Looking for advice/encouragement for next steps


#1

Hi - I know the fat lady hasn’t sung yet, but she’s practicing right now. I am just looking for advice on what to do next and what questions i need to be asking my doctor.

As you can see by my signature, we’ve been down a long road. I am feeling less than great about our chances of being pregnant right now. I’ve done tests to determine what could be wrong (no blocked tubes, uterus looks great, but low AMH), yet we are still unable to get pregnant. I am not sure if doing IVF is worth it again. We’ve spent 20 grand not including drugs, and all I have to show for it is gaining 15 pounds LOL. You would think they would give us a shirt saying “I did two rounds of IVF and all I have to show for it is this lousy shirt” - haha.

Is there any other kind of test I should be taking before deciding if IVF is worth spending money on again? Is there anything else that I could be missing? I feel like we are grasping for air in the dark.

Also, if we do IVF again, should I wait a month and start again (We did that this past time and I was shocked by the number of follies we had)? Or should we wait some time before trying? If so, how long?

As always, your advice and support is so welcomed and I am grateful for it. I’ve been away for a while just trying to focus on life and being happy and not worrying about getting pregnant, but now I find I can’t do it without y’all. :slight_smile:


#2

I’m not sure how much help I can be. I’m not experienced with IVF; however, I do know the value of a second opinion. I had many questions about my treatment and felt like the physician I started with was more into a “one size fits all” approach to a diagnosis. I’d had a few monitoring appointments with a different doctor in the practice. I felt like he was more on top of new research and practice. I switched to him and next cycle I was pregnant. I hope this helps.


#3

@WannaSquishy - thanks for your input. if I am posting in the wrong forum, let me know. And congratulations on your first little miracle and baby dust to you on a second. :slight_smile:

I did seek a second opinion at a different practice and they told me they would only put me on clomid (which I was surprised by as 6 months of doing that before did nothing). However, the first practice and second practice don’t place nice with each other. Since the first practice has my husbands sperm on ice, we think there may be issues trying to get them to give it to the second practice. We also can’t get any fresh sperm from my husband for at least another year due to the treatment he used for cancer.


#4

I think you might have an issue with embryo quality. Day 3 embryos should be 7 to 9 cells, with an ideal number of 8-cell. From the embryos you made, only 1 is within that range. So I guess the question is, is it egg quality or sperm quality that is affecting the embryo quality. Since you mentioned that the sperm is being kept at a different clinic, you might want to look into that. Does the clinic that performs the IVF grade the sperm when they receive it?


#5

Great point Careen. I wish my doctor would just put it to me bluntly. Every time I try to ask, they go into stories about other people conceiving when the odds were against them.

The sperm is being banked at the place we are doing IVF at which is making it difficult to switch practices. They said the quality is good ( after washing). They didn’t give us any specifics beyond that but this is a great question I will ask my doctor. I’m trying to compile a list if questions as I’m sick of trying to figure it out.


#6

Looking at your signature again, I think maybe egg quality might be contributing. If you stim too long (like longer than 11 or 12 days) then you start “frying” the eggs. You seem to have been on a super high dose of Menopur (300 IU is 4 vials a day, right?) and having such high doses also affects egg quality. I’m surprised that your doctor chose the same protocol twice, although the second time you made a good number of eggs. Because your AMH is so low you might want to look into doing a protocol that doesn’t involve using BCPs). For me, starting BCPs over-surpressed me and then I needed high doses of gonal-f and menopur to get my ovaries going. It also caused problems with having a lead follicle.
Of course every woman is different, but these are things you might want to ask about for next time.
Good luck! :cheer:


#7

And I would definitely ask for a copy of the semen analysis report.
Do you know if they are doing regular IVF fertilization or ICSI?


#8

I’m by no means an expert. In fact in more of a baby when it comes to this stuff. But I do think its interesting the 2nd clinic suggested clomid. My RE told me stats on clomid go down substantially at the 3rd month. Also…I know mine was very careful with my menopur…mini lupron…and gonal f specifically to avoid ohss and poor egg quality. He repeatedly told me its quality over quantity and I ended up with 7 high quality eggs. I’ve also read its really best to do 5 day transfers given how much we are paying and that 3 dayers are often less successful. It sounds like they aren’t really answering you’d questions. I’d shop carefully for a new RE. Mine was recommended by my gp. But its no big clinic, no web site, no fancy anything. But he’s a genius and I’m treated very well. I’m totally confident in him. Ask “why” and when you get answers you can understand you might be onto something. Jmo. Best wishes.


#9

Thank you Tika and Careen. Hearing others thoughts who’ve done this is so helpful.

I was surprised I was put on BCP for several months but they said they had to because my estrogen levels were through the roof from the IUI’s. they also said that it seemed that my hormones were all out of whack and that I was releasing too many hormones too early before ovulating.

I got the embryo report back today and only 1 of my remaing three embryos made it to blast and is being frozen. The report did indicate that they fertilized the eggs with ICSI.

And yes, 4 bottles of menopure each night. When I went for a second opinion at the other clinic, they said they would take a much more conservative approach and do clomid with a couple other drugs. I just don’t want to waste more time and more eggs and start all over. Plus, since the first clinic has my husbands banked sperm, it makes it more difficult to switch.

@tika…what doses of medicine were you on since your doctor seems to get that quality matters? Congratulations too, btw, lots if positive thoughts and vibes being sent your way.

I also found what Careen said helpful in that if we do this again, I am going to push for day 5 transfers or not bothering with transferring embryos that are only 4-6 cells. It’s too expensive and stressful to go through this and to have the odds stacked against us in that situation makes it worse.


#10

Ps…careen…a lead follicle. Dies that mean one is bigger than all the others? I ask because I had one that was at 21 when all the others were at 10-15. It made me mad because I had a ton of smaller ones but they never got to mature because they wanted to trigger me due to the larger one. That happened with the first cycle too ( though I had way fewer follies).


#11

Hi [B]lacedtogo[/B]: just wanted to tell you there is a thread for ladies with DOR which you might find helpful:

http://forums.fertilitycommunity.com/infertility-support-forum/2020213485-ivf-success-low-amh-92.html#post1108579418

Can I ask why you froze one blast instead of doing a transfer?

Best of luck! This is not an easy road. :bsv:


#12

If egg quality is an issue, I would absolutely, positively ask your doc about DHEA supplementation. The studies are compelling.

Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR)


#13

@oldermom…I have been taking DHEA for about 3 months now. I’m hoping quitting caffeine and taking DHEA is what helped me to get so many this last round but quality is definitely an issue from the sounds of it.

@alex…I’ve been following that thread which is what got me doing DHEA. I just need to get better about eating high protein diet. We froze a blast as I did a 3dt with 3 embryos (per doctors recommendation). I had 3 left and so they were still trying to figure out if the remaining 3 would progress anymore. Only one made it to blast so they froze it. I guess if I hadn’t already done the 3dt, I would have gladly had that one transferred instead.


#14

Spoke to RE today - blood test came back negative for Pregnancy as expected. I asked her some of the great questions outlined above.

In regards to less drugs, she said with women who have lower ovarian reserve, the protocol is to use more drugs. With that, it may also affect quality, but the quality may have been bad to begin with.

I asked her why wouldn’t we wait until day 5 before transferring to have fewer embryos but with a better chance of implanting? She indicated that this doesn’t matter. She said the folks who get to day 5 had better response and would most likely get pregnant because they had more eggs or better quality of eggs to begin with. She said since my quality isn’t that great, you can’t take a chance of losing what you already have so they pick the best of the best and put them in at Day 3. I don’t really agree with this logic, but not sure what else I can do.

I still have one blast on freeze (the only one that has ever made it to a blast) so I can opt to transfer that now or go to donor eggs (which is what they are recommending). I think because we want more than one child, we may pursue one round of IVF without donor eggs to see if we can get any more blasts so that we have more frozen and hopefully some implanting (hate to put the one blast in and then try to go for another child in a few years when I may have no eggs or even poorer quality of eggs). Or we will go straight to donor eggs because as the RE put it, they will always be there if we want more children.

Kind of a disappointment but oh well. Just have to weight the options. If we do a round of IVF using my own eggs, and it doesn’t work, then we have to pay for another round with donor eggs. Or we just move to Donor eggs and pray it works on one try. Stinks to have weigh the decision.


#15

Hi I’m new here. I’m not sure how to put together a signature board. HELP!
I just got my first bfn yesterday and we are devastated. I really need some support. Family and friends say they are so sorry and can’t believe it but don’t fully understand. I’m not sure what to do next.


#16

Laced2Go: So sorry about your BFN. Hugs. :grouphug:

On the other hand, congrates on your frozen embryo! :clap: I’ve never had any embryos make it to freeze and that’s a great accomplishment.

To answer your question, yes what you described is having a lead follicle. The problem with having a follicle that’s 20 mm and all the others less than, say, 15 is that it can trigger ovulation even if you’re taking ganerilix and so you have to do the retrieval earlier than the optimal time. The two protocols that I know of that address this is the estrogen primining protocol and the mini-IVF.
Is the second clinic that wants to do IVF with clomid talking about the mini-IVF protocol where you produce 2 to 4 eggs?

I don’t really agree with your doctor that the best way to have a successful IVF with low ovarian reserves is to pump you with more drugs. Of course I’m partial to the estrogen priming protocol because that’s what worked for me.
I do agree with your doctor about doing 3-day embryo transfers. If you have a lot of embryo then you can wait until day 5 to see which ones are the healthiest. But if you only have a few embryos you don’t want to risk losing them in the incubator. The best place for an embryo to thrive is in the uterus nourishing on its mother’s blood.

I hope you are able to take a step back before going to donor embryos. There’s nothing wrong with using donor embryos but sometimes I think clinics push for it because it gives them better statistics.
And lastly, most women don’t do FETs with only one embryo. Generally they’ll do another round of IVF so they transfer 2 (sometimes 3) at once. Also, not all frozen embryos survive the thawing process, so that’s something to keep in mind.

Stay strong. I know you probably think you’re running out of time and need to rush into the next cycle, but 34 is considered young in the IVF community. For the four months in between my 1st and 2nd cycle I was sometimes impatient, but that time allowed my body and my mind to recover from the first failed cycle.


#17

@Beanie - welcome. I am so sorry to hear you got a BFN - it is so disheartening but you’ve come to the right spot for support. For sig help, click on “User CP” at the top and you can see there will be a list of items including editing your signature.

@Careen - I’ve never heard of mini-IVF until you brought it up. How does that work?

My husband is all for donor eggs, but I am not crazy about it. It’s hard for me to wrap my head around possibly carrying a child that I have no genetic ties to. I’d rather have a surrogate or just adopt. Weird I know because I will love my child regardless of where it came from but it’s just something I am not ready to accept yet. However, I think trying to get our head around maybe paying for two IVF cycles (one of my eggs if they don’t work and then again for donor eggs is so daunting).

I’m trying not to rush but it’s been 3 frustrating years - and since my husband is recovering from cancer and turning 40 next year, I think he is freaking out a little bit. Your advice has been great and soooo helpful and insightful. Can you tell me about the estrogen priming protocol? I am curious about that especially since what you described is what I’ve been going through.


#18

For your info:

Last cycle I did natural modified cycle, which was that the first 9 days, I had no meds at all, just went in 3 times for ultra sound to see what was going on. At the first 2 ultrasounds, there was maybe one follie only. At the 3rd ultrasound, there were 5 follies, so we started meds then (day 9)- I took repronex and later added orgalutran (to stop me from ovulating before ER).
At ER, we retrieved 6 eggs, which for me is good.

I share Careen’s view: with diminished ovarian reserve, don’t really think being aggressive on meds is necessarily the best (different REs have different views, though). Also agree with her re 3 day transfer: the body is the best incubator and if you only have a few embryos, it’s best to transfer, then to wait, as none may make it to day 5.

I have also started to think about DE since I have had 2 failed IVF and have initiated some researching about this- however, I am not there yet- I think it’s a process, it takes time to get there, and maybe you (and I) need to ensure we are satisfied we have done all we can with OE before moving on. These are though decision. You’ll know what to do when the time arrives. And yes, there are other options to consider, all which are valid - surrogate and adoption. All that matters is what is right for you and your family.

Good luck with the decisions you have to make in the next weeks/months. And sorry about the BFN- it’s tough, I know. Take time to heal.


#19

[QUOTE=Laced2go]@oldermom…I have been taking DHEA for about 3 months now. I’m hoping quitting caffeine and taking DHEA is what helped me to get so many this last round but quality is definitely an issue from the sounds of it.

@alex…I’ve been following that thread which is what got me doing DHEA. I just need to get better about eating high protein diet. We froze a blast as I did a 3dt with 3 embryos (per doctors recommendation). I had 3 left and so they were still trying to figure out if the remaining 3 would progress anymore. Only one made it to blast so they froze it. I guess if I hadn’t already done the 3dt, I would have gladly had that one transferred instead.[/QUOTE]

My AMH was dismal at 0.89, and yet I still managed to get this old body pregnant. :wink: I still swear by the DHEA.


#20

Hi there. I was on dhea my last two full ivf cycles. The one in November failed, now ever this one is looking hopeful. I have positive on HPT and my beta in 5 days time. This time I was on dhea 25mg x 3 dailynformthree months, last time 2 months. This time I dropped 8 kg, las time 2 kg as advised by clinic. I haven’t had caffeine in ages. This time they used ‘embryo gen’ as the culture which has a slightly better percentage. So sorry bfn happened laced2go. This is our 8th full cycle after our first ivf daughter 3 years ago. This is hopefully my first :bfp: in that time. :bsv: for all.