Your thoughts please
on approaching our last IVF cycle
, Apr 22 2012 03:05 PM
11 replies to this topic
Posted 22 April 2012 - 03:05 PM
DH and I said before we started IVF that we would try 3 fresh cycles and up to 6 frozen cycles. So we have done 2 cycles so far..from those 2 cycles we got 7 eggs each time, despite the second one doubling the dose of gonal F!
Just for background, Im 40 with blocked fallopian tubes, DH is 44 and pretty normal sperm, though he has only had one analysis done and it showed the motility was low, but still acceptable. He was put on menivit..but he hasn't had it since our last fresh cycle in April last year
for the first cycle we had 4 fertilize, transferred one 5 day blast chemical but BFN. no frozens
second cycle only 3 fertilized. As there was less than 4, my clinic transfers at day 3. So we transfered one 3 day 8 cell and froze the other two, both at 7 or 8 cells. BFN. But we got positives for each of the 2 that were frozen. Sadly we miscarried both, the first at 10 weeks, the second at 8 weeks.
so for our 4 transfers, we got negatives for both fresh cycles and positives for both frozen cycles.
Im wondering if we should push to just do frozen cycles for our last IVF..if both fresh ones didn't work.
should I push for the specialist to throw everything at me drug-wise to get more eggs? I was at 450 gonal f on the second cycle. People in USA have told me that they reckon my cycles have only been micro ivf as we only stimmed with gonal f and that they usually have several types of stimming drugs happening at the same time.
I will discuss it all with my specialist next week..I just wanted other peoples thoughts on it.
Posted 22 April 2012 - 04:34 PM
The USA do lots of things differently, so I would ignore what those over there are telling you.
As for upping your doses, it may help, but higher dose have shown to produce lower quality eggs & it's really quality over quantity that is more important.
In regards to Fresh v Frozen, are you saying you want to do a fresh cycle, then freeze & transfer frozen embryos another time? You would still be paying for a full stim, then another FET, with the possibility of loosing some on the thaw.
I would just do a fresh, then if there were any frozen, use them, but that's just me.
Good Luck with your cycle.
Posted 22 April 2012 - 07:05 PM
So sorry for your losses.
I think it's just chance which cycles have resulted in pregnancies and which haven't. IVF is a numbers game and therefore it seems like a good idea not to reduce your chances by taking a risk that some embies won't freeze or survive the thaw.
Not wanting to put the cat amongst the pigeons, but are you putting too much pressure on yourself saying this is definitely your last cycle? IVF seems to be working OK, its more a question of recurrent miscarriage. Have you had that investigated? When I was at that point of having several unexplained losses (age 38) my FS said that it was just a question of getting the "right embie" and to keep going a bit longer.
Hope this cycle works perfectly for you.
Posted 22 April 2012 - 10:23 PM
Thanks Jules and Meggs. Yeah, i was wondering if the FET's both working were just flukes. Im sure the first fresh one did try to implant.
we decided before we started that 3 would be it..but you never know..if we have the funds we may try a 4th time.
I haven't had the recurring miscarriages investigated, but my specialist said he would if the last cycle didn't work..so im guessing he will when i see him next week. Both the FET's were completely natural..so maybe he may add soemthng to help keep them in..if such a thing exists..lol.
Posted 22 April 2012 - 10:34 PM
Hi kez71, where are you doing IVF at? It's just that I was told that if my tubes were blocked that they would then tie them. Unfortunately I can't remember the reason why as my tubes weren't blocked, but it made sense at the time. Maybe it's worth asking your FS.
All the best.
Posted 22 April 2012 - 10:46 PM
I think you are doing great with 2 pregnancies from 4 goes, that must be very encouraging. I wouldn't stop the ivf after 1 more go because I think it is serving you well in getting you pregnant.
The miscarriages are another story entirely, and IMO if you are getting to 8 and 10 weeks that is nothing to do with IVF once you are that pregnant you are in pretty much the same boat as someone with non-ivf pregnancies suffering recurrent miscarriages - I have been there with 3 miscarriages before I got lucky and it sucks I know. But I agree with a PP on getting tested - there are a raft of blood tests that can rule out all sorts of reasons for recurrent miscarriage many of which have easy fixes. The other possible cause is of course a problem with the foetus - this can only be determined by testing the individual foetus after a miscarriage if you have a D&C. I'm older too so realistically I know that this is a possibility unfortunately, my last miscarriage was also at 10 weeks. Good luck OP
Posted 22 April 2012 - 11:17 PM
If you were going for American-style protocols you'd be putting multiple embryos back, etc. IVF is both a quality and numbers game. Not much point getting heaps of eggs that don't fertilize.
You seem to have had a very good result in terms of pregnancy rates as a % of your eggs and embryos.
At your age, the miscarriage rate is very high on average, and as the PP said, your miscarriages probably aren't an IVF issue, but probably a chromosome issue. Obviously though, it needs to be checked out.
We started saying we'd do three stim cycles, and changed our mind during the second (because we didn't get the opportunity to do as many frozen as we had planned due to not enough embies) and said we would do four stim cycles. Then again, we said we would never do IVF. What I am saying is, just take it one step at a time and wait and see what happens next time.
Posted 23 April 2012 - 07:28 PM
I did 9 stim cycles with varying levels of Gonal F. I found I got better results (quality and quantity) of eggs on lower doses. I have low ovarian reserve and was 38-39yrs old while stimming and had my best results on 175u. For me, more was certainly not better. Some FS will go as high as 900u! As per PP, I have also heard that higher doses may compromise quality.
Good luck OP. It's a positive sign that you have shown you can get pregnant. If you were getting BFN after BFN, that's a different story.
Posted 24 April 2012 - 02:56 PM
Thanks for commenting ladies. I really appreciate you taking the time out to reply.
Indigo, thats really interesting that your best results were on the lowest dose! I had the same number of eggs each time, but one less fertilize on the higher dose..it is interesting how it all works.
Prilou, Im going to Monash IVF. Yes sometimes tubes are taken out due to some liquid that accumulates in them. I got to 8 and 10 weeks, so I don't imagine its anything to do with that..I will ask though, thanks
Tibs thanks. I agree 2 pregnancies from 4 transfers is really good. I don't want to stop trying, but that money has to come from somewhere and we don't have PHI, so are self funding this. Hopefully the next time will be it and we won't have to worry about trying again!
I did want to do a D&C this last time to check for anything they could see. However I saw the doc on Monday, 4.30pm with spotting, he got me in for a scan right on 5pm. we saw no heartbeat. My next appointment with the doc was wednesday morning, but I bled tuesday evening from 4pm to about 10pm..very clotty and gross. When I told the doc on the wednesday he said there was no point as it would have been expelled already.
Maloney, I guess being girls we are allowed to change our minds..lol
Posted 24 April 2012 - 03:11 PM
I wouldn't worry about fresh vs frozen, as I think it was just luck that your two +ves were on frozen.
I also wouldn't worry so much about egg numbers, since the quality seems OK - they fertilise, and they implant (50% of the time.)
However, I wouldn't be risking trying to get to blast again. I would be asking for day 3 transfer & freeze, in the hope that your uterus will save the ones that might not have made it to blast in the lab.
My stim was when I was 32, so we're completely different in that regard. However, I go 4 eggs from my first stim (with puregon, not Gonal F, but a relatively low does.) 3 fertilised. First fresh transfer was a BFp and my son. First frozen was BFN, second frozen and I'm nearly 9 weeks PG.
So from 3 fertilised eggs - possibly 2 babies. Obviously quality was way more important than quantity in my case. Also, my fresh transfer was on day 2, and my other 2 were frozen on day 3 (and transferred within 18 hours of thaw.) With our low numbers, we will run the risk of not getting any to blast - and since you know you've already produced good ones which stick at Day 3 - I'd run the risk of a couple of extra transfers of duds, just in case 'the uterus can save them,' which is a bit unknown. No-one has the right answer to this question - you can only play the numbers in your circumstance and that's how I'd play em.
Good luck. Hope you don't need to worry about stim #4.
I am also reading a book about IVF at the moment, which talks about how not enough work is done generally to try to cure the infertility (in your case blocked tubes, plus maybe age) before throwing IVf at it, and more microsurgery on tubes (in the hands of really skilled surgeons) could actually produce more babies.
MonashIVF is a world-renowned clinic, so I'm not suggesting they're just after your money. Some tubal blockages genuinely are inoperable, but I guess it's worth asking the question?
Edited by Lokum, 24 April 2012 - 03:12 PM.
Posted 25 April 2012 - 07:45 AM
However, I wouldn't be risking trying to get to blast again. I would be asking for day 3 transfer & freeze, in the hope that your uterus will save the ones that might not have made it to blast in the lab.
I agree with this 100%. I know all clinics do things differently, but if I was in your situation (which I will be in a few months from now), I'd ask to have the embies transferred no later than day 3. Are you doing ICSI or standard IVF? Try ICSI if you can. Is your DH on Menevit now? And can you investigate taking DHEA and CoQ10 for 3+ months before the EPU? Again, I know everyone responds to different protocols ( I was also on 450 GonalF), but I believe DHEA and CoQ10 dramatically improved the quality of my embies for my last EPU. For me, it also seems to help to take Pregnyl to extend my luteal phase. And acupuncture also seems to be a positive treatment for me during the week of my EPU and just following the ET. If this is truly your last stim cycle, I'd pull out all the stops and demand the FS do it "my way" as described above. FWIW, I think your results so far have been great, so as other PP's said, it is just a numbers game and luck of the draw in the end. I'm so sorry for your losses, and I hope 2012 brings baby joy for you, OP.
Posted 25 April 2012 - 07:29 PM
Kez, as you would know, every person is different so I'm not suggesting what happened to me will to you, but perhaps I'm a good comparison in alot of ways.
*preg & m/c mentioned*
I started IVF at 40. My FS said 3 stim cycles was 'average', but for older patients he generally pushed that out to 4. So, as PPs have said, perhaps you might want to be open minded as you go into this one because you're still only below the 'average' in terms of stats.
I ended up having 5 stim cycles, and 9 transfers. I'd probably write off one of those stims because we used by DH's frozen sperm which I now believe had a major impact on fert rate. From those cycles, I had no success with freshies but 3 BFPs with frozen (natural) cycles - so 3 out of 4 frozen cycles got me BFPs. Two of those were early mc/s, the other I am now 24 wks preg with.
There are actually some studies to show better results for frozen v fresh but this very much depends on the quality of your clinic's vitrification process.
As far as the frozen cycles go, I was a high responder so now firmly believe my body wasn't in the right state to receive an embie after a fresh cycle. I always felt horribly bloated after EPU and just wasn't quite 'right'. I believe the successful embies just preferred the more natural environment of a drug-free cycle.
I moved clinics during the process and went from 350 gonal/puregon to 200 and basically got a better result. Not saying that's what you should do, just that high levels of FSH clearly weren't doing much for my egg quality.
My clinic is a blasty clinic only - so I have always transferred 5 dayers. Can't give you a whole lot of advice there so others are probably best placed. I did have a 3 day tfr at first clinic with no success (was a fresh cycle).
Finally, I'd really really encourage you to have some follow up testing since you've had the two m/c. Although my follow up testing didn't end up showing anything definitive, I did have more support in luteal phase in the form of clexane & prednisone - and got the BFP when prednisone was added.
Best of luck
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