Aboyt to start 3rd IVF
2 Replies
Jo from Oz - October 16

Hi Dr Jacob

I've read your previous topics - and appreciate not only your knowledge, but your upfront easy to understand delivery.

I'm 40, overwieght, no PCOS, non-smoker, No children. Possible previous pregancies: lost in early stages (luteal phase defect?). 18 months TTC. Dh is 32, normal motility etc.

We've had 2 IVF/ICSI cycles so far this year.

1st time: Standard protocol (Syrenel day 2-13; Pregnel 425/day day 3-13; Egg Pick-up day 15; Transfer Day 20)

12 follicles: 16 eggs: 14 mature: 11 fertilised; 6 growing strong. Pgd = 1 dud. 5 ok day 5; Best 2 blastocysts transferred on day 5. 0- frozen. Crinone progesterone am/pm following.Spotting say 31. Blood test on Friday day 33 HcG = 17 then >2 on Monday.

2nd time: Standard protocol (Syrenel day 2-12; Pregnel 400day day 3-12; Egg Pick-up day 14; Transfer Day 17)

10 follicles; 9 eggs; 8 mature; 7 fertlised; 6 growing strong. No pgd as by end day 2 - 3 had multi nuclei. Day 3 transferred best 2 x 8 cell. Assisted hatching, & Glue. None Frozen. Crinone progesterone am/pm following, as well as 2 x Progest shots.

Blood test day 32 was -ive. Long light period form day 33.

As you physically/emotionally/financially this becomes a drain. We are prepared to go again. Specialist wishes to do a long protocol next time. Syrenel from day 20 (next Friday) then scan day 6 next cycle followed by pregnel shots (450/day). He prefers blastocyst, Full PGD/Isci/AH. and glue. Then I presume same progesterone protocol.

Is this a reasonable protocol to maximise our chances? Why in the first cycle did I show HCG at 17, then 0? Can this be fixed. Why did the second batch have multi-nuclei? Can this be fixed? Can you suggest anything else to be done this time or the next (should we go again)?

I'd appreciate your thoughts ? many thanks, Jo from Oz

PS _ The maximum No. of embies they transfer now is 2, except for over 40years. I'm forty - and wondered what are the chances of them all taking if I transfer 3 or 4 good blastocysts given my age. Both previous times we seem to have 3 or 4 ok embies - but tranfer the best 2 - and the left over not frozen.


B. Jacobs, M. D. - October 16

On your initial appointment, I would have alerted you that the published implantation rates for womem 40 to 44 years of age is 6.1% That is about 1/3 the implantation rate for women who are 30. I would have offered donor egg. For my patients who are lates 30's and early 40's who wish to try with their own eggs, I use a micro dose flare protocol.
Good luck.


Jo from Oz - October 24

Thank you for the clarification & advice:-)

I'll discuss your information with my specialist.

Many thanks, Jo



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