Regrouping

Today, I regrouped and called the clinic. My doctor called me back and we had our "discussion" about WTF happened with our first IVF cycle and why we didn't make it to transfer. We talked about the 3 IUIs with injectibles that we did under her care over the past year. We talked about how I responded to the drugs in each of those situations:

• IUI#1 - May 2009 - I did Femara on days 3-7, and then did one vial of Menopur (M1) to stimulate. The way I responded was "progressive" and "IVF worthy" this time around. At baseline, my follicles were 9, 8, 7mm. Pretty big to start with.
  
• IUI#2 - August 2009 - similar to IUI#1 and I was ready for trigger on Day 12. I responded well, and this is a pretty early trigger without much for meds. At baseline, my follicles were 7, 5mm.

• IUI#3 - February 2010 - did Femera on different days and started M1 early. Triggered on Day 9. Really early. At baseline, my follicles were 8, 9mm.

Based upon this, my protocol for IVF was structured based upon my quick response to stims during my IUIs. The goal with IVF is to stimulate eggs to maturity in a way that isn't too quick and in a way that doesn't take too long. We also want to evenly grow a lot of eggs rather than focus on only a handful like you do with an IUI.

With my IVF, my baseline ultrasound had many follicles and the potential was there. However, the follicles started out much smaller than with my IUIs. They were more like 4, 3, 2mm. This was most likely due to the fact that I was on birth control prior to IVF, but was not on birth control prior to my IUIs. I had a lot further to go with the IVF. So even though I did respond with the given protocol (M2), I stalled out a bit and had to go double the dose (M4) to get the follicles going again. We ended up stimming 4 days later than a typical IVF protocol. Possibly too long for my little eggies. Of course, these realizations are all in hindsight.

Again, 12 follicles were retrieved and 9 of those were mature. The doc thinks that the mature eggs were "exhausted". The nucleus of the eggs were mature enough, but maybe the surrounding cytoplasm was at a different stage, and therefore the eggs were a little lopsided because of the way they were stimulated. The clinic rates the quality of mature eggs on a scale of 1 to 10 with 1 being the perfect egg. Most of mine were 3's. My average was 3.8. Not awful, but not great either. I didn't have any 1's or 2's.

Lastly, many would dispute trying to do a 5 day transfer instead of a 3 day transfer when only 2 embryos fertilized. On day 3, the two little guys looked good - and would have been worthy of a 3 day transfer. But then they just stopped - which is indicative of egg issues. The doc said that around day 3, the DNA of the egg and the sperm quit telling the embryo what to do and let the embryo grow on its own. If the embryo doesn't do what it's supposed to on its own, then it just quits. The doctor's theory is that the embryo wouldn't know how to grow on its own inside or outside the womb, and its better to know if the eggs will make it prior to transfer. If a 3 day transfer was done, they would never have know what had happened to those so-called "perfect" eggs. And, personally, I would have been out $3K, another week of PIO shots, and still had a BFN at the end of the day.

I asked if there was anything we could have or should have done to prevent this. She said there wasn't. It was out of character for me to respond the way I did to the Menopur, and there was no way to tell that I would respond as slow as I did in the beginning. The quantity of eggs came to fruition, but it wasn't until the eggs were retrieved and evaluated and the fact that only 2 fertilized after 24 hours shows that there were egg issues. The doctor said I actually do have a good quantity of eggs in my "ovarian reserve" and that there definitely decent quality potential. With better stimulation protocol, she thinks that there were be a better quality of egg.

With a 2nd IVF, the plan would be to start me at M4 instead of M2. This may depend upon my baseline ultrasound to make sure they don't push the follicles too hard either. That's basically it. Everything else would be about the same. I told the doc that we couldn't afford another round until January - when my insurance changes. She said to call the clinic when I get my period in late October/early November to get on the January schedule and to start BCPs again.

Gosh, November seems so far away...at least it's August already.