Looking for advice afer a failed cycle.

[positively]

Good Day and thank you so much for being so wonderful and answering so many womens’ questions. How so very thoughtful!!
I just experienced my first IVF failure with a grade A 3 day embryo. Fortunately, I still have some frozen to use again. My RE does not seem concerned and said there is nothing wrong with me. The only other pregnancy I experienced was a blighted ovum about 9 months ago. I am reading and I believe that just because I had a blighted ovum, it does not exclude implantation dysfunction from being an issue of mine. At what point would you test for this? Also, being that I’m 30, is it possible for all of my embryos, even though they appear great and are of grade A quality, to be chromosomally abnormal. I may just be jumping the gun but I am curious as to when I should as my RE for further testing. My husband and I were tested for infectious disease, my blood count and all other day 3 labs were tested as well as CF. Everything is okay so far.
Another random question, what is your take on acupuncture before FET? and are you more inclined to encourage SET or are you okay with two?

Here is the info from my IVF
am 29, tried to conceive for a year using at home insemination due to my husband’s ED. Went to an RE, did one un medicated IUI and got pregnant (March 2013). At that time, my lab work was FSH: 10.1 ; LH: 11.1 ; AMH: 3.97 ; estradiol level was 45
my prolactin was 10.9. I know that my fsh is borderline but that is the highest its been. In the last year, it has gone from 10.1 – 9. My lowest AFC was 27.
I did 6 unmedicated IUIs with no success. I think the timing was mostly off. Then I decided that with me being 29 and my husband being 35, I needed to act on my FSH. We did our first IVF cycle. Everything looked great. 30+ follicles on day 3, an fsh of 9 estrogen of 25.
I started on 300 ius of follistim. after 4 days, my estrogen was 920 and I had 4 follicles measuring 10-13 – I continued 300 iu of follistim. the next day, my estrogen was 1343 dropped follistim to 150 iu. the next day, estrogen was 210 – dropped follistim to 75iu. The next day estrogen was 3365. My follicles were:
2@19
4@16
3@14
2@13
2@12
7@11
2@10
I triggered that night and had retrieval 36 hrs later. At my retrieval there were 31 follicles but 22 eggs retrieved. out of the 22 eggs retrieved, 8 were mature. All 8 fertilized on their own and the report was
4 @ 8A ( one of these was compacting)
1@ 8B
1@ 6A
2@5A
We did a 3 day transfer of the 8A that was compacting.

[Dr. Wisot]

I really can't give "advice" here but can answer questions.

Based on what you write I would not be concerned about implantation issues based on one single embryo transfer. I wonder why they did not let your embryos go to blastocyst at your age and with the embryo quality you indicate.

Your high E2 could have had an adverse effect on your endometrium in the fresh cycle, so you may do better in a frozen cycle. You could try another single embryo transfer or transfer two. You should rely on your doctor's judgement on this.

Good luck.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[positively]

Thank you so much for your quick reply. I have no idea why my embryos weren't taken to blastocysts, either. I'm so confused by this whole process.

[Dr. Wisot]

Youn can ask your doctor why.

Also I forgot to mention that many patients feel that acupuncture helps them relax and reduce the stress around the time of transfer.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[positively]

I just want to report back and say that I did acupuncture and I really liked it. I felt more relaxed than ever.
Also for my FET, my RE thawed my 3 day embryos (both 8 cell grade A) the day before my transfer. They both thawed perfectly with all 8 cells in tact. By transfer (the following day) one was a 12 cell grade A embryo and the other was an early morula. Do you know if signs of growth after thaw increase the success of implantation? Also, have you ever heard of a 4 day FET?

[Dr. Wisot]

I am not aware of any randomly controlled studies that demonstrate a difference in success when embryos progress after the thaw. They are usually transferred soon after thaw so we may not get a chance to observe if that happens. But when it does and I am seeing more often with vitrification, it would seen to make sense that would be a good thing.

I have not had any experience with 4-day transfers.

Do you know what the difference is between a 3-day and 4-day transfer?

ONE DAY!

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[positively]

Thank you for the quick reply!
Yes, it is just one day.. just a weird one!! It threw me off but I'm glad that we were at least able to see that the embryos were okay after thaw! Have a great weekend!

[positively]

I just had a quick question.
I did a FET with two embryos. I had my HCG tested today, 13 days after a 4 day transfer. My hcg was 1,389, my e2 was 2,302 and my progesterone was 17.4. I’m concerned about my progesterone. Is that really low? I am on endometrin 3x a day.

[Dr. Wisot]

Don';t worry about the progesterone because you are on supplements which do not show up in the blood significantly. What you are seeing in the blood test is what the pregnancy is producing and that's actually good.

See-a little acupuncture to relax you and transferring in a non-stimulated cycle did the trick.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

[positively]

I definitely think the acupuncture did the trick! I'm glad I took your advice! Thank you again for everything!