Well that was a complete failure

Of the 13 eggs (or a baker's dozen as K called it), 10 were mature, 2 were immature, and 1 was clearly abnormal. Of the 10 mature, 8 fertilized. There were doing ok on day 3: 3 or 4 grade B and 3 or 4 grade C (I can't remember if each was 3 or 4 because I was so upset because I only heard this after they told me everything had failed). However, on day 5 none were blastocysts. When they rechecked on day 6 they all had died except one very poor quality blastocyst which "fell apart" when they touched it to try to biopsy. I am devastated. I was worried we might not have any genetically normal embryos on PGS, but I never thought we wouldn't even have any embryos to test. I am 26 and K is 28. His morphology increased from 0% to 4% and he has been taking supplements.

The clinic says they aren't sure what went wrong. I talked to both doctors and heard slightly different information. The first said that they sometimes see embryos go downhill after 4-5 days if it is a sperm problem. The second was worried my UC might have effected my egg quality.

There are only a few differences between this cycle and last:

1. UC
After E was born I was diagnosed with Ulcerative Colitis. My symptoms weren't horrible, but they weren't under control until about 2 weeks before starting IVF. I am taking Hum.ira. Maybe my UC effected my egg quality. Hopefully, now that my symptoms are under control my egg quality might improve. I am going to start taking supplements for egg quality. I searched the CCRM supplement list and am going to take:

DHEA – 25mg x 3/day
Myo Inositol 2gm (twice a day)
Melatonin 3mg (at bedtime)
Co Enzyme Q10 (200 mg x 2/day)
Omega-3 fatty acid 1000mg (once daily)
Vitamin C 500mg (once daily in the AM)
Vitamin E 200IU (once daily)
L-arginine 1000mg (twice a day)
Pycnogenol 100mg (once daily)

2. Met.formin
My last IVF cycle I had been on 1500 mg met.formin for ~4 months. This time I was only taking it inconsistently few 2-3 weeks. I was really really nauseous on the bcp for IVF, and I thought the met.formin might be contributing so I didn't take it as often. I had my hormones checked and they did not show a typical PCOS pattern, so I figured I didn't really need the met.formin. However, now I am back on the 1500 mg and will take it everyday.

3. Medications
The main difference in medications was 1st cycle I did follistim only for 3 days then added menopur. I took them both together at night. This time I started menopur and follistim on the same day and took menopur in the morning and follistim at night. I also took about twice the total amount of injections this time (150 follistim vs 75 per dose and used 11 total vials of menopur vs 5), since we were trying to get more eggs. We got 13 vs 11 last time. Also, I used 4 vials of ganirelix vs only 1. I felt they were on the fence on having me trigger on Friday vs Saturday. They had me wait (I think in hopes of having my estrogen rise more, since it still was only 800), where my first Drs had me trigger at a similar stage - part of me wonders if we waited one day too long to trigger (I forgot to ask the Dr this)? I asked the doctor if we used too much drug, and she said no because we still had a healthy total number of eggs and my estrogen was not too high. She says that I required more medications for only slightly more eggs may be a sign of decreasing egg quality, but still my overall dose isn't as high as some women use/need. However, one concern is that my estrogen was never very high and was somewhat low considering my follicle size. Because of this she wants to try a micro dose Lupron flare protocol to cause higher FSH/LH/estrogen and hopefully recruit more follicles and have healthier follicles.

Based on all these things my plan is to give my UC more time in remission before we try again and give the supplements and met.formin time to improve my egg quality. I have heard you need about 3 months. At this point based on my schedule I could work in another IVF try in between January 12 - February 8th (which would give me only 2- 2.5 months) or March 9 - May 3rd (which would give me 4-4.5 months.) The only problem till waiting till March is if we do have success in creating blastocysts that we can biopsy and freeze, based on K's translocation they estimate only 20% will be normal. We could have no normal embryos and would need to cycle again. However, we move out of state again at the end of June and my May schedule is not really amenable to another IVF cycle. We could possibly squeeze in another cycle in June, but then would have to return to the clinic at a later date to do the FET or have the embryos transferred to a different lab closer to where we move for the FET. I'm not really sure on what to do at this point. Do you think I can improve my egg quality enough in 2 - 2.5 months or should I wait 4 - 4.5 months?

Another thing to question is if we should do anymore testing on K. One doctor suggested testing for sperm DNA fragmentation, but even if it is fragmented there isn't much was can do. They can do a testicular aspiration to get sperm, but there is not much evidence on this improving outcomes. Plus, we were told that many of K's sperm with unbalanced mutations probably don't make it out of the testicle (this his lower concentration), so if we aspirate we could get an even higher percentage of abnormal sperm. If it was super fragmented I would still want to try again with his sperm, since we know it worked once. It's hard to give up on his sperm or my eggs at this point since our first IVF was successful. I hope we can figure things out.

We also have considered talking to our original clinic, but it would be incredibly difficult to get back there to cycle (as it is 6 hours away.) The only way it would work is if I could do monitoring here, which I'm not sure they would agree to, and only go back for retrieval. At this point I am willing to give this clinic one more try. If we have complete failure again we would not try at this clinic a third time. There is no other clinic other than the one I am at for several hundred miles, so we don't have another close option.

Any suggestions or opinions on what we should do?


 

Retrieval

Retrieval was this morning at 7 am. They retrieved 13 eggs, which I am happy with (but doesn't everyone wish for more.) We will find out tomorrow how many were mature and fertilized.

The bad part is that I don't feel the best. I already had a sore throat and cough before retrieval. Now I am also very crampy and when I cough my shoulder kills me - I'm not sure if it is referred pain or what. I'm definitely more uncomfortable than I recall being after my last retrieval. The doctor today had to push the retrieval needle through part of my cervix, which caused bleeding, and she had to put a stitch in my cervix.

I'm trying not to stress too much. It's hard not to start doing math. I have 13 eggs but not all are mature, not all will fertilize, not all will make it to day 5 to be biopsied, and not all will be genetically normal. I hope in the end I will have a few healthy, genetically normal embryos to transfer.

IVF Days 7 and 8

IVF Day 7
Estrogen 482, Progesterone 0.2
10/30 Menopur 75 and Ganirelix AM & Menopur 75 and Follistim 150 PM
Starting to feel a little bloated and uncomfortable

IVF Day 8
Estrogen 824, Progesterone 0.5
10/31 Menopur 75 and Ganirelix AM & Menopur 75 and Follistim 150 PM

Plan is for trigger tomorrow night and retrieval Monday morning
11/1 Menopur 75 and Ganirelix AM & trigger with HCG at 8 PM

IVF Day 6

10/28 Menopur 75 AM and Follistim 150 PM
10/29 Menopur 75 and Ganirelix AM and Follistim 150 PM
Follicles: R: 6 13-16 mm, L: 4 13-16 mm
Estrogen: 431, Progesterone: 0.4

IVF Day 4

10/23 Baseline ultrasound: R: 33 follicles, L: 20 follicles, lining 2.7 mm
10/24 Menopur 75 AM and Follistim 150 PM
10/25 Menopur 75 AM and Follistim 150 PM
10/26 Menopur 75 AM and Follistim 150 PM
10/27 Menopur 75 AM and Follistim 150 PM, Ultrasound: ~10 7-10 mm on R and ~5 7-10 mm on L, Estrogen 147

Round 2

So I know I am a horrible blogger and disappeared for the last year. Things with my pregnancy went well other than horrible nausea till ~26 weeks (However, Zofran helped sooo much). At 36 weeks and 5 days I gave birth to my perfect little boy, who is no longer very little anymore. He had to stay in the hospital 1 week due to an infection, but has been very healthy since then.

I finished medical school and we ended up moving for my residency. We will be in our current location for 1 year and then a different location for 3 years. I looked ahead to where we move next and realized there are no IVF clinics nearby, so we are in the process of starting IVF again. We met with the local clinic and told them about K's brother's translocation. They ran genetic testing on him and discovered that he carries the same translocation, which we both sort of expected given his low sperm morphology and counts. So we are going to do PGS.

I go in tomorrow for my baseline ultrasound, and if everything looks good I will start injections tomorrow. All the meds are lined up on my kitchen table and in the fridge. My new doctors are planning on being more aggressive than last time since we will not do a transfer right away, which will decrease my chances of ovarian hyperstimulation as there will be no beta-hcg, and because we need more eggs to have more blastocysts to test with PGS. Once they retrieve the eggs we will do ICSI and PGS on the day 5 blastocysts. They send a few cells to a lab out of state and freeze the day 5 blasts. Once we know our results, we will plan when to do the FET.

I still read all the blogs I used to read - almost everyday. I'm impressed with those who have kept up their blogging. I'll try to be better this time :)