Failed cycles? Plenty of eggs but crappy results? I bet I know why…

I wish I had written this a long, long time ago but it took a friend cycling to make me realize how important the following information will be for those of you going through IVF, IUI….  Do not ever let your follicles get too big.  My former RE likes to trigger when the cohort (most of the eggs) are measuring 17.  The simple fact is that eggs (especially older eggs) often will not have great outcomes if they get much larger than 22.  Heck, even 20.  If you are doing an IVF cycle and you notice that most of your eggs are in the 18 or 19 range then you should have triggered…plain and simple.  Do the research and see what happens when your follicles get too big…  

When in doubt you need to question.  Try a low dose cycle for the heck of it (you can always convert to an IUI).  I find it interesting that I produced the same amount of eggs on 300 menopur/300 follistim as I did with a 150 menopur/150 follistim – sometimes more isn’t better…in fact, sometimes more is not good at all.  Just a little PSA.

Let me know if any of you have had bad results with large follicles (or the reverse and don’t forget your age!).  Good luck to everyone trying….

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All day testing

I’m in Colorado – just finished all day testing at CCRM. I’ve come away with a huge spiral notebook of things to read, a stack of orders for bloodwork that must be completed, an enormous headache caused, no doubt, by their no caffeine policy, a sore and (sorry TMI alert) bleeding uterus from having a foot long thread inserted into it….and hope, I have hope! I love this place. Never have I seen an operation like it (and I’ve been around). They are indeed everything I thought they would be. Dr. Schoolcraft is a nice guy – I liked him enormously. His nurse Kathy was amazing – spend literally hours talking me through the entire process. They run a tight ship – no waiting around – everything spelled out, scheduled, organized. Wow.

Guess what I found out today? After 6 IVFs and God knows how many times someone has looked into my uterus – Dr. Schoolcraft found scar tissue from a previous D&C – most likely when I was 31 years old and had a blighted ovum. All this time and no one ever said a word about it. Lest you think this might be the result of my last D&C – that is highly unlikely as my RE did suction only. Dr. Schoolcraft suggested that any embryo trying to inplant in this area of my uterus would struggle. I’ll be getting surgery to remove the scar tissue soon – probably back in Atlanta. He also agreed that microarray (genetic testing on the embryo) would be my best shot. He figures that I have an 80% probability of finding a normal embryo….so we are doing it. Forget the IUI – I’m going to wait for my next period (most likely February 27) and then resume estrogen patches 15 days later. I’ll get a period in late March and an egg retrieval around April 8-10th (approximate). There will be other decisions once we know how many eggs we get – but for now we are planning to flash freeze them either at day 3 or day 5. I’ll do a frozen embryo transfer a few months later and then hope, hope, hope.

The bad news is that I had 8 resting follicles (these are the follicles that show up in your ovaries at the beginning of your cycle and serve as a predictor of how many eggs will be retrieved) – this is down from 15 in August. You see – just a few months at the age of 40 can send you off a cliff. Who knows how many I’ll have next month – could go back up but unlikely. Dr. Schoolcraft said that a resting follicle count of 8 will likely correspond plus or minus 2 to my results at retrieval. If I had 10 eggs…mature and fertilized – I’d be the happiest girl in the world. I’m not sure that resting follicles are that predictive in everyone – but they have been for me.

I’m not going to think about the cost – I have a loan for the entire amount ready and waiting for me to access it. This is far more important than anything in our lives right now so its cost is irrelevant for me. One thing that was repeated over and over again – “your eggs are 40 years old”. I get it….time is literally running out. I don’t have a year to make more mistakes – I have months…

I’ll post more later – for now a much needed massage is waiting.

Sperm.

Today we did our first of two sperm injections.  We had to take our son with us – which proved to be a huge nightmare.  I’m very sensitive to the feelings of my fellow infertiles and strongly believe that a child has no place in a fertility clinic.  It never really upset me but had I had several failed cycles, I don’t think I’d be able to bear seeing one at the doctor’s office.  Anyway – he came along for lack of child care options.  C and I took turns keeping him occupied and tried very hard not to let him tear the entire waiting room apart (no luck).  C gave his specimen and we then went to McDonald’s to wait for them to prepare the sperm – spin it free of white blood cells, crappy sperm, etc.  When we arrived back 2 hours later they were ready for me.  When I saw the nurse she said, “well your husband has a great sample for you – he has 85 million sperm ready here”.  My jaw nearly dropped to the ground.  85 million post wash!  That is 120 million pre wash – just insane.  Let me put it this way – you only need 20 million post wash for an IUI to have a good chance of being successful.  The nurse advised me not to tell him because, as she said, he would get a big head.  I agreed…but ended up telling him.  I’m not sure why I did this because I’d much rather have him believe that his sperm are the reason we are doing these procedures but, I guess it isn’t anymore!

On to the insemination, I normally don’t see my doctor during cycles – this is a large practice and the doctors all rotate for procedures.  Of course I know my doctor and have had many chats with him but I am just not used to spreading my legs and finding him down there – if you know what I mean.  It is so much easier when I don’t really know the person.  So, in walks Dr. S – who is rather young and handsome and all of a sudden I realized that I had not even bothered to make myself acceptable for viewing (to put it delicately).  The poor guy basically had my entire womanhood in all its glory right in his face – and I was cringing the entire time.  In the middle of the procedure – after he had inserted the speculum – he asked the nurse to hold down on my bladder as he was having trouble inserting the long tube into my uterus.  And then the nurse says, “oh be careful not to pee on the doctor”.

Oh darn – just what I had in mind to do.

I was so glad when that shit was over.

I was also glad that my doctor seemed stumped by my “excellent response” to low dose stims.  When I asked him what he thought about all of this and how it could benefit future IVF cycles should I not get pregnant he said he would have to have a think about it.  Well I already thought about it and came to the conclusion that I have spent thousands of dollars on medication and probably damaged perfectly good eggs because of a protocol that was all wrong for me.  Thanks doc.

So – IUI part 2 is in the morning.