Question:
Dear Doc, I would appreciate an opinion on this current IVF cycle I'm on and my previous failed cycle. I'm 37. My period is regular ie 28-32 day cycles. This is my second IVF. I started suprefact on day 21, 40 units for 13 days, 15 units from the 14th day onwards. 300 iu Gonal F on the 16th day for 4 consecutive days now. I will be seeing my RE tomorrow. My period came on the 10th day I was on Suprefact, 30 days after my previous period.
My first IVF also started on day 21, I was on suprefact for 14 days @ 40units. I started puregon 350iu on the 15th day-was on 350iu for 11 days, 250iu on the 12th day and 225 on the 13th day; suprefact was at 15 units. 13 eggs retrieved, 9 fertilised but only 4 left on the 3rd day when the transfer was done. 13dp 3dt my HCG was 375. At 18dp 3dt, my HCG was 2065. I was bleeding lightly post transfer and when the time came for the ultrasound, no sac was found and my hcg level had dropped to 117-end of my BFP. What do you think my chances are for this second cycle? I would appreciate any advise you might have. A. from K.L., Malaysia
Answer:
Hello A. from Malaysia,
Thank you for writing me all the way from Kuala Lumpur! Let me comment on the information that you have given me. The first IVF cycle looked pretty good except that the embryo development was poor. If 9 eggs fertilized, you should have had 9 embryos formed. Despite this, you were able to get pregnant, which proves that this treatment plan (IVF or in vitro fertilization) can work for you. The miscarriage has nothing to do with the IVF. Once the pregnancy occurred, it becomes an independent entity and will either progress or miscarry on its own. In your case, a chemical pregnancy occurred leading to a miscarriage. Most miscarriages occur because of spontaneous genetic/chromosomal abnormalities that occur at the time of cell division. Because the embryo was abnormal, a fetus did not develop, thus leading to the miscarriage. This was probably due to the "age factor."
As a woman ages, more and more of her eggs become weakened/debilitated leading to abnormal embryo formation. Therefore the miscarriage rate increases. Keep in mind that IVF can only give you the opportunity to get pregnant. Whether or not implantation and pregnancy occur are up to your body's and the embryo's natural processes. We do not have the technology to make that happen. It has to happen on its own. So the fact that those processes occurred is a very good sign :) and all you need now is to get a good and healthy embryo into position. Then you'll have a successful pregnancy.
I'm glad to see that you are now in another IVF cycle. Since you had a chemical pregnancy, I am confident that you can achieve pregnancy eventually. Because of your age, it will just require persistence on your part.
Good Luck on your second cycle,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
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