Three failed rounds of IVF and time to talk to the doctor
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Anonymous
| Hi - I'm at Shady Grove as well and in the same situation as you - almost. 2 failed cycles, biggest issues is MFI (although I have mild PCOS as well). Dr. thinks its sperm quality but obviously on way to be sure. What are your doctor's thoughts on that? Our plan is to try one more round with PGD testing and go from there. The other things I asked about on my consultation last week were an endometrial scratch (to assist with implantation) and also some immune testing (on the off chance your body is preventing implantation). I have Dr. Devine and she thinks since I'm young (33 in a couple weeks) and in good health she wants to see what happens if we transfer a genetically normal one before moving to other tests / options. Thus - she supports the genetic testing next time around since her hypothesis is the sperm quality. We are also going to do PICSI instead of ICSI next time which might help with sperm quality - also something to ask about. I'm feeling pretty miserable about the whole thing as well so definitely happy to commiserate! |
Anonymous
NP here... just wondering, I didn't know Shady Grove did PICSI -- how much extra does that cost? |
Anonymous
Can you share how your embryos developed between day 1-5? There's a thought out there that sperm issues affect days 3-5 so curious to see if things drop off by then. Regarding Pgd - I think that many good embryos don't make it when stressed to day 5 and then Pgd. Here's a real world wild scenario that happened to a friend of mine. She's out of state and was doing an ivf plan that involved Pgd testing and transfer of only one embryo at a time. She had 7 eggs fertilize. All were good up to day 3 by day 6 only 2 made it and were sent for testing. Of those two only one was genetically normal. Here's the kicker - even though that was a freeze all cycle pending the Pgd results she found out that she was pregnant the day they have her the Pgd results approx 15 Dpo. How??? Her progesterone spiked before retrieval. They had sex per doctors ordered the day of trigger to ensure fresh sperm. Guess one follie released early. Now isn't that interesting of 7 eggs fertilized only one was certified as genetically normal. Yet she's pregnant with a random egg that released on it's own somehow and so far all is well - she's 8 weeks along. |
Anonymous
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15:10 poster (and new to this site so not sure what NP means). PICSI doesn't cost anything extra at Shady Grove. They don't have conclusive research to prove its better than ICSI - but the thought is that it will help select more normal sperm than just looking at them through the microscope. We had 17 eggs, 13 mature (she was nervous about hyperstimulation since I had like 20 follicles on each side so I new I'd have about a dozen when I triggered). 12 fertilized, all 12 looked perfect at day 3. At day 5 we had 9 but only one full blast that we transferred (BB) then one 6 day that was good enough to freeze (AB). I honestly think the AB one came close and might have been a clinical but I didn't test early enough to know. I had every symptom in the book though on my FET and after the fresh I felt absolutely nothing so was not surprised at all with the BFN.
For embryo development, apparently the embryonic genome in the sperm kicks in on day 3 and the sperm take over the development. Hence why my doctor thinks we had a sperm issue since I had an almost perfect fertilization rate and everything looked perfect at day 3. No way to tell for sure though. My husband just had varicocele repair surgery with Dr. Shin (now part of Shady Grove). We're praying that this + PICSI will work for us next time around... probably starting sometime in January. If not I don't know if I'll have the strength to go on - this whole process is so draining - physically, financially, & emotionally! Crazy story from the person above me who got pregnant - I wish that would happen to me! With PCOS and such a low sperm count from my husband we don't really have a chance of it happening naturally. |
Anonymous
Ahh - "knew" iphone autocorrect 
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Anonymous
My husband has the same issue (varicosele) and sees dr shin. Will the survey help his sperm count? |
Anonymous
| The surgery is supposed to help both count and quality. Given that we started so low (2m) the odds are that even if his count triples we'd still need IVF. It takes 3-6 months to see results. We'll likely do our next try when he's at about 4 months. With ICSI / PICSI the count is less important than the quality so I'm really hoping that getting the heat off the sperm by having the surgery will help with that. Dr. Shin said he's never come across an insurance that doesn't cover it and can definitely talk to you about odds of improvement. My husband went to his first appointment alone and didn't ask any of these questions so I went to the second appointment with a long list ready. It was a simple procedure but rougher recovery than expected - my husband is 5 or 6 weeks out of it and still has some pain. I guess everyone is different but he was definitely out of commission at the gym and in the bedroom for ~3 weeks. We're also planning to do the PGD testing this time around as I mentioned, if we can get enough embryos. Apparently it's like $4500 no matter how many you have!!! At this point though, we want to know if there might be something wrong with all the sperm or eggs so we can consider other options. Assuming I can get similar numbers as my last fresh cycle - the plan is to test everything that looks good enough to freeze (assuming we have at least 3 or 4) and then transfer 2 that they would otherwise discard. Feel like we might as well give the lower quality ones a shot instead of throwing them out! Are you up for another cycle or hoping to get the sperm count up and try naturally? |
Anonymous
| Also - last poster again - my husband saw a huge improvement in morphology and motility from vitamins and maca. Everything was still low - but morphology went from 1% to 3% and motility from 20% to almost 40% with three months of Fertilaid and maca. Count stayed the same. On my side - I've been taking ubiquinol as another poster mentioned to help with egg quality. That and vitamin D are definitely worth adding if you haven't - Shady Grove recommends vitamin D so imagine you're on top of that one. |
Anonymous
I caution you with relying on Pgd as a diagnostic means of finding out if you have genetic problems. Unless you have tons of embryos make it to day 5/6 it won't give you a true sense of whether or not you have chromosomal issues. Take my friend who got pregnant on a Pgd freeze all cycle. Her initial view of the situation was that of 7 eggs only 1 was normal. I told her no. The only thing we can deduce from your cycle is of 2 embryos 1 was normal which is a pretty great ratio at our age (36 years old). |
Anonymous
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NP. We went to Shady Grove originally because of male factor infertility. We decided to change clinics when we had too many failures. Even though Shady Grove didn't flag my TSH of 3.5, my new RE looked into it and put me on Synthroid until my TSH was under 2. We also did the hydraluron binding assay which found that only 10% of the sperm bound (normal is greater than 80%) so the RE recommended P-ICSI. We asked about the sperm DNA fragmentation test but the doctor said there's not much you can do with that information. DH had a grade 1 varicocele. One doctor was on the fence about operating on it and the second urologist said that surgery wouldn't make a significant difference.
My husband totally changed his lifestyle- no coffee, rarely any beer and started working out twice a week. Our IVF at the new clinc worked on the first go and we miraculously became pregnant without fertility treatments with our second child. |
Anonymous
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OP again: I just looked up my notes from our egg retrieval, in case this tells anyone anything: 13 eggs, 9 usable, 7 embryos produced, all 7 made it to day five, and then three were discarded. The remaining four were transferred over three cycles, quality ratings AA, AB, or BA.
We saw the RE (Sagoskin) yesterday and he wants to do the exact same stim protocol for our next round. I asked if there was anything we could do to the protocol to get better eggs, he said no. He gave us paperwork for karyotyping. I asked if there was any other testing we could do, such as for clotting issues, he said they only test for that if you have recurrent miscarriage, not implantation failure. I forgot to ask about thyroid, but I'm going to check with the nurse for my latest TSH. The doctor highly suggests we do PGS for the next round. I just need to get my husband on board, but I think it is the right way to go. I don't know anything about P-ICSI, so I might also ask the nurse about that. |
Anonymous
| I am in a similar situation to you, but when I met with dr. widra he said that he does not believe that implantation failure is real and did not want to do additional testing on me. He also just pushed trying more cycles and maybe pgs. It's so frustrating because I feel like we are not figuring out the cause of my failures. |
Anonymous
Yeah, wouldn't it be nice if they could just tell us why this isn't working? I realize that much is always "unexplained" even when you have a diagnosis. Maybe we're just unlucky, who knows. We just have to keep playing the odds, as irritating as that is. Sagoskin says PGS will improve our chances 10-12%. |
Anonymous
NP here. This kind of thing makes me so mad. Really? You want to wait to see if I have recurrent miscarriage prior to administering a simple test? I don't understand why EVERYTHING isn't tested prior to jumping into something as major as IVF. I hate finding out about tests I could have had after I've already had a bunch of failed cycles. Makes no sense. |
Anonymous
| For OP - I would definitely ask about P-ICSI. It doesn't cost more and given that you know you have MFI you want to make sure you're selecting the best sperm possible. Devine told me the same thing your doctor told you - same stim protocol for me, thinks the eggs are generally ok (although you did get higher graded embryos than me). PGD testing seems like the way to go try and gain more insights. If you know you are transferring a genetically normal one and that still fails - then I think you have to look into other potential implantation issues. They also said they wouldn't run those tests on me until I had more failures or failure from genetically normal one. |