Re: Dr, Could really use your advice

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Posted by Larry Grunfeld, MD on July 18, 19100 at 08:54:33:

In Reply to: Dr, Could really use your advice posted by Carla on July 17, 19100 at 20:23:14:

Multiple IVF failure is very frustrating, but your RE should have a clue as to why it didn't work. As a general rule, IVF failure is broken down into egg (and resulting embryo problems) and uterine problems. It is important that the embryology lab where your IVF is performed is sophisticated enough to have confidence in your embryos. I doubt that using Humagon contributed to your failed cycle.
If you are using one of the better labs, speak to your RE about your results. If your lab is not in the top ranking of success rates, consider a second opinion.

Larry Grunfeld, MD

: We have no known problems contributing to our infertility - 6 years ttc #1 with 1 mc from naturally achieved pg in '91.

: In Aug 95, we went through our first IVF. Both my husband and I were 27 years old at the time. Lupron and Metrodin was started right after menstruation. 13 follicles aspirated, 8 eggs, 5 fertilized, 1 arrested, 4 embryos were transfered on day 2. I'm not definate on the amount of cells of the embryos. I remember having a 3 day transfer and I could have sworn they were 8-celled but my official record say that it was a 2 day transfer, so I'm not sure what went on. No data about embryo size or quality is written down so I can't refer to that. ICSI was not used. Reguardless, it was a success and we now have 4 year old daughter.

: Just completed IVF #2 with negative results. I was on the long Lupron Protocol 20u. Started taking 4 vials Humegon (from recalled batch). Lupron decreased to 5 units. On day 4 of stims my E2 was 264 and was told to decrease my Humegon to 2 vials. On day 7, US showed 4 or 5 lead follicles around 12-14 in size. E2 was 471. I was told to once again increase my medication to 4 vials/day because the E2 was lower than expected. By this time I had heard of the Humegon recall and opted to change to Pergonal for the last 3 days of stims. E2 on day 10 was 1151 and US showed 5-6 follicles over 14 in size.

: Retrieved 9 eggs but only 2 fertilized. This clinic uses ICSI on all patients because they feel it increases your fertization rate. I'm not sure if I agree. Of the 9 eggs, 5 were ICSI'd. 2 fertilized, 1 fertilized abnormally (3PN), 1 had fragmented polar body, 1 was damaged during ICSI. The other 4 poorer quality (2 had large zona and 2 immature) eggs were left to fertilize on their own IVF, but of course had zero fertilization. Had a 3 day transfer with 2 embryos, but we were given slim odds of achieving pg. One embryo was 4 cell and the other 5-6 cell with fragmentation.

: We were told it apparently was an egg quality issue. I just turned 32 last week. Could the Humegon have contributed since it was recalled? Would I necessarily have the same results next time? Could a change in protocol affect the quality of the eggs/embryos? We honestly don't know what we should do at this point.

: Do you have any suggestions about what our next step should be? Thanks for your time. Carla

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