Tuesday, April 20, 2010

Secondary Infertility, High Responder PCO Patient: Why Did I Fail Two IVF Cycles?


Hi, I am 28 years old and my husband and I have a naturally conceived 3 year old son. We are dealing with secondary infertility. We have gone through 2 IVF cycles.

1st IVF/ICSI cycle-21 eggs--11 fertilized (70% fert. rate)--transferred 2 great 8 cell embryos. None to freeze. Negative result

2nd IVF/ICSI cycle
19 eggs--(85% fert. rate)--8 embryos on day 3
1-8 cell grade 1 (best)
2-8 cell grade
21-8 cell grade
32-7 cell grade
22-5 cell grade 2

No transfer because of lining issues. Did one FET--ended in a chemical pregnancy.

My question--do I have poor egg quality? Lab results said some eggs were abnormal, with thicker zona. Any hope to go through IVF again?

I'm from Fargo, ND. Thanks in advance!


Hello M. from North Dakota,

From the number of eggs retrieved, I presume you also had a high number of follicles (>20). That indicates that you are responding like a PCO patient, or have PCOD. Studies have shown that there is a decrease in pregnancy rates with PCO patients, probably due to a high number of immature eggs retrieved. It also seems to affect egg quality. That is not because you have abnormal eggs, it is probably because the PCO causes an inefficiency in egg maturation.I would not give up hope. In fact, I would encourage you to continue trying because you will be successful. It may take some more tries, and hopefully, your doctor will adjust your protocol to try to reduce your stimulation. It would be better to have fewer follicles with good eggs than lots of follicles with poor eggs.

By the way, I just had a patient from your end of the country, Montana, that previously went to a clinic in Washington state and had two failed IVF cycles. She was a secondary infertility patient as well. Well, the change in weather or location or clinic did the trick because she became pregnant with one attempt, and with twins. Infertility Physicians and clinics are not all equal. That may have a bearing on your success as well. I am worried about the fact that despite all the eggs, your embryo quality rate and number to freeze were so low. That might also indicate a laboratory issue.

In any case, don't give up hope. You will eventually be successful.

Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.

Comment: Thank you for your insight! Very much appreciated! :)


  1. Great info. I never knew until fairly recently that secondary infertility was so common. Here via iclw.

  2. Thank you for your comment! I will have to look at your blog as well! Good luck on your family building journey! EJR, MD

  3. Hi there- found your blog via ICLW. It's nice to see the perspectives on infertility from the other side of the stirrups!
    Happy ICLW!
    ~Miriam (ICLW #9)

  4. Wow... it's great to see a blog from an RE's perspective! I'll stop by again!


  5. Happy ICLW!

    It was a pleasant surprise to open this blog. I will definitely be a follower!


  6. Wow - what a great resource! I am going to follow your blog and hopefully learn more info on all of this.

    ICLW #119

  7. I love this! How encouraging. Great Q & A. Great blog, can't wait to read more. I'm your newest follower from IComLeavWe.


  8. thank you for providing answers to so many of our questions

    ICLW #107

  9. Dr. Ramirez,

    Thanks for visiting my blog and for hosting this blog. This will be such a great resource for so many women!!

    I'm happy to share our story, and I think that more doctors need to approach PCOS like my doctor did...treating every patient as if they are insulin resistant and suggesting the low amylose diet along with glumetza. I can't tell you how many people I know it has worked for and I wish more doctors tried this option before pushing patients to IVF.

    Best of luck to you and thanks again!



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