Hi, I am 28 years old, married since 3 years, trying to get pregnant since 2 years. I had ectopic pregnancy since 15 months which ended by right laparoscopic salpingectomy. Then I tried clomid for 3 cycles, HMG induction for 2 cycles and I tried fresh IVF (in vitro fertilization) with long protocol.
I took 1 amp menogone , 1 amp fostimon 75 mg, 1 amp fostimon 150 mg/d. there was 36 mature follicles , all fertilized well, then 4 good embryos were transferred on 3rd day but ended badly on 5th week by blighted ovum.
Then I tried frozen embryo transfer by thawing the embryos and let them grow to the blastocyst stage. We got 14 good blastocyst from 19 embryos, then 2 hatched blastocysts were transferred. I took estrogen valereate 6 tab/d till endometrium thickness 8cm, then progesterone supp 800 mg/ d , aspirin 75 mg/d. but again a negative BHCG on due time.
Some history:
a) semen analysis is good with no abnormal forms or motlity
b) patent left tube by hysterosalpigogram
c) history of endometriosis discovered during laparoscopic salpingectomy.
d) good hormonal profile FSH, LH, TSH, prolactin, anti-phospholipid tests
Now I am planning to repeat but I still have 12 frozen blastocysts, but I need your advise because we thawed the 3rd day embryos from the first ivf , then let them grow till the blastocyst stage , then did the transfer the last time , then refreezed them again.
My question:
I am undergoing a new frozen cycle now. I take 6 tablets oral estrogen valereate/ day, 200mg sildenafil (viagra) vaginally/ day and vitamin e, aspirin, and after the endometrium reached 8.5 mm thickness on the 10th day stimulation, it decreased on the 13th day to 6 mm although I still take the same dose with no discontinuation, sure of the expiry date.
What is your explanation please, and what can I do to prevent cancellation of the cycle? If I continued the same dose is there any hope for restoration the thickness?
Please answer me because I am frustrated and breakhearted.
N. from Egypt
Answer:
Hello N. from Egypt,
This is a protocol question, which I do not answer because protocols can vary widely and there is not only one way to do things. That being said, there is some general information that I can provide.
First, keep in mind that you have been pregnant with IVF and so can get pregnant again. IVF only gives you the opportunity to become pregnant, it cannot make you pregnant because there are still some natural steps that must occur on their own. Studies have shown that if you have gotten pregnant in the past, your chances of getting pregnant with IVF are higher. Also keep in mind that, just like trying to get pregnant on your own each month, it does not always work. Sometimes it can take several attempts before it is successful.
Second, it is well documented by studies that the best way to deliver hormones for IVF is either by injection, by patches or by vaginal delivery. Oral tablets can be used vaginally (you just push them to the very back). This helps with maximum absorption of the hormone and delivery to the uterus. Oral intake has been shown to be the worst way to give hormones for IVF because most of it is lost when it passes through the liver. I personally use patches, which most US doctors use, but tablets used vaginally is also a good option.
I would not necessarily cancel the cycle, because time can be taken to develop the endometrial lining further. It is only finalized once the progesterone is started. That is what determines the timing of the transfer, which for a blastocyst, should be on the 6th day after starting the progesterone. If you have not started the progesterone yet, you can keep using an increased amount of estrogen to get the lining to 9 mms.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Good health care is more than a doctor with access to the latest in technology or the best education from the best university. These are important but so are the human sides of treatment and diagnosis. For a woman, that is especially important, and finding the best women's diagnostic center is essential for the comfort of the patient.Cardio Vascular Health
ReplyDeleteI agree with your comment. Good "health care" requires a focus on the human side. There needs to be compassion, sympathy, understanding and personalization. Many television shows show doctors with a lack of these qualities but good diagnostic or treatment skills and so these doctors are given a pass. But, that does not have to be the case. Patients should select their doctors with as many of the high qualities that they can get. Don't settle for just a few of them.
DeleteIn addition, despite where a doctor may have been educated, that education does not lead to equal doctors. That education only gives each doctor the basis for further education and development of their skills. That is why it is called the "practice" of medicine. Doctors that don't keep up with their education, don't enhance their skills or don't have the other essentials like diagnostic acumen, decision making or self control under pressure will not make good doctors. Also doctors that have the arrogance to think they know everything despite their limitations also make for bad doctors. In fact, they can be dangerous.
This blog is not to discuss the politics of medicine or health policy, but thanks for making the point. Our government wants to replace good doctor qualities by poorer standards through quicker education and training and replacement by providers that know less but practice beyond their capabilities. This will eventually lead to a two-tiered health care system (rich vs poor) and a decline in the overall quality of American health care.