1 Replies
allison - February 10

Dr. Jacobs,
I hope you can help me with some insight, sorry but this is a bit long:
I just had an IVF cycle that failed (this is the 4th). The first two cycles I was on a long protocol of Lupron and Gonal-F and I didn't stimulate well. The stim length was 12 days in both cases (the dose was increased from one to the other), there was a total of about 17 follicles, with the leads around 20mm on day 12. No fertilization occured in the first (3 eggs retrieved), and out of 7 eggs in the 2nd, only one fertilized but did not develop. So my RE, determined to succeed, changed my meds: short protocol - Gonal-F (7 days) and then Menopure + Cetrotide. He also decided that I need to stim for longer so that eggs mature. I stimmed very very well, HCG day 14, 10 eggs retrieved (23 follicles), 9 mature, only 2 fertilized (emergency ICSI was done on the other 7 on day 1, 2 fertilized, none developed; there is no MF). The 2 embroys reached only 4 cells on day 3, they were transfered, but no pregnancy. This last cycle our RE decided to go with only menopure + cetrotide and stick to the long stim protocol where follicles get to be larger than 30mm. I stimmed very well -- too well - day before retrieval E2 was 7300 (so far no hyperstim, thank god). 14 eggs were retrieved (24 follicles), 1 got fractured, so were left with 13. Our RE had decided that this time he'll do ICSI on all the eggs right away, not to take chances. 7 were good enough for ICSI. None fertilized. Our RE is puzzled. We are puzzled.
Do you think his assesment that in my case the follicles need to be bigger for eggs to be mature is right? Is there a question of timing here? He think I'm a unique case (the eggs he said. all looked very good when retrieved).
We're meeting with him tomorrow for a follow up. What do you suggest we ask? Have you ever seen a case like this? Any ideas?
(I should add that I am 34, baseline FSH 4.7, LH 2.2, E2<30, all other tests normal, no MF).

Thanks, allison


Barry Jacobs, M. D. - February 11

I am not familiar with the protocols you have described. It is my understanding that I am one of the few RE's who does not add some LH (one of the componants of Menopure) to my stimulation protocols. I have had very poor pregnancy rates with Cetrotide, and I give hCG to go to retrieval with follicles far smaller tha 30 mm. I am at a loss to tell you what to ask, except what your RE plans next.
Good luck.



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