2 replies to this topic

Hi!
I have some questions about our last icsi and about our protocol.

I think I am a poor responder (me 36, husband 42), since high doses of Menopur has been required. 2006 our daughter was born after our second icsi (First cycle they used ivf but few fertilized so after that icsi). Menopur 300 was used, resulting in 10 eggs and 7 fertilized. One of them resulted in our daughter!

Now 2 years later we have just gone through our second icsi after our daughter. In the first of this two icsi-cycles I had Menopur 300, resulting in 5 follicles, 3 eggs, all fertlilized, 1 continued to develop and was transferred, with a negative test.

In the next cycle the dose was increased to 375 and 13 eggs were retreived, 11 days of stim. The problem was that 8 of these eggs were immature and could not be used for icsi, only the other 5 could. 2 or 3 of them were fertilized and 1 could be transferred. Still waiting for result. In all 4 tries we have done the long protocol with down regulation.

Now, I am very confused about the 13 eggs this last time. My E2 was 1600 stim day 7. A had an ultrasound made on stim day 8. The biggest follicle was 12mm. 2-4 follicles I think were in that size and the rest smaller. I had the Pregnyl 4 days after, and ER 2 days after the trigger.

Was ER done too early?

Is immature eggs like in my case typical for a poor responder? Does my result mean I am not able mature more than 5 eggs?

Or should the 13 eggs/8 mature be seen as a result of to short time of stimulation?

Is there anything in the protocol, in your opinion, that could be changed to increase our chanses?

We have some kind of male factor as well but the count varies very much. After wash this time only 0,16 m. and last time 0,96 m. We have also become "natural" pregnant but miscarried last year. Does the sperm quality and count at the time of the icsi, affect the fertilization and embryo quality?

Should we wait 3 month before we move on to another try, since the sperm count was so low this time? He had an infection + fever 1 month ago.

My dear also husband forgot (I reminded him after, I can assoure you!) about the hot bath restriction and was in a whirlpool bath (38 degrees Celcius) for about 10 min. What temperatures should be avoided?

Many thanks in advance for your time!
/Jamjo

Edited by jamjo, 16 April 2008 - 06:53 AM.

[yanie]

you might want to look into IVM.
good luck

Dear Jamjo

You are using high doses for a moderate (sometimes low) number of eggs, which, you are right, might qualify you a 'low responder'.

There are several protocols available...long protocol, antagonist, flare, estrogen priming....and reasons to consider each one.

However, as a general rule, we decide whether or not a stimulation went well based on measurements taken on the day of the Ovidrel/HCG trigger shot. On this day, you hope that:

Your "lead follicles", the ones we expect to retrieve eggs from, are between 15 and 22mm in size (ideally 17-20)
Your estrogen is approximately 1000 per lead follicle.

Of course, there are cycles that result in pregnancy that don't fit this pattern, but in general, this is what we like to see.


My suggestions:

1. Ask your doctor what other protocols their team uses for low responders. In your specific case, I cannot tell you if the immature eggs were related to the stimulation or not....I would need to see the complete records, including embryo results, to make an accurate assessment. But it is reasonable to at least consider alternative protocols before trying again.

2. Ask if there are lifestyle modifications that might help. There is much talk of DHEA these days, but there are some potentially serious and irreversible side effects too so I would suggest you only consider this intervention under guidance from your team.

3. You worry about your partner's variable sperm counts. Ask your doctor if is is necessary in your case to freeze a sample of sperm. If its a 'poor' day when the freezing is being done, then it can be discarded and can try again. But when it is good, then you *know* you will have a good sample (fresh, but if necessary, frozen) on the day of retrieval.

Yours,

Tom Hannam