If you only had two mature follicles would you proceed?

[Anonymous]

Anonymous wrote:

Anonymous wrote:He should be counseling you to do an IUI--no sense wasting the cycle, since all it takes is one egg. I got PG first IUI, 4-6 follies and seriously compromised sperm (though we didn't know it at the time--counts all fine, sperm just couldn't break into my eggs.)

Go for it. Good luck.

If it doesn't work, talk about changing protocols, you may be oversuppressed if you are doing Lupron, for example. I had a second pregancy using Ganirelix--better results for women who tend to be oversuppressed. If he won't switch protocols, switch REs.... Go to Preston Sacks at Columbia, he is AWESOME.

How old were you with the second PG?

37 with first, 41 with second

[Anonymous]

Anonymous wrote:

Anonymous wrote:He should be counseling you to do an IUI--no sense wasting the cycle, since all it takes is one egg. I got PG first IUI, 4-6 follies and seriously compromised sperm (though we didn't know it at the time--counts all fine, sperm just couldn't break into my eggs.)

Go for it. Good luck.

If it doesn't work, talk about changing protocols, you may be oversuppressed if you are doing Lupron, for example. I had a second pregancy using Ganirelix--better results for women who tend to be oversuppressed. If he won't switch protocols, switch REs.... Go to Preston Sacks at Columbia, he is AWESOME.

A couple people said RE should be changing protocols. For all three cycles RE insists on using bravelle and menopur. In the first IVF, we did birth control and lupron. In the second IVF we nixed the birth control and did lupron on the belief that bc suppresses ovaries and they wished to avoid that. In the third we did no birth control, no lupron and instead ganirelix with vivelle patches. I asked why we couldn't stop using bravelle and menopur and use something else instead. RE said all of these meds are the same essentially. How can that be? Then why do different RE's use different stim meds on women[b]?

I would get a second opinion. As you point out, you don't have time to wait. As for the drugs being all the same, this is not what I understand. While in theory they all do the same thing, every woman's body responds differently to these drugs--they may work on various hormone receptors differently--I had poor results with Lupron and Follistim alone, but got PG with Ganirelix, Follistim and Menopur. Sounds like your RE is being lazy. We are not one size fits all, especially in the baby-making category. Please see another RE--I recommended Sacks at Columbia--I went to SG for my first and found them to be very much a cookie cutter operation--they never did get beyond calling my problem "advanced maternal age". Turns out it wasn't, but we didn't know that til we saw Sacks at Columbia, who wasn't content to keep trying the same thing over and over--he figured out we had a weird male factor issue (one that doesn't show up on the usual rounds of tests) Got PG 1st time after he determined that.

[Anonymous]

I don't necessarily agree with the pp - by changing the approach each time (bcps and lupron, just lupron, just the patches), those are major changes in the protocol that are appropriate to make. While it may be true that a small number of women respond differently to the various FSHs (Gonal, Bravelle, etc.), changing that is not likely to have as much of an effect as making the changes that your RE already has done.

There are a couple good books out there by REs about the IVF process that cover the various protocols and make it easier to understand what is going on.

[Anonymous]

I agree with the previous poster that it sounds like SG has made some major changes esp. with this last cycle (adding ganirelex, patches). Simply changing from one FSH to another (for instance gonal F to follistim) isn't likely to make a major difference as those are essentially different brand names for the same drug.

However, I would get a second opinion. This is relatively easy and inexpensive to do and it might help greatly to have another set of eyes look at your case. However, I don't think SG is doing anything out of the norm here or is being lazy or cookie cutter.

[Anonymous]

OP here.

Well the results each cycle are always attributed to my age. But could there be something they're not seeing?

Some RE's at other clinics seem to have a particular interest in patients who respond poorly to meds and will take aggressive measures to help older patients achieve pregnancy. Check out www.colocrm.com But my current RE attributes everything to advanced age and doesn't seem to care to go further..in fact, he was asking me to consider abandoning the idea of conceiving with my own eggs. My situation may well be due to advanced age, I certainly won't deny that. But I wonder something else is not right. ARe the embryologists highly regarded at Shady Grove? I hear the expertise of the embryologists make a difference, especially where older patients are concerned. But I don't know who the embryologists are at SG. They don't have their names or bios or any information about them up on their web site. DH has sperm issue. No workup was done, besides an initial semen analysis, to determine if DH's sperm could be causing the embryo's to not take.

[Anonymous]

I have read lots of posts touting the embryologists at SG. For all I know they may be the best.

That said, from what it sounds like to me, your doctor has decided that advanced age is the problem. It may be. However, SG (Osborne/Widra) gave me the same diagnosis at age 37, after doing only the basic sperm analysis on my husband. We got lucky and got PG on our first IUI so no further investigation was done. Fast forward, three years, we want to have another child. While I cannot complain about the successful results we got a SG, we decided to switch to Columbia/Preston Sacks. Smaller operation, always go to same office, see same doctor--just more personal. At any rate, we tried a few IUIs--no success, even though my numbers were ok for my age, 41. Since time wasn't on our side, we opted to try IVF, on his counsel that we could learn more from it--as to how my eggs fertilize, etc.

I responded well--he deliberately gave me lower doses of meds given my numbers and previous conception--I produced 12 follicles, 11 eggs retrieved. Only ONE fertilized. Turns out the problem was not me, but a particular sperm issue where the sperm cannot always penetrate the egg. He sent my husband for a more specialized test, and he came back borderline for whatever this sperm issue is. Next IVF we used ICSI, got PG first time.

Just an example. It is worth getting another opinion, you have nothing to lose. Good luck.

[Anonymous]

OP, I'm the 17:39 poster. I do think that SG has done a good job switching up your protocol. I don't know what Sacks does that would be different, although as others have said it may be worth your time to do a consult. I have done some research on REs who treat older women (no offense - I'm pushing 40 and have egg issues myself), and the only other approach I've seen that SG is not big on is a lower stim approach, on the basis that that might get better quality eggs. There is a place in NYC called New Hope that does this, to mixed reviews - they do a low stim approach and their pregnancy rates are lower but the cycle cost is a lot less, too. Also, Dr. Cheek in New Jersey and the Cornell clinic in NYC are the two big guns on the East Coast treating older women. There is a poor responder section on IVF Connections - you may want to look at some of the comments on there of people who have consulted with some of these folks, if you're interested in pursuing that path. Good luck to you.

[Anonymous]

Thanks. I did hear about Cornell. Will have to check their statistics.

[Anonymous]

OP here. I wanted to provide an update. I had my ER on Sunday morning. I had six follicles, three were mature, and three were not quite mature. They ICSI'd the first three mature ones, left the other three alone. These other three matured overnight though. So by the next day, I had six mature follicles! What a difference from what my SG RE predicted - only two mature follicles. In fact, RE was trying to discourage me from continuing and recommended I halt the cycle. So glad I didn't listen to RE!!! So anyhow, the three younger eggs that matured overnight were immediately ICSI'd on Monday. Out of all these six, three fertilized normally and were dividing by ET time. I was so relieved.
BUT - in other IVF cycles I can actually see the embryo being transferred (they look like white bubbles on the ultrasound) and RE points it out to me. But this time, I saw no bubbles or white specks. In fact, RE did not point out the transfer while it was taking place either. To add to my concern, RE asked me to stay in place until he could determine from the embryologist that the catether was indeed empty (had no embryos still left in there).
Now, my mind is spinning with questions like, "So were the embryo's actually transferred?" "What if the embryologist screwed up?" Arrrrgggghhh!!!!!

[Anonymous]

Wow - I'm really happy you had 3 good ones! Keep us updated. (And sorry, don't have the answer re where's the embryo, but maybe you should put in a call to your RE just for reassurance).

BTW - why did they ICSI'd?

[Anonymous]

ICSI was due to DH sperm factor.

[Anonymous]

FYI - research shows a pregnancy rarely occurs ( < 2% ) from the transfer of only embryos that originate from immature eggs.

As for the embryologists at SG, Dr. Tucker (Director, IVF and Embryology Laboratories) was responsible for the first “ICSI baby” born in the US.

[Anonymous]

OP here. Yes I was told the chances of those two embryo's taking was low.

Dr. Tucker seems to come with impressive credentials. I doubt he handled my ICSI himself though. I met my embryologist. She appeared to be a 25 year old woman.

[Anonymous]

PP, if the eggs matured outside of the body, however, are they still considered embryo's resulting from immature eggs? They were ICSI'd when they matured.

[Anonymous]

I believe they are still have the low success rate. I had a similar experience and was told the chances were very, very low for eggs fertilized a day after retreival. But, that said, it does happen.