That's about the follicle number I would expect from you on today's ultrasound; and as I said before, with these follicles or eggs and a normal growing speed, you are making good progress toward your bingo. Most patients, if not all, proceed to egg retrieval with 4 follicles. I am not sure about you, but working in the lab, I beg for quality rather than quantity. Frankly, I rather get 2 good eggs than 12 ugly eggs because "12" is an illusion to the patient, and at the same time, I put in the same amount of effort for a probable failing result, which makes me feel sad too. So, don't be greedy for numbers; rather, hunger for quality and good care from your care-providers.
Yes, if you have a choice of using simple IV sedation (no full anesthetic), go for it; but you really don't have to decide too soon.
I think you may be confused with the "suppression" of using nasal spray. Using suppression (or the long stimulation protocol), it is a suppression of the pituitary glands (i.e. the endocrine/hormonal system) rather than the immune system. While the ovaries produce somewhat similar number of eggs in each cycle, the suppression method (long protocol) as compared to what you are using now (antagonist protocol) are not very different in outcome. In some cases, the suppression method may over-suppress, causing a slower pace of follicular growth and in effect, you need even more injections of Gonal-F to achieve the same no. of eggs. As applied to your particular situation, since you are not producing a lot of eggs, the antagonist protocol is more appropriate. If you were to have used the suppression method, you would have to spend a lot more time and $$ on medication, and yet probably still obtain the same number of eggs and outcome.
You have used "suppression" in different contexts. Cetrotide is the "antagonist" I mentioned above as in the antagonist protocol. What do you mean by "only on day 5/6", and what did you use last time then? I don't think it is less ideal. Tell me what your thoughts were in this one, I have no clue.
Thanks for your reply. You're treating us blogfriend as your patient. I am sure you're not working in the lab I am attending (because cultivating to blast for the remaining embroyos is not their standard).
Firstly, your answer assures me that my doc has used the right protocol (antagonist protoco) that suits my situation.
Secondly, I used cetrotite (suppression med) on day 5/6 of my injection versus the long protocol where suppression med was used prior to the treatment.
Thirdly, it seems that there is no way to increase the number of follicles. From my understanding after several read from this blog, we generate a certain amount of eggs per cycle. If I have say 7 eggs in reserve, the stimulation can only help these 7 eggs to mature. The stimulation cannot produce more eggs. Is my understanding correct?
4. Is there any way / protocol that could help increase the number of eggs?
I want both numbers and quality. haha. You know, I have been planning / thinking how I will have my embroyos cultivate to day 5. No need to plan this given there is not sufficient number. I feel that the more embroyos I have, the more i can "play" around with it using different method.
I need to get a part-time job in the lab to help with income flow. haha.
Hi cutecutetown,
My last frozen egg just inplanted last Saturday and I have been resting at home for the last long weekend holidays. I feel that my lower stomach area has a very mild pain reflection like yesterday and today, I would like to consult you whether this is normal or not? or it's just my overreacted? Kindly share with me.. thanks.
Hi cutecutetown, my m has not yet come since mar2, so I went to see doctor last thur. After u/s, he said that my 內膜is not thin, and he said there's some分泌, so he said there may be ovulation. But according to my past experience, it's unlikely. So I prefer he 通經. Also, he said that since it was difficult for him to put the eggs inside the uterus, so he suggest me 擴宮。what do you think? I don't know what he was doing, but just have some blood for one day and now feel abdominal pain, and fever. Nut I'm not sure whether the fever relates to this or just flu. So should I cotinue to do fet in late may and should I stop the doctor doing the so called 擴宮？
Hi，cutecutetown
I have seen my new doctor on 26 apr，she said that it will be fine and can start new IVF next cycle if it will stop bleeding on／before 5 May
At first, I was full of confidence that I can recover before 5 May（ie. 2 weeks after the embryo release naturelly）
since I just release some brown/yellow liquid on 28ㄧ30 Apr，now is bleeding again in sharp red color from yesterday
but no painful in my uterus
1）Is it abnormal ？
2）Is it mean that I may need to take medicine to clear it
3) I take Chinese medicine last saturday and sunday，will it extend my bleeding ？
When can I take Chinese medicine 去調理？
4）I walk in hurry these couple of days , am I wrong？
I just failed my ivf today. I get married last year and soon after I get married, I accidentally found out that I got very very low AMH (1.85 pmol). I was very shock as I have always been a healthy person, never did any surgery and still have regular period. I was only one week passed 34 when I received my result. I was in great panic and rushed into IVF even though i have only been trying naturally for a few months.
For my 1st cycle, my day 3 FSH was already 14.3 and my doctor was pretty surprised given my age. I was given 300iu of gonal-f and started adding centrotide after 5 days of stimulation. Unfortunately, I only got 2 mature follicles and we decided to cancel the cycle.
For my next cycle, my FSH decreased to 7.2 and doctor changed to 450iu of menopur. Again, i got only 2 follicles and we decided to go ahead as it's very likely that i won't be producing more than that. However, at the day of retrieval, only 1 is mature. The egg got fertilized and became a grade 2 4 cell at day 2. Since my doctor suggested me to accumulate more embryos in the following cycle and put them all back in one transfer, we froze that embryo at day 2.
For my 3rd cycle, doctor changed back to gonal-f but increased dosage to 600iu hoping to push more eggs out. However, u/s only showed 3 eggs on the day of triggering shot and ended up only 2 of them are mature. Again, both eggs fertilized and became grade 2 4 cell at day 2. Since i was asked to perform an urgent overseas assignment at work during that cycle, we didn't do the transfer and froze those 2 embryos as well.
For my 4th cycle (i.e. the last cycle i just failed), i originally planned to do fet only. However, antral follicle count showed 7 follicles which was the best i ever had. So doctor suggested doing stimulation as well (gonal-f 450 iu). During my last doctor visit before retrieval, my E2 suddenly dropped from 9xx to 6xx and was told by my doctor that it wasn't a good sign. Anyway, we decided to still go ahead with the retrieval and out of our surprises, we got 5 mature eggs this time. At day 3, i got 1xgrade 2 8 cell, 1xgrade 2 9 cell, 1xgrade 2 6 cell and 1xgrade 2- 6 cell. Doctor decided to transfer the 8 cell and 9 cell. Given my age and the quality of my embryos (i was told by the nurse that they seldom give grade 1 in their lab only like once in a few years), my doctor's hope for this cycle was relatively high. Unfortunately, my blood test today indicated that i was not pregnant.
In short, I still got 5 frozen embryos (3x grade 2 4 cell, 1xgrade 2 6 cell and 1xgrade 2- 6 cell). I planned to do my FET next cycle and i got the following questions:
1) given that my E2 suddenly dropped in the last cycle before retrieval, does it indicate that my eggs are of poor quality?
2) i heard that embryos should ideally have 8 cells on day 3, does it mean that chance of my day 3 6 cells embryos are lowered?
3) i was told by my doctor that even though my egg number is very low, he is quite happy with the quality of embryos i got. His suggestion is that even if i failed FET of these frozen embryos, i should still have reasonable chances of success by doing more fresh cycles. However, from what i read in the internet, success rate for poor respondents like me seems to be very very low. I am not sure if i am just wasting my effort and money by doing back-to-back ivf cycles like this. May i know what's your view?
4) I am fine with the concept of egg donation and in fact i found a friend who's willing to donate her eggs to me. However, my doctor thinks it's too early for me to consider this. Since donor egg cycle do not guarantee success either, i would like to save some $$ for my future cycles using donor eggs and hence i was thinking of moving to donor eggs if i failed with the frozen embryos. Is it really too early?
Sorry for the long message and thanks in advance for your time.
1,2. Yes, Cetrotide is used in antagonist protocol to suppress an unexpected LH surge. Cetrotide may be given to you daily (at a small dose) or just one shot that lasts for a few days before another one is needed; both ways work well.
3. More or less true. Each woman was born with a fixed number of eggs. When we enter puberty and have our 1st menses, a handful of eggs are being recruited into each menstrual cycle. We don't know how the body picks the handful each time, but it is logical to assume that the body picks the better ones when we are young, or reproductively active. The handful of eggs in each natural cycle will be encouraged to grow by our own hormone; so by ovulation time, only one wins the "competition" while the others are selected against (they simply die just like dead cells, the body is good in "cleaning" them up). With IVF, you have those painful daily injections to give these eggs a chance and trying to have a win-win situation. (a) In some women, the handful of eggs respond reasonably well to the injections, grow, and are retrieved. (b) In some, all eggs grow but not at similar pace; still some usable eggs are retrieved. (c) Yet in others, some eggs don't like to respond very much, but still, a few eggs will still be retrieved.
In answering your question, generally yes, the number of eggs in that handful is somewhat fixed. The stimulation dose (your 375 iu as compared to, say 150iu) 'feed' these eggs so that they grow; so you can imagine the dose can't be too small, and yet too big a dose is unrealistic. Then, how these eggs respond is also important. It is very common that a small amount of eggs in the same cycle will not respond very well. They are the smaller follicles. Depending on the follicle size, these eggs may catch up with the others and turn up to be mature and fertilisable at the time of egg retrieval.
4. There is almost no way to increase the quantity in that "handful"; just like if your hand is a fixed size, there are only so many pieces of candy your hand can hold. However, how to make this "hand" hold good candies? I wish I have the magic answer, but it seems that it all begins with a healthy lifestyle and a balanced diet. A healthy lifestyle includes your stress level, sleep quality, and amount of moderate physical exercises. A balanced diet means a normal diet with perhaps some supplements. This is important for long-term, not just by doing it 2 weeks before ivf treatment.
Yes, everyone wants both quality and number; but it only happens in a rare bunch. And to throw you some cruel facts, when a woman has both, she may have a thin endometrium or something else that causes poor or no implantation. So, be careful of what you wish for, and be happy with what you have already got.
cutecutetown
點評
littletwinkle
Why does a woman has both quality and number may have a thin endometrium?
發表於 11-5-3 23:53
Did you mean you "bingo", or you had an embryo transferred last Saturday? I am not sure if the pain simply means you had over-eaten a little over the long weekend holiday and your intestines are "complaining", or if it could mean something else. In any case, if the pain persists, go to see a medical doctor.
I don't have much knowledge of what is actually being done in 擴宮 (dilatation), but some patients need it because it is nearly impossible to put the embryos into their womb. Advising you as a friend rather than someone with the professional knowledge of 擴宮, I still suggest you give it a try. It is not a compllicated procedure; and for those patients who had it done, they had easier ET. An ET carried out non-traumatically has better chance than an ET which is traumatic (which makes you very painful, due the the various special tools to straighten your cervix, transverse the cervical canal, "forcing" through into the uterus, etc.). Hopefully your doctor will schedule the procedure to fit your FET date.
You must have had a very difficult ET last time. The dilatation procedure will likely help; if not, it hopefully helps to achieve the same effect as 通經.
"Why does a woman has both quality and number may have a thin endometrium?"
-the sentence above is not complete, I had "or something else that causes poor or no implantation".
I was saying that just as an example. It indeed happens in some cycles; not common though. My point is, along the road of subfertility, and also other roads in life, we can't always win. I wish all my patients and all those I have talked to here, to have a complete family; but both you and I know that this can't happen in all. As long as you have tried your best (I am pretty sure you all have) , "be happy with what you have already got". For those who have achieved the "goal", be thankful. For those who do not, still be glad that you have been here and walk out with no regret.
cutecutetown
點評
mother2be
Cutecutetown: I agree with your last two sentences very much. but how many times / budget should we set until we call it quit? For those who're not successful and have invested a lot tend to continue
發表於 11-5-4 09:51
Dear cutecutetown, thanks. The dilation was done on thur, but I have fever and abdominal pain on tue, would these be cause by the dilation? Or something else given it's already a few days. Would thereby any inflammation?
點評
cutecutetown
Yes, it's possible. My guess is that the dilatation caused you abdominal pain, but the fever needs to be taken care of. You have a real reason for at least a quick checkup with your doctor.
發表於 11-5-4 11:09
Dear Whicheng, my case is similar to you. I feel that i am a poor responder to the stimulation even though i have 7 anatal count and low FSH. I only generated 4-5 follicles each time. My doctor also asked me to freeze those eggs - which i don't prefer as the defreeze process may destroy the eggs a bit. I don't have good experience with FET. My doc also use similar dosage as your doctor.
It seems that we are visiting the same clinic. Is yours reproductive healthcare?
1) I am just being a little paranoid and probably over-worry; did your new doctor do an ultrasound scan on your abdomen during your visit on apr 26? I think you should at least call and consult your new doctor if you are still bleeding.
2) Too early to say, sometimes the bleeding may take longer because this is not a normal period, it is an induced abortion if you have taken medication. This is also one of the reasons to check with your new doc again.
3) Maybe, I don't know what Chinese meds you had. Tell your doc about taking Chinese meds too. I am always worried when patients "secretly" take Chinese meds while on ivf treatment; I just don't know what unknown effect the herbs may have after interacting with the western medicine. Taking Chinese medicine 去調理 before or after ivf is fine, as long as you tell your ivf doc about it and with her support.
4) No, there is nothing wrong with you by walking in a hurry. Is that the work pace of Hong Kong people anyway? I guess you are just uptight. You can't really rush things when it comes to fertility; I know time is tight, but you can afford a little time for your body to come to its usual state. Try to relax your mind first.
This is my first time writing in this blog and it is indeed thankful to have you the expert here to give us comfort and the valuable advices.
I will turn to 40 this Sep and have just done my 2nd IVF, put in the embryo on 30 Apr. May I ask you one or two questions here?
1. I had got a very little bit of blood came out after 抽卵 and I understand this was because of the tiny wounds caused by 抽卵. It continued on the day of putting in the embryo. As I have started 塞約from that day, the residue came out in light browish for which I thought is the blood mixed up with the residue. The "very light bleeding" stopped on 1 May. My concern is would the embryo be "flushed out" with 血水(即使是非常少量) while the embryo was just put in?
2. I have done 3 times IUI and 2 times IVF and always believe I have met a very good doctor. However I heard that the lab itself might play a key role in contributing to the success rate and that one of the famous hospitals in HK has the particularly good lab when compared with others. My hubby is thinking to turn to that hospital for the lab if we fail this time. Would you think this is something sensible?
Yes I read your posting and I also think we are in a similar situation. I feel so hopeless given my poor responses and really don't know how much longer I should try. Anyway, I am not too sure if it's good to disclose my doctors name here. Maybe you can email me to talk? My email is [email protected]
Whicheng
點評
mother2be
Whicheng, i sent you a personal message on your baby-kingdom's message box. please check, i am eager to know which doctor you use. i hope i am wrong.
發表於 11-5-4 11:11
Sorry it took me a while replying those messages before yours, hope it's not too late in answering yours.
1) I can't say your eggs are of poor quality just because of the sudden E2 drop. Just the cycle itself is a little odd with 7 follicles compared to previous cycles, but I agree that you should still give it a go. I wish the E2 didn't drop so that your follicles could grow a little further; but we did have cases with sudden E2 drop, proceeded to retrieval, and things were fine. The eggs might be of poorer quality - probable but not absolute. I can't tell whether it's the egg's intrinsic quality causing the E2 drop or the E2 drop causing poorer quality. Nevertheless, 5 out of 5 eggs fertilized and the 5 embryos looked reasonably well; that alone was a very good result.
2) Yes, the ideal is 8-cell, but I can't say no more because I have too many cases bingo and give live births by ETs or FETs of 6-cell.
3) Yes, I am happy with your embryo quality as well. If you have unlimited financial support and also emotional willpower, doing ivf cycles may eventually get you there. However, for the present moment, my suggestion is that your frozen embryos should hopefully give you 2 rounds of FET if they thaw out fine. Try to use them up as soon as you can; if they still get you nowhere, it may not be a bad idea to rest for 2-6 months, recuperate and re-think what you want. The road of ivf is costly and time-consuming.
4) It will still be a while before you come to egg donation, but it is good that you have given it some thoughts. Has your friend married, and/or have a child? Be aware that egg donors need proper counselling and also medical assessment, and they may opt out after knowing what egg donation means to them. But assuming your friend passed all the hurdles and is still happy to donate, I don't think it is too early to at least consider a donor cycle. You may still want to try your own eggs for 1 or 2 cycles; but I think that's the last line beyond which you should seek other options.
A last note on your AMH, which is not a test commonly available in HK. However, it is a more consistent parameter in assessing ovarian response as compared to day-3 FSH. So, in a way you are lucky in knowing your ovarian response is reduced and seek ivf "earlier" in your fertility journey. I wish you best of luck in your upcoming FET!
cutecutetown
1. Your concern is valid, although in reality it is not likely. Besides, the bleeding is from the wound(s) in your cervix, which is downstream from the womb; in other words, the blood has not been in contact near anywhere your embryo was placed. 塞約 also happens to be in the cervix only, so some of the residue was probably seeped down along with the blood. As for the actual medicine in the piece of pessary, it should be absorbed already. The residue you found was probably the inert (inactive) ingredients that made up the bulk of the 塞約.
2. It is hard to believe that a good doctor is not attached to a good lab. And honestly speaking, success rates still largely depend on the woman's age. It is a little difficult for me to comment on which lab(s) in HK is better, simply because I think they are all comparable. While the choice is still yours, I would suggest you follow your own instinct in choosing. Don't just turn there because the hospital is famous; make sure you feel good and comfortable with your attending doctor who will be looking after you during the ivf progress.
While you two can support each other, I am afraid your situations are very different. While Whicheng truly has 2 eggs/3 eggs each time, and with a proven high day-3 FSH (let alone the AMH result), mother2be has a very different hormonal profile. Treatment methods may be similar, but the care should be individualized. It is dangerous to have the "one-for-all" assumption.
In earlier comments, mother2be asks how many times/budget should we set before we call it quit. Good question, and this can be different for different people, because we all have different tolerance to budgeting, emotional readiness for failure, and considering alternative options. I can't give you a "golden" rule to adhere to; but assuming you have reasonable tolerance in all areas, my very personal suggestion is that "3 IVFs" should at least be a landmark. Whether you have embryos to freeze or not, after doing 3 IVF's with egg retrieval, it is a good time to evaluate where you stand and whether you want to change course or not. For younger patients, the 3 can stretch a little over the course of time; for older patients, do not wait between cycles for too long. In any case, don't just put in time and effort blindly and endlessly; how to walk this fertility road is a very personal take, assess your chances wisely and carefully.
Thanks so much for your prompt reply, cutecutetown.
For Q1, I just always think the wounds are on the ovary and the blood must pass through the womb all the way to cervix. I am so wrong?? -_-!!
For Q2, yes I fully understand woman's age matters the most in the success rate. But you know for the desparate couples like us, getting old and with all previous attempts failed, we tend to try evey "possible" way that "may" give us a little more hope. Surely will discuss with my hubby seriously on the topic once this 2nd ivf attempt fails (haha, in fact i am not confident in getting it done in this attempt : ( but yet to give up!) What I now start worry is my doc will give up if I fail this time. Would you think the docs will do so if they somehow consider the patients have very little potential to bingo via IVF?
Thanks again for your time and kindness in answering the Qs.
Cheers,
Siushuk
點評
mother2be
your doctor won't give up on you if you're on private line as long as you continue to pay for the treatment. why would they give up on you if you diligently pay your fee every month?
發表於 11-5-4 14:21
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