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Hi Dr.Smith
What is the maximum/best E2 level before triggering on a good IVF cycle?
At what level will E2 starting effecting Egg Quality?
What is the best length of stimmualtion? (10 days??)
What is envolved in co-culturing? Does it really help with Egg Quality?
After 2 failed IVF's, should Assisted Egg Hatching be something to consider?
Thank you for all your help! It is very much appreciated!!
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Q1. Approximately 180 pg/ml per mature follicle (>16mm) is the rule of thumb.
Q2. We have observed that E2 levels >6000 pg/ml are associated with diminished egg quality and poor embryo development. Others have reported decreased implantation rates with E2 levels in this range.
Q3. 9-11 days is the norm, but up to 13 days is O.K. if coasting is used. Stimulations should not be less than 9 days as this does not give the eggs sufficient time to mature in the follicle.
Q4. Co-culture is pretty much a dead issue. I am only aware of one U.S. program that persists in performing co-culture with homologous endometrial cells. The decline in application of co-culture is a direct result of vastly improved in vitro culture conditions that have been developed in the last 8 years. Unless the lab has sub-optimal culture conditions, co-culture would not likely result in improved embryo quality. The main determining factor of embryo quality is the genetic make up of the embryo.
Q5. Assisted hatching has been shown to be beneficial for patients with repeated IVF failure.
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