QuestionQUESTION: Dear Dr.Ramirez,
First off thank you for your time in reading this.
I've just been through my first round of IVF with a positive pregnancy test, turning into a chemical pregnancy.
I was told the day of my transfer that my eggs seemed like an older persons eggs (I'm 35). And that even tho my eggs were all mature (10 collected, 4 fertilized, 2 made it to transfer) they were missing "the stuff in the middle, cytoplasm". Now granted ICSI was done on frozen sperm, husband has very low motility after vasectomy we still were able to have two make it to transfer.
I guess what I'm wondering is, is it worth continuing for another IVF, with fresh sperm? Does having poor egg quality at 35 mean I will never be able to conceive a biological child? Is there anything that can be done to improve egg quality...DHEA, etc?
Thank you very much for your time.
Melissa
Bay Area
ANSWER: Hello Melssa from the U.S.,
There is nothing that can be done to improve egg quality, but you are missing a very important point. You got pregnant! Not only did you get pregnant, but you got pregnant in your first try! That shows that IVF can work. Sure it is possible that the reason the pregnancy did not continue was due to inherent egg problems, but that may not be the case in every attempt. Every cycle and every batch of eggs are unique. It will only take one good egg that forms into a good embryo for you to have a successful pregnancy so don't give up. I would strongly recommend that you continue to try. After all, you have shown that IVF (which by the way cannot absolutely make a person pregnancy because the last two steps are still natural steps) can get you pregnant. Keep that in mind. It is now just a matter of time.
Good Luck,
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: Hi Dr. Ramirez,
Thank you very much for your reply and I hope you had a great vacation! I wanted to follow-up with my last appointment following the chemical pregnancy. We met with the doctor and he suggested that we try the Lupron-Long protocol. My oocytes had some atresia that might be helped with the long protocol. He mentioned that I might have mild PCOS since I was oily on my upper lip and chin, even though my ultrasound showed no signs of pcos of my ovaries and I am of normal body weight and bmi. My question is, does this make sense? Are there tests of pcos? Have you seen success with people switching protocols and getting better results?
Last question, which is from left field is, do you know of a good clinic in Shanghai China?
Thank you very much for your time,
Melissa
AnswerHello Melissa,
I usually don't like to comment on different protocols because there is no "right" protocol. There are many variations and they work equally well, but of course, much depends on the patient. The "long protocol" is the standard protocol that most IVf clinics us and has been in use for a long long time. It was the first protocol to be developed. The variations of this are all to increase the ovarian response especially in patients that don't respond well. It has nothing to do with egg quality. There is nothing that can change, affect or improve egg quality. It will depend solely on the follicles stimulate in that particular cycle, the eggs recruited and their inherent quality and the handling of the eggs and embryos after they are retrieved. The latter point is very very important and what causes a variation in pregnancy rates among IVF clinics. Laboratory technique and quality are super important.
I also do not agree with your doctor's "diagnosis" of PCO. Surely, there are variants of PCO and not all patients have all the findings consistent with this disorder. But in order to make the diagnosis, there has to be at least two criteria. "Oily skin" is NOT one of those criteria. Most PCO patient will have irregular menstrual cycles plus one other finding. It can be ovaries that have the characteristic PCO look or increased facial hair or increased weight or an elevated LH/FSH ratio (the LH is usually twice as high as the FSH) or elevated testosterone or the patient stimulates too strong in an IVF cycle producing too many follicles.
I'm afraid I don't know of another IVF center in Shanghai, but I do know of an excellent one in California. I have had several Chinese patients from mainland China, one being an embryologist, who have told be that the Chinese facilities do not compare to US facilities in terms of quality and pregnancy rates. For that reason, the ones that can afford to come to the US do so.
Good Luck,
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
