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male factor drugs recurrent miscarriage 40

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#1 Pat9

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Posted 09 February 2013 - 07:23 PM

My DH and I have been TTC since 2011. I have miscarried 3 times – each time before the 12 week mark. Because of my age at the time of my first MC (38) my family dr. suggested I see the Hannam Fertility Clinic to start the process of checking into possible treatments and causes. I was assigned to Dr. Carol Redmond, and was delighted and overjoyed when I arrived at my first appointment already pregnant (we conceived naturally). Unfortunately, I miscarried that child and a subsequent one. After a lot of testing (AMH, sono, blood tests, karyotype, etc.) it was determined that there was nothing that could explain the multiple miscarriages. We were also told that we were not candidates for IVF because of my age (I was 39 at the time). So, we began the process of TTC (naturally) once again. Not once did Dr. Redmond suggest we analyse DH sperm, and it never occurred to me to ask since she was adamant that the drugs he was taking were perfectly safe from a fertility standpoint during our first appointment.

 

So, we started trying again last summer. Unfortunately, conceiving a 4th time was taking longer and becoming more difficult for my DH, and we were both becoming impatient. I went back to my family Dr. and requested another referral. She was very surprised to learn that my DH had not had his semen analysed. This is apparently routine. Does anyone know if that is true?

 

This week we went to the second clinic for another opinion. This dr. would like to investigate sulfasalazine – a drug my DH has been taking for quite some time to treat a unique form of arthritis (AS). I did a bit of research on this drug, and it seems it can cause the sperm to be toxic in men which can lead to chromosomal issues … chromosomal issues lead to miscarriage …. Hmmmm. Is that the case here? It is highly possible. We are still investigating with our drs.

 

Is there anyone out there that is aware of the affects of sulfasalazine on male fertility?

 

An important lesson learned on my part. If you are not happy with your prognosis – get a second opinion!


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#2 gibasgirl

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Posted 09 February 2013 - 10:04 PM

Hello Pat9,

I am sorry you have had so many losses and wanted to wish you well.

Your age does not necessarily preclude you from doing IVF; many women your age (or older) have undergone IVF successfully either with their eggs or donor eggs.

Normally in the lead-up to IVF (or some other technique of assisted reproduction) testing is done on both partners.

When a woman has had 3 or miscarriages it is common to do testing on that, too. There is such a thing as a miscarriage workup (I forget the exact name, but some of the other ladies on this site can shed light on this for you).

Another thing to explore are immune issues. There is a branch of IVF medicine that looks into immunological factors that cause miscarriage. Not all IVF doctors (REs) belive is this, but more and more are and are incorporating treatments that reduce or prevent miscarriages from occuring.

You may want to start with reading a book called "Is you body baby friendly" by doctor Allan E. Beer.

The Markham Fertility Centre offers immunological treatment and they do the immunological testing via the Allan E. Beer Centre in the U.S. There is a 9-month wait to see Dr. Virro (he heads that clinic) but a shorter wait to see the other doctor, Dr. Garcia. But she also does the immunological testing.

I believe Dr. Laskin of the Lifequest clinic does immunological treatments. I think it's Laskin.

Another thing to explore is whether you have a uterine septum. Those can affect a woman's ability to carry a baby to term and are often a factor in early miscarriage.

Medications like the one your DH is on can be problematic, but if that is a complicating factor hopefully he can take another while you are cycling.

It takes approximately 72 days (90 days?) for a man to produce sperm, and so there is time. It will take a few weeks/months to complete all of the testing and follow-up so it could all work out.

Wishing you all the best.
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#3 Pat9

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Posted 10 February 2013 - 08:56 AM

Gibasgirl,

 

Thank you so much! I started to think this way, but my thinking was quickly redirected by the last last Dr. I had (she was an RE). Now I understand why. I have had the preliminary blood work to test for some immunological factors, but I have not seen a specialist in this area. It is so helpful to know that there are specialists here in the city. THANK YOU THANK YOU THANK YOU!

 

Yes, our current fertility dr. indicated that my DH would have to be off his meds (or on something comparable) for 3 months. He then suggested we boost my eggs and inject the sperm after boosting egg production. It seems there is a strong possibility that I might end up with twins this way, but he said often the twins help one another. Hey, I am totally fine with 2 babies, but DH is terrified about what it might do to me though so we will cross that bridge when we get to it.

 

I will check out the book. Truly appreciate your response. It is so wonderful to find so much information and support on this forum. I cannot tell you how hopeful that makes me feel.

 

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#4 wannabmamma

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Posted 10 February 2013 - 08:33 PM

Hi Pat9,

 

I'm sorry to hear your story. I'm not sure if this would help, but I am surprised they didn't do any testing for Male Factor.

 

My DH and I have MF, and it's partly due to DNA fragmentation. I have been reading up a lot on it, and have found that a high DNA fragmentation can cause difficulty conceiving and lots of miscarriages, because things just don't go right with the embryo.

 

Perhaps you should suggest that they do a DNA fragmentation test when they test your DH. They say that many times, the other problems like poor sperm count, morphology, or motility can be absent, even though the DNA fragmentation may be high. Unfortunately, a high DNA fragmentation makes IVF outcomes poorer than the other problems, but, if you do have that problem, maybe the drugs are causing it, and then it can be improved.

 

Also, I could be making no sense whatsoever, because I'm not a doctor, but it wouldn't hurt to make sure they do that test while they're at it!

 

Best of luck to you:)


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ME: 38 DH: 40
TTC: since Dec. 2011
Dx: MF - low motility/morphology, DNA Fragmentation (40+%)
 

IVF #1 April - July 2013

BCP-Gonal-f, Luveris, Cetrotide, Ovidrel cycle with endometrial biopsy

3 morula transferred, none to freeze

BFP, but low beta doubling time, u/s shows baby developing behind, M/C July 18 8388.gif

 

IVF #2

August 30: AF - Cyclen BCP

September 28th - Endometrial Biopsy, last BCP

October 1: AF

October 5th: Treatment begins - Gonal-f 150, Luveris 150, L-Thyroxine 25mg

October 9th: add Cetrotide

October 14th: Ovidrel 2 x 250

October 16th: ER - 27 follies, 12 eggs retrieved

October 17th: embryology report - 6 fertilized

October 18th: 5 left (grade 1,2 and 3)

October 19th: One 8 cell, four 9+ cells including one 67 cell 

October 21st: ET two morula and one blast left - transferred all three, none to freeze

November 4th: Beta - BFP 756

November 6th: Beta - 2123yahoo.gif 

July 6, 2014: perfect baby boy born! wavey.gif 

 

IVF #3 October-November 2015

September 11 - October 5: BCP

October 9: Begin same deal, but with L-Thyroxine 50 mg, and no endometrial biopsy...things went about the same....

October 19: ER (one day ahead of schedule). Not so bad. Don't remember what they said about follies and eggs.

October 20: 13 eggs retrieved, 11 mature, 8 fertilized

October 22: 8 still going! Level 2s and 3s.

October 24: 8 embryos still going. 2 great, 2 good, 1 okay, 3 not terrible. ET one blast, froze one.

October 26: Two more embryos made it to Grade 3 blasts and were frozen. Three in total.

November 2: Very Small Negative (Beta was 6...ya, any lower and it would have been a BFN. lol)

 

FET #1

November 7th: AF called in day 1 (not sure what to expect yet)

 

 


#5 Pat9

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Posted 11 February 2013 - 08:46 PM

Thanks so much! My DH is set to have a DNA Integrity Assay at Mount Sinai so we will see. Yes, I am very surprised Redmond did not test my DH. It's annoying.

 

 

Hi Pat9,

 

I'm sorry to hear your story. I'm not sure if this would help, but I am surprised they didn't do any testing for Male Factor.

 

My DH and I have MF, and it's partly due to DNA fragmentation. I have been reading up a lot on it, and have found that a high DNA fragmentation can cause difficulty conceiving and lots of miscarriages, because things just don't go right with the embryo.

 

Perhaps you should suggest that they do a DNA fragmentation test when they test your DH. They say that many times, the other problems like poor sperm count, morphology, or motility can be absent, even though the DNA fragmentation may be high. Unfortunately, a high DNA fragmentation makes IVF outcomes poorer than the other problems, but, if you do have that problem, maybe the drugs are causing it, and then it can be improved.

 

Also, I could be making no sense whatsoever, because I'm not a doctor, but it wouldn't hurt to make sure they do that test while they're at it!

 

Best of luck to you:)


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#6 gibasgirl

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Posted 11 February 2013 - 10:17 PM

Oh you have Redmond? I had Redmond. Now it makes sense. That is how she is. She does not believe immunology plays a role in fertility issues. Does not immediatly look into male factor issues, and even when they do appear is more inclined to focus on the eggs as the root cause.

She is good at what she does, but does not go outside of a specific range and if you need treatment that goes outside of that, she simply cannot offer the support you need.

You may want to look into using CoQ10 to boost egg quality. (You can reas up on it in the Acupuncture thread and the Naturopath thread).

With time (and age) the chances of having twins through IVF decreases. There is also a difference between the transfer of embryos and embryo implantation. The hope is that when an embryo is transferred it will burrow into the lining and snug into place for 9 months, but that does not always happen.

The thinking is, if a couple of embryos are transferred (either because the mother is "older" or the embryos are not of high quality, transferring 2 means they can help one another, but only one will make it through because it was helped along by the other)

In any case, follow your intuition. That little voice inside of you will not lead you astray. I wish I had.

Also, some of the immunology tests are pretty specialised and can only be accurately done in the States

Hang in there and all the best to you.
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#7 Wantingour1st

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Posted 12 February 2013 - 10:47 PM

I don't understand why Fernam turned you down for ivf when you were 38.  it was only 2 years ago for you right?  i'm also sorry to hear of your miscarriages, i cannot imagine how painful that would be.

 

I also don't understand why no one had your husband's sperm tested, that's horrible.


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me 43, FSH 5, AMH 8.8 pmol/L is "Low Ovarian Reserve" which is 2.3 to 15.7 pmol/L

dh 41, low sperm, good for IVF

 

chance of IVF working because of age: 5% or less

 

we're taking lots of vitamins, (always did but now are taking a few different ones: InnoQnol CoQ10, PQQ, Inositol powder, baby aspirin, Prednisone (cuz i'm MTHFR I did a blood test & shows positive for blood clotting), Synthroid/Eltroxin (for my slightly elevated antibodies to thyroid I got after IVF) DHEA, Melatonin, Folapro (active form of folate), Royal Jelly, Bee Pollen, L’arginine, L’carninitine, Grape Seed, Pycnogenol, Resveratrol, Astaxanthin, NAC, Macca, E, C, D, Chinese Tea, homeopathic detox Unda numbers, weekly acupuncture, No dairy, no wheat, no sugar, everything organic I can find.


#8 Pat9

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Posted 13 February 2013 - 08:44 PM

Sorry to hear that you had Dr. Redmond as well. She is very discouraging. Knowledgeable, but not able to think outside the box at all.

 

Thanks for clarifying the twin thing. It makes sense.

 

I did a bit of research online after the third miscarriage, and found Dr. Braverman in NYC. He is apparently a reproductive immunologist. Have you heard of him before?

 

Thanks for the reassurance re CoQ10. I have been taking since my 2nd miscarriage. Pharma Plus has them on sale this week by the way - 400mg at 30% off.


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#9 Pat9

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Posted 13 February 2013 - 08:47 PM

Hi Wantingour1st,

 

It was actually Redmond (not Fernam) at Hannam that I saw. She clearly has a bias. Oh well - I am over it. On to greener pastures and positive thoughts! smile.png  Thanks so much for your kind note. Wishing you best of luck on March 3rd!

I don't understand why Fernam turned you down for ivf when you were 38.  it was only 2 years ago for you right?  i'm also sorry to hear of your miscarriages, i cannot imagine how painful that would be.

 

I also don't understand why no one had your husband's sperm tested, horrible.


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#10 gibasgirl

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Posted 13 February 2013 - 08:50 PM

When I was 37 she told me I was old. So there you go.
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#11 Pat9

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Posted 13 February 2013 - 08:53 PM

Ok, so now I can say it ... she's an idiot. A complete heartless idiot. 


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#12 Pat9

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Posted 16 February 2013 - 05:02 PM

Update! Saw Dr. Cepeda today. It seems semen analysis is normal and hormones are. We are still waiting for results of DNA fragmentation. If all appears ok, we are proceeding with IUI in a couple of weeks (!). If not, we will go off medication and try IUI in 2-3 months. 

 

There is hope. That is all I can say. That in itself makes me feel so much better.


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#13 sophi_H

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Posted 16 February 2013 - 07:20 PM

Hi Pat,

 

I am really surprised that MF was not investigated at the beginning. I guess you were pregnant when you went there, and the Dr thought it is ok. But the fact that your husband takes sulfazalazine, a known drug that can cause infertility in male, oligospermia., should have triggered some investigations. DNA fragmentation is an expensive test, but worthy to be done before going to any IUI or IVF, and I am glad you did it.

Even your DH reumatologist should have told him that sulfazalazine can cause problems with infertility, but maybe they were thrown off by the fact that you did get pregnant 3 times.

Now let's see the fragmentation tests.

And too old for IVF at 39.............hm............excuse me.......I am really really surprised that an RE told you that....................!!!!! pardon.gif


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Me 40, DH 49

IVF 1 - 5 embryos - PGD - all abnormal

IVF 2- 8 embryos - PGD- 2 N, one transfer - BFN, the other gone after thawing

IVF 3- 4 embryos - none on day 5

That is the end of IVF journey

 


#14 sophi_H

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Posted 16 February 2013 - 07:42 PM

Hi again,

 

There is an italian dancer that got pregnant and 53 and has actually given birth at a baby girl ( gossip from my mom....but i did find the article)

So 53 and fertility tx ( i am sure she had an intervention, people in Europe go behind boundaries, I dont know if any RE here would do IVF at this age)

 

 

Carmen Russo, is pregnant at the age of 53. She's just the latest in a wave of celebrities who have announced pregnancies later in life. She appealed for people to 'understand' her desire to have a baby and not judge her, but is it a woman's right to experience motherhood regardless of her age?

 

http://www.dw.de/pre...-age/a-16345633


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Me 40, DH 49

IVF 1 - 5 embryos - PGD - all abnormal

IVF 2- 8 embryos - PGD- 2 N, one transfer - BFN, the other gone after thawing

IVF 3- 4 embryos - none on day 5

That is the end of IVF journey

 


#15 gibasgirl

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Posted 16 February 2013 - 09:59 PM

Yes.

Why the need to control women? A woman's right to choose if she gets pregnant, when she has sex, with whom, how many, if she marries or not. All of it. So I will say this falls into the category of controlling women and it really is up to her.

Congratulations to that actress. Oh, and my DH's aunt had an aunt who had a baby at 53. His aunt is 79, so that was quite a number of years ago.

Steve Martin became a first time father at 67. Nobody questions a man's right to parenthood later in life.
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#16 Pat9

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Posted 17 February 2013 - 09:27 AM

Yes, it is a woman's right to experience motherhood at any age. I firmly believe that. I commend this actress and many others for not giving up, and for following their heart and needs despite the opinions and judgement of others. People will always judge one another. It is human nature. 


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#17 Pat9

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Posted 18 February 2013 - 09:23 AM

Thanks Sophi_H. My family Dr. was also surprised that my DH was not tested. We disclosed the medication on the forms we submitted before our first visit, and we brought it to the RE's attention after my second miscarriage. She was adamant that the drugs and his condition were not the issue, even though he was never tested. Not impressed. Any dr. should qualify their instincts with tests. They are scientists, aren't they?

 

Anyway, if I dwell on it too much I get discouraged and angry and that's not good is it?

 

Sending you tons of hope as you await the next step in your journey. It sounds like you have discovered the cause which is great. What happens after 3 months? Will they do IUI/IVF or will you try naturally? 

 

 

Hi Pat,

 

I am really surprised that MF was not investigated at the beginning. I guess you were pregnant when you went there, and the Dr thought it is ok. But the fact that your husband takes sulfazalazine, a known drug that can cause infertility in male, oligospermia., should have triggered some investigations. DNA fragmentation is an expensive test, but worthy to be done before going to any IUI or IVF, and I am glad you did it.

Even your DH reumatologist should have told him that sulfazalazine can cause problems with infertility, but maybe they were thrown off by the fact that you did get pregnant 3 times.

Now let's see the fragmentation tests.

And too old for IVF at 39.............hm............excuse me.......I am really really surprised that an RE told you that....................!!!!! pardon.gif


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#18 Pat9

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Posted 23 February 2013 - 08:54 PM

The results are in. Male Factor does not appear to be the issue. DNA Frag 18% - within the normal range. Going off sulfasalazine just in case we have to try again. Hoping we do not have to though!


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#19 wannabmamma

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Posted 24 February 2013 - 05:49 PM

Great Pat9 :) Good luck, hoping all goes well with this one!


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ME: 38 DH: 40
TTC: since Dec. 2011
Dx: MF - low motility/morphology, DNA Fragmentation (40+%)
 

IVF #1 April - July 2013

BCP-Gonal-f, Luveris, Cetrotide, Ovidrel cycle with endometrial biopsy

3 morula transferred, none to freeze

BFP, but low beta doubling time, u/s shows baby developing behind, M/C July 18 8388.gif

 

IVF #2

August 30: AF - Cyclen BCP

September 28th - Endometrial Biopsy, last BCP

October 1: AF

October 5th: Treatment begins - Gonal-f 150, Luveris 150, L-Thyroxine 25mg

October 9th: add Cetrotide

October 14th: Ovidrel 2 x 250

October 16th: ER - 27 follies, 12 eggs retrieved

October 17th: embryology report - 6 fertilized

October 18th: 5 left (grade 1,2 and 3)

October 19th: One 8 cell, four 9+ cells including one 67 cell 

October 21st: ET two morula and one blast left - transferred all three, none to freeze

November 4th: Beta - BFP 756

November 6th: Beta - 2123yahoo.gif 

July 6, 2014: perfect baby boy born! wavey.gif 

 

IVF #3 October-November 2015

September 11 - October 5: BCP

October 9: Begin same deal, but with L-Thyroxine 50 mg, and no endometrial biopsy...things went about the same....

October 19: ER (one day ahead of schedule). Not so bad. Don't remember what they said about follies and eggs.

October 20: 13 eggs retrieved, 11 mature, 8 fertilized

October 22: 8 still going! Level 2s and 3s.

October 24: 8 embryos still going. 2 great, 2 good, 1 okay, 3 not terrible. ET one blast, froze one.

October 26: Two more embryos made it to Grade 3 blasts and were frozen. Three in total.

November 2: Very Small Negative (Beta was 6...ya, any lower and it would have been a BFN. lol)

 

FET #1

November 7th: AF called in day 1 (not sure what to expect yet)

 

 


#20 Pat9

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Posted 26 February 2013 - 07:33 AM

Back to the drawing board...th_agrr.gif


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#21 gibasgirl

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Posted 26 February 2013 - 03:10 PM

Oh crap. I am sorry, Pat.

#22 Pat9

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Posted 26 February 2013 - 09:17 PM

Thanks so much. This is quite the journey, let me tell you. Not for the faint of heart, is it? 


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#23 wannabmamma

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Posted 26 February 2013 - 09:36 PM

Sorry to hear Pat9:(

ME: 38 DH: 40
TTC: since Dec. 2011
Dx: MF - low motility/morphology, DNA Fragmentation (40+%)
 

IVF #1 April - July 2013

BCP-Gonal-f, Luveris, Cetrotide, Ovidrel cycle with endometrial biopsy

3 morula transferred, none to freeze

BFP, but low beta doubling time, u/s shows baby developing behind, M/C July 18 8388.gif

 

IVF #2

August 30: AF - Cyclen BCP

September 28th - Endometrial Biopsy, last BCP

October 1: AF

October 5th: Treatment begins - Gonal-f 150, Luveris 150, L-Thyroxine 25mg

October 9th: add Cetrotide

October 14th: Ovidrel 2 x 250

October 16th: ER - 27 follies, 12 eggs retrieved

October 17th: embryology report - 6 fertilized

October 18th: 5 left (grade 1,2 and 3)

October 19th: One 8 cell, four 9+ cells including one 67 cell 

October 21st: ET two morula and one blast left - transferred all three, none to freeze

November 4th: Beta - BFP 756

November 6th: Beta - 2123yahoo.gif 

July 6, 2014: perfect baby boy born! wavey.gif 

 

IVF #3 October-November 2015

September 11 - October 5: BCP

October 9: Begin same deal, but with L-Thyroxine 50 mg, and no endometrial biopsy...things went about the same....

October 19: ER (one day ahead of schedule). Not so bad. Don't remember what they said about follies and eggs.

October 20: 13 eggs retrieved, 11 mature, 8 fertilized

October 22: 8 still going! Level 2s and 3s.

October 24: 8 embryos still going. 2 great, 2 good, 1 okay, 3 not terrible. ET one blast, froze one.

October 26: Two more embryos made it to Grade 3 blasts and were frozen. Three in total.

November 2: Very Small Negative (Beta was 6...ya, any lower and it would have been a BFN. lol)

 

FET #1

November 7th: AF called in day 1 (not sure what to expect yet)

 

 


#24 Pat9

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Posted 02 March 2013 - 02:48 PM

Test results are back. Male factor is not the issue. We learned from last one that I may need progesterone support. No issues getting pregnant, just cannot seem to maintain the pregnancy beyond the first trimester. Thanks everyone for your advice and support on this one. We have a new plan in place so we will see how it goes. At least we investigated this one. The drug may cause problems with motility in others though, so if your DH is on it, be sure to check it out.


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