Thoughts on 4th IVF Protocol

hopefulhusband

My wife and I are about to begin our 4th round of IVF, and I would like to hear some opinions regarding our protocol and if anyone else has had a similar experience (along with final outcome).  My wife has PCOS and our issue is egg quality, per 3 different doctors.

We began with 3 failed IUI's which came and went quickly.

1st round of IVF (Antagonist Protocol with HCG trigger):

Understimulated - 17-day stim cycle (Dr was cautious with low dose of meds because of PCOS)

Only 5 mature eggs, all arrested by Day 3

2nd round of IVF with ICSI (Antagonist Protocol with HCG trigger):

Overstimulated (Dr doubled the dose because of previous understimulation)

25+ eggs from only one ovary (the other ovary was too swollen to get to)

18 mature, 15 fertilized, ended up with 3 embryos to freeze at Day 7 (growth was very slow)

Embryos were poor quality, but had first transfer anyway with 2 embryos - they did not implant

3rd round of IVF with ICSI (Long Lupron Protocol with HCG trigger):

Switched doctors and Long Lupron was suggested to try and suppress my wife's ovaries to the point of getting better eggs, along with retrieving one day early to help avoid overstimulation

17 eggs were retrieved in total, 14 mature, 12 fertilized

At Day 3, nurse called and said there were 5 embryos left that looked "stellar"

We went in for a Day 5 transfer and were told all arrested

About to begin 4th round of IVF with ICSI (Long Lupron Protocol with HCG trigger):

Our doctor believes we had the right protocol, but that there are a few improvements we should make for this round.

1) My wife was on BCP for 6 months to really suppress her ovaries

2) Our retrieval will be on the day it should be, rather than one day early like the previous round.  Dr believes some of the eggs may not have been ready to come out and the extra day can further their development

3) Instead of disturbing the eggs and checking them on Day 3, they will remain in the lab unharmed and only be checked on Day 5 transfer.

Thanks.

northbeach3

Not sure about the best protocols for better egg quality but does your clinic do day 3 transfers?

 I’ve seen several women transfer early bc some embryos stand a better chance in utero than in their cultures. They also typically transfer multiple embryos under the presumption that many will not implant. Might be something to consider, esp if you weren’t trying to do PGS testing. 

Best of of luck to you and your wife. 

prudence9-2

like @northbeach3 said, I would probably also ask about a day 3 transfer. 

Good luck!

adirat

I agree about trying a day 3 transfer. Are you taking any supplements for egg quality, like CoQ10?

mayflower513

Just a thought.  Have you had semen testing?  I saw somewhere (could be wrong) that the sperm takes over after day 3, so that was what popped into my head.

I don’t know how the not disturbing thing will affect anything BUT my lab checked them at day 2 (so they could decide on a day 3 or day 5 transfer) and then said they will not be checking them again until day 5 as to not “bother” them.  So there could be something to that.

megmac2010

I don't have PCOS, but I do have poor egg quality. My protocol, the second time around, also included 4 months of DHEA and we added hgh (Saizen) during stims. I got way more eggs, more fertilized, and had more make it to day 5 in my second round. We did a 3 day transfer of two perfect-quality embryos, but unfortunately, *TW experienced a chemical pregnancy with the fresh transfer *end TW

I also did 4 months of a supplement package called OptiOva, 4 months of 4g of inositol, and I added melatonin in the last two months before my retrieval. We also increased my Gonal-F dose significantly. I'm not sure what change caused better results, but this cycle was a million times better!

Good luck to you!!

Aera11

*lurking from PAIF*

egg quality was our issue & both DH & I were on supplements (dhea, co q10, myo-inositol, acai).  I did four rounds of IVF & *tw* am 35 weeks pregnant from our fourth round.  What we did different for the fourth round was add in HGH (human growth hormone).  There isn't a ton of research on it & the results sound 50/50 when you poll users, and I can't say that's what made a difference for us but it was the round that gave us this pregnancy.  I never produced many eggs to begin so we always did Day 3 transfers, so I second the other comments on asking about Day 3.  We also did icsi & assisted hatching along with gonal f, menopur, cetrotide & ovidrel.  It's definitely worth asking about the HGH.  I was discouraged because we only ended up with the one embryo to transfer & we had always done two, but that little one was all it took. Best of luck to you & your wife! This journey is hard & you're welcome to dm me if you have any questions about the HGH/omnitrope.

tosh24

***lurking*** I can't offer too much advice re: PCOS, but I did rely pretty heavily on my naturopath during my treatments. Has your wife considered seeing one? Both DH and I were on COQ10, plus I added in NAC (another strong antioxidant that's good for egg quality). Omega-3 is also important as is Vitamin D. When it came time for my transfer (I only did frozen transfers) my naturopath put me on melatonin, extra zinc, and brazil nuts for selenium (4 a day). All of those have been shown to affect uterine receptivity. You may be able to take those during a stim cycle but I would ask a naturopath to make sure there aren't any contraindications with the fertility meds. I also did acupuncture 1x/week and extra during stims and right before/after transfer. The difference in my follicle recruitment with and without acupuncture was astronomical. For my IUI cycles, I would be on the exact same protocol and with acupuncture I would have so many follicles I was almost cancelled (and was once with 10+) and the cycles without acupuncture I would only have one follicle. Acupuncture has been shown to increase blood flow to the ovaries and uterus and has a positive effect on follicle recruitment and uterine lining. It's important to find someone with a specialization in fertility. Best of luck to you guys!

sunny_side

@hopefulhusband I agree with the group that day 3 is worth asking about. I’ve heard that embryos may arrest “in the lab” but they are made to survive in the womb so they may look poor quality but be a perfectly healthy baby! 
I’m also on my 4th round of IVF and have done aggressive microfose protocols in Jan, Feb and March. My RE said he wanted to try something different because even on high does of gonal, menopur, & lupron, I was understimming and when they did get eggs all but one arrested. This month I was put on a Clomid and minimal gonal F cycle because the Clomid works in the brain vs a more direct stim in the ovary. They said for some ppl it produces quality over quantity in terms of number/condition of eggs retrieved. Having said that, I am waiting for my report to come back of my 2 fertilized eggs will make it to freeze but I’m happy I tried something new vs. doing the same thing and expecting different results! Good luck to you and your wife! 

hopefulhusband

Thank you all for the advice.  Our clinic did recently become 5-day transfer only, but our doctor said he will review our eggs following fertilization and exceptions can be made for day 3 if he thinks we would have a better shot. My wife has also been on COQ-10 as someone suggested.

tinjp78

@hopefulhusband may I ask 1) if your wife is on FEMARA 2) on ER what are the (range) sizes of the follicles 

on another note, one question to ask a fertility clinic is if they have a Time Lapse Incubator. This machine will monitor the embryo 24/7 without having the need for technicians to take it out from the containment to check because this process damages the embryo.

hopefulhusband

1) She was on Letrozole in the past due to irregular cycles, but was taken off once her cycles were back to normal.
2) Last IVF round follicles were in the 17-18 range the day before retrieval.  Adding back the day should get us closer to the 19-20 range.

tinjp78

Thanks for answering my questions. The reason I asked for 1) is because this med is believed to enhance egg quality and 2) although it is a common knowledge that above 18mm size follicles are ideal, around 14-15 too may contain good eggs and 19-20 could sometimes already be too big. I'm no embryologist but there are really lots of other factors to read into especially if the previous processes didn't work. It is good to know that your RE has new/other options for you. I hope and pray to see progress and positive results for you and your wife. If you'd like, you could jump into one of the monthly threads in here too?