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Amniocentesis - Diminished ovarian reserve?

Diminished ovarian reserve amniocentesis IVF male factor

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#1 Traveladdict

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Posted 29 May 2015 - 02:30 PM

Hi!

 

Briefly, I'm 32 and my husband is 33. I have diminished ovarian reserve and we are also dealing with male factor infertility.

 

My husband and I had a successful IVF/ICSI cycle this past March after having a really poor response in Feb. We had 5 eggs at retrieval, all fertilised and on day 5 transferred a 5AB embryo while 3 were still progressing. On day 6 the lab froze 2 grade 1BB embryos. We did well with this cycle given our fertility problems. This is our first pregnancy.

 

We have opted to do IPS for now. I just had my NT scan yesterday at 12 weeks and everything looked fine, though the tech would not answer my questions. She did write down on my form that the nuchal fold was 1.2mm so I know that's excellent. I'm feeling better about the pregnancy, but I'm still worried about potential trisomies as the IPS detects at most 90% of down syndrome cases. After going through infertility, I don't think I could cope with a special needs child to be honest. I still have to wait for the blood work and combined results from the second trimester. It doesn't sound like they would take into account my diminished ovarian reserve to calculate the odds of having trisomies... Also, the bloodwork requisition forms I got from my GP only ask for PAPP-A at 12 weeks and again between 15-18 weeks; shouldn't the second bloodwork look for hCG, AFP, uE3 and inhibin A? I'm confused! I don't think we have the cash to splurge on NIPT at the moment so I wonder whether we should consider doing an amniocentesis? If we chose to, where would be the best place to have amnio done in the GTA?

 

Any input/advice/stories would be appreciated.


Me (32) - DOR

Him (33) - MFI (10-20% motility, 0-5% morphology)

Jan 2013: started TTC

Jan 2014: first consult with RE; Mar 2014: dx with DOR (AFC:7, FSH:12.5), started 75mg DHEA and 600mg co-q10 daily

Jul-Oct 2014: FSH varrying between 3.5 and 6.5! ... IUIs #1-4 (3 x femara + 1 x overlap(femara+gonal-f) all BFN

Feb 2015: DH had follow-up with urologist, no varicoceles detected, DNA fragmentation is 9.77! Prescribed Clomid

Feb 2015: IVF 1.0 (AFC:7; FSH:?) - Antagonist protocol (no BCP): 300-375IU gonal-f ... cancelled due to poor response converted to IUI#5, BFN

Mar 2015: IVF 1.1 (AFC: 9; FSH:6.5) - microflare protocol (no BCP): 10 units diluted lupron twice daily + 375IU gonal-f daily:  5R/5M/5F-ICSI (2015-03-17), transferred 1 day 5 embryo grade 5AB (2015-03-22); froze 2 early blasts (grade 1BB) on day 6 Faint BFP at 5dp5dt... Beta#1 (10dp5dt): 391, beta#2 (12dp5dt): 1097! First US (2015-04-17): measuring 6w1d, 117bpm, EDD: Dec 10

May 2015: DH had follow-up with urologist, Clomid did nothing


#2 Hopingfor1

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Posted 30 May 2015 - 07:34 AM

Hi Traveladdict,

 

I know you posted this in the "Ask the RE" section, but since you also asked for input/advice/stories I thought I would give you my experience.

 

Firstly, congratulations on your pregnancy!

 

I also had DOR and poor response.  I was a few years older than you, but when my bloodwork results came back, the risk of DS was given to me as 1/1,400.  When I talked to my OB he said he didn't think any other testing was necessary, but because I was over 35 I could have an amnio if I wanted.  He said I did need to know that the risk of miscarriage with an amnio was about 1 in 200.  That is small but he said the risk of miscarrying a genetically normal baby due to the amnio was much higher than the risk of the baby having DS (based on my nuchal ultrasound and blood results).  

 

Even before talking to him, I knew that I wouldn't be able to go through with an amnio unless I knew there was a high probability that there was a problem.  That was just my personal feeling and what was right for me - it doesn't mean it is the right choice for you.  There are also a lot of things that even an amnio will never be able to detect - things such as autism that aren't even apparent until the child is older.

 

Having said all that, I had already decided I did want to do the NIPT.  It was expensive ($800), but it put my mind at ease.

 

One other thing - I haven't heard of anyone paying for an amnio, so they are likely all OHIP covered, but I do remember my doctor did mention that I could go ahead and have one if wanted, even though my testing was normal because I was over 35.  He said at under 35 they are done if the testing comes back abnormal, but at over 35 I had the option to have an amnio if I wanted one even though my testing was normal.  NIPT is also now covered by OHIP ONLY IF your initial testing screens positive.

 

It is a personal decision with no right option for everyone - it will depend on you and what you feel is best for you.

 

I wish you all the best with your pregnancy.


  • ociwoman likes this

Me: 40  = High FSH (ranges from 8 - 15), Low AMH (2.7), Low AFC = DOR

DH: 43 = borderline sperm analysis

Started TTC#1 January 2010

 

2011 - 2012 - First fertility clinic, lots of testing, operative hysteroscopy to remove polyps, multiple unsuccessful IUIs, 1 IVF (150 Menopur/150 Gonal F) converted to IUI due to poor response

 

2012 - got second opinion and after AMH results came back, advised at 36 I had a less than 5% chance of conceiving via IVF.  Donor eggs strongly recommended but not yet ready for that (I should say - hubby not ready for that.  I was ready for donor eggs - I just wanted to be a Mom).  Decided clinic wasn't for us and back to clinic #1

 

2013 - IVF #1 (after 1st converted to IUI).  Estrogen Priming protocol - start Climara patch 7 days post ovulation and change every other day.  3 orgalutran injections beginning day after first Climara patch applied.  Start stims day 2 triggered on night 15 of stims = 3 eggs retrieved, 0 fertilized via ICSI = no transfer  (300 Gonal F/150 Menopur & Orgalutran)

 

2013 - Switch clinics

 

Office hysteroscopy = all clear

 

IVF #2 (37 years old) June 2013 - Estrace priming protocol.  4 mg estrace started 7 days post ovulation.  Start stims Day 3 (300 Gonal F/150 Menopur & Orgalutran)

Slow response as usual

Triggered on night 12 of stims (given the option to cancel as it looked like we'd get 3 eggs - knew we wouldn't do any better so continued).

ER:  6 eggs, but advised some were small and would be immature

Fert report:  5 of 6 eggs immature.  2 fertilized via ICSI (including one of the immature eggs)

ET:  Transferred our only 2 embryos - a 5 cell and an 8 cell

11dp3dt = BFP - HCG = 65

16dp3dt = HCG 1,305 (cautiously pregnant)

7 week ultrasound = 1 baby HB = 141

12 weeks ultrasound NT scan = NT = 1.7mm all looks good.  Combined with blood work risk is 1/1,400

Got Harmony blood test results back (done for peace of mind) - all clear and we're having a GIRL!

EDD = March 2014 (cautiously looking forward to that date)

However - baby had plans to arrive early. After PPROM and managing to cook the little one a bit longer, our bundle of joy arrived at 33 weeks.  After a 3 week NICU stay, she is finally home.  We are totally in love and forever thankful for our little miracle baby - Ashley Nicole.

 

 


#3 Traveladdict

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Posted 30 May 2015 - 11:14 AM

@ Hopingfor1, thank you so much for taking the time to reply and share your story! It's much appreciated smile.png

 

It looks like your DOR was more serious than mine given your history, but I'm glad to hear that you ended up with your miracle even if it was earlier than anticipated...

 

It's hard not to worry about the potential risks when you have DOR, especially for me since I'm a scientist and it's just part of who I am, reading the litterature, looking at numbers/stats... It's not helping! I've also been unemployed since last November and although we're doing fine fiancially, I just don't want to add extra money to the line of credit; we're $2k away from paying off the IVF smile.png

 

GOOD NEWS!!! I just happened to check the LifeLabs website for info about their Panorama NIPT and ways I could get OHIP to cover and, OMG, as of May 27 2015, they just reduced the price from $795 to $550 smile.png Suddenly it feels way more reasonable to be able to have some peace of mind for the rest of the pregnancy. I just told my husband about it and he said I should go for it! I shall spread the news...

 

http://us4.campaign-...ab78&e=[UNIQID]


  • Hopingfor1 likes this

Me (32) - DOR

Him (33) - MFI (10-20% motility, 0-5% morphology)

Jan 2013: started TTC

Jan 2014: first consult with RE; Mar 2014: dx with DOR (AFC:7, FSH:12.5), started 75mg DHEA and 600mg co-q10 daily

Jul-Oct 2014: FSH varrying between 3.5 and 6.5! ... IUIs #1-4 (3 x femara + 1 x overlap(femara+gonal-f) all BFN

Feb 2015: DH had follow-up with urologist, no varicoceles detected, DNA fragmentation is 9.77! Prescribed Clomid

Feb 2015: IVF 1.0 (AFC:7; FSH:?) - Antagonist protocol (no BCP): 300-375IU gonal-f ... cancelled due to poor response converted to IUI#5, BFN

Mar 2015: IVF 1.1 (AFC: 9; FSH:6.5) - microflare protocol (no BCP): 10 units diluted lupron twice daily + 375IU gonal-f daily:  5R/5M/5F-ICSI (2015-03-17), transferred 1 day 5 embryo grade 5AB (2015-03-22); froze 2 early blasts (grade 1BB) on day 6 Faint BFP at 5dp5dt... Beta#1 (10dp5dt): 391, beta#2 (12dp5dt): 1097! First US (2015-04-17): measuring 6w1d, 117bpm, EDD: Dec 10

May 2015: DH had follow-up with urologist, Clomid did nothing


#4 SunshineTTC

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Posted 30 May 2015 - 12:05 PM

Note that DOR is about quantity not quality. Unless other issues, egg quality is related to age. It often goes with DOR because DOR is usually related to age, but DOR in and of itself doesn't necessarily mean poor egg quality. Hence why younger early 30s women with DOR have a better chance of conceiving vs older.

Me: 40 41 42 43 44 45, single, FSH 6, LH 2 (FSH not high, but exceeded 2:1 ratio), DOR (AFC 5-7, v.low AMH), all else normal/healthy.

After a difficult 6 year journey of everything going wrong, amazing baby boy born Dec 2018.  Donor sperm + DEB-USA donor eggs.  Detailed journey in 'about me'.

 


#5 Traveladdict

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Posted 30 May 2015 - 12:22 PM

Note that DOR is about quantity not quality. Unless other issues, egg quality is related to age. It often goes with DOR because DOR is usually related to age, but DOR in and of itself doesn't necessarily mean poor egg quality. Hence why younger early 30s women with DOR have a better chance of conceiving vs older.

Thanks for your input! Based on what I've read so far, I'm not sure whether DOR affects more quantity over quality or both to be honest. My RE and the nurses at the clinic always told me it's about quality and not quantity... I do understand that quality is better in younger women with DOR, but it's so hard not to worry!


Me (32) - DOR

Him (33) - MFI (10-20% motility, 0-5% morphology)

Jan 2013: started TTC

Jan 2014: first consult with RE; Mar 2014: dx with DOR (AFC:7, FSH:12.5), started 75mg DHEA and 600mg co-q10 daily

Jul-Oct 2014: FSH varrying between 3.5 and 6.5! ... IUIs #1-4 (3 x femara + 1 x overlap(femara+gonal-f) all BFN

Feb 2015: DH had follow-up with urologist, no varicoceles detected, DNA fragmentation is 9.77! Prescribed Clomid

Feb 2015: IVF 1.0 (AFC:7; FSH:?) - Antagonist protocol (no BCP): 300-375IU gonal-f ... cancelled due to poor response converted to IUI#5, BFN

Mar 2015: IVF 1.1 (AFC: 9; FSH:6.5) - microflare protocol (no BCP): 10 units diluted lupron twice daily + 375IU gonal-f daily:  5R/5M/5F-ICSI (2015-03-17), transferred 1 day 5 embryo grade 5AB (2015-03-22); froze 2 early blasts (grade 1BB) on day 6 Faint BFP at 5dp5dt... Beta#1 (10dp5dt): 391, beta#2 (12dp5dt): 1097! First US (2015-04-17): measuring 6w1d, 117bpm, EDD: Dec 10

May 2015: DH had follow-up with urologist, Clomid did nothing


#6 SunshineTTC

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Posted 30 May 2015 - 07:38 PM

"Diminished ovarian reserve" is by definition exactly what it says, a reduced reserve (quantity) of eggs left in the ovaries.  Success is very much about quality and not quantity.  A majority who suffer from DOR are of advanced maternal age which then makes those few eggs they have left likely of much poorer quality also, so a double-whammy.


Me: 40 41 42 43 44 45, single, FSH 6, LH 2 (FSH not high, but exceeded 2:1 ratio), DOR (AFC 5-7, v.low AMH), all else normal/healthy.

After a difficult 6 year journey of everything going wrong, amazing baby boy born Dec 2018.  Donor sperm + DEB-USA donor eggs.  Detailed journey in 'about me'.

 


#7 YellowBee

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Posted 01 June 2015 - 03:21 AM

Hi Traveladdict,I do not have DOR and I really don't know how it affects your eggs, but as someone who did IPS and NT with perfect results just to find out at 22 weeks that our baby has DS (and I should add that our 20 weeks u/s also had good results, only my paranoia and insistence to get the amnio done helped us to find out, since every medical worker we've met told as I'm crazy to want an amnio with my results) I urge you to pay whatever it is it now costs to have a NIPT done. Trust me, you can't pay enough for your peace of mind. Good luck!
p.s. I was 33 years old when I've got pregnant (If age is important)

pxjcm5.png


#8 Traveladdict

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Posted 01 June 2015 - 07:08 PM

Hi Traveladdict,I do not have DOR and I really don't know how it affects your eggs, but as someone who did IPS and NT with perfect results just to find out at 22 weeks that our baby has DS (and I should add that our 20 weeks u/s also had good results, only my paranoia and insistence to get the amnio done helped us to find out, since every medical worker we've met told as I'm crazy to want an amnio with my results) I urge you to pay whatever it is it now costs to have a NIPT done. Trust me, you can't pay enough for your peace of mind. Good luck!
p.s. I was 33 years old when I've got pregnant (If age is important)

Thanks for you input, it's much appreciated! My husband is not in favor of getting the amnio unless absolutely necessary as he's not willing to risk a miscarriage at this point. I'm also really paranoid about the "what ifs" and I totally understand that good results don't guarantee a good outcome. I'll request the Panorama NIPT now that is has dropped in price, I'm just waiting to hear back from my doctor about the 12 week blood test to see whether it's positive, in which case NIPT would be covered...


Me (32) - DOR

Him (33) - MFI (10-20% motility, 0-5% morphology)

Jan 2013: started TTC

Jan 2014: first consult with RE; Mar 2014: dx with DOR (AFC:7, FSH:12.5), started 75mg DHEA and 600mg co-q10 daily

Jul-Oct 2014: FSH varrying between 3.5 and 6.5! ... IUIs #1-4 (3 x femara + 1 x overlap(femara+gonal-f) all BFN

Feb 2015: DH had follow-up with urologist, no varicoceles detected, DNA fragmentation is 9.77! Prescribed Clomid

Feb 2015: IVF 1.0 (AFC:7; FSH:?) - Antagonist protocol (no BCP): 300-375IU gonal-f ... cancelled due to poor response converted to IUI#5, BFN

Mar 2015: IVF 1.1 (AFC: 9; FSH:6.5) - microflare protocol (no BCP): 10 units diluted lupron twice daily + 375IU gonal-f daily:  5R/5M/5F-ICSI (2015-03-17), transferred 1 day 5 embryo grade 5AB (2015-03-22); froze 2 early blasts (grade 1BB) on day 6 Faint BFP at 5dp5dt... Beta#1 (10dp5dt): 391, beta#2 (12dp5dt): 1097! First US (2015-04-17): measuring 6w1d, 117bpm, EDD: Dec 10

May 2015: DH had follow-up with urologist, Clomid did nothing






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