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Failed IVF Cycle: Help Dr. Jacobs

5 posts on this thread and the last post was on March 31st, 2009 5:26 PM
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Bmorrison - Feb 4th, 2008 11:46 AM
 [Original Post]

I am 37yo and hubby is 50. Male factor, had varicoele repair, IVF with ICSi still suggested by RE. My FSH 5.5 and Estradiol 27. Here is how my stim went: OCs 11/26-12/24/07. Started Bravelle and Menopure 150 IU x 7 days, Bravelle 112.5 and Menopure 75 IU x 1day, Bravelle and Menopure 75IU x 1day, Centrotide x 4days and triggered with Ovidrel 250mcg. Started Stim injections on 1-3-07. Had first u/s and blood on 1/8 (E2 level 1310 and 13 follicles) 2nd u/s and blood 1/10 (E2 2154 and 20 follicles) 3rd u/s and blood 1/11(E2 2763 and 25 follicles) 1/11 lead follicles 23, 10, 19x2, 18x2, 17x4, 16x3. Was never monitored again after 1/11. RE office called that day and said to trigger at 8pm on 1/12 with retrevial set for 7am on 1/14. At retrevial only 6 eggs were obtained, only 2 fertilized with ICSI. Had 3 day transfer with grade 1 -(7 cell) and grade 3-(6 cell). Failed IVF cycle. The real kicker is I had a 1 time only chance on my insurance. Any advice on what should have been done differently and what questions should I ask my RE? Why only 6 eggs? Do you think my E2 was too high? should they have monitored me after 1/11 and before 1/14?

B. Jacobs, M. D. - Feb 4th, 2008 4:38 PM

The protocol you used is quite different from what i use for my patient who ate 37 or older. Each program has a set of protocols they are comfortable using. I use only FSH, and no the products like Menopure, which contain LH. I am in the minority in that regard. I do not use Cetrotide, but, instead use a microdose flare protocol. Also, please note that the stimulation protocol may not have been the problem. The fact that you are 37 and not 27 is very important.
Good luck.


Bmorrison - Feb 4th, 2008 6:23 PM

Dr. Jacobs

Thank you for your quick reply. My question is this: How could I have had so many follicles, but so few eggs. Were my E2 levels rising too quickly? In my inital post I included my follicle sizes and E2 levels. Should I have been monitored after my last u/s on 1/11 before retrevial on the 1/14? According to my RE the problem was that I did respond like a 27 year old, not like a 37 year old. I am a nurse, and it just seems to me that I produced many follicles too quickly. The size range I included were from the last u/s taken the day before my trigger.


B. Jacobs, M. D. - Feb 4th, 2008 9:15 PM

I really do not know why more eggs were not retrieved. The best person to try to answer that question is the RE of did the procedure.
Good luck.


misty_RN - Mar 31st, 2009 4:43 PM

Dr. Jacobs,
6 years ago my husband had a vasectomy, but since coming home from deployment to Kuwait has changed his mind and wants to have a family. He is 40 years old. I just turned 36. I'm wondering: Is our best option to try a vasectomy reversal or to try a testicular retrieval and do IVF with ICIS? I want a baby so much! (I always did. I just didn't want to choose between him and a baby.) I've waited soooo long for this but I'm afraid we may have waited too long. Can you give me your opinion regarding what you think is our best option....

Much Thanks,
Misty


B. Jacobs, M. D. - Mar 31st, 2009 5:26 PM

I use a different protocol than does your RE. I do not add any LH to the stimulation, and for my patients over the age of 35, I use a microdose flare protocol.
Good luck.



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