QuestionHi Dr. Ramirez -
I'm completely confused about the outcome of my IVF cycle. I went throuh a round of IVF 6 years ago (at age 25)...dx mild endometriosis but severe male factor infertility...did a long lupron protocol, retrieved 16 eggs, 10 fertilized, 4 to blastocyst...did a transfer of 2 5-day blasts and had my son, then went back and did a frozen transfer of the remaining 2 and had my daughter...
Flash forward to now...decided to have another baby (I'm now 31). All baseline testing was great...day 3 FSH 6/Esro 65, AFC 29...lap showed no endo...the doctor recommended a new "Lupron Trigger" protocol due to my previous high response. I started the cycle with a simple cyst on the left (apparently not hormonally active - baseline Estro below 20).
BCP's for 28 days (supposed to be 21 but at check cyst was still hormonally active - estro 338, so they kept me on 7 days more). Then stimmed with gonal f and menopur...added ganirelix day 8...here was my protocol:
day 1-3 gonal f 75, menopur 75
Day 3: follicles seen but none larger than 10 mm; estro 212
day 4-5 gonal f 75, menopur 75
Day 5: 4 follicles right, 2 left (cyst there still); estro only 365
day 6-7 gonal f 75, menopur 150
Day 7: 5 follicles right, 3 left; estro 808
Day 8: estro 1089 - upped to 150 gonal f, 150 menopur, start ganirelix
Day 9: estro 1360 - gonal f and menopur 150 ea
Day 10: estro 1665 - gonal f and menopur 150 ea
Day 11: estro 2750 - gonal f 150 and menopur cut to 112
Day 12: estro 3665 - lupron trigger
(for days 8-12, follicles bounced from 8 to 10 total)
triggered on day 12 with Estro of 3665 and 5 follicles on the right, 4 on the left...they did say development was scattered; some pretty large and some smaller, but development never "evened out". They expected 8-10 eggs at retrieval and wound up with a whopping 5 (waiting for the results of the fertilization report). Also, the cyst on the left side went from "simple" to some sort of complex, blood filled thing over the course of the cycle and is still there now.
Needless to say, I'm more than a little disappointed. Based on my previous great response to IVF and my current baseline tests, I'm not sure how this could go so poorly.
Does this indicate that something is wrong with my ovarian reserve or function, or could this just be from using a different protocol than before? Could the cyst have caused problems? I'm so confused. I am assuming this will be a failed cycle, and wonder if we should do something different next time? Any help and suggestions would be greatly appreciated!!
AnswerHello Corie from the U.S. (Maryland),
I know that by now you may have the results from this cycle, but if not, then don't "assume" that this will be a failed cycle. I tell my patients always that it only takes one good embryo to be successful. You don't need to have 5. You may not have anything to freeze in this cycle, but that is okay.
It sounds like you were a high responder in your previous cycle i.e. possible PCO-type tendencies, so your doctor adjusted the protocol. You were on a low stim protocol, hence a lower yield. You max estradiol was high but may be due to the fact that you started with a high estradiol. This level also could have affected your ovarian response as well. Obviously the cyst was hormonally active and I probably would have postponed the cycle to suppress it. The reason it turned "complex" is because it was going through the process of resolution.
I'm sure that your doctor will review this cycle, if it failed, and make appropriate changes. Each cycle is a unique cycle in which the ovaries respond differently and the eggs retrieved are different, therefore the outcome can be totally different. Also, keep in mind that despite your perfect record with IVF in the past, that is usually not ordinarily the case. IVF is not a perfect technology. Just like it can take normal women several months of trying to become successful with getting pregnant, IVF can take several attempts as well because the last two steps are "natural" steps that we don't have the technology to influence.
Also, although you used the "long lupron" protocol the previous times, the "antagonist" protocol you used this time works just as well and is the protocol I use exclusively with my patients. The result of this cycle was not due to the antagonist protocol. I like it because it saves my patients lots of money and lots of injections.
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
