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發表於 11-5-11 14:42 |只看該作者

回覆 cutecutetown 的帖子

Gentomama: many congratulations to your first milestone. Transferring blast seems to have a higher implantation rate.

New comer: you've so many embroyos to work with, 7/20 to blast stage is a good result. Per my doctor, the embroyos not reaching blast stage could be do to the lab environment. The ones that do not reach blast stage do not necessary mean the embroyos are not healthy. transferring blast has higher success rate than transferring day 3 embroyos. Let's hear what cutecutetown say.

Cutecutetown, doctor did not suggest my remaining 2 embroyos to cultivate to day 5 as she scares that I will have none to freeze on day 5. All along our dealings, she always hesitate to cultivate to day 5. My instinct says that the lab is not very capable to cultivate day 5 blast even though they can theorectically do it.

Today is 2 days after my transfer, I felt my stomach is a bit "kuk". Went back to doctor to check my uterus lining. It increased from 10mm on the day of transfer to 11.9mm today. So, I think the "m come" feeling does not really indicate m is coming. Looking at this increase, does it mean that my M is not likely to come yet?

Secondly, doctor said the my uterus lining shadow is not perfect (i.e. all white is perfect). She prescribed some Duphaston to me. Does uterus lining not perfect has a great impact on implantation? I consider the embroyo quality has more to do with implantation than uterus lining (provided that the lining passed the thickness threshold).

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PWYO7657

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發表於 11-5-11 15:21 |只看該作者

回覆 cutecutetown 的帖子

Dear cutecutetown

thank you so much for detailed explanations. actually, i have 30 to begin with and there were 24 Day 3, i froze 4 Day 3 with remaining 20 to go for day 5...then only 7 left. therefore the chance of going to day 5 is only 35%. quite low, right? is that due to bad quality of eggs?

Anyway, notice that you mention that the success rate of transferring 1 or 2 embryo is quite big. just wondering what is the difference in success rate. actually, i am 35 but really want to avoid twin, therefore, i want to go for 1 day 5 embryo transfer. but seeing that the success rate differ quite big, so i have some hestiation about that. what's your suggestion? actually, this is my 1st FET and therefore i have no idea of how myself response to the FET.

thanks so much on your information.

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GentooMama

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發表於 11-5-11 15:57 |只看該作者

Dear Cutecutetown,

I always appreciate your frankness. I do understand this is a very critical period for me. Psychotherapy actually helped me a lot in facing this. I understand due to my age, it will not be a surprise to have another miscarriage because of the genetic problem. Of advanced age. I still feel glad that at least I can have a second chance. Hope eventually at least one turn out to be good. I have also told myself pregnancy or even a live birth is just a beginning of a tough journey. We wil face numerous problems in raising a kid. If we can't face these now, how can we face the challenge ahead. So though I am a bit scared, I am calm.
In QM, they don't check HCG unless they suspect an exotic pregnancy. I have asked about the bleeding and they said the medication dosage is enough and so we can only relax and wait. They also explained most of time there is no reason that can explain the bleeding. So I am now taking bed rest at home and let God do the rest! Sure hopefully I can tell you in three weeks time the 2.5 milestone achievement! You are really so nice and comforting to all of us.

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GentooMama

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發表於 11-5-11 15:58 |只看該作者

Sorry it should've ectopic pregnancy not exotic. Haha!

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cutecutetown exotic is not bad, better than ectopic

發表於 11-5-12 01:02

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bigears

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986^#

發表於 11-5-11 16:16 |只看該作者

Hi Cutecutetown,

I have done the ET on Mon and that late afternoon got diarrhea, went to toilet for three four times. Tue and today is OK, but quite worried whether the diarrhea would have very bad effect on the success rate.

Thanks.

Bigears

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cutecutetown See if my earlier replies #810,#817 help (dated around 2011-4-5) 發表於 11-5-12 01:50

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987^#

發表於 11-5-11 23:46 |只看該作者

回覆 ychoho 的帖子

Dear ychoho,

Thanks for your caring. Usually I try not to delay my replies because jm's are probably waiting. Due to the recent busy "traffic", I may respond a little slower than before. Remind me if I miss your message, I generally follow the order of your posts.

Back to your questions la. Hm... be careful when interpreting "putting 1 or 2 embryo makes a big difference in success rate, but not much difference between putting 2 or 3". The other jm was young, with good embryos, failed one fresh and 1 or 2 frozen ET previously. If you refer to the same post, I also mentioned about twins and my view of having singletons would be the best.

So, it really depends if you get some good embryos after thawing. Usually, at least in my lab, we take into consideration all these factors right from the moment when we freeze your embryos. We often freeze 1-2 embryos per container, very rarely 3 in a container. We try to accomodate all possibilities if one day you come back for the frozen embryos.

Now, with your remaining embryos, I hope your lab will thaw them such that you will have at least 2 good embryos for transfer. In other words, if they thaw 3 and at least 2 were good, they should save the remaining 2 for next FET; if they thaw 3 and only 1 is good, then thaw the remaining 2. In any case, transfer up to a maximum of 3 embryos, which is quite reasonable as you had done the same last time. Therefore, the decision is not really based on whether you want any embryos left behind or not; rather, it should be practical to give you a reasonable success chance right at this moment.

And you still have a booking with a public hospital in Sept/Oct? I think you are well-"secured", at least from now till your FET time. Good luck and I wish you bingo in this coming FET :)
cutecutetown

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發表於 11-5-12 00:38 |只看該作者

回覆 mother2be 的帖子

Hey mother2be,

You disappeared for a few days and come back with even tougher questions for me...

Sorry I have never heard of checking the uterine lining a few days after ET. With my minimal knowledge in uterine morphology after ET, it should not look perfect (the 3-layer appearance). I would therefore take your ultrasound scan as a normal finding, but again, I am not a medical specialist, so only take my view as side opinion only. Did you have a blood test as well? What type of luteal phase support are you on right now (do Crinone, Endometrin, or injections sound familiar to you)?

In any case, your M won't come so soon because you are on luteal support medication. I have to agree with you that embryo quality is my no.1 importance because you have normal uterine thickness.

As for your frozen embryos, I can't blame your doctor if she doesn't believe in a lab's culture system. From another angle of seeing this, if your 2 remaining embryos are good, it doesn't really matter whether they are frozen on day3 or day5 because if we culture them, they will still become blasts and got frozen on day5. On the other hand, if they are no good, freezing them on day3 might have cost you extra $$ for storage plus a wasted FET preparation. This is the theory, while my lab can do day5, it doesn't mean all labs can do the same?!

Last word about "

er my doctor, the embryos not reaching blast stage could be due to the lab environment. The ones that do not reach blast stage do not necessary mean the embryos are not healthy." As a lab person, I need to defend ivf labs in general that the facilities nowadays are very much designed as a controlled environment. I would not have made such argument if the lab were to operate the same way as some 10-20 years ago; but we evolve with the industry and doctors need to evolve their mindset and prove what they claim as well!! Don't just pass the blame to the lab, simply admit that you rather want some psychological peace while your patients can still afford to pay the freezing charge as a little "insurance".

I am just taking this chance to air my frustration, and frustrations of embryologists in general. This is absolutely not your fault, if you worried. Instead, you gave a good chance for me to stand up for myself and my colleagues. I should be thankful for this chance because I would have kept it inside otherwise.

Cheers, cutecutetown

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989^#

發表於 11-5-12 01:01 |只看該作者

回覆 PWYO7657 的帖子

Dear PWY07657,

Re-read my last reply; 35% is a good blast rate. Donor-egg cycles (donors' average age of <30yrs) have an average blast rate of 33% (1/3), so, your 7/20 is as good as young egg donors!

Since this will be your very first ET, want to avoid twin, and you are only 35, I would recommend you to go for one day-5 embryo transfer. The success rate between the transfer of 1 and 2 embryos also depends on your age, the no. of previous ET attempts, your subfertility cause(s), and other factors. Be very cautious when you read and interpret my responses to other jm's.

Rather than keeping it like a secret, many studies have shown that transferring 1 vs 2 embryos (I take them as good embryos with potential, but in the lab, we only grade them by their appearance alone) gives similar live birth rate. The women in these studies are mainly the good-prognosis group, i.e. young, not with very complicated fertility history or background. Then we also need to balance the costs/burden on the pregnant women too, healthcare costs, complications associated with multiple pregnancies, premature births, long-term effects on premature babies, etc.etc. That's why I also mentioned previously that I think singleton birth is the best ..... but sometimes, singleton arises from transferring 2 embryos. So, IVF is a very individualized care; one size cannot fit all.

cutecutetown

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Chocobean

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990^#

發表於 11-5-12 04:04 |只看該作者

Hi cutecutetown,
can you share your opinion on this study reported today?
(http://www.theglobeandmail.com/l ... ggs/article2017576/) It sounds really promising, but is it too good to be true?

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bigears

積分: 326

991^#

發表於 11-5-12 09:18 |只看該作者

Thank you cutecutetown, read your reply 817 and 810, very soothing! My lab only does Day 2 ET, so now reading your Day 5 ET amazed me!

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mother2be

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發表於 11-5-12 09:56 |只看該作者

回覆 cutecutetown 的帖子

Hi Cutecutetown,

I am glad you took this opportunity to vent your view about lab environment. All along the treatment with my doc, I told her that I want to have my embroyos cultivated to blast. I have been planning how to do it. In view of just a small amount of embies, it's natural to transfer the day-3 ones. On the day of transfer, I asked the doctor to cultivate the remaining 2. Her sincere advice is "not to".

Sigh, I am being cheated for HKD5,000 frozen fee. day 5 cultivation costs only HKD2,000. If none survive, then I can save my frozing fee. But she catched my psychological side and pointed out I may not have any embies left. To buy that insurance, I went ahead with day-3 freezing.

Today is 3 day after transfer, I have slight abdominal cramp (silightly similar to M come but not exactly the same, it makes me want to do "big business" in washroom). Also, I have a lot of watery discharge (not vaginal discharge). It is watery unlike mucus. Doc said it was due to the injections.

If I fail this time, I will stop this IVF for a while. I am drained mentally and financially. It burns cash quicker than anything. I think I will face the following dilemma. If bingo, all the money spent of course is worthwhile. If not and if I stop the treatment, all the effort and money spent will be really in vain. In order to achieve our destination, I thinkthis thought will drive me to continue the process until bingo given I am a persistent person. Unlike persistency in studying, this persistency costs us a fortune.

Luteal Phase: I am currently on 1) endometrin vaginal tab twice every day. 2) ovidrel injection twice (on day 3 and day 6). That's all I have for my luteal phase.

Just learnt on the news that Suki Tsui (the artist) is 5 months pregnant. Sigh...everyone is moving on...

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993^#

發表於 11-5-12 10:24 |只看該作者

回覆 Chocobean 的帖子

Hello Chocobean,

Thanks for sharing the news piece. On one hand, it is good to learn about a magic number (which I don't think is true anyway); on the other hand, it will be very very bad if the number were to be true.

If you read the details in the news, the norm for young women is 10-12 eggs per ivf cycle. Indeed, at least that's the mean no. of eggs retrieved per cycle in my centre and many centres. The number 15, which I believe, is an after-fact. In other words, for those who can give 15 eggs, they have to be at least a good responder to ivf stimulation. If they are a good responder, given the number of eggs and derived embryos, of course they have a better success rate. It's almost like a Chinese saying, "everyone knows your mom is a woman". (I don't mean to criticize the study, which has a huge sample size of 400,000 cycles. Just the logic follows naturally and probably won't need to narrow things down to just one number.)

I also notice that it mentioned the decline of live brith rate in cycles with 20 eggs or more. I recently read a quick scientific report about young egg donors who produce 20 or more eggs compared to those who produce <20. In the report, it also came to the same conclusion that those giving >20 eggs have lower success rate. And based on my own experience, I also find that women with 20+ eggs indeed don't do very well as compared to those with fewer eggs. It could just be my over-expectation from these "super good" responders, or indeed there is something bad about having too many eggs.

In any case, the number of eggs retrieved is just a reflection of how well a woman responds to an IVF stimulated cycle. By logical deduction, the more eggs (not overly excessive) you have, the more embryos that can be produced. However, we also have the quality versus quantity issue, especially in women of more advanced age. We should be glad with this news article that it didn't spell out a number which is the cut-off, below which nobody gets pregnant. (I believe that number is zero.)
cutecutetown

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Chocobean

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994^#

發表於 11-5-12 10:52 |只看該作者

Wow, thanks for your insight on the piece. Based on their large sample size I was thinking that, darn, they might be on to something. But wow, if the norm is only 10-12.....then yeah it's just kind of obvious that those who respond well will respond well. =)
I hope this piece doesn't become a sensational push towards higher drug dosages and push for more than the lady can provide. Thank you again.

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PWYO7657

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995^#

發表於 11-5-12 13:40 |只看該作者

回覆 cutecutetown 的帖子

Dear Cutecutetown

thank you very much for your support to the decision.

however, after reading the 'golden rule', this seems to me that my success rate is quite low as i had PCOS and therefore had 40 eggs retrieved (30 are mature). i thought that the quality of my eggs/embryo is not as good as those with fewer eggs which may reduce the blao rate and therefore the success rate. same as other jm, going for ivf is a very painful decision & process. need to get myself prepared....

thanks.

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cutecutetown The 'golden rule' is, as long as you have one good embryo, you have a chance. To make a baby, all you need is one, don't be greedy. 發表於 11-5-12 16:22

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996^#

發表於 11-5-12 16:17 |只看該作者

回覆 mother2be 的帖子

Dear mother2be,

IVF is somewhat like stock investment - return is not guaranteed; therefore, do not keep putting time and money in. You really need to set an endline upon which you will accept whatever the result may be. Although you are still far from this desperate point, it is not a bad idea to think of how to handle the worst scenario should it arise.

Back to more positive thinking. Your luteal phase support is fine, simply make sure you do not miss any dose.

Note on those pregnancies reported from celebrities. Don't try to compare to them, because you can never be sure whether they conceive naturally or through ivf; and you never know if they have used donor eggs/sperm or not. Simply be happy and confident because you know how much you have been through and how much you should be proud of yourself.

"Add oil" for you and all jm's.
cutecutetown

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mother2be

積分: 2731

997^#

發表於 11-5-12 18:11 |只看該作者

回覆 cutecutetown 的帖子

I wonder why a lady who conceive naturally does not require luteal support, while luteal support is so important for IVF people. I would assume aside from the fertilisation process is different, once the embroyos are in our uterus, the process is same as natural conception. So I would think luteal support is in fact not too important. Am I right?

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Whicheng good question, i always got the same question in mind too. My doctor even suggested progesterone shot in oil for the first trimester if bingo. 發表於 11-5-12 18:29

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998^#

發表於 11-5-13 00:42 |只看該作者

回覆 mother2be 的帖子

Dear mother2be & Whicheng,

Oh dear, you gals want a biology class. A short version follows: Remember that in a natural conception, all hormones (estradiol, LH, progesterone) are at physiological levels. When the single egg of the month gets ovulated, the empty follicle will shrink to become the corpus luteum, which produces progesterone to support the endometrium. If the egg is not fertilized, the corpus luteum regresses, progesterone level drops, and menses begins, giving you the bleeding period of a menstrual cycle. If the egg gets fertilized and the resulting embryo implants, the embryo produces HCG (the key hormone that gives you a bingo). The HCG in turn supports the corpus luteum to keep producing progesterone, which supports a healthy uterus. In short, the embryo and the uterus support each other, through hormones and other local factors.

You have been through IVF and know that during your ivf stimulation, you inject hormones daily to boost egg growth. When your eggs are retrieved, the nursery cells (those that should become corpus luteum) in the follicles/ovaries are also sucked out as well. Also, your estradiol is much higher than a normal natural cycle. With barely enough cells in the ovaries to become corpus luteum and a non-physiological estradiol, the progesterone we give you is to supplement, or simulate, the natural state so that your endometrium will still proliferate. If no embryo implants, there is no HCG in the system (if you weren't given HCG injections) and eventually the endometrium knows it, giving you the failing moment when menses begins. However, when an embryo has implanted, the little life progressively produces HCG everyday, which supports the corpus luteum to produce progesterone, while you are still given progesterone just in case the corpus luteum does not produce enough. On the day of your bingo test (usually ~14 days after the fresh ET), the embryo has produced enough HCG to a level detectable in your bloodstream as well as in urine. [That's why we don't recommend you to check bingo early, there may not be enough HCG in the system to be detectable, and you cry over the test result.]

This is a condensed version of why you are given progesterone after fresh ET. In short, we just don't know if your corpus luteum will be deficient to produce progesterone, and we also don't know if your embryo will implant; so, we give enough prog. to sustain and proliferate your endometrium.

With this information, you can deduce why in a natural-cycle FET, you don't really need progesterone support.

The next logical question is progesterone in the form of vaginal insert or oil injection. Indeed, before the advent of vaginal insert, progesterone is given as shots. Again, it gets down to doctor's stubborn character; when they don't believe in something (by their instinct, not by evidence), they refuse to believe it. There are numerous studies showing that vaginal insert is just as effective as oil shot. However, doctor's mind is one thing, patients sometimes also think injection is better. When vaginal insert was first introduced, patients were quite skeptical because of cultural conservativeness or human nature of refusal to changes. Practically, vaginal insert is far more convenient and causes no pain as compared to shots. Biologically, vaginal absorption and action to the uterus is more direct compared to shots, in which the dose is probably diluted down in the bloodstream. Lucky that both modes prove to be equally effective; so if you prefer injections and do your own shots, make sure you do it right.

I think this is more than enough biology to satisfy your curiosity, will stop here.
cutecutetown

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mother2be Dear Cutecutetown, thanks very much for your explaination and walking this journey with us. It makes us walking this journey easier. 發表於 11-5-16 10:39

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miffycat

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999^#

發表於 11-5-13 00:51 |只看該作者

cutecutetown,

I should have FET on next Tue or Wed. Doctor will advice me tomorrow. I will also check with her to see whether I should do "assist hatching"...last time IVF, my 黃體 is over 400, my doctor mentioned that the level was good enough...is it? I asked my doctor how can increase the success rate, she mentioned, nothing special, my figures were OK last time, depends on luck then!!

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Whicheng