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Baby Kingdom - 親子王國香港討論區 › 首頁 › 想生BB› ivf Q & A

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樓主: cutecutetown

ivf Q & A

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發表於 11-2-17 14:11 |只看該作者

Dear superwife,

Embryos of 4-5 cells on day 2 are good at the right speed. You are doing well so far :)

It is fair to do ICSI given your husband's sperm and your previous unsuccessful IUIs. The fertilization rate of your eggs is not very high, but still acceptable. Do not worry about it because your embryos are fine.

Urination, even right after ET, will not affect the embryos placed into your uterus. They won't simply 'slip off' because the uterus is a dynamic muscular structure trapping the embryos in. I know on textbooks the uterus is always drawn with an "empty air space" inside; that is just an illustration not very proportional.

If you take the day of ET as day 2, implantation usually happens from day 5 to day 7; but still, it may vary a little from this window. Some women claim that there will be "implantation blood"; not to deny its occurrence, but it is not a reliable indicator of implantation. It is rather normal to feel simply nothing around that time.

Will you do blood test or just home pregnancy test on day 12 and day 14? Doing it twice is just to play safe in case there is false-positives or false-negatives.

It is sometimes hard for 1st-time IVF people to get through their 12-14 days of wait after the ET. Take it easy and try to relax. Don't give yourself too much stress as you have come through a long way already. Give yourself a big hug!

cutecutetown

原帖由 superwife 於 11-2-17 12:06 發表
Hi Cutecutetown,

Thank you very much for your detail explanation.

I had 3 embryos for ET yesterday, which was the day 2 after ER. The doctor did tell me the grading of embryos even I asked for that. ...

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superwife

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發表於 11-2-17 16:38 |只看該作者

Dear cutecutetown,

Thank you so much for your warm encouragement.

The doctor said that I will have pregnancy blood test after 12 and 14 days of ET.

I will resume work tomorrow and will try to relax to welcome my bb(s) :)

原帖由 cutecutetown 於 11-2-17 14:11 發表
Dear superwife,

Embryos of 4-5 cells on day 2 are good at the right speed. You are doing well so far :)

It is fair to do ICSI given your husband's sperm and your previous unsuccessful IUIs. The fe ...

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sukudo

男爵府

積分: 5487

623^#

發表於 11-2-23 17:07 |只看該作者

原帖由 cutecutetown 於 10-10-7 15:16 發表
Dear sukudo,

If I were you, I would go for 微創割左個水pop, 順便刮埋宮. This will give you a clean start to proceed with ivf. The presence of that 水pop really hinders your ivf pursuit because your ...

cutecutetown
do u remember me?

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cutecutetown

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發表於 11-2-23 23:08 |只看該作者

Hey sukudo,

Yes, of course. Generally I remember names of those who have appeared in this blog, but not all the details.

So how is everything with you? Started an ivf, or bingo on your own??

cutecutetown

原帖由 sukudo 於 11-2-23 17:07 發表

cutecutetown
do u remember me?

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Bobomok

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625^#

發表於 11-2-24 01:29 |只看該作者

hi cutecutetown

I've read your thread and found you are very kind and nice to help those women wanna have babies. Can you help my sister who is very sad now? She didn't want to do anything.

She did IVF in Jan and her M just come (just 12 days after embryo transfer). The doctor did the egg retrieval on Day 19 and her normal cycle day is 32 days. Is it something wrong with the doctor? Should he do the egg retrieval on Day 16 like normal cycle day? Thank you

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MeikoBB

別墅

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626^#

發表於 11-2-24 12:13 |只看該作者

Hi Cutecutetown,
I saw all your advices and reponds to the jm here which I found very useful & helpful! The following is my case, would like to seek your advice if I have done a right decision? Thanks!
我今個月開始第一次ivf, 因為有pcos 所以醫生幫我用低劑量谷蛋75iu, 打到第五日成績都好好, 略略估計也有十幾隻蛋, 而size亦很理想。到打針第8日,有一隻蛋已經有1.9mm其他個d就平均係1.5mm, 醫生就叫我當日開始打埋抑制劑。過左個weekend, 星期一即是打針第十一日返去check, 大約有15隻蛋d蛋已經好大有D已經成2.0mm, 所以醫生就要我驗血,如果ok就會當晚打放蛋針, 後日抽蛋。但報告發現黃體好低, 得0.2-0.5, 而E2亦只得1200-4500,所以醫生就就叫我繼續打抑制劑&谷蛋針,第二日再返去check。點知一照u/s, d蛋再大d, 最大個隻已經2.8mm其他就大約1.6-2.2mm不等, 但個內膜就由12mm跌到得返9.9mm。醫生即時要我再抽血, 個report 見到E2 升左一陪但黃體只係升左小小: 0.3-1.1, 咁我已經知道d蛋只係size 大但未熟咁就算抽出黎都唔知有幾多隻係好..雖然醫生極力叫我當晚放蛋, 後日抽蛋, 但最終我決定put a stop to this cycle! 因為係呢一個Step, 我仲可以揀, 可以等下一個cycle d指數好d先試總好過一開始已經有uncertainty.
可唔可以比D意見我其實我嘅決定啱唔啱呀?

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JLK

洋房

積分: 36

627^#

發表於 11-2-24 13:57 |只看該作者

New IVF Attempt

Hi Cutecutetown,

I will see the doc tomorrow to prepare for the new IVF attempt. Last time I got pregnant by FET (I failed when I did ET) although the embryo stopped the heartbeat in week 7. I am wondering if I should choose FET instead of ET as the success rate of ET may be affected by the hormonal injections in the same cycle.

Regards,
JLK

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cutecutetown

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628^#

發表於 11-2-24 15:03 |只看該作者

Hello Bobomok,

In IVF when hormone injections are given to stimulate egg production, the no. of days of injections is totally independent of the length of the woman's normal menstrual cycle. In other words, the day of egg retrieval is decided upon based on the size of the follicles (as appeared on the ultrasound) and also her hormonal level. To view it from another perspective, some women do not even have regular normal M cycles, and some even do not ovulate. If we were to do egg retrievals based on their cycle length, IVF doctors would be in deep trouble...

It is very sad that your sister failed this round. Nowadays, a very generalized pregnancy rate from IVF is only about 40%, and this figure may be higher or lower due to the woman's age and also different fertility background. Because the process of undergoing IVF is a very stressful experience, definitely not all will get their babies the first time. Success rate for 2nd time or 3rd time is still reasonably good. I can't go through all the details here, but please allow your sister to grieve for a little while. Once she recovers from her emotional distress, she can visit her doctor again to discuss further steps.

cutecutetown

原帖由 Bobomok 於 11-2-24 01:29 發表
hi cutecutetown

I've read your thread and found you are very kind and nice to help those women wanna have babies. Can you help my sister who is very sad now? She didn't want to do anything.

She did ...

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cutecutetown

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發表於 11-2-24 15:46 |只看該作者

Hello MeikoBB,

I can't help myself from giving you a two-thumbs up!!

Honestly, there is no right or wrong decision here. The evidence (the ups & downs of your hormones, the discrepancies in follicle sizes, etc.) all point in the direction that even if you had the egg retrieval, your result were likely to be suboptimal; however, in most private practice, the doctor may not even suggest your cancellation. Most patients, given similar scenario, would have chosen to proceed, spending more time and hope but still end up with poor results and back in ground zero.

Since proceeding is such a norm, I think you are having some anxiety because you are afraid to be wrong in not "following" the "usual" path. However, I do see your reasons and I totally support your rational thinking. Your decisiveness is admirable; and yes, many others would have chosen the "usual" path instead. Sometimes, following your mind and instinct is the best.

So, are you ready to start your 2nd attempt? I suppose you do understand your pcos background, which is the main culprit for having plenty of follicles easily but they tend to be not very synchronized in growth. Let's see how your 2nd round will be like.

All the best,
cutecutetown

原帖由 MeikoBB 於 11-2-24 12:13 發表
Hi Cutecutetown,
I saw all your advices and reponds to the jm here which I found very useful & helpful! The following is my case, would like to seek your advice if I have done a right decision? Thanks ...

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cutecutetown

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積分: 9496

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發表於 11-2-24 16:02 |只看該作者

Hello JLK,

Have we talked before?

While the injections may indeed confuse your body a little bit, it is hard to resist the transfer of fresh embryos (unless your doctor won't let you have fresh ET due to some medical concerns).

I may be biased because I am an embryologist; but I feel that having good-quality embryo(s) (with good appearance and good intrinsic potential) is still the most crucial to give full-term babies. While the endometrium is still important in nurturing the implanted embryo(s), it is quite optimized already even with all the injections.

When you visit your doc next time, do not hesitate to discuss your thoughts with him/her. I am sure he/she will also give you some reassurance of what is the best for you.

cutecutetown

原帖由 JLK 於 11-2-24 13:57 發表
Hi Cutecutetown,

I will see the doc tomorrow to prepare for the new IVF attempt. Last time I got pregnant by FET (I failed when I did ET) although the embryo stopped the heartbeat in week 7. I am w ...

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MeikoBB

別墅

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631^#

發表於 11-2-24 18:19 |只看該作者

cutecutetown,
Thank you soooo much for your prompt reply and being so supportive. Since this was happened to me just this past Monday, so I am still struggling if I have made a right decision although my hubby keeps telling me I have done it right. The worst feeling I had on this incident was being criticized and questioned by my dr when he was told I've put a stop half way through without giving a try. He stressed to me that all index looked perfectly well and questioned why I saw those as not good and asked if I was very professional and knowlegeable on interpreting those numbers...I am sad, so wondering if I really have made a wrong decision, or I should have given it a try since I am not a professional in interpreting those numbers which I cannot deny for sure.

Besides, may I ask a few more questions, cutecutetown? Have you ever come acrossed to any cases which were similar as I, i.e. the follicles size is optimal but the progesterone and E2 are not at the right level? What does that imply to? Are PCOS women prompt to have such problem?
Before I started the IVF this time, I have taken 5 months rest after 2x of iui failure. During these 5mths, I have been monitoring my BBT and hoped for nature contraception. The chart showed that I have ovulation on day16(temp rise from 36.3 to 6.9-37 in 4 days), just that the high temp could only last for 10days max.
I know my Progesterone level may not be very good but I was really shocked when I saw the level was that low even with the assistance of injection during IVF...I am frustrated and worried.
Sorry for having so many questions, I am just worried my problem is getting more complicated than I thought!

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cutecutetown

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積分: 9496

632^#

發表於 11-2-24 23:10 |只看該作者

Dear MeikoBB,

Don’t worry about the decision now.
We cannot turn back in time to revert the decision, nor can we walk through first and then go back if we don’t like the outcome.
So, I am very glad your hubby also supported your decision.
My humble opinion is that you need to put aside the experience of this time and move forward.
Only if similar situation happens again in your next try, then perhaps choose to proceed instead.

I scrolled back to read your last message again and realized that you did not state the units of E2 given.
Besides, the number you gave on follicular measurements look like they should be in cm, not mm.
Now I have a question for you; did your dr actually go through what these numbers mean with you?
If you don’t mind coming to this thread during your next ivf cycle, you may want to share your doubts and thoughts so we can walk through it together.
Quite often, with better understanding of what’s going on, stress will be less and it may be easier if you’ll need to make any critical decision.

Now, let me try to answer your questions.
For E2, it should continue to rise with the growth of follicles; however, there is no right or wrong level because it is generally proportional to the number of growing follicles in the ovaries.
As for progesterone, we actually want to keep it low while your follicles are still growing.
Progesterone becomes more important when you have finished egg retrieval and getting prepared for embryo transfer.
Very simply put, progesterone needs to be maintained within a certain level for implantation and early fetal development.
There are indeed plenty of things ivf doctors constantly monitor and adjust for a woman going through ivf to optimize the whole process so that she can get pregnant and take home a baby as the ultimate reward.
I have a slight feeling that you may be confusing progesterone with LH (luteinizing hormone).
With LH, we also want it low, but not too low, because a sudden rise of LH while the follicles are still growing may trigger ovulation, which means we may lose the eggs.

My understanding with basal body temperature (BBT) is that it should decrease very slightly when a woman ovulates, and once the body temperature has risen to a stable level, the woman enters luteal phase, which is already too late if you want to conceive during this stable time window.
Luteal phase generally lasts for ~14 days for most women, which somewhat agrees with what you said (4 days when temp. rises from 36.3 to ~37, and stable for ~10 days).
If you have very regular periods, I encourage you to try the natural way ~day 11 to even day 16 of your natural cycle.
Even if you will pursue ivf, you should still try in between ivf treatment cycles to maximize your chance.
(Of course I am assuming your fallopian tubes are not blocked and your hubby’s sperm is normal.)

Cheers, cutecutetown

原帖由 MeikoBB 於 11-2-24 18:19 發表
cutecutetown,
Thank you soooo much for your prompt reply and being so supportive. Since this was happened to me just this past Monday, so I am still struggling if I have made a right decision although ...

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Bobomok

複式洋房

積分: 108

633^#

發表於 11-2-24 23:36 |只看該作者

hi cutecutetown

Thank you very much for your advice. I think my sister's problem is that she cannot control her emotion. She cannot stop questioning herself what's going wrong like:
(1) did the embryo implant
(2) or it did implant but subsequently miscarry
(3) not enough rest or stand too long...
So I can only find the answers for her. You are right that more knowledgeable, less stress. Maybe it help her to restore her emotion. Thanks again!

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MeikoBB

別墅

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發表於 11-2-24 23:58 |只看該作者

Hi Cutecutetown,
Let me share with you the index:
Monday (after 10 injections of 75iu + 4 x 0.25 Centotide)
E2: 1200 - 4500
Progesterone: 0.2 - 0.5
midline: 12
follicles number: 14-16
size: 1.6-2.5cm

Tuesday (12 injection of 75iu + 5 x 0.25 Centotide)
E2: 2400 - 8500
Pregesterone: 0.3 - 1.1
midline: 9.9
follicles number: 14 (counted)
size: 1.7-2.8cm

The dr didn't get into details about the index but said if he told me more, I would be getting more confused...just listened to him was the golden rule.
After got the readings on Monday, he told me the follicles are not mature enough so advised me to have 2 more injections (one at 5:30pm and next morning after the centrotide)
On Tuesday, after he found my midline was flattened, he took another blood test and asked me to inject the ovidrel 9pm that evening...but I drew back after I was told about the readings.

I also wanted to conceive naturally but after 3 years of trial + 2 x of iui in June & Aug last year, I still get a bingo, I came to the ivf path.
For your add'l info, apart from PCOS, I also suffered from high prolactin but already on medication and now it is within safe range, the last reading was 13. My hubby doesn't has much problem with his sperm but the morpholegy is a little weak, only 7% vs 14% as the optimal level.

As per your advise, do you mean I should try naturally a few times after the ET to increase the chance? But....shouldn't we refrain from any sexual intercourse after the ET?

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lollybb

大宅

積分: 1332

635^#

發表於 11-2-25 07:11 |只看該作者

dear cutecutetown,

do you still remember me? i'm planning to do the FET in May but still trying natural bingo in the meantime. I've seen another doctor for blood check and he said that my immune system is 高一級戒備 and he gave me some medicine :Metformin and Steroid. Do these medicine help implantation? Anything i can do to prepare for the FET at this moment? btw, my ascites has disappeared, will this also help the implantation? thanks.

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cutecutetown

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積分: 9496

636^#

發表於 11-2-25 14:01 |只看該作者

Dear Bobomok,

Please tell you sister that as long as she followed her doctor's instructions and took medication accordingly, she had done all she could. In fact, she had done her best already; there are simply too many factors that she could not help, control, or do better. If IVF can give a 100% bingo chance, then we would be better than "Wong Tai Sin".

Answers to her questions:
1. The embryo(s) did not implant;
2. No, and therefore no micarry issue;
3. Stress is always hard to gauge. In theory, standing and not enough rest will not displace or expel the embryo if it is a good one.

cutecutetown

原帖由 Bobomok 於 11-2-24 23:36 發表
hi cutecutetown

Thank you very much for your advice. I think my sister's problem is that she cannot control her emotion. She cannot stop questioning herself what's going wrong like:
(1) did the embry ...

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cutecutetown

男爵府

積分: 9496

637^#

發表於 11-2-25 16:31 |只看該作者

Dear MeikoBB,

Thanks for the sharing.

As for sperm morphology, I won't be too worried about it. I hardly see any patients coming through who have a normal morphology of >14%. Most are between 4-10%, and they seem to get pregnant alright.

A note on sexual intercourse. What I meant was to keep trying while you are not on IVF treatment; in other words, when you are on your natural cycling month, it won't harm to try. Refrain while you are on ivf injections and the 2 weeks after ET.

cutecutetown

原帖由 MeikoBB 於 11-2-24 23:58 發表
Hi Cutecutetown,
Let me share with you the index:
Monday (after 10 injections of 75iu + 4 x 0.25 Centotide)
E2: 1200 - 4500
Progesterone: 0.2 - 0.5
midline: 12
follicles number: 14-16
size: 1.6-2.5cm
...

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cutecutetown

男爵府

積分: 9496

638^#

發表於 11-2-25 16:57 |只看該作者

Dera lollybb,

Long time no see. Honestly, I don't remember your treatment history; but things seem to be improving for you, especially with the disappearance of ascites, which is always a good news.

The medicine you mentioned has no direct effect on implantation. Metformin, in the context of IVF, helps in patients with PCOS and/or high BMI (body mass index). With steriod I am not too sure, perhaps it helps to suppress your "higher-defense" immune system. In very general terms, when your BMI is lower or PCOS symptoms are reduced, and the immune system does not over-react, the overall uterine environment should be more 'welcoming' to the embryo(s).

Cheers, cutecutetown

原帖由 lollybb 於 11-2-25 07:11 發表
dear cutecutetown,

do you still remember me? i'm planning to do the FET in May but still trying natural bingo in the meantime. I've seen another doctor for blood check and he said that my immune sys ...

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Wonderfish

複式洋房

積分: 109

639^#

發表於 11-2-25 17:58 |只看該作者

Hi cutecutetown,
你好, 感謝你一直熱心解答大家的問題, 真係幫到大家很多！
我有2個問題請教:
1. 1月時我原本打算做第2次IUI, 怎知發現谷了10粒8粒eggs, 於是醫生建議轉做IVF, 把eggs抽出, 醫生曾提及eggs數量多但長得較慢, 後來implanted了三個胚胎, 都是1,2級的, 其中2粒亦成功著床, 可惜9周內都先後停育了。現在我擔心其他的雪胎, 因為醫生曾提及eggs長得慢, 而那2粒初步成功的後來也沒長, 是否那批eggs先天已有問題？其實胚胎的grading是否只關乎表面形態？實際上質素如何是無從得知？
2. implantation 後醫生一直有開2種荷爾蒙藥, 一是白色圓形塞陰的, 另一是藍色Estrofem, 口服和塞陰. 但網上的資料指Estrofem是懷孕忌服的, 請問以你所知, 在IVF療程中使用estrofem是不是常見的做法？會影響胎兒嗎？
A million thanks in advance!!!

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cutecutetown

男爵府

積分: 9496

640^#

發表於 11-2-25 23:19 |只看該作者

Hi Wonderfish,

1. Although your embryos are derived from the same cohort of eggs, their developmental potential is independent of each other. Somewhat similar to a class of students, they are in the same classroom and belong to the same grade, but they vary in performance in different subjects.

You are very correct that embryo grading is only a 表面形態. From experience we know that embryos with poor grading are likely to have poor potential; although those with good grading tend to have better potential, many of them are just good-looking on the outside but bad inside.

2. Estrofem, and also some other common medication used during IVF, are originally designed as contraceptives; therefore, many of them are 懷孕忌服. However, the principle of using these medication is to regulate reproductive hormones so that the intended purpose can be realised. In IVF, the doctors definitely need to control your reproductive hormones in order to tell your body to do the right thing at the right time. That's why if you read the entire information sheet of any drug, it will often say "use as directed" or "consult your doctor before use".

Yes, indeed, many doctors prescribe Estrofem (together with other medication) to IVF women after their embryo transfer. With or without Estrofem is a medical decision, but whether you have Estrofem or not, it is not going to negatively affect the implanting embryos or the fetus if you get pregnant.

cutecutetown

原帖由 Wonderfish 於 11-2-25 17:58 發表
Hi cutecutetown,
你好, 感謝你一直熱心解答大家的問題, 真係幫到大家很多！
我有2個問題請教:
1. 1月時我原本打算做第2次IUI, 怎知發現谷了10粒8粒eggs, 於是醫生建議轉做IVF, 把eggs抽出, 醫生曾提及eggs數量多但長 ...