Question:
I just failed my second IVF (in vitro fertilization) procedure. I am 37 years old living in the Bay Area. My husband has slow swimmers and not great morphology either. We used ICSI (intra cytoplasmic sperm injection) with both IVF procedures.
The first cycle I had 8 eggs, 6 fertilized and only two made it for transfer. The second cycle I had nine retrieved, 8 fertilized and we transferred two embryos on day 3, one an 8 cell and one a nine cell. We were able to freeze 3 embryos, not of as high quality. I believe the frozen embryos are 5 and 6 cells. I am planning to use the frozen embryos, but it seems like a lost cause as the quality of the embryos are not as good as the fresh ones that were transferred. I am doing acupuncture treatments as well.
Any advice would be most helpful. L. from San Francisco, California
Answer:
Answer:
Hello L. from the U.S.,
I am sorry to hear of your failures, but IVF is certainly the best treatment for you based on your husband's problem and your age.
Without reviewing your IVF records, I cannot give you any specific information regarding your cycles or chances. Keep in mind that each IVF center uses different protocols and methods and pregnancy rates vary. For example, my pregnancy rate in your age group with ICSI is 56% per attempt with 41% continuing pregnancies. Pregnancy rates are very dependent on the stimulation, how many mature eggs are retrieved, embryo development and transfer technique. In addition, in your age group, having failed one IVF cycle already, I would have placed back all four embryos, even though the lesser celled ones were not as good quality. There is no utility to freezing them, and the prognosis with those embryos is not good as you already know. The success rate of a frozen embryo transfer cycles with good embryos is approximately 30%. Your best chance, once you have tried with the frozens if you choose, is to keep trying with fresh embryos.
In my protocol, I would probably place you at the max stimulation protocol, add low dose aspirin, low dose heparin, medrol and increased progesterone with the next cycle. Acupuncture certainly does not hurt and I would recommend that you continue it. On a side note, when my wife & I went through IVF she was 37 like you. We also did ICSI. She had 14 eggs retrieved, eight fertilized, and we ended up with one nine cell, one eight cell and the other two 5 cell. After conferring with her RE, (she was under the care of my colleague at the time) we decided to transfer all four. She became pregnant with a singleton, our daughter, who is now a healthy young teenager (her baby picture is on the Doctor's Background page of my blog). Needless to say, we did not regret our decision :)
Good Luck on your journey, I will keep my fingers crossed for you both!
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
I am sorry to hear of your failures, but IVF is certainly the best treatment for you based on your husband's problem and your age.
Without reviewing your IVF records, I cannot give you any specific information regarding your cycles or chances. Keep in mind that each IVF center uses different protocols and methods and pregnancy rates vary. For example, my pregnancy rate in your age group with ICSI is 56% per attempt with 41% continuing pregnancies. Pregnancy rates are very dependent on the stimulation, how many mature eggs are retrieved, embryo development and transfer technique. In addition, in your age group, having failed one IVF cycle already, I would have placed back all four embryos, even though the lesser celled ones were not as good quality. There is no utility to freezing them, and the prognosis with those embryos is not good as you already know. The success rate of a frozen embryo transfer cycles with good embryos is approximately 30%. Your best chance, once you have tried with the frozens if you choose, is to keep trying with fresh embryos.
In my protocol, I would probably place you at the max stimulation protocol, add low dose aspirin, low dose heparin, medrol and increased progesterone with the next cycle. Acupuncture certainly does not hurt and I would recommend that you continue it. On a side note, when my wife & I went through IVF she was 37 like you. We also did ICSI. She had 14 eggs retrieved, eight fertilized, and we ended up with one nine cell, one eight cell and the other two 5 cell. After conferring with her RE, (she was under the care of my colleague at the time) we decided to transfer all four. She became pregnant with a singleton, our daughter, who is now a healthy young teenager (her baby picture is on the Doctor's Background page of my blog). Needless to say, we did not regret our decision :)
Good Luck on your journey, I will keep my fingers crossed for you both!
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California
Hi Dr. Ramirez, thank you so much for commenting on my blog. I can't believe the time you dedicate to patients and offering advices on your blog.
ReplyDeleteMy RE is aggressive. I think he has your same philosophy. He transferred all five of my embryos taking into consideration that I'm 40 and has never achieved a pregnancy. I had one 9-cell, grade A; one 7-cell, grade B; one 6-cell, grade B; and two 4-cell, grade C. I'm just hoping something sticks.
I was also inspired by your wife's story of her IVF success.
Thank you!!!
You're welcome and I certainly hope at least one of them "sticks" :) I will be checking back in a couple of weeks to see some good news on your blog! Take care!
ReplyDeleteHi Dr, I am 37 years old my husband is 42. We live in south Australia. I have done 3 ivf cycles, first cycle they retrieved 4 eggs 3 were good to use only two fertilised but fertilised abnormally, nothing to transfer. Cycle 2 retrieved 3 eggs none fertilised. Cycle 3 retrieved 2 eggs both fertilised but arrested on day 4, again nothing to transfer. Doing another cycle in a few months. Any advise would be great.
ReplyDeleteHello,
DeleteIn oder to give you advice, I would need to review your medical records to see what was actually done. There are too many open questions, such as dosing protocol, timing of HCG, etc. It also makes me wonder as to whether or not there are lab issues.
Certainly at your age IVF success if more difficult, but by three cycles I would have expected you to be successful. But I worry about the stimulation because you certainly did not have as many eggs as I would have preferred to have. Keep in mind that the only way to overcome the "age factor" is to try to find the few perfect eggs left in your ovaries. That is a statistical problem. The more eggs you can retrieve, the higher the chances of finding the perfect egg. When you have few eggs retrieved, it will take longer to find the perfect egg. There was a study done that showed that at age 37, only 2 of 10 embryos were normal. So ou can see that you need to have at least 10 eggs to work with.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.
Dr Ramirez, I live in Australia and am 37, started ivf at age 36. Husband has low motility and I have low amh, even though doc is puzzled with my good response with lower stimulation of 150 units of gonal f. Have done 6 ivf cycles. The first was with 450 units of gonal f and luveris producing 3 eggs. We did pgd and icsi and one was genetically good. When put back it resulted in a chemical pregnancy. The 2nd ivf was 450 gonal f and then pushed to 600 which resulted in 9 eggs. All immature except one which was tested and came back genetically abnormal. Third cycle with antagonist 450 gonal f yielded 3 eggs all abnormal. Fourth cycle with 459 gonal f 8 eggs, 2 made it to day 5 but were abnormal when tested. Ivf 5 used lower stimulation 150 units of gonal f. This resulted in 12 eggs, 9 fertilised, 7 made it to day 5 and only one was normal when tested using pgd which was frozen due to high progesterone. Ivf 6 again on 150 units of gonal f resulted in 10 eggs, four made it to day 5, all abnormal. Not sue where to go from here. Any feedback would be appreciated as im at a crossroad of what to do.
ReplyDeleteHello,
DeleteI know this is very late in reponding to you but somehow I missed your post. I hope that by now you are pregnant, but if not, here are my thoughts.
We know that the primary problem with age is that the eggs, that a woman is born with, decline in internal quality. This affects her chances of getting pregnant and the chances of having a normal embryo. What you have experienced is that most of your eggs form abnormal embryos. There is nothing that can be done about that. So at this point you have two choices: (1) continue trying with your own eggs with the hope that eventually you will get a perfect embryo and have a successful pregnancy or (2) proceed to use donor eggs. I wish there were more to offer.
Respected Dr.Ramirez:
ReplyDeleteIm 37 yrs old just had my 1st ivf cycle.It was failed unfortunately.My fsh 6.9, AMh 0.94ng.i did the long protocol with decapeptyle 0.1mg for down regulation.stim by menogon 4 ampules USG on D8 showed 2 follies.Dose increased to 6 ampules for the following 5 days & ended up with 5 eggs on retrieval.According to embroyologist both sperm and egg werent good quality but 4 fertilized with 3 excellent D3 embryo & 4th of lesse quality.4 of them made it to transfer but no implantation occured.
I wanted to add that my husband had 2daughters from a previous marriage the younger about 2yrs old.So i dont understand the issue of his low quality sperm.i have no idea if they did chromosomal screening or assisted hatching.I dont know either they did ICSI or Ivf.
ReplyDeleteI just need your expert opinion and advice about my next protocol.And Im wondering if i'm diagnosed as a poor responder
Hello,
DeleteSomehow your post got split into three so I'm just going to answer this last one since it has your question.
The major issue that you face at 37 years old is egg quality. A woman is born with all her eggs and they age with her. Unfortunately, the quality declines with age such that a woman's fertility ends by the early 40's. There is no technology to make eggs better at this time. The only option is to try to get a lot of eggs out at a time to increase the chance that there will be a good egg within that batch. There is not always a good egg in the batch. There was a study done last year or so that showed that in 37 year old women, only 2 of 10 formed embryos were genetically normal. So what IVF does is help you to get pregnant by getting a lot of eggs out at a time. Imagine that you have a bucket with all blue balls but there are a few red balls in the bucket as well. You can't see the red balls so in order to find them you start pulling out blue balls in hand fulls until you find a red ball. This is the same concept that IVF is applying.
One IVF cycle is not enough. In older age women it can take several attempts before a good embryo (red ball) is found. In you case, the one thing I would recommend is that your doctor consider using a high stim/antagonist protocol. The long protocol that you used tends to suppress the ovaries too much and your ovaries already have a little resistance to stimulation so you don't want to suppress them too much.
Protocols is what makes one clinic or doctor different than another. That is why it is important for you to choose your doctor carefully. This choice can make the difference between success and failure.
Good Luck