We had our follow up appointment yesterday (Friday) with our RE. We were very impressed with him, the thoughts he shared about our 1st IVF cycle failing, what he learned from the cycle and what he recommends for our new protocol to be! 🙂
In terms of our 1st IVF cycle, he thinks the main reason it didn’t work was because of the quality of the blastocyst stage embryo transferred. It was a 3bb grade or, as he had explained it to us at the time, about 88% on a scale of 1 – 100. From what I understand, blastocysts are graded with a number and two letters. The number refers to the degree of expansion of the blastocyst (I am not sure what scale our RE uses, so I will ask one of the nurses at my next appointment or call to find out). It may be anywhere from a 1 – 3 to a 1 – 6 scale, with 1 being the most expanded and 3 – 6 being the least expanded. Some REs reverse the scale making the higher number indicate higher quality). The first letter (A,B, or C) refers to the quality of the inner cell mass (the part of the blastocyst that is going to be the baby) and the second letter (A, B, or C) refers to the quality of the trophectoderm (the part of the blastocyst that is going to be the placenta). Ironically, the blastocyst stage embryo that made it to the “freeze” (i.e. cryopreservation) developed into a 2aa the day after our transfer. Our RE seemed frustrated by this, but assured us that IVF is an imperfect science and if he had anyway of knowing that particular embryo would have developed into a higher quality one on day 6, than the one he chose on day 5, he would have held out another day and transferred that one. Our RE pointed out that having the 2aa embryo available to us for a Frozen Embryo Transfer (FET) in the future is encouraging.
Our RE shared with us that the number of eggs (11) that were retrieved from my left ovary is average at his office, Fertility Centers of Illinois (FCI), for a patient with both ovaries in play, so he was very pleased to get that many from just one of my ovaries! Of the 11 eggs retrieved, 4 were not mature and thus they did not attempt ICSI to fertilize them. Our RE told us that of those 4 that weren’t mature, 2 were overdone and 2 were underdone. He was very pleased that of the 7 remaining that all 7 fertilized and that as of Day 2 – Day 3 they all looked very good. However, ultimately only 2 made it to a quality level to be transferred or frozen. This was a concern for our RE. He also said that when the embryologist first looked at my eggs, after the retrieval s/he graded them as “poor.” However,our RE did explain that the poor quality could have been caused by the use of straight FSH (Follicle Stimulating Hormone), the medication called Follistim that I injected for 9 days leading up to the ER, to stimulate my ovaries to produce more eggs than normal. Our RE told us that there is a debate in the IVF medical community about whether FSH alone or FSH combined with medications that drive the LH (Lutenizing Hormone) helps to stimulate the production of higher quality eggs. Our RE believes that the addition of LH can create higher quality eggs, though he said it doesn’t work for everyone. He told us that it is a gamble (whether or not it makes sense to introduce LH in our next cycle), but one that he thinks is worth it. Our RE did also comment that Bob’s sperm quanity and quality looked good when the embryologist received it, which we were glad to hear.
We asked about the quality of the lining of my uterus that develops to support an embryo that might implant and our RE said that he was pleased with how mine looked at the time of the ET. He explained that the endometrium lining is measured in two ways: Thickness and Pattern. He said that they like to see the Thickness range between 5 – 20, but that the actual number is irrelevant, in that an “18” is not better than an “11.” My Thickness two days before my ET measured 10. He said that the pattern they like to see is called “five line” and that is what mine was.
So how does this all translate to the new protocol for our 2nd IVF cycle? Our RE wants to “push” for more quality eggs this time and he explained that he intends to do so by upping the amount of FSH I inject daily from 300IUs to 375IUs to try to help my follicles developing faster and by introducing 75amps of medication that will do more to drive LH called Menopur. He also plans to try to retrieve my eggs at least a day earlier than last time, in effort to avoid over mature eggs. Ideally he likes for his patients to do the “trigger” shot (HcG) when they have at least 3 follicles measuring 19mm, however with my 1st cycle we triggered with 3 of my follicles measuring over 19mm.
The name of the new protocol he is prescribing for us this time around is “Double Suppression of Lupron.” It is somewhat self-explanatory but the “double suppression” part refers to the fact that when I get to day 14 of being on the pill (today I am on day 4), I will start 10 unit Lupron injections daily in conjunction with my last week of being on the pill. Since both the pill and Lupron are used in IVF cycles to suppress women’s follicles from ovulating on their own, in this case I will be suppressing doubly. Then when I finish the pill on day 21, I will continue on with 10 units of Lupron daily until I get my period (the nurse said it usually takes 1 – 2 days). I will go in for an appointment on day 2 of my period and, assuming everything looks good (as far as my blood work and ultrasound), that evening I would lower my Lupron dose to 5 units and then start 375IUs of Follistim and 75amps of Menopur. So yes, this cycle I will get to do a grand total of 3 injections a day for about 8 days or so! But it totally seems worth it to me, understanding the reasoning behind it.
As far as projected dates for my Egg Retrieval (ER), Embryo Transfer (ET) & “Beta” pregnancy blood test (based on what the nurse explained to us), our ER this time will likely take place between Monday, June 11 – Friday, June 15. The ET will then likely be between Saturday, June 16 – Wednesday, June 20. The Beta blood test, to determine if the embryo implanted, would then likely be the week of Monday, June 25 – Friday, June 29. Since Bob and I will be in Vegas that week, the nurse explained that I could do a Home Pregnancy Test (HPT) and if it was negative stop the medications and come in when we get home, after my period would start, for the usually blood tests, ultrasound and follow up appointment with our RE. She said that if it was positive I would continue the medications (Progesterone-In-Oil injections and Baby Aspirin) and come in for the Beta blood test that Monday, July 2 after we return. If the ER and ET are closer to 6/11 and 6/16 respectively, there is also a small chance they would let me have a Beta blood test the Friday, Saturday or Sunday before we left for Vegas, to determine if our 2nd IVF cycle was successful! But we’ll see… I will certainly keep you posted!!!
I know this was a long post, but I also know that many of you will appreciate reading all these details about what we have learned from our 1st failed IVF cycle and what our RE has planned for our 2nd, hopefully successful, IVF cycle! We did ask him if our chances increase or decrease based on our 1st cycle not working and he said no, especially because everything he was able to learn from the 1st one. He said some people claim that success rates in 3rd and 4th IVF cycles can go down based on cycles #1 & #2 failing, but that these days with the quality of embryologists and the developments/improvements in the science of IVF that the success rates do not necessary fall. We found all of this very encouraging and could not have been more pleased with or impressed by our RE and how he handled everything about our meeting with him on Friday! We look forward to this next IVF cycle that we are embarking on and hope and pray that it brings us the child that we so desire to join our family! Thank you for your continued support, thoughts and prayers!