QuestionGood afternoon
I was wondering if you could advise me on my ivf procedures and if there is anything that could be done differently. I have had 2 ivf procedures the first one was a long protocol 8 eggs 7 fertilised with icsi 2 eggs transferred 1 early blastocyst and 1 morula nOthing to freeze. I was on 450iu of menopur for this. I was in 2 x 400mg of cyclogest and had early bleeding 6 days after day 5 transfer. The second cycle was a short protocol 350iu of menopur and 75iu of gonal f with oraglatron. I had 9 eggs 7 fertilised and a three day transfer of 2 embryos grade 2 7 cell and grade 2 8 cell. The cyclogest was increased to 3 x 400mg a day and still I had early bleeding 8 days after 3 day transfer. I have just done my 3rd ivf and had 350iu or menopur again and 75iu of gonal f on short protocol with oraglatron. I had 10 eggs 7 mature and 6 fertilised. This time I have been on 25 mg prednislone from start of stimulation and antibiotics from trigger injection. I had a 3 day transfer 2 of grade 1 eggs 8 cells each. I have been doing PIO gestone injections since egg collection and 1 cyclogest 400mg each day. 2 embryos were frozen. I am just worried its going to result in early bleeding again and a bfn. I am 32 years old using donor sperm all basic tests look normal. Any help would be appreciated. Many thanks
AnswerHell Elizabeth from the U.K.,
I'm sorry for the delay in getting back to you. Your doctor appropriately increased the progesterone, which is part of what I would do. I must precede my other recommendations with the statement that protocols are highly variable, even between doctors in the same practice. Therefore, one doctors' protocol recommendations are not necessarily accepted by all doctors nor necessarily the best way to do things. They can just be personal preferences.
One thing that I see is that you didn't have the greatest yield of follicles in the first two cycles, although you had just enough embryos to transfer. The development quality of the embryos were not that great in the first two cycles either. In the third cycle, you did better in the stimulation and had better embryos to transfer. Hopefully, that will do the trick.
My approach would have been different, however, because I prefer to use the "mixed" protocol (as you did in the third cycle), use a higher to dosage to get maximal yield and add some other medications in failed patients such as low dose heparin, low dose aspirin and estrogen. In any case, if this response finds you with a positive pregnancy, then this discussion is all for naught, but you'll have my congratulations. If it is negative, then we can have further discussion.
Good Luck,
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
