Advice on Very Badly Failed IVF

try4no1
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Joined: Wed Feb 26, 2014 10:03 am

Advice on Very Badly Failed IVF

Post by try4no1 »

Hi Dr W

I contacted you a while ago about IVF My husband and I went through our first Round of IVF and it failed on multiple levels and looking for advice whether it was a protocol issues, something we did or just bad luck. iam 29 and my husband is 30

Here is our Story, We have been TTC for over 18 months I have PCOS and my husband has Severe MFI.
With my PCOS I seem to ovulate, i have periods regularly. I have recently had call my bloods done with. FSH 6.9, LH 5.1, Estrodol 44, AMH 3.65, AFC is 10-15 on each ovary so up to 30 total, prolactin 20.1, My testosterone was normal. My husband has low morphology and motility however 4-5 months ago has had the bilateral variocele repair surgery.

We opted for IVF has we had insurance coverage and fed up of the waiting and was told with both factors with us being young and with IcIS we could by pass the problems and had a 70% chance of success.

So for my IVF cycle I was on an angonst protocol of gonal f and menopour with cetrotide. base line fsh 6.9, e2 44 after 6 days of stims i had 20 follicles around 13-15 mm and e2 was 600. I started Cetrotide then and came back to the clinic 2-3 days later all 20 follicles were 18-21mm. I looked great on the US and all blood work normal. I triggered that night with ovidril has i was having increased pain and my RE was worried with OHSS risk and came back 35 hours later to have my ER.
This is where it all went wrong. With 20 follicles all measuring 20mm+ they only got 3 eggs ( they say there was no evidence of premature ovulation and all other follicles were empty). 2 of which were mature, Both Fertilized via IciS and we opted for a 3 day transfer instead of 5 due to the low number. An hour before the 3 day transfer the lab called to say they checked on the embryos and both embroyos had arrested and we were left with nothing to transfer. they embryos were 1 cell they didnt move passed fertilization we were told.

Apart from being devastated that at 29 i had no embryos to transfer after having what we thought was an excellent response to Stimulation. How can we prevent this happening, The lab did mention that maybe the egg quality was poor however at 29 i have a BMI of 25.1 however i am only 7 lbs away from normal BMI. I followed the protcol spot on, I exercise and eat well and I have been taking prenatal vit and supplements and acupuncture for the last year. I just dont want to have to go through this again, I am worried... was it they way I was stimmed?? was it the lab?? have you seen this response in someone "reproductively" young. I am scared that something is happening but no blood work is showing what. we are completely lost and want to try again but I need to make sure all mistakes are corrected. My RE has been great but all admitted this is extremely rare and has only seen it happen once before.

Any advice I know this was a long Post so I thank you for ur Time
Kind Regards
Very Upset and Frustrated IVF Patient. :(
Dr. Wisot
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Re: Advice on Very Badly Failed IVF

Post by Dr. Wisot »

What you are asking for is a consultation which I really can't give here.

But I can say that I have seen this kind of problem with Ovidrel and we don't use it. The problem with Ovidrel is usually in obese women which you are not, but it can occur at normal weights.

Cetrotide is an antagonist, not an agonist, by the way.

I'm sorry to hear that you has such a bad result.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
try4no1
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Re: Advice on Very Badly Failed IVF

Post by try4no1 »

Thank you for the reply, I didn't mean for it to come across as I was wanting a free consultation that wasn't my intension. However the advice with ovidril is great I have now read more about it and that is definitely something I will have my RE change.

I was more curious if this was a common problem you see in PCOS patients?

What I really wanted to know was this more of an egg quaility issue or a stimulation protocol issue. You don't have to say what protocol you would use but I was wondering in your experience is it more the egg quaility is poor in pcos patients or poor if not correctly stimulated. I hope that makes sense. And sorry for the Cetrotide mix up.

Thank you.
Dr. Wisot
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Re: Advice on Very Badly Failed IVF

Post by Dr. Wisot »

Hi:

I did not mean to imply that you were trying to get a free consultation. What I meant was that to get a meaningful and complete answer to your inquiry I would really need complete information.

I don't think what happened to you is related to PCOS.

No need to apologize for not knowing that Cetrotide is an antagonist because that's what you come here for, to learn new information. If you knew everything I would be out of a job. :)

Since your doctor is not providing you will satisfying answers maybe you should go get a formal second opinion.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
try4no1
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Re: Advice on Very Badly Failed IVF

Post by try4no1 »

So your saying it was likely protocol. If so that's a bitter sweet we went through that but protocol is easier to fix then egg quality.

Thank you for such great information.
Dr. Wisot
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Re: Advice on Very Badly Failed IVF

Post by Dr. Wisot »

No. I think the problem was probably the Ovidrel which did not mature the eggs adequately to have many not release and others to not fertilize or develop.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
try4no1
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Re: Advice on Very Badly Failed IVF

Post by try4no1 »

I wanted to update you and hopefully anyone else in my situation, after a poor IVF the first time we consulted our RE about different protocols and decided to do a down regulation with lupron to have more control. I upped the Gonal F to 187.5 and menopour the same 75 iu and add FULL 10,000 trigger!

Well I needed to stim 2-3 days longer and didn't get as many follicles last time I had 20+ follicle but only 3 eggs this time we had 16 follicles, 13 eggs and 9 fertilized. All 9 made it to day 3 with 7A+ 8 cells embryos and 2 b/c grade 5/6 cell embryos, we ended up transferring 2 A+ on day 3 my RE wanted to wait for day 5 however I had too much apprehension of not having anything on day 5 and we had beautiful high quality on day 3.. We ended up freezing 4 grade A+ on day 6 and unfortunately this wasn't our cycle and it wasn't successful however going from no embryos to transfer in one cycle to transferring 2 and still have 4 expanded blasts to freeze out of 9 was pretty awesome to us and hopefully it gives hope to someone else that just a short change in protocol or cycle can make a huge difference. We are currently undergoing our first FET cycle..

Thank you for your help I really pushed for the HCG trigger to be changed my RE was great and listened and I really think that was the winner. I didn't have OHSS either with in the larger dose of HCG. I am excited to see how the FET works and should we have to do another fresh cycle I am happy that we can make great quality embryos as hoped and one day a little baby! :)
Dr. Wisot
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Re: Advice on Very Badly Failed IVF

Post by Dr. Wisot »

Thanks for the update and glad to hear it's more encouraging, :)

You may actually do better in the FET cycle since the endometrium will not be overstimulated as in the stimulation cycle. You might ask your RE to do a "scratch" biopsy in the cycle before the FET as that sometimes promoted implantation when you have had a failed cycle with good embryos.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California
try4no1
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Re: Advice on Very Badly Failed IVF

Post by try4no1 »

Thank you for the reply, we actually went straight into the FET the next cycle so we didn't have a cycle in between so I don't think we can get the scratch biopsy right? I am currently on Estrace to build my lining with transfer in a couple of weeks. Is there anything else that can be done by myself or RE to aide implantation we will transfer 2 embryos in the FET in a couple weeks. Is assisted hatching a good option or is it risky.. My frozen blasts are high quality expanded blasts.
try4no1
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Posts: 13
Joined: Wed Feb 26, 2014 10:03 am

Re: Advice on Very Badly Failed IVF

Post by try4no1 »

One other thing was I noticed in my fresh cycle was that I felt the lupron really stripped my lining and I had an extremely heavy period at the start of my cycle on day 3 estrogen was 20 and the lining was 4mm and only 7mm at ER and 8-9mm At ET. When I had my baseline testing for FET my estrogen had dropped so low at day 1 was 11 and lining was 7mm and the period wasn't too heavy like that one before.. My RE wasn't concerned that the estrogen had dropped so low but I can't help but think that maybe my body isn't sustaining enough estrogen so I am hoping the continued estrace in this cycle will help maintain a possible pregnancy and bump up the lining to help my embryos be a little more sticky. :)
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