When to cancel an IVF cycle

[Anonymous]

First Ill state I am older, 42 but with good reserve numbers. I am in the middle of one last OE retrieval cycle and am underwhelmed by the results.

On day 2 I had 9 follicles. I went back on day 9 after 5 days of stims, still 9 follicles of those 1 was measurable (ie growing). I went back yesterday on day 11 now there were 8 follicles of those 3 were measurable. Throughout this time my estrogen level has been rising steadily, although less sharply than previous cycles.

This is the first time through many IVF cycles where the number of follicles has failed to increase and even worse to decrease. In previous cycles the number of measurable follicles I have at this point is = to the number of eggs retrieved. (I think because even if the other follicles start to grow they wont be ready at the same time as the lead ones).

I think we should consider cancelling this cycle. A recent ERA showed that my blasts need to be put back on day 6, not day 5. If there are only 3 eggs I think the chance of anything growing out to blast is slim.

As far as I can tell my clinic doesnt see anything wrong bc my estrogen level keeps rising appropriately but since this cycle started I only have had contact with revolving cast of nurses bc "my nurse" is out on family business.

I feel like I am suffering from what do you expect at your age but I think its not really worth it to continue with such a poor prognosis.

For context: my ERA cycle that began in mid-august showed baseline follicles of 15 which grew to 23 the next week. This month's follicle count is low and I think my body's reaction to the protocol lackluster. In Feb and April I did 2 retrievals which yielded 13 and 14 eggs respectively.

[Anonymous]

I'm confused-are you banking embryos? You mention previous IVF retrievals but didn't provide any details as to their success/failure (i.e. how many made it to blast, did you have PGS testing, etc). It's difficult to give advice without knowing the outcome of those retrievals. Also, is money an issue? Are you paying OOP for these retrievals?

[Anonymous]

Anonymous wrote:I'm confused-are you banking embryos? You mention previous IVF retrievals but didn't provide any details as to their success/failure (i.e. how many made it to blast, did you have PGS testing, etc). It's difficult to give advice without knowing the outcome of those retrievals. Also, is money an issue? Are you paying OOP for these retrievals?

Here is the flow of things. I did 2 back to back cycles at this past winter/spring that yielded:

13 eggs -- 9 fertilized -- 4 blasts
14 eggs -- 11 fertilized -- 5 blasts

I am not doing PGS testing bc my doctor thinks possibility of correction etc. it might not be doing me any favors.

They put in 7 of the 9 over 2 fresh transfers and one FET. (I previously transferred 2 PGS normal blasts from another clinic.) All 9 of those blasts resulted in BFNs and a chemical on the most recent transfer.

In August - Sept. an ERA found I am pre-receptive on day 5. My plan had been to transfer my last two blasts and move to DE. But I want to give this new information a chance to work and decided to do one last OE retrieval before moving on to FETs.

I am midway through the cycle and my results to date look poor. Because my transfer plan hinges on being able to put back blasts through an FET (mimicking the ERA), I think only 3 eggs is too low a number to count on any blasts. Maybe I should cancel this cycle.

I guess my questions are 1) Has anyone faced a poor outlook and considered cancellation? What did you do? 2) Has anyone seen follicles counts stall/decrease? How did your cycle turn out?

[Anonymous]

Did you substantially change your stims protocol? If so, I would cancel and ask to go back to the old protocol. Also, did you take Lupron during the ERA? It can suppress you a lot and it makes it hard for ovaries to do their thing in future stim cycles.

[Anonymous]

If you only have 3 eggs thus far from stimming, I would cancel (especially since you already have a few frozen embryos left) and you have new information on when to transfer via the ERA. Good luck!

[Anonymous]

Anonymous wrote:If you only have 3 eggs thus far from stimming, I would cancel (especially since you already have a few frozen embryos left) and you have new information on when to transfer via the ERA. Good luck!

My mistake--it looks like you don't have any frozen embryos left over. In that case, I would continue stimming (since you've already begun) and go through the FET (assuming you have ones that make it to blast and freeze) and use the new ERA info to transfer on the correct date. If that fails or you don't have any embryos that make it to blast or freeze then immediately move on to DE. Good luck!