Need Input

finallyamommy · #1 (**permalink**) 05-12-2008, 05:35 PM

So I'm on a break from starting another cycle right now. Not sure what I want to do. I give you girls who have done more than 3 cycles a lot of credit. I'm exhausted. I think I'm experiencing a let down right now, similar to how I used to feel after final exams when I was in school. I'm fighting fatigue every morning, but once I get going, I'm usually "okay." (Having a 3 yr old may be part of that, but it doesn't really go away, so I don't think it's all her, KWIM?)

3 failed IVF cycles. I always responded well to the stims and had very nice numbers to work with after retrieval, but for whatever reason, even after transferring 5,5, and10 (!), we weren't successful. I turn 44 next week, so age and egg quality could have a lot to do with it, but I also know I can get pg, since my DD was conceived naturally, even after 4 miscarriages over 2 years.

So what I would like input on is that I have ONE (yep, only one) frozen 5 day blast... do I attempt a FET with only ONE? What are the odds that this ONE will thaw and be viable for transfer? Do I go through all the meds in preparation for a day 5 transfer and hope to God it takes? I don't know if I should continue with another fresh cycle or not given my age... it's a lot to invest... financially, physically and even more so, emotionally. Not sure I have it in me if the odds are against me b/c of age.

Another question, if I'm able to stim well, retrieve strong numbers, why are none of them taking? And why isn't anyone running more tests on my DH? Do I need to request further investigation on his part? I get so angry that the woman is the one who gets poked, prodded and injected with dyes, saline, then hormones and stimulants... is it standard procedure that the guy only has to have an SA done then nothing else, even if some of his numbers aren't that strong (morphology and maybe quantity)... or does ICSI weed out the poor swimmers or morphologically challenged? LOL

Any and all input is welcome. I'm open to suggestions, ideas, anything to help me decide what my next steps should be. In the meantime, my decision is to just chill out for a while, get all the meds out of my system, regroup then make another decision in another month or so.

Please... I'm asking for candid comments here. No hard feelings even if you have something to say that you don't think I'd want to hear, really, I want to hear it!!!

TIA...

NickiY · #2 (**permalink**) 05-12-2008, 05:52 PM

Hi Lynn. A FET cycle is certainly a lot less demanding than a fresh. I woudl say it is definitely worth giving it a go even with one (al though I have to say I attempted a FET with 3 blasts and none of them made the thaw- but my RE tells me that is pretty unusual). What does your RE say about thaw rates and success rates with FET?
As for fresh, the way I see it you have no reason not to try again- as you say you stim well, had good fert rates, there's really no reason for it not to work except your age and surely then it's just a numbers game- keep going long enough ad you will get that lucky embryo.
I know nothing at all about male testing sorry- although I thought that's why ICSI was done- to identify the strongest sperm.
Are you considering other options at all (DE, adoption etc) or is it IVF or nothing?
Good luck with your decision.

Tkeys · #3 (**permalink**) 05-12-2008, 07:18 PM

I don't have a lot of answers, but when I was waiting at the RE office, I read some articles. One of the things that I read is that some "older" women do better with a 5 day transfer/assisted hatching sometimes . . . that the outer shell (zona) can toughen/fail to hatch properly. So, since you have so many eggs and stim well, and there doesn't seem to be a problem with quality, maybe you'd be better off on a fresh cy letting the eggs grow to blast stage and trying assisted hatching? Also, maybe the meds they are using for the lining are causing your lining to be too thick? Perhaps a different mix (no viagra, or something else) and steroids or something would make a difference? I don't know - just grasping at straws!

Did they ever figure out why you've had so many m/c? Perhaps trying again naturally with medicine supports in the 2ww would be worthwhile? I don't know . . . I'm just wondering if you are being "over-medicated" somehow - another article I read said that the lining was key to success of IVF.

Okay . . . that is all I've got. I can't help you on the FET, though.

JSquare · #4 (**permalink**) 05-13-2008, 06:08 AM

Lynn, I am so sorry your last cycle didn't work. I was holding out so much hope for you

I don't presume to know exactly how you're feeling, but I think I'm kind of there right now. I'll be 39 in August so age is a factor for me too. After the BFN in cycle #2 our RE ran a ton of tests on me but it all came back o.k. There is nothing physically wrong with me. DH's SAs have all been right in the normal range for motility and quality. They did b/w on him, not sure what they ran exactly but it all came back clean. But, I don't ovulate without drugs. Even on Clomid I was lucky to get a few follies. Our RE said we have only a 1% chance of getting pregnant the old fashioned way.

From cycle #1, at 5 days, they had 2 perfect blasts to freeze so that is what I'm working on transferring now. DH and I didn't want to go with just 2 but the thaw rates at my clinic are about 95% so that's really good and they're pregnancy rates with frozens vs. fresh are the same.

I could have written where you said:
"it's a lot to invest... financially, physically and even more so, emotionally. Not sure I have it in me if the odds are against me b/c of age."

To answer your question, since you asked for input, I say YES do the FET with the 1 you have! This cycle has been a lot easier on me, it's very different than the fresh. I'm really hoping that doing something different will bring about a different result

Good Luck to you in whatever you decide to do. I'll be here cheering you on, we all will!!

aquarianangel · #5 (**permalink**) 05-13-2008, 06:35 AM

Lynn, I could have written your post myself! Well except that I do not have ANY little ones yet, and our ages are different.

I have the same questions and frustrations. Cycling is emotionally and physically exhausting. We too have ONE frozen emby left. I stim very well and retrieve a good number. They fertilize well too. But my RE has done only 5 day trnasfer and many peter out ( according ot RE's standards) by day 5. Then they wait one or two more days to make a decision on freezing. This led to just one embryo left to be frozen. Sad.
I have seen here time and again how REs do a 3 day transfer even with fragmented embies that do not look like they might make it to day 5 or 6 or 7 even. Inspite of such supposedly not perfect embies, ladies here have had BFPs and a perfect baby in their arms at the end of 9 months.
That really makes me question my RE's methods. Are their standards too rigorous? Anyone have an opinion on this?

We also do not know wether to go ahead and do a FET with just one embie or do a fresh cycle. I found my FET to be very relaxing and not at all taxing on my body. But I am also not sure if it is worth to go thru all that for one embie that may or may not thaw successfully. But then it is only a question of taking lupron for a few days...no biggie.

Another alternative is to do a fresh cycle and also transfer the embie along with fresh ones.

I would love to hear what others have to say.
Sorry for hijacking your thread Lynn.

want2beamommy13 · #6 (**permalink**) 05-13-2008, 08:50 AM

Lynn, I wish I had the perfect answer.........but I dont.

I can say, though, that doing an FET was a whole different ball game than a fresh cycle and I'd consider transferring that embie, when you're ready......before you move on to another fresh cycle.

I agree that the DH's get the 'easy' out when it comes to IF. But I think I've learned that it affects them too, more than they lead on.

Just remember, ANYTHING IS POSSIBLE! Keep your head up g/f. You know I'm rooting for you my HB!

mildlydelirious · #7 (**permalink**) 05-13-2008, 11:14 AM

I did a one embie transfer (although it ended up I actually had two frozen and transferred two-just didn't know that until transfer day). Did that make sense? It was still a BFN.

FETs are a ton easier on the body. Although the emotional turmoil is the same. It's never easy. But if you have the energy to go again, why not? There's no reason to believe the embie won't thaw just fine.

I'd work on lining issues too. Make sure you are getting the tri-laminar lining pattern. Also ask about the anti-phospholipid panels. Are you already doing heparin? I thought I read that you were?

What finally worked for me after five cycles of my "perfect" looking embryos was a 3dFET with DEs with a boatload of estrogen, progesterone, heparin, and steroids.

~m

finallyamommy · #8 (**permalink**) 05-13-2008, 10:51 PM

Thanks for your honest opinions ladies. I knew I could count on you to provide some food for thought!

Nicky: I haven't considered other options (DE, adoption) only because of my age and the fact that I DO have a DD that I gave birth to. I feel so blessed that I have her that #2 would just be icing on the cake. But I did come from a family of 4 kids, so I would like my DD to have a sibling, if it's possible. If not, I'll figure it just wasn't meant to be...

T: I thought we were going to do assisted hatching on our first cycle, but I don't think it happened. But we definitely did on cycles 2 & 3. The reason we did the 3 day transfers was b/c both REs preferred to let nature take its course on the implantation and development vs letting the embies go to 5 days. I did have the triple line during my second cycle. That was also when I did the intralipid infusion...

J: What's puzzling to me is that everything they tested me for (APA, NKA, HSG, you name it, I think they did it), my results came back fine. Even my blood work on day 3 came back great, especially for my age! Egg quality was suspect on some of them (some with a harder shell, some a little squooshier than others), so that's what lead my second RE to think that it's just a numbers game for me... You really think I could have success thawing out the 5 day blast? Is there any greater success with a 5 day blast vs anything less mature?

Meenu: So you've done both fresh & frozen cycles... what is a typical protocol for a frozen cycle? And when do you start? Funny you should mention doing another fresh cycle and timing it to do the frozen one... we discussed that with our RE on the last fresh cycle. But given the "numbers game" he was trying to beat, he felt our best chances were to put all our eggs back in my basket (LOL) on day 3 and let nature take its course vs losing some/any between day 3 and day 5.

HB (Renee ;0): I'd like to know what your protocol and timing were too on your frozen cycle. Everyone says how much easier it is (I guess b/c there's no stimming involved)... really, how much easier is it? Would be interested in comparing what you did vs. Meenu...

Marian: Funny how you wound up with 2 vs 1... After my first cycle, I received a follow up letter from the embryologist that I didn't have any left to freeze... and in my phone follow up with my RE, he mentioned that one was frozen... HUH? Turned out that there was a glitch in the computer software, and I did in fact have one frozen. Go figure. I was so hoping that I would get pg in one of the three cycles that I wouldn't have to worry about thawing and its subsequent quality... As mentioned, I did have the triple line during cycle #2... that was when I did the intralipid infusion (maybe it was worth it?) with the Viagra suppositories... but no such luck. And yes, I was doing the heparin/baby aspirin regimen... they even had me doing that before I started my IVF cycles. I was on a break from the OPKs and the heparin/BA when I got pregnant naturally while we were on vacation. What kind of steriods were you on when you got pg (if you don't mind me asking?

Not sure if I mentioned it here or not, but my RE is no longer at the clinic where I did my 3 cycles. So would it be worth it to have a follow up consultation with the medical director who IS still there even if he isn't the one that treated me? Or do I wait until June when my previous RE is hoping to open his own practice? Any thoughts on that?

One last question. I presume that the one frozen embie belongs to me... if I choose to use an RE that is no longer with the practice through which it was frozen, can I obtain possession (for lack of a better/proper term) of it?

Sorry my response/additional questions got so long... just so much on my mind... ugh.

JSquare · #9 (**permalink**) 05-14-2008, 06:05 AM

Lynn - our RE prefers 3 day transfers for fresh cycles. He says it's better to let them grow in their natural environment, but they freeze at 5 days.

At my consult for my chemical (cycle #1) our RE said it was probably a chromosomal abnormality due to my egg quality (my age?). They did half ICSI for that cycle and we determined we didn't need it in the future, so that was good. They did AH for both cycles. My RE does AH for anyone over 38 years old. For cycle #2 they said it was just a bad stim cycle. I had 13 eggs, 8 mature, 5 fertilized "naturally." They transfered 3: 1 8-cell with zero fragmentation; 1 6-cell with some frag; and 1 4-cell with zero frag. If I had 4 make it they would have put 4 in, the most they'd do for me. We did that second cycle fresh hoping, of course to get pregnant, but also to get more to freeze, which we didn't get any. It was just a total failure all the way around.

DH and I were sure we'd do a fresh for cycle #3. When we went for our follow-up consult from cycle #2 we met with the senior doctor in the group, not our regular doctor - so yeah, you don't have to do your follow-up with the doctor who did your IVF. The senior doctor is very well known around here and very respected. I was happy to meet with him. He said we really should use the blasts we have frozen from cycle #1 and he convinced me with their stats - I hope those stats hold up for us!! I can only go by what they tell me and they have really good results with FETs. I have a 60% chance of getting pregnant with IVF at all so it's still a big gamble.

My protocol was/is:
Meds - vitamins, Folic acid, baby aspirin, and acupuncturist herbs
I see my acupuncturist once a week
BCP for 1 month (I don't ovulate regularly and my cycle can go anywhere from 28-42 days so they use BCP to know exactly where I'm at in my cycle)
Lupron shots for 2 weeks
Estrace pills started last Saturday
u/s next week which could change how much Estrace I'm taking
b/w next week for Progesterone level and then PIO shots start
start Medrol and then FET tentatively set for May 28th

I don't know the legality but I should think that you and DH "own" your totsicle and can go wherever you want with it. Does anyone know differently?

Tkeys · #10 (**permalink**) 05-14-2008, 07:28 AM

Did you have AH on a 3dt? My RE will only do AH on blasts. . . that is why I was asking about the 3dt v. 5dt. My RE says the success rate is higher when you put back blasts, BUT if the number/quality you have does not look like it will definitely sustain to the 5 day mark, they prefer a 3dt (which is what I had). They require a minimum of 4 perfect 8 celled on day 3 before they will push to a 5dt.

I was also told that FET have an overall lower success rate, but since they only freeze blasts, that improves the odds of success.

finallyamommy · #11 (**permalink**) 05-14-2008, 08:09 AM

Yes, T. We did AH with our last two 3dt's.

In our 3 cycles:
#1 resulted in 18 retrieved, 18 fertilized (8 normally), 6 available on day of transfer, 5 transferred, 1 frozen.
#2 resulted in 22 retrieved, 20 fertilized (13 normally), can't remember how many were avail on day of transfer, but 5 transferred, none to freeze by day 5.
#3 resulted in 20 retrieved, 17 fertilized (10 normally), 10 transferred... none left to freeze.

Oh, I don't know. Guess all I can do is make my follow up consultation appt and go from there...

aquarianangel · #12 (**permalink**) 05-14-2008, 01:02 PM

Lynn, my FET was so much easier than a fresh cycle! My RE said that our bodies are much more relaxed because we are not stimulated and hence more receptive. I just took BCPs and Lupron shots, along with vitamins, estrace, folic acid etc. No PIO, not follistim no trigger nothing.

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