 and u/s showed 9 follicles. The doc asked me to increase my dosage to 225 units and continuing Lupron for 2 days and then my E2 dropped to 112 and I still had 9 follicles.
What is making my E2 go down
The doc went ahead and changed my plan to stop Lupron and went to 75 units Gonal F and 75 Repronex. Now my 2nd day E2 now level was 550. Since I responded to this I was asked to continue with the same plan for 2 more days but was given Antagon once a day. Them my 2nd day E2 level was 1020. Then my went to 150 repronex and 75 gonal with antagon and my E2 level was 1640 and eventually the follicle were 20 mm 19mm 17mm and i don’t remember the other readings. Then the day came and I got the HCG shot. They retrieved 17eggs and 14 went through normal fertilization.
Why did I not respond to Gonalf but with the repronex combination combination? Is it possible that Lupron inhibited my follicle growth. Can this be the case?
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Dr Smith
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Re:Varied response to stimulation
« Reply #1 on: 04/01/05, 13:35 » |
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Your questions are more appropriate for Dr Jacob's Infertility 101 Message Board, so I suggest your post your questions there as well.
I have seen patients respond the way you did to pure FSH products such as Gonal F (as opposed to Repronex which contains both FSH and LH). The Lupron was also contributing to the problem, as you had "over supressed" from the higher dose of Lupron. Your doctor did the right thing by eliminating the Lupron and switching you over to stimulation medications containing both FSH and LH. The cycle was salvaged and, based on what you said, the fertilization results appear normal.
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PR
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Re:Varied response to stimulation
« Reply #2 on: 04/03/05, 16:40 » |
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Thank you so much for the response. I have heard repronex inhibits good embryos. Would this be the case that out of the 14 normal fertilization 9 went through PGD and out of which 2 came out normal and they are waiting for tomorrow (day 6) . Can this be associated with repronex or just my age? Do you think I would have reponded to pure gonal f without lupron?
Thank so much for your reply.
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Dr Smith
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Re:Varied response to stimulation
« Reply #3 on: 04/04/05, 19:08 » |
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The genetic makeup of embryos is not affected in any way by Repronex or any other brand of stimulation medication. The PGD revealed that you have the expected percentage (around 20%) of genetically normal embryos for someone that is 40. As to future stimulation protocols (if necessary), please ask Dr Jacobs. Good luck with the transfer.
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PR
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First I would like to thank you so much for replying. Not all doctors are as receptive and patient to answer irritable questions from patients. Once again thank you.
If embryos in the outside world grow at different rate does it correlate to anything? Does this relate to any slow development or genetic defects? for example if one embryo reached at blastocyst at day5 and the other reached at day 6. Does this mean anything?
What is the rate of normal embryos (genetically) for a 41, 42 and higher up.
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Dr Smith
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Re:Varied response to stimulation
« Reply #5 on: 04/06/05, 09:50 » |
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The general opinion is that embryos that reach the blastocyst stage on Day 5 have a slightly better developmental potential compared to embryos that reach the blastocyst stage on Day 6. However, the difference is very small if, in both cases, the embryos are fully expanded blastocysts with an adequate number of stem cells. Embryos that grow slowly at the cell stage (2-8 cells) can be normal or abnormal (so its not al that predictive). However, embryos that stop growing at the cell stage are always genetically abnormal (assuming that lab conditions are optimized).
The percentage of genetically normal emryos for women over 40 is somewhat variable, but ranges from approximately 20% at 40 to very near zero at 45+.
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