Thank you, worked 2 days over the 4-day holiday weekend, not so bad for an embryologist :)
1. We need to compare apples to apples here. In your case, your husband's sperm fertilized your eggs alright; if the same sperm were used for ICSI with your eggs, the same good fertilization rate would result. Although it is impossible to speculate, your embryos shouldn't look better or worse as a result of a different mode of fertilization.
It is true that the embryologist selects the best-looking swimming sperm, but I really don't know if it is the "strongest". What you read on the internet ("ICSI gives better quality than traditional IVF") may apply to cases where the sperm is not good enough for traditional IVF. In those cases, not all eggs may be fertilized, and the fertilized ones usually don't develop very well.
The small hole created by our general ICSI technique is way too small to be considered assisted hatching, at least in my opinion. Assisted hatching makes a hole, a slit, or a thinned area on the shell of the embryo.
2. Assisted hatching is often performed on late day-2 or day-3 embryos. The procedure itself is generally safe and should not increase the rate of miscarriage. However, what your doctor meant could be that in embryos which normally would not be able to hatch out, they might not be developmentally competent and therefore, even by letting them hatch and implant, they would not continue growing and give rise to a miscarriage.
3. Yes, transfer day 3 and culture the remaining to day 5 can be an option. You either have your ET on day-3 or on day-5, not on both days.
Yeah, finally one of my ideas work (that is I will be transferred a day-3 embroyo while having the remaining embroyos to continue to cultivate to 5-days for freezing). This option also sounds very viable to me.
I feel that my doctor does not put into much thought of my case. I have to rely on myself to come up with ideas. I think I have given lots of ideas to my doctors, and should be charged at a discount for my 2nd IVF. But I don't dare to ask for this discount as I am afraid my doctor will ask me to find another doc.
I started my ivf treatment and just informed by the nurse that my Hormone level is 330 (day 3) which is ok for taking the injection continuously. I asked her am I in the marginal and she just said that if it is not okay, i have to stop the injection. I want to know more about this. What is the normal range then? Gratfeul for your advice. Thanks.
Believe it or not, the idea of transferring day-3 embryos and culturing any remaining to day-5 is part of the routine in my lab for some patients. Depending on how good the communication is between your doctor and the lab, many doctors will listen to recommendations from the lab; so, it is not quite the doctor not thinking of ideas to help you, he/she has to include the lab as your treatment is in progress.
I don't think your doctor will ask you to find another doc; if he/she really would say that, then you may truly need another one
I believe the hormone (330) is estradiol, which needs to be low in order to start ivf injection. Your level was ok to start treatment, as your doctor has already started you on injections. Estradiol will become more important and indicative of your folliculuar growth later; generally, your doctor will use this information, together with ultrasound findings and levels of other hormones, to decide on what to do with your treatment.
Look forward to some good news from you :)
cutecutetown
cutecutetown,
What is assist hutching? Is it needed for everyone for easy implantation? Will all labs do this process? The thickness of the wall of embryo affect implantation? I saw from the screen the my embryos are having very thin walls, still need assist hutching or "thin wall" is just my illusion?
Assisted hatching (胚胎輔助孵化) is a laboratory procedure in which the "shell" of your embryo is either breached (i.e. open a hole) or thinned. Most labs use a laser to do the procedure, while some still use acids or mechanical method.
My lab has special criteria for such procedure because we don't see all patients need it to get a bingo. Generally speaking, I only offer it to those patients who have failed at least twice with good embryos, or to those whose good embryos have "thick" shells. The logic is that the shell may have prevented the embryo from hatching out of the shell and implanting into the womb. In this selected group of patients, still not all of them get pregnant; for those who do, we really don't know if it is the assisted hatching that helped or if the patient simply gets lucky to have competent embryos. Remember that not all good-looking embryos are developmentally competent; so, assisted hatching won't help in cases where the embryos are truly no good.
I believe all labs in Hong Kong has assisted hatching available; however, some doctors/clinics include it as a routine service, while some only offer it as the lab sees fit. When you saw your embryos have very thin walls, then they were probably ok. You will be amazed to see those with thick walls, which I see every now and then in the lab.
I have had my 4th day of Gonal F 375IU injection. Tomorrow, I will see my doctor to see my follicles development. I am 31, going to be 32 real soon. From information in this blog, I learn that 375IU Gonal F should give a normal 33 woman 15 follicles approximate.
I am thinking of changing a doctor at this stage because I am losing confidence in my doctor / lab. Is it advisable to do this at this stage? Reason being I feel that I am the one who comes up with plan and needs to ask a lot of questions in order to get an answer.
Having said the above, is it better to continue with this doctor at this stage to minimize complications.
My plan to refine from last process is to
1) use day 3 or day 4 embroyos.
2) use assisted hatching
3) use ICSI.
I see many people bingo at first time. With my age and rather straight forward subfertility reason, I should have bingo last time.
1. Yes, I have heard.
2. If you will go for a 3rd ivf, there is no harm to try and see if the endometrium thickness may improve after this method.
3. Your embryos didn't implant was probably due to the thin/borderline endometrium, although I am still a little concerned with the "shadows" of your embryos. Not sure if co-culture will help in your case; and a long time ago the IVF centre at Queen Mary Hospital had it available, not sure if it continues to offer it.
The number of follicles for any woman of any age is not governed by the dosage of Gonal F; the whole concept is simply wrong. There is no way to estimate this number without seeing the ultrasound.
You are thinking too much in many aspects. If you don't tell here, I (as ivf providers) don't even know that you will venture that far. While it is understandable that questions will arise along the ivf journey, do not attempt to come up with your own answers and dwell in negative thoughts. At this stage, it is too late to change doctor/lab; and trust me, your doctor/lab does care about you and your embryos. As we take care of many patients at various stages of their ivf everyday, we can't have sit-together talk time with every couple; so, generally speaking, no news from us is good news.
Comments to your plan:
1) Use day 3 embryos.
2) May consider assisted hatching.
3) Based on last ivf, you don't need ICSI. But ask about it if you feel more comfortable.
You see many people bingo at 1st time, meaning there are also many who failed. It is good to see you have confidence, and I believe in you too. However, it is not uncommon for those who failed 1st time will succeed upon the 2nd or 3rd time.
Thanks for your reply. So what govern the number of follicles if it's nothing to do with the medication used?
How come at one time when I took lower dosage, I produced 7 follicles, and at the other time, I produced 12 follicles (after stronger dosage is used)? As such, I logically link the dosage amount with the number of follicles.
I have FET HRT this cycle. Doctor asked me to take 14-days Estradiol from Day3 and then come back for ultrasound scan and blood test on Day17. If endometrium thickness is okay, FET can be done 3 days later. I want to know in case ovulation takes place before I come back hospital (Say Day 13-14), will my FET be stopped due to 子宮內膜過早黃體化? I asked this because I read some web info saying 放胎時間要與子宮內膜功能同步, 否則不利/不能夠著床.
Some doctors do antral follicle count just before starting stimulation/medication to estimate the number of follicles a woman will have. Then, by giving injections, the hormones encourage all the follicles to grow. I will give you some "homework" to actually look up how an egg grows from day 1 to being ovulated in a normal natural 28-day cycle. By doing so, you will hopefully have a better picture of what occurs naturally and how ivf "manipulates" this cycle through the use of hormones, ultrasound, and lab work.
This is a hormonal replacement cycle in which hormones will be used to "take over" your natural cycle; in other words, because you are only given estradiol, your endometrium cannot be 黃體化. I reviewed your past posting and remember that your cycle was a little long after your ivf. By using HRT, you don't have to worry about not ovulating, or progesterone too high, etc. Your doctor will have better control in timing your body, and together with the ultrasound on day 14, when things look right, you will probably be given progesterone as well. At this point your womb should be totally in synchrony with the embryos.
This method is quite common in western countries; I suspect that we, being Chinese, are more conservative and still try to stick to the "natural way" whenever we can. In terms of bingo success, FET HRT as in centres overseas is good; the same is true in my centre. So, you need no worry but relax.
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