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If you need to contact me , please write to me to this email ID : manjupadmasekar@yahoo.com. I will be happy to help.

Thursday, December 27, 2012

Why did my IVF cycle fail ?

Try and try again until you succeed !



The first question that arises in a patient’s mind after an IVF failure is ‘Why did my cycle fail ?’ A failed IVF cycle is heart-wrenching. It is painful because your dreams are shattered, your hard-earned money has gone down the tube and you do not know what to do next ! As humans we all need an answer for the failures we encounter. Why did a particular endeavor fail ? If we get an answer for this , then we tend to have peace of mind , because we believe that we can achieve success the next time around if we can rectify what went wrong in the previous attempt. But when an IVF cycle fails unfortunately no one has an answer for the same – not even your doctor ! You might have had a perfect cycle – lots of eggs, good fertilization rate, good quality embryos, excellent endometrium, easy embryo transfer – but no positive pregnancy test !  On the other hand your friend might have had a very poor IVF cycle (with few eggs and poor quality embryos) and they might end up getting pregnant ! IVF is like a gamble – which involves not only your money , but also your fragile baby dreams ! The sad truth is that there is no logical explanation for the outcome of an IVF cycle – be it a success or a failure. This is because we are still not intelligent enough to understand the logic beyond the bio’logical’ process that controls embryo development and implantation. Once the embryo is transferred to the uterus , no one knows what happens to it after this– after all, how can we track the fate of a microscopic ball of cells once they are inside the uterine cavity ? We cannot predict which embryos will implant and why, and hence we do not know why an IVF cycle fails or succeeds ! Fortunately or unfortunately , no one cares the other logical question - ‘Why did my cycle succeed ?’ – this doesn’t have an answer either !

The first person patients turn to when their IVF cycle fails is their doctor. He is the person who performed everything from the ovarian stimulation to the embryo transfer. He is the one who advised them to do IVF ; and reassured them that they had a good chance of succeeding. Patients naturally think that their doctor should have an answer for the most important question that haunts them – ‘Why did my cycle fail ?’ There are patients who are naive about the IVF process , and who get angry with their doctor when he cannot offer a satisfactory answer for the failure. They start imagining the worst – that their doctor did not perform the procedure well, or that the clinic is not competent , which is why the cycle failed. Some might blame themselves , because they start thinking that their body is not conducive for achieving a pregnancy; that their uterus is not good enough to accept the embryo; and that they are not fit to carry a baby. Some believe that their body is defective or that it “rejected” the embryo. Many start obsessing about all the ‘mistakes’ they did during the 2ww – from not taking enough rest to eating certain ‘forbidden’ foods. Many patients start blaming themselves for the IVF failure and might even think that it is a punishment from God !  But a well-informed, IVF literate patient understands that an IVF failure is nobody’s fault. Such mature patients get better emotional protection after an IVF failure because they do not blame others or themselves for the failure. They do not think their body is defective (and hence their self-esteem is not damaged) ; and they accept the failure with a strong heart and mind which will in turn help them to look forward for ways to make their baby dreams come true !

 The most important duty of an IVF doctor is to teach his patients how to prepare themselves for an IVF failure. A good IVF specialist will spend time and energy to educate his patients about the uncertainty inherent in an IVF process. He will not falsely raise the hopes of his patients and he will not promise them a baby. Such a mature doctor not only protects his patients from the emotional assault of failure, but also protects himself from the wrath of his patients ; and also does not need to trot out a plausible lie to satisfy the patient when the cycle fails !

What causes an IVF cycle to fail ?

No one knows the answer ! There are some explanations , for example – poor quality of the embryo ; genetic defects in the embryos ( which we cannot always diagnose); or the presence of an unreceptive endometrium. But the problem with existing IVF technology is that there are no sure ways to find out which embryo is genetically normal and which endometrium is  receptive. Hence giving an exact reason for the IVF failure to an individual patient is not always feasible , because of the limitations inherent in today’s ART. Let us consider a fertile couple who is trying to have a baby in their bedroom. Do their attempts at baby making sex result in a baby every month they have intercourse during their fertile time ? Of course not ! A young fertile couple may take up to one year to achieve a pregnancy - and they have just a 15 – 25 % chance of conceiving in a particular menstrual cycle. This clearly shows that human reproduction is remarkably inefficient. During IVF the chance of achieving a pregnancy in a single attempt is significantly higher- most clinics around the world have a success rate of 40-50 %. But it is impossible to pinpoint why 6 out of 10 women who undergo IVF fail to achieve a pregnancy and why the other 4 are successful in their attempt. 

What will not cause your IVF cycle to fail ?

The following will not cause your IVF cycle to fail :
1)      Not taking bed rest
2)      Coughing during 2ww
3)      Stress
4)      Your food habits (eating the so called ‘heat generating’ foods ! ( for example chicken etc)
5)      Pseudoscientific reasons such as NK cells and HLA matching

What happens when an IVF cycle fails ?

Even though the patient tries to understand that there is no valid explanation for an IVF failure , many a time the heart is not ready to accept what the head says. As it is rightly said , the heart has reasons that reason does not understand.Since there are so many emotions connected with an IVF cycle , the heart of a patient naturally craves for an explanation for the failure , so that the “ fault “ can be rectified in the subsequent cycle. They believe that this will help in achieving the much desired pregnancy. This is where many IVF doctors play games with their patients – some for money, some unable to face patient’s questions, some because of the fear that they might lose the patient to other doctor and some in order to maintain their ‘I know everything’ image  ! 

Patients don’t like being told doctors don’t have all the answers ! This makes them uncomfortable, and they start doubting their doctor’s competence. If he cannot even answer such a basic question, then he must not be very good ? Maybe we need to get a second opinion ?  This is especially true when the doctor over-promises success before starting the IVF cycle ( as many do, to lure the patients into doing IVF  with them).  They promise them the earth and the moon – and when they cycle fails, they often abandon these patients and refuse to see them, as they don’t want to have to answer awkward questions. Even worse, rather than acknowledge the state of their ignorance, many doctors will concoct pseudo-scientific answers for the failure, such as immune rejection because of overactive NK cells in the uterus ; or HLA similarity between the partners. They will then run a panel of expensive and painful tests ( of no proven validity) , and then find “abnormalities” which they will then go on to “treat” before starting the next IVF cycle. The patient is hooked,  because she believes that the doctor has now pinpointed the fault – and now that it has been corrected, the next IVF cycle will definitely succeed ! Many are sadly disillusioned when the next cycle also fails – and they then start belatedly doing their homework !

How do IVF doctors react when their patients demand an explanation for the failure ?

When an immature IVF doctor is confronted with the question – ‘why did my cycle fail ?’ he may feel offended. Many feel that their clinic’s competency is being questioned ! Many doctors will accuse the patients for the IVF failure. They might say : your uterus is not good enough; you didn’t take enough bed rest; you did not follow my orders etc. Such answers will increase the patient’s agony because they start believing that they are the reason for the failed IVF.

There are doctors who have a very paternalistic approach. They feel they are like God and no one should question them. They take pride in their intelligence and in their ability to give answers to all the patient’s questions. When such doctors are confronted with  the ‘why did my cycle fail ?’ question , they order a list of expensive, useless tests and subject the patients to treatments which have never been proven to be helpful. Ironically , this gives immense satisfaction to patients , because they believe their doctor is striving hard to find where the fault is ; and will be able to rectify it with expensive treatments. Patients delude themselves that costly treatments are highly effective and the doctor in turn gets the satisfaction that he has given appropriate answers to the patient’s question ( because many of these test results turn out to be abnormal, even though the abnormality is of no clinical importance). 

Only a mature doctor has the courage to give the honest answer – ‘I do not know’ !Of course , there are patients who are not mature enough to accept this explanation , nor do they appreciate the doctor’s honesty. They think that the doctor is not knowledgeable enough to guide them and look for doctors who will give them an explanation for their IVF failure. They believe that since that particular doctor has an explanation for the failure , he will make sure that the pitfall is corrected and make their next IVF cycle a success !

What are some of the futile treatments employed in the field of IVF ?

The below treatments do not have any scientific proof for their efficiency !
1)      IVIG therapy – Intravenous immunoglobulin therapy
2)      Intralipid therapy
3)      Paternal lymphocyte immunotherapy
4)      Use of heparin

My IVF cycle failed- what should I do ?

Try again ! This is the only good answer and a good IVF doctor’s answer will be exactly this. A good IVF doctor will not order a bunch of expensive tests after each IVF failure. A good IVF doctor will make sure that his patients have realistic expectation about the entire IVF process. If you want to be a mature IVF patient , educate yourself about the process. This will help you to have sensible expectations of IVF treatment.  It will protect you from an emotional breakdown ; and from unnecessary tests and treatments. 

If IVF treatment is like a gamble, are there ways to reap the best out of what I pay ?

There are clinics which want to make the IVF treatment a win-win situation. They offer something called a money back guarantee programme. You pay for a certain number of cycles (for example 3 IVF cycles) and if you do not get pregnant within those 3 cycles , they give you back your money. This is a wonderful option , which could help you preserve your peace of mind , at least as regards the financial aspect. So before starting an IVF cycle make sure that your clinic has such an option and ask them whether you qualify for such a programme.

The field of IVF is highly commercial and you need to protect yourself from being exploited by money-minded and irrational physicians. Your doctor is not always correct and unbiased. So please become well-informed about the process before starting it. Find a good doctor who will have your best interests at heart. If you are constantly diverted from your aim of having a baby by having to do unnecessary tests and treatments , you will get exhausted very soon. It makes going through subsequent IVFs impossible. Being knowledgeable and having realistic expectations about IVF will help you to remain strong , and will keep you going. Be careful not to get fed up before getting pregnant !

60 comments:

  1. It is not necessary that you have a reason for failure of your ivf cycle. Nobody can confirm you that your ivf cycle will be successful.
    fertility treatment

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  2. Hi Manju! Do you think better patient-doctor contact in the form of a website where you could track your IVF treatment progress would make you feel better/make you cope more easily with the average number of tries needed to finally concieve?

    ReplyDelete
    Replies
    1. Can you please explain ? I could not understand your question !
      Manju

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  3. People who don't know the rules and news about the IVF must see this article as your article has given more useful information and suggestions. this article can help the couples who are going to have a baby through IVF treatment.

    http://kiranivfgenetic.com/

    ReplyDelete
  4. Hi manju
    I recently failed my second ivf. 2 Top grade 3 day embryos were transferred in a good endometrium . I have hashimotos disease and do you think this might be preventing successful implantation? I have 3 embryos freezed from this cycle. My doctor wants to try heparin for the up coming fet. I would like to have your suggestions about what to do differently for success this time.

    ReplyDelete
    Replies
    1. May I know your age and if you have pictures of your embryos can you please send it to me : manjupadmasekar@yahoo. com.

      Not all IVF cycles end in a pregnancy. A very good clinic might have a success rate anywhere between 40 -50 %. And this success rate is mostly for women of younger reproductive age. There are so many uncontrollable, unknown factors which are at play during an IVF cycle. What you can do to maximize your chance of success is to select a compatent clinic.

      If you had good embryos, if you are with a competent clinic and if you are of younger reproductive age, all that you must do is to repeat the cycle. FET has a better chance of success than fresh cycle. I wish you lots of good luck !

      Hashimoto will definitely not prevent implantation. Make sure your TSH is normal.

      All I can say you is to try again.

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    2. Please let me know the reason for IVF !

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  5. I will be 30 in few months. I dont have embryo pictures but have seen them.
    My clinic is competent and well known. My tsh is between 1-2 . I am doing ivf because of tubal blockage due to pelvic infection history.
    Actually I have read somewhere that antibodies due to hashimotos might prevent successful implantation, hence I wanted your opinion regarding this. Can heparin make any difference in my case? I have only 3 embryos freezed so I wanted to do anything and everything for success this time.
    Thanks manju!!

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    Replies
    1. Antibodies due to Hashimotos will not prevent implantation, I am 200 % sure about it. I have several friends with Hadhimoto and when their TSH is normalized they conceive quickly. So do not worry about it.

      Heparin will not make any difference when you do not have underlying clotting disorders.

      Can I suggest you something ? Instead of obsessing what to do differently please relax. Make your body feel good - pamper yourself ! Healthy food, calm mind which is ready to accept varied outcomes, inherent happiness can all help a lot. Yoga or breathing excercises are great too. Good luck !

      Manju

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  6. Thanks manju..
    Your reply was really helpful for me. I will definitely try to keep my mind peaceful, which is difficult for me but certainly not impossible.

    ReplyDelete
  7. Hi manju
    Have you heard about G-CSF injection? My doctor has prescribed me this to help with implantation for next fet.

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    Replies
    1. Yes, I have. How will you take it ? Does your doctor talk something about infusing it into your uterus before embryo transfer ? G-CSF is naturally produced by the endometrial cells. There is no scientific proof that it really helps with implantation. I don't think there is any harm in trying. If you take it as injection please read whether it has any side-effects and discuss the same with your doctor. Please do not think it is a magical potion,your chance of success doesn't really go up with G-CSF, so have realistic expectations to prevent emotional break down if in case the cycle doesn't work out.

      How many cycles have you tried ?

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  8. No she didnt say any thing like that but I had a talk with other patients.. they told me that she gives directly in the uterus itself.. I have had two failed cycles. She also performed lupus and acl tests on me and said based in the results she will decide about g csf injection. The results were negative.

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    Replies
    1. She will infuse G-CSF in your uterus. You can give it a try. Atleast you will have the satisfaction you did your best.

      Delete
  9. Hi manju!
    What should be day 12 endometrial lining thickness for FET? I had my day 12 scan today and thickness was 7.1 mm . Dr wasnt satisfied with the thickness and vascularity. I was given g - csf on day 10. I was expecting my fet this month. She said she will see on day 15 and then tell. I fear ovulation will occur till then and I may lose a chance of fet in this month. I have 3 embryos frozen.

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    1. I personally do not believe that endometrial thickness matters. I conceived twins with an endometrial thickness of 6.7 mm. If I were you I will go on with the transfer, with your present endometrial thickness. I know doctors have a different opinion regarding this.

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  10. Ok..btw by which cycle day fet happens? As I have next appointment on day 15 only so I was wondering whether I will have time on my side to ask for the transfer?

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  11. Embryo transfer for FET is usually carried out 3 days or 5 days after progesterone supplementation. Are you on a natural cycle FET or medicated FET ? Are you taking estrogen tablets ?

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  12. Yes Manju, Its a medicated cycle and I am taking estrogen tablets.

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    Replies
    1. If it is a medicated FET you can be sure that you will not ovulate. The estrogen you are taking will suppress ovulation.

      There are reports that taking estrogen even for two months before embryo transfer doesn't affect the outcome of the cycle. This means embryo transfer in medicated FET can be performed at anytime, your doctor can even wait for weeks until your lining gets to a decent thickness. But in my personal experience my lining never grew after the first 14 days. It remained the same thickness irrespective of the estrogen dose. Hope you understand what I said. If you do not understand please do clarify your doubt.

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  13. Yes manju, I do understand what you are trying to say. In my case dr has prescribed estrogen till cd 14 only. She will perform the scan on cd 15 and will make further decision. Thanks for clarifying my doubt regarding ovulation. I was worried that I may ovulate before the next appointment.

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  14. And I would like to thank you Manju, for answering so many queries of mine. There are so many doubts which pop up in my mind, all of which I obviously can not ask to my doctor or anybody else. But if I put these questions on your blog, I am assured that I will get an answer. Thanks for being there. Your knowledge and experience help a lot of people who are new in this journey.
    May god always bless you

    ReplyDelete
    Replies
    1. I am happy that I could be of some help, it helps me to be strong too. Thanks for all the kind words and good luck !

      You can also write to me : manjupadmasekar@yahoo. com. Will be happy to clarify your doubts regarding IVF.

      Delete
  15. Hi Manju,

    I am 33 years old turning 34 born in 1980. I was diagnosed with severe endometriosis about two years ago (2012) and have gone through surgery to help reduce it as well. The surgery was initially to help reduce the pain and the 4-6 mm endometrioma but found severe adhesion as well. The pain since have subsided but the endometrioma came back to be about the same size. I've gone through another surgery to remove polyps in the uterus which was very small but might interfere with the embryo implantation. I did three rounds of clomid with time of intercourse that failed (required by insurance for coverage). My DH was normal. The infertility clinic also suspect PCOS. My blood work came out normal as of 8/29/2013. Free t4 is 1.1 ng/dl, TSH is 1.91 ulU/mL, Estradiol is 38 pg/mL which is in follicular ovulating stage. Prolactin is 15.5ng/mL, LH is 4.4 mlU/mL which is also in follicular ovulating stage. FSH is 3.3 mIU/mL which is also in follicular ovulating stage. My Anti-Mullerian Hormone (AMH) is 11ng/mL. The range means for adult female <6.9 >= 1.06ng/mL = improved odds for live birth and high antral follicle count. I'm not really sure what the AMH really means.

    I failed my first IVF cycle in May 2014. They were able to harvest 13 eggs (all poor quality). 11 were fertilized (ISCI). 2 good embryo (day 5) was transferred fresh into the uterus. Beta count shows negative result. I was able to freeze 6 day 6 embryo (5 good and one fair). My follow up appointment is in two weeks. I'm not sure if I should up my chances and put all 6 embryo in for the next FET? Or is that too much too soon. I fear that due to my initial poor egg harvest that my chances are very low and that combine with my endometriosis makes it even lower. Any suggestion is welcome.

    I really enjoyed reading your blog and your personal experience in IVF. You inspire me to keep going even against all odds.

    JJ

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    Replies
    1. Dear JJ,

      Your high AMH shows that you have PCOD. The upper normal value of AMH is 6 or so. You have extremely high AMH and in a way it is good ( eventhough it indicates PCOD ) because it shows that your ovarian reserve is good. Please read about AMH in my blog, use the search box !

      Can I ask you some information ?

      What is your BMI, are you overweight ?
      Does diabetes run in your family ? Are you insulin resistant ?

      Your IVF cycle seems to be good. You had blastocysts to freeze and that is great ! What was your e2 level during IVF, before the trigger (hcg) shot ?

      Can you please send me the pictures of your embryos that are transferred to you ? This will give me a chance to asses their quality. My mail ID is manjupadmasekar@ yahoo. com.

      You must remember that you have great chance of success. FET is much successful than fresh IVF cycle because of lack of excess hormone.

      Please do not transfer more than 2 or if possible one ! Multiple pregnancy has very high risk and the results can be devastating. Always remember that your final destination is not just any baby , your aim must be healthy pregnancy and a healthy baby. I wish you lots of good luck and thanks for all the kind words !

      Manju

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    2. Hi Manju,

      Thank you for the your hopeful words. I am five feet 6 inches and weight about 160 pounds, so the BMI I calculated was 25.8, which is overweight (25 to 29.9 = overweight). Note to self, go on a diet =0. Diabetes does not run in the family and I am not insulin resistant. I met with the physician to go over the results and he is also very hopeful of an FET success. I asked about my estrogen level, which was very high 5395 (normal range is 250-350). So now that I don't need to produce eggs to harvest, it will be better I hope. I will try the FET with two embryo and see how it goes. I'll keep you updated of the progress in August.

      JJ

      ps: I emailed you the pix of the embryo.

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    3. Hi Manju,

      I want to give a little update. My second FET with two embryo failed. I did a third FET with one good embryo (one other thawed embryo did not look good) and was successful. Sadly it did not last due to the severe abnormal physical defect to the fetus at 3 months. I had to do a D&C. I am now attempting my fourth FET. I am currently at the 10day wait period. Which is exciting yet feels so very long.

      Congratulation on your success and beautiful daughter!

      JJ

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    4. JJ, I appreciate your strength and courage. (((Hugs)))

      I know this journey is heart wrenching, but never give up. You will forget all this pain someday when you hold your little one.

      Lots of love and prayers from Anisha and me. I am praying for a positive this time and a healthy baby. Keep me updated, if possible.

      Delete
  16. It seems like you are giving detailed medical advice despite your disclaimer......?......

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    1. Thanks for reading the disclaimer :)

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  17. Hi Manju,

    I feel very blessed to have come across your blog during this time. My husband and I have been TTC since 2012, sought help from at RE in 2013. After no luck with numerous med + timed intercourse cycles (Clomid cycles, Fermara + Ovidrel cycles, strictly Follistim + Ovidrel cycles), 3 failed IUIs (Follistim + Ovidrel) we decided to take the plunge and do IVF/ICSI this past October. Until then we were diagnosed with unexplained infertility but after our failed IVF/ICSI cycle, RE is getting more insight on what my eggs do. RE retrieved 36 eggs, 6 which were mature… 6 more were cultivated and matured giving us a total of 12. RE explained that the 6 that needed 'help' maturing usually do not do as well. Well only 6 fertilized and made it to day 3. After day 3 all arrested. We were so crushed. RE ordered the Karyotype testing from BioReference for Chromosome Abnormalities and thankfully both DH and I came back with normal results. My RE's second option as to what may be my problem was that my eggs were not metabolizing insulin properly (I may be misunderstanding his exact explanation here, please forgive me as I was in tears during our consult) so I'm now on Metformin for the next month until our next IVF cycle, which ET is tentatively scheduled for Dec. 5-8th. He mentioned that he'll be changing my meds up a bit as well. I want to know what your thoughts are on this? Do you think this would help as far as having more mature eggs/better quality eggs to work with for our next cycle? Praying this is our 'cycle'. Again, so grateful to have come across your site… it is so helpful to me. Also, adding my RE only does 5 day FETs.

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    1. Don't worry. Your prognosis is great. My guess is you have PCOD. May I know how old are you and your BMI? Does diabetes run in your family? Did you ever take a glucose tolerance test?

      If you are overweight and insulin resistant (your body fails to use insulin appropriately) that must be your problem. Metformin is a great option for you. But, metformin alone will not be of much help. You have to reduce sugar and all refined carbs intake. You must follow the diet of a diabetic person and also exercise. This will help to produce good quality eggs. Have you heard about myoinositol? It is a great supplement to take for PCOD. Answer my questions so that I could help you better.

      Delete
  18. I'm 30, with a healthy BMI of 20. (5'8 and 130lbs). The only history of diabetes in my family is my great grandmother. I've had an Comprehensive Metabolic Panel in which my glucose was measured (came back at 75mg) but it didn't seem to be very specific (this was just from a yearly-rountine physical). My acupuncturist had me on Inositol for a few months but I've stopped taking it. I can start that again if it helps. :) My diet is pretty healthy and I exercise 6 times a week… I've cut back on intensity due to RE having me monitor my heart rate to 140.

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    1. I think you have a type of PCOD called occult PCOD. Retrieval of 36 eggs and most of them being immature, points to this. Do you know your AMH level ? You will benefit from metformin. I would suggest you to take metformin and try on your own for 6 months. There is a possibility that you conceive on your own. Metformin should be taken at a dosage of 1500 mg to reap maximum benefit.

      Delete
  19. Wow… that would be amazing. I'm starting at Metformin at 500mg week 1, 500mg twice/day week 2, 1000mg once/day week 3, then 1000mg twice/day week 4. Praying this helps… I've read it takes a few months to get into your system. From my OAR report it reads my AMH level at 3.53 ng.

    Additional numbers from my OAR report: ERS 16 calculated, E2 46.8 pg/ml, FSH 4.32 mIU/ml, Inhibin B 119.0, LH 6.91. This test is from January 2014, so it reads to be 10 months old.

    Thank you for your help and knowledge. I've yet to seek a second opinion as we're just now getting some insight and seeing what my eggs actually do. It has been a journey indeed!! In the meantime I'll read up on occult PCOD. Thank you again so much for taking the time to answer my questions!!


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  20. Hi Manju,

    First off, congrats on your pregnancy. What a beautiful blessing. I'm writing to update on our second IVF cycle (my last comment was on Oct. 30th, above). We tried again with 6 weeks being on Met (above dosages listed), and different meds. We did 300iu Follistim but used .10 units of microdose Ovidrel this time (days 1 - 4 and day 7 & 9). I started Ganirelix cycle days 7 - 10. I triggered with 250mcg Ovidrel on cycle day 11 and we went in for egg retrieval on day 13. Results were: 35 eggs retrieved, 14 mature, 11 fertilized, day three we had 7 of which all were fair. On day 5, 3 had dropped down to poor, and 2 were fair. Today was day 6 and 2 hit blast but were poor quality- one 3C and the other 2C. The embryologist and my RE suggest that we do not biopsy these since there's a high chance they'll be abnormal (my RE only does FET and we elected the PGS Testing). I am so broken right now… It's so hard to stay hopeful. We've been TTC since 2012. We speak with my RE on Monday and I am anxious to see what he says/thinks our next step should be. I don't know where to go from here? Do you have any advice on how to improve egg quality? I've been seeing an acupuncturist once a week for several for 6 months now. In addition to Prenatals and Fish Oil, I take DHEA, Folic Acid, Ubiquinol and Inositol. I'm still taking 2000MG Met as well. What are your thoughts on Royal Jelly? Should I include that-- if so, the raw form or pill? I apologize for all the questions, you are so insightful and I wanted to see if you had any suggestions or advice. Should I get a second opinion? I'm seeing a well-respected RE in Houston. I am so broken to have another failed IVF cycle. Is there a chance of a future successful cycle? It seems we're getting the same results with slight improvement… I'm discouraged that none of my eggs were of good quality… I'm 30 years old and DH is 35. Any thoughts or words of encouragement would be so helpful.

    Jessica

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    1. Dear Jessica,

      Very sorry for the pain and disappointment you went through. Thanks for the detailed information about your cycle!

      Jessica, I would still tell you that your doctor did a poor job. You have PCOD. I don't understand why he fused 300 IU of gonal F! 35 eggs is too high number. Growing such huge amount of eggs and the resulting increase in estrogen can harm your egg quality. Starting gonal F at a lower dosage, say, 100 IU and giving a longer stimulation (how long were your ovaries stimulated this cycle?)will lead to fewer eggs ( aiming for 10-12 eggs) and better egg maturity and quality. This is what I think.

      Jessica, if I were you, I will continue with metformin. Stop everything other than folic acid. Please take 5 mg folic acid per day. Eliminate sugar from your diet and include an excercise regimen. Please talk to your doctor about having a mild ovarian stimulation which will aim for fewer but more mature eggs. This will definitely improve egg quality.

      How many days apart you get your periods? What is your estrogen level on the day of trigger shot? What is your BMI? What is your TSH level?

      You have no other problem. Poor egg quality is due to PCOD and wrong ovarian stimulation approach. Please do not gulp down unnecessary supplements. You will never know what they are doing to your body. PCOD and DHEA is the worst combination. Stop all the supplements please!

      Delete
  21. Thank you for the info and kind words. I immediately start Birth Control after my egg retrievals. I was on it for 7 weeks in between my last failed cycle (ER was on Oct. 10th and I started stims for this last cycle on Dec. 1st.). I stimmed 10 days and triggered with Ovidrel on the 11th. ER was on day 13. I know from my natural cycles in the past that IF/when I ovulate, it's always later in my cycle. I've always had normal cycles, typically 30-33 days apart. I've been on fertility meds for over a year now, so I'm not sure what my body does 'naturally' anymore. My estrogen level the day of trigger was 7746.41. My BMI is 20, I've cut back on working out and have actually gained a few pounds. I eat very healthy and have cut back on processed foods/sugar. I cannot find a TSH level in any of my reports… My lab work during my cycles only measure my estradiol, LH and progesterone. Should TSH be included? The day I trigged my LH was <.01 and progesterone 2.9. I will stop taking additional supplements (whew!). My acupuncturist put me on a high dosage of DHEA right before my last cycle. I did just pick up a natural (honey) form of Royal Jelly- will this compromise anything? I will talk with my RE on Monday about trying a lower/more progressive stim, although I'm not sure he will listen to me. This previous cycle I only had 6-7 good sized follicles that were 17mm-18.5mm. The other eggs were much smaller.

    Jessica

    ReplyDelete
  22. Hi again,

    Update on our consult yesterday…. RE said our 2nd failed cycle was due to poor egg quality. He went on that over our last 2 failed cycles, I've produced 71 eggs total (several were smaller eggs since he takes all of them during ER). He stated that most/all arrest during my cycles. He did tell me that my poor quality 3C blast from this cycle has been sent off for biopsy (I had two that made it to blast, but the 2nd one wasn't good enough to biopsy). I was surprised being the nurse said it wouldn't be sent off due to poor quality. Praying that it comes back normal, but I know it is unlikely. He agreed that our next cycle, we would begin stims at a lower dosage, again with the Follistim + MicroOvidrel. He made it sound hopeless for us… he said it was very uncommon to see such poor egg quality in my age. That typically he sees women who cannot produce eggs and who respond poorly to stims have eventually successful IVF cycles. Basically, I am the opposite of this… Since I produce several and they all seem to arrest before hitting blast. He made it sound like it was an undetermined genetic issue on my end (we've both tested normal for the counsyl and karyotype tests). I have a huge hole in my heart… he began to say our other option is donor egg and adoption. It just keeps getting harder. We are trying cycle 3 with the same RE mid-January. We are praying for a miracle…

    Thank you, Manju for reading our journey. Writing to you helps give me strength.

    Jess

    ReplyDelete
    Replies
    1. Jess, I do not agree with your RE. I still very strongly believe that it is possible to get good quality eggs from you, provided, they stimulate your ovaries properly. Too high dosage of Gonal F is doing only harm to you. Your progesterone levels are way too high on the day of trigger! This can be the result of premature luteinization of follicles leading to poor quality embryos. I think you must try the basic long lupron protocol with low dose gonal F. This will help to grow the follicles synchronously and low dose medicine will lead to more mature eggs. Haven't you thought of changing clinic? What use there is going to the same person? Wouldn't he try to prove he is right in the next cycle too? Keep taking metformin, folic acid and also baby aspirin. You must search typing occult PCOD, you will get some answers. You can also mail Dr.Malpani regarding occult PCOD and ask his opinion too. He responds to all e-mails. His mail id is info@drmalpani. com. It is also important to check your AMH level.

      Delete
  23. I believe so too. It just doesn't make sense. I've researched the long Lupron protocol and I'm surprised he didn't suggest this. I know when I triggered with Lupron on my first IVF cycle my pituitary gland didn't respond well to it (according to my RE). This resulted in only 6 mature eggs. Would the long Lupron protocol work well considering I didn't respond well to the medicine? I made an appointment to get a second opinion on the 29th. If he suggests a different approach and feels confident about it, I may switch doctors. I also wrote to Dr. Malpani regarding my failed cycles. Thank you, Manju for helping me step out of my comfort zone. I've been with the same RE for quite some time. I will keep you posted.

    Jess

    ReplyDelete
    Replies
    1. I was surprised that he used microdose hCG. Might be he thought this will lead to much mature eggs, but, what it actually did was to raise your progesterone levels and most probably premature lutenization. Long lupron, low dose Gonal F and longer stimulation ( 12-14 days ) must help you. Surprisingly your AMH doesn't seem to be that high! I did 5 IVFs with the same clinic because I do not want to step out of comfort zone and it was a grave mistake. Atleast if you switch clinic and get the same results you can learn something. Good luck!

      Delete
  24. Hi Manju,

    Congrarts on your beautiful baby, seeing the pictures brings tears to my eyes. You give me hope!

    Doing my 'after IVF update'. I just finished my 3rd IVF cycle with a new RE, at a new clinic. His protocol for me was Menopur 150 units days 1-5, then he increased to 225 units days 5-12. I stimmed for 12 days. He took me off Metformin as well. I also took a daily steroid injection (Omnitrope .25 units), he said this may or may not help, but wouldn't hurt. I triggered on day 13 and went in for ER on day 15. I received my report yesterday- 17 eggs retrieved, 4 mature, 2 fertilized. Today 4 more matured and fertilized in the lab, however, I know those typically don't do as well. Manju, I feel hopeless. He said over the phone that I had an 'intrinsic follicle dysfunction'. We meet with him next Monday to discuss the results and another protocol. He mentioned triggering with 2 Ovidrels next cycle. I just don't understand why I produce so many immature follicles, and so few mature ones…. I will get a day 3 report of the 2 that fertilized on day 1 on Thursday, but I've been down this road before… Please write with your thoughts on my 3rd IVF cycle.

    Many Blessings,
    Jessica

    ReplyDelete
  25. Just received the update from our 3rd attempt… Nothing made it to blast. I'm heartbroken. We meet with our RE this afternoon to discuss… I'm sure donor egg and adoption will be addressed. I just want hope or positive news for once. Please share your thoughts when you get a chance.

    Jessica

    ReplyDelete
  26. Hi Manju,

    Your blog has been so useful with lot of information.

    I am 32 and my wife is 28. We ve been married for 2 years. Tried IUI about couple of months back but wasn't lucky.

    Have two natural cycles and no luck too.

    thinking of the option of second IUI. We are very desperate for a baby. We are getting treated in
    Shrushti hospital, ramapuram. Dr. Samundi Sankari has been remarkable to us. She was thinking of doing a mini IVF when did the IUI, coz my wife had good quality eggs and she was fearing of multiple birth.

    Is it now better to go for mini IVF? or to proceed with IUI itself? What is the diff bet mini IVF and the normal one?

    please advice.

    ReplyDelete
    Replies
    1. If there are multiple follicles ( and hence eggs) developing during IUI, there is a high chance for multiple pregnancy. Multiple pregnancy has many risks associated with it. At such times, the doctor might want to take out the eggs, fertilize with your sperms in the lab and then transfer one or two embryos to your wife's uterus ( this is what she calls as mini-IVF, the word mini implies that the IVF is done with less medicine and fewer eggs, as opposed to a normal IVF where the amount of medicine used is high and hence more eggs are produced). During IUI, fertilization of the egg happens in your wife's body and the embryo thus formed travels to the uterus and implants. During natural conception only one egg is released and only one embryo is formed. But, because of the medicines used for IUI, in some women many eggs are formed. So, if all the eggs fertilized in a woman's body and if more than one implants there will be multiple pregnancy. Since during IUI everything happens inside the body we can't control the number of embryos that might implant. But, if we take out the eggs and fertilize them in lab we can control the number of embryos that reach the uterus and hence can avoid twins, triplets or more.

      IVF has much more chance of success, for example say 40-50 % compared to only 4 % or so when IUI is performed.

      I would follow your doctor's suggestion. I think she is right in suggesting you to try mini-IVF.

      But, you must understand that unfortunately both techniques do not guarantee a pregnancy. With IVF the chance of pregnancy is high when compared to IUI. Since your wife produces lot of eggs, I am sure you will reach your dream sooner or later. Lots of good luck !

      Delete
    2. If there are multiple follicles ( and hence eggs) developing during IUI, there is a high chance for multiple pregnancy. Multiple pregnancy has many risks associated with it. At such times, the doctor might want to take out the eggs, fertilize with your sperms in the lab and then transfer one or two embryos to your wife's uterus ( this is what she calls as mini-IVF, the word mini implies that the IVF is done with less medicine and fewer eggs, as opposed to a normal IVF where the amount of medicine used is high and hence more eggs are produced). During IUI, fertilization of the egg happens in your wife's body and the embryo thus formed travels to the uterus and implants. During natural conception only one egg is released and only one embryo is formed. But, because of the medicines used for IUI, in some women many eggs are formed. So, if all the eggs fertilized in a woman's body and if more than one implants there will be multiple pregnancy. Since during IUI everything happens inside the body we can't control the number of embryos that might implant. But, if we take out the eggs and fertilize them in lab we can control the number of embryos that reach the uterus and hence can avoid twins, triplets or more.

      IVF has much more chance of success, for example say 40-50 % compared to only 4 % or so when IUI is performed.

      I would follow your doctor's suggestion. I think she is right in suggesting you to try mini-IVF.

      But, you must understand that unfortunately both techniques do not guarantee a pregnancy. With IVF the chance of pregnancy is high when compared to IUI. Since your wife produces lot of eggs, I am sure you will reach your dream sooner or later. Lots of good luck !

      Delete
  27. Hi manju,

    I was reading your blog and hats off to you for the wonderful effort. I am sure so many patients are indebted to you for the emotional support.

    My wife is 35 and she had a spontaneous abortion in 7 weeks (natural) 6 months post marriage last year. We have been trying to conceive since last sept but didn't workout. We are approaching a ivf center in Mumbai. We had series of tests. Everything was normal incl thyroid. Fsh was 9 on day 3. Her amh is very low 0.7/and afc was only 2 on day 3 (one was 12 mm)

    My sperm count was 21 ml/50 motility. The gynec we were approaching told it was borderline so was put on oligocare forte (coq 10/ vitamin). But later at ivf center they said I have no issue, but asked to repeat test with DNA fragmentation and suggested induced ovulation/natural or iui (amh was not ready that time). But after 2 weeks of original test it came 6 ml/30 motility) but DNA was good (14 PC apoptosis)

    Now the ivf center says iui won't work go straight to ivf. They scared us by saying we may need embryo donor. She is now on ovares 25mg (dhea), argiprime solution twice per day.

    My wife had depression in past and last 16 months she's not on medication. Her prolactin was high ( 30) in jan 2015, but has come down to 10 recently. She has impaired fasting may be due to her depressant (her hb1ac is 6.4). Of late she has become bit aggressive after taking dhea.
    I am diabetic for last 1 year on glycomet under control (6.3 hb1ac). I have stopped taking statin as I read it affects sperm coount

    Pls also comment about our condition.

    ReplyDelete
  28. Hi Manju,
    I am 41years old and dreamed of being a mother fir as long as I can remember. We decided last year to begin our journey of becoming parents....To my horror, after trying for almost a year we found out I had DOR.. We decided on IVF, and had a great experience with our RE... I did well with treatment and ended up with 12 eggs, 11 fertilized, 5 went to PGD testing, all 5 abnormal, and 0 to transfer... I am absolutely heartbroken, angry, broke, and not sure where to go from here... We meet with our RE next week for follow up...What to do??? Egg donor?? Try again?? Embryo adoption??? Not sure how to pay for anymore treatment, but not ready to give up!!! Thanks for all your wonderful posts!!!

    ReplyDelete
    Replies
    1. You will make your dreams come true , Lots of prayers and good luck !

      Delete
  29. Hi Manju,
    Both my husband and I are turning 38 this year and we have been trying since the past 3 years. We have been through 3 failed IUI and 2 failed IVF cycles. The first IVF cycle, the beta HCG test was a false positive of 17 and not zero (chemical pregnancy).
    For the third cycle of IVF, we went with a completely different protocol through a new doctor. I was on GONAL- F and Luveris and not on a recombinant drug. My AMH has always been low and has reduces since our first IVF cycle. It was 0.56 for our third cycle. We were able to get 2 embryos out of the 4 follicles even with high stimulation. The doctor just said that they were good quality but did not give us any further details.

    The doctor advised us to freeze them. As part of the protocol, I went through a hysteroscopy and laproscopy as well before our third IVF cycle. I've been asked to take progynova tablets and get the endometrium thickness checked and when its optimal, they will do the ET.

    The doctors have also suggested that we go through another round to collect more embryos while my ovaries are receptive so to collect a few more embryos and bank them. We have also been presented the option of D- eggs if this fails.

    Mixed bag of emotions and more positive actually after reading the experiences of your readers and your journey specially. Thanks a lot!

    ReplyDelete
  30. I think your doctor is guiding you correctly. With low ovarian reserve it doesn't mean you can't have a healthy baby. But to be honest the chance is greatly reduced. I know women who conceived healthy babies with low ovarian reserve. But sadly not everyone with low ovarian reserve ends with a baby. As long as you produce eggs , you have a chance of attaining your dream. The problem is , no one can say when. IVF is financially , physically and emotionally taxing. So many accept the verdict and move on. It is like gambling - you don't know when you will hit the jackpot.

    Your doctor is doi g the right thing. If possible do at least 4 cycles , collect eggs and embryos. Try with them. My sincere prayers and wishes that you succeed in your attempts.

    Did your doctor freeze eggs or embryos ?

    ReplyDelete
    Replies
    1. Hi Manju,


      Thanks for the response. After the pick up, we got 2 grade 1, 8 cell embryos on Day 3 which were frozen. The doctors suggested that we wait for the next cycle to do the transfer. I was on progynova daily from Day 2 of my cycle and I had to do scans from Day 8 to measure thickness of the endometrial layer. On day 15 or 16 i was at 10 mm and the doppler showed a good blood flow as well. We went ahead with the Embryo transfer on April 12th.
      In the 2 week wait period now where I have to take umpteen number of pills and injections.

      Delete
  31. Hello Manju
    I am 41 going 42 in couple of months. I just had my first IVF cycle and manage to have 2 blastocyst good quality based on the embryologist. 1 blasto day 5 was transferred, however got the HCG level under 0.1 so negative. The second blastocyst Day 6 (on day 5 all was good quality but she couldn't see the ICM, and on Day 6 she was able to see the cells and freeze it.
    So my question is the description of the second frozen embryo day 6 do you think it could have a chance to survive thawing and I have an opportunity for a FET ? I am just asking if you have experienced late embryo dvp and even looks good quality they wont survive the thawing?
    I am looking to schedule the FET in 2 months (I just finish this fresh cycle with a failure and wont meet the doctor for the ivf review until august). Thanks. ( I am well aware my chances are extremely low probably under 4% chance of pregnancy, due to my age my egg are too old but who knows...)

    ReplyDelete
    Replies
    1. Even embryos which do not get the optimal ranking turn into beautiful , healthy babies , many a time. I do not have any personal experience , but , I have heard stories from women who got their baby from a poor looking embryo. Good luck !

      Delete
    2. Even embryos which do not get the optimal ranking turn into beautiful , healthy babies , many a time. I do not have any personal experience , but , I have heard stories from women who got their baby from a poor looking embryo. Good luck !

      Delete
  32. Hi Manju
    I am completely new to the IVF world. I am approaching 42 and my first IVF I got only one quality embryo. Which did not develop to the blastocyst stage and degenerated day 7. So IVF failed. We have 2 healthy kids and I was doing IVF for gender selection. Me and my husband are healthy. What may be a reason do you think for the IVF failure.

    ReplyDelete
    Replies
    1. The reason is egg quality. A woman's egg quality starts to decline as she ages and the number of eggs which can be obtained via ovarian stimulation decreases too. You are 42 - even if you are healthy and look young , the unfortunate truth is , your ovaries are too old ! Good luck !

      Delete
    2. Thank You manju. We are going to do a second IVF. this time dr said we will use human growth hormone. I am not sure if that helps. I was wondering why they didn't do that the first place. I was going for ultra sound and blood work every 3 days. they identified that the medicine working slow for me and the follicle development also very slow. I still have hope. Thanks for your wishes, I appreciate it.

      Delete
    3. Hope growth hormone works for you. But it is unlikely that they find a great difference. It's not your fault. Reproductive system , especially a woman's , ages too quickly.

      Delete

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