QuestionQUESTION: Dear Dr.Edward,
I am 34yrs and My wifes is now 31yrs and We have been trying have a baby for last 3 years and we tried 2 IUI's using clomid & 5 IVF Cycles in which 3 went to Embryo Transfer. In all the IVF Cycles DR ended up in getting 4-5 Follicles max in which 1-2 follicles fertilised. During the Stimulation all Hormone Level looks very normal. Even Follicle Count was very atleast 7 on each Ovaries with measurement of more than 16mm. We dont know why every time we try it fails. we are very Disappaointed and depressed at the moet and we have decided to give for atleast 6-7 months.My wife conceived naturally in 20002 but we have abort the child due to Visa requirements which is stupid mistake we did in our life and now we are paying the price. Please tellus based on your experience whether we could have our own child. The biological clock is ticking very fast for now.
Regards
GB
ANSWER: Hello Gopi,
First of all, you wife is still plenty young and the biological clock is not yet an issue. It won't be an issue until after 35 years old.
I am skeptical about your IVF cycles. They don't sound well run to me. Based on what you have said, your wife had 14 total follicle at stimulation, of which only 4-5 eggs were retrieved, 1-2 fertilized and in only 3 of the cycles did you have an embryo to transfer. Considering your wife's age, that is a very poor outcome. First of all, retrieval rates should be at least 60%. That would mean 8-9 eggs should have been retrieved. In addition, the minimum threshold for fertilization is 60% as well. Our statistics, which are slightly higher than the national average for your wife's age group, is a 63% pregnancy rate. That means that in the 5 attempts you have had, your wife should have gotten pregnant 3 times.
I can only conclude that you are not in a good IVF program/clinic. First of all, the clinic may not be stimulating your wife well enough, may be triggering too early and may have some laboratory issues leading to poor fertilization, poor embryo development and poor implantation rates.
My recommendation to you would be to find another IVF clinic. Your wife should have gotten pregnant by the 3rd attempt.
Sincerely,
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.
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QUESTION: Dear Dr. Edward,
Hope you had well deserved Break.We tried our IVF Cyles 3 in Melbourne IVF, 1 in Monash IVF and 1 in India(Chennai)at Madras Medical Mission. Every time when my wife was stimulated either GonalF or Puregon with dose varies between 225-450 and AFC was done which shows 6-7 follicles on each side with measuring 17-22. during egg collection only 4-5 eggs got retrieved. Even the LH level seems to be very normal. Doctor's who have treated my wife were amazed and they have got no answers to the problem what we have been facing now. Do you think doing a laproscopy will be able to identify the problem? Please advise.
ANSWER: Hello Again,
Well, you certainly have tried enough clinics and some have been very reputable. Your stimulation seemed very adequate with the trigger at the appropriate time. Retrieval still seems to be a problem, however. With 12-14 total follicles, I would expect at least a retrieval of 10 eggs. 4-5 eggs is too low. Therein lies a problem. Also, you wife could be stimulated harder, such at a total of 600 IU with a mixed protocol of Gonal-f and Menopur (HMG). The goal would be to get a higher yield in the number of eggs retrieved. That way you can get embryos to transfer. With a retrieval of only 4-5 eggs, you have a low chance of having an embryo to transfer.
With IVF cycles there is an attrition rate at each step. That is, we want 15-20 follicles because retrieval will yield 10-12 eggs. Of those eggs, some will not be mature (and not able to fertilize). Of the mature ones, only 60% will usually fertilize normally so that we will be down to 6-8 embryos. From that we will get 2-4 good embryos to transfer. You can see that if you are only getting 4-5 eggs at retrieval, you are already handicapped.
Maybe you should try a U.S. clinic. We tend to stimulate much more aggressively.
Sincerely,
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.
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QUESTION: Dear Dr.Edward,
Thank you very much for your advice.My wife has gone through lot of stress & pain both mentally and Physically we have now decided to give a break for atleast 6 months. Do you think using Comid and try naturally will help some how??
AnswerHello Again,
This will have to be your final question.
If you are planning a break, which is a good idea, I would take a break completely. No fertility treatments of any king. You never know, your wife might conceive on her own after the stress is gone. The bottom line is, take a break and don't think about pregnancy for a while. When you and she are ready again, proceed aggressively again, as you have been doing.
Sincerely,
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.
