XP: IVF ladies - embryo quality questions (long)

Mayan2011

Good evening ladies.  I usually post on the IF board, but thought this group would be better for the advice I am seeking.  DH (40) and I (31) have been trying to conceive for just over a year now.  We have a very progressive family dr. who started running tests on us at the 6 month mark of TTC.  DH came back with low everything.  We moved to a RE and he said that IVF/ICSI was really our only option.  He was actually quite optimistic bc of my test results and age.  Perhaps, a little too optimistic bc it allowed me to get my hopes...

We just finished our first IVF cycle (unsuccessful).  Our WTF is on Friday so I am gathering my thoughts and fine-tuning my questions.  I was on the antagonist protocol (112iu Bravelle and 75iu Repronex - these seem like really low doses to me??), which yielded 15 good sized follicles, but only 9 eggs (8 mature).  5 of the 8 fertilized, but were pretty fragmented.  We did a 3dt and only had 2 6-cell, 1 5-cell, and 2 4-cell embryos to choose from... definitely not rockstars.

So my questions for those that dealt with embryo quality issues are: (1) What protocols did you try?  (2) What worked best for you and why?

Any other insight or questions that you can think of for me to put on the list for the RE are appreciated. 

TIA!

Happycouple

We have a similiar diagnosis to you guys (except i may have elevated FSH now).  I have always 'responded' well to the long Lupron protocol (I believe that is the name).  I have heard of people doing the antagonist cycle though in attempt to gain better quality or more embryos. 

We have had a variety of quality eggs.  On our very first succesful IVF/ICSI there were only left with 2 embies on the day of transfer--all others didnt make it.  The two we tramsferred we of average and good quality.

 In 2010, we did 2 IVF's and an FET.  All failed cycles....we had a perfect embryo and good embryos transferred on all of them and none of them worked.  This last FET in Feb we transferred 3 average embryos at best--in no way stellar and as of right now Im PG (doing 2nd beta tomorrow).  With all this said, sometimes embryo quality does not necessarily mean a BFP or BFN.  Unfortunately, sometimes you just need to tweak the protocol and try again. It sounds like you are a pretty good responder which is good AND you dont have any IF issues which is very good!  You could always try some diet changes, accupuncture etc in hopes of better quality.  What did your docs say?

caityr

I am sorry for the bfn. It sucks. I dealt with quality issues but also was dealing with DOR so we sort of assumed I may have some quality issues too. I had 2 early losses and that sort of sealed the deal for my local RE who said with my borderline fsh and poor quality embies I should look into DE. I switched to a clinic with better stats for women who are poor responders and they had several changes for me. I started DHEA therapy, did a different protocol (estrogen priming with lupron flare) and used endometrial co culture which for some women improves embies dramatically. However only a handful of clinics use it. In my case it was worth the effort. I still never had anything to freeze but I have dd today. You may have not had the right dose of meds, they may have triggered you at the wrong time, there are so many things. I would though, at your age, not assume your eggs are crummy. Just tell yourself you may need to try a few times to find the right recipe. You may also want to show your stim sheets to another RE to get a second opinion. GL!

Mayan2011

Happycouple:

We have a similiar diagnosis to you guys (except i may have elevated FSH now).  I have always 'responded' well to the long Lupron protocol (I believe that is the name).  I have heard of people doing the antagonist cycle though in attempt to gain better quality or more embryos. 

We have had a variety of quality eggs.  On our very first succesful IVF/ICSI there were only left with 2 embies on the day of transfer--all others didnt make it.  The two we tramsferred we of average and good quality.

 In 2010, we did 2 IVF's and an FET.  All failed cycles....we had a perfect embryo and good embryos transferred on all of them and none of them worked.  This last FET in Feb we transferred 3 average embryos at best--in no way stellar and as of right now Im PG (doing 2nd beta tomorrow).  With all this said, sometimes embryo quality does not necessarily mean a BFP or BFN.  Unfortunately, sometimes you just need to tweak the protocol and try again. It sounds like you are a pretty good responder which is good AND you dont have any IF issues which is very good!  You could always try some diet changes, accupuncture etc in hopes of better quality.  What did your docs say?

Thanks for the info and positive thoughts.  It is so easy to only focus on the negative right now.  

I haven't spoke to my RE yet so I don't know what he is going to say...  I have thought about accu and changes in diet.  Although, I am pretty healthy to start with.  I even gained weight for this cycle bc I read that miscarriages are higher in ladies that have a BMI of less than 18 (I usually hover right around 18).  I will admit that to gain the weight I didn't eat more veggies, ha...  I also tried the 1 cup of pineapple per day (core included) for 5 days after ET, but obviously that didn't help.  Are there other foods that you are aware of that are suppose to help with egg quality?

Did you find that accu helped you?  Many on the IF board seem to use it.  I assume this would be something to do when I am cycling as opposed to prior?

sliz

i did long lupron and ended up with very good quality - several left to freeze (althought we won't know how they thaw)....i am surprised they started with the antagonist protocol - I thought long lupron was the default. Did you have any other tests (i.e. checked for pcos, insulin resistance, etc?). Also I did do accupuncture - every week during the stim and right before transfer - I believe it helped. I had been doing it for several months and was also doing it when I got pg with the twins (albeit for only 2 or 3 times)....

Mayan2011

sliz:

i did long lupron and ended up with very good quality - several left to freeze (althought we won't know how they thaw)....i am surprised they started with the antagonist protocol - I thought long lupron was the default. Did you have any other tests (i.e. checked for pcos, insulin resistance, etc?). Also I did do accupuncture - every week during the stim and right before transfer - I believe it helped. I had been doing it for several months and was also doing it when I got pg with the twins (albeit for only 2 or 3 times)....

Thanks for your response.  I appreciate your input and questions.   

I am not sure how the Dr's check for PCOS?  I have never had a cycst (that I know of) and have fairIy regular cycles (~30 days).  In the beginning, I did have a baseline AF count, hysteroscopy, the standard mandatory STD tests, and hormone tests (day 3 fsh, prolactin, etc...).  Once the cycle started they ran the standard bloodwork.  I don't think they tested for insulin resistance.  I am pretty embarrassed to say that I didn't keep a journal of everything I was tested for and the results.  Lesson learned the hard way.  I will be asking for copies of everything at the WTF.  I also went to the lab today and signed up for e-results.  It is a new secure system that my lab just started.  I will be able to access all of my results online and print them off so I have my own copies.

As for the accu, I think I am going to integrate that into my next cycle.  Many ladies seem to find it pretty useful.

mbjmaybebaby

I had 2 canceled IVF's (we didn't make it to ER bc of failing to stim).  1st was long Lupron & 2nd was Antagonist.  What finally got me to an ER was EPP (estrogen priming). In addition to this protocol I started taking 7 wheat grass pills every day and 75 mg of DHEA 4 months prior to the cycle.  Both are said to help with egg quality.  We retrieved 12 eggs, 5 were mature and 4 fertilized and we froze them on day 1.  When we thawed we thawed all 4 and they all made the thaw and we transferred 3 (B+, 8, 7, & 6 cell).  For my FET I did acu right before and right after the transfer and did POM and Bromelin (what's in pineapple core). 

Who knows if any or all this helped but I figured it was worth a shot!

Good Luck!!

LALASEPT05

I agree with one of the pp - it is interesting that he chose to start you on antagonist protocol if all of your tests came back ok. Typically long lupron is the starting point for someone who seems otherwise 'unexplained' or its male factor. I would ask about that and try to get more clarity on your test results to see if there something else he may have seen in your test results. It does seem like your doses are pretty low but it's hard because I didn't take those meds. I know it's better to start out low to make sure you don't overstim the first cycle. Good luck on your follow up appointment I hope you get the answers your'e looking for.

erin5407

Sorry to hear about your BFN .    We have just finished our 3rd IVF cycle which was unsuccessful as well (we are trying for #2).     All three of our cycles have been the long lupron and we have not had good quality embryos... although our second second with not such great embryos resulted in our now 18 month old daughter.)    We are going to do the antagonist protocol for the next cycle to try something different.   My doc is also running a sperm dna test on my husband to see if there is something with the dna that is causing fragmentation with our embryos.   That might be worth asking about?    She said if their is an issue there are vitamins and drugs that my husband can take to improve the quality.    I hope you get the answers you are looking for but also wanted you to know that there are lots of babies made of not so great embryos.   Best of luck to you!