QuestionQUESTION: ..
hi, i am 28 y old, married sice 3 years , trying to get pregnant since 2 years , i had ectopic pregnancy since 15 months w ended by rt laparoscopic salpingectomy ., then i tried clomid for 3 cycles , HMG induction for 2 cycles ,
and i tried fresh IVF , with long protochol, i took 1 amp menogone , 1 amp fostimon 75 mg, 1 amp fostimon 150 mg/d. there was 36 mature foolicles , all fertilized well, then 4 good embryos were transferred on 3rd day but endsfer trano ed on 5th week by blighted ovum,
then i tried frozen embryo transfer by thawing the embryos and let them grow to the blastocyst stage. we got 14 good blastocyst from 19 embryos, then 2 hatched blastocysts were transferred , i took estrogen valereate 6 tab/d till endometrium thickness 8cm ,then progesterone supp 800 mg/ d , aspirin 75 mg/d. but negative BHCG on due time.
N.B
a) semen analysis is good with no abnormal forms or motlity
b) patent lt tube by hysterosalpigogram
c) history of endometriosis discovered during laparoscopic salpingectomy.
d) good hormonal profile FSH, LH, TSH, prolactin, anti-phospholipid tests
1- now i am planning of re do but i still have 12 frozen blastocysts , but i need your advise bec we thawed the 3rd day embryos from the first ivf , then let them grow till the blastocyst stage , then did the transfer the last time , then refreezed them again.
my question:
h am undergoing a new frozen cycle now, i take 6 tab oral estrogen valereate/ day , 200mg sildenafil vaginally/ day and vitamin e , aspirin , and after the endometrium reached 8.5 mm thickness on the 10th day stimulation , it decreased on the 13th day to 6 mm although i still take the same dose with no discontinuation , sure of the expiry date.
what is your explanation plz , and what can i do to prevent cancellation of the cycle ? and if i continued the same dose is there any hope for restoration the thickness?
plz answer me bec i am frustrated and breakhearted
ANSWER: Hello Nada from Egypt,
This is a protocol question, which I do not answer because protocols can vary widely and there is not only one way to do things. That being said, there is some general information that I can provide.
First, keep in mind that you have been pregnant with IVF and so can get pregnant again. IVF only gives you the opportunity to become pregnant, it cannot make you pregnant because there are still some natural steps that must occur on their own. Studies have shown that if you have gotten pregnant in the past, your chances of getting pregnant with IVF are higher. Also keep in mind that, just like trying to get pregnant on your own each month, it does not always work. Sometimes it can take several attempts before it is successful.
Second, it is well documented by studies that the best way to deliver hormones for IVF is either by injection, by patches or by vaginal delivery. Oral tablets can be used vaginally (you just push them to the very back). This helps with maximum absorption of the hormone and delivery to the uterus. Oral intake has been shown to be the worst way to give hormones for IVF because most of it is lost when it passes through the liver. I personally use patches, which most US doctors use, but tablets used vaginally is also a good option.
I would not necessarily cancel the cycle, because time can be taken to develop the endometrial lining further. It is only finalized once the progesterone is started. That is what determines the timing of the transfer, which for a blastocyst, should be on the 6th day after starting the progesterone. If you have not started the progesterone yet, you can keep using an increased amount of estrogen to get the lining to 9 mms.
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
---------- FOLLOW-UP ----------
QUESTION: thanks sir for your helpful answer but i wanna do a fresh cycle this month. i want to know if i can start decapiptyl amp while i am taking oral estrogen now then i stop oral estrogen to let the period come then begin the induction regarding the long protochol? because i dont have time to begin after the coming period by ocp then begin suppression.
and what further important investigations or advice do you recommend for me?
i am waiting for your answer
ANSWER: Hello Again,
I'm sorry, I'm not sure that I understand your question and am not familiar with the medication "decapiptyl amp". You'll have to give me a medication name for me to look it up.
If you are taking oral estrogen in order to force a period, what you would do is take the estrogen for two weeks, then add progesterone for one week, then stop the two. That will cause a menstrual cycle bleed. However, if you are having normal and natural cycles, that will mess things up completely and you will have abnormal bleeding. Therefore, the easiest and best method is to go on the birth control pills, which suppresses your natural ovarian function and substitutes an artificial cycle to induce a period. This is the preferred method for most IVF clinics in order to schedule an IVF cycle.
I hope that clarified things for you.
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
---------- FOLLOW-UP ----------
QUESTION: thanks again for your help. decapeptyl is GNrh agonist like luprone . my question is:
can i begin lupron soon as i am still taking oral estrogen after cancellation of the frozen cycle and stop the oral estrogen to let the period come and start FSH injections and i dont have time to wait for the next cycle ?
AnswerHello Again,
Thank you for that clarification. If your FET cycle was cancelled, they should have had you stop the estrogen and gone on progesterone for 10 days. Once you finished that, you would have a period. You can then begin preparations for another IVF cycle by either going on the birth control pill in anticipation of a cycle to start 3-4 weeks later or start the fresh cycle with the onset of your period, as you suggested. But you have to take the progesterone to cause the endometrial lining to slough so that you denude the lining with the period. You can then start the ovarian stimulation.
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
