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High and low stims and embryo quality (pics incl)

June 14 2007 at 7:36 PM
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Kiwichick  (Login kiwichick145)

 
Gosh, you're probably sick to death of me prattling on about embryos, so please skip if this bores the living daylights out of you. After seeing my embies yesterday I thought it might be interesting to do a little additional analysis of the protocol-quality link. See what you think (grades are 5 = highest).


IVF#1 (age 40.4): microdose flare, 300IU Gonal F, cancelled due to no response


IVF/ICSI#2 (age 40.7): antagonist, 450IU Gonal F, 4 follies, 2 eggs, 2 embies: 7-cell grade 3, 4-cell grade 3 (don't have pics of these, sorry, but grade 3 is pretty ugly - see the 3rd embie in IVF#3)


IVF/ICSI#3 (age 41.2): antagonist, 450IU Gonal F + 75 Luveris, 6 follies, 6 eggs, 4 embies: 8-cell grade 4, 7-cell grade 4 compacting, 7-cell grade 3, 5-cell (not graded but probably 4)

Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket


IVF/ICSI#4 (age 41.4): antagonist, 450IU Gonal F + 75 Luveris, 6 follies, 3 eggs, 3 embies: 8-cell grade 4, 6-cell grade 3, 4-cell grade 4

Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket


IVF#5 (age 41.7): antagonist, 450IU Gonal F + 75 Luveris, 1 follie, cancelled it myself in disgust


IVF#6 (age 42.0): antagonist, 150IU Gonal F + 75 Luveris, 2 follies, 2 eggs, 1 fert (frozen sperm, no ICSI), 1 embie: 9-cell grade 4 or 5 (sorry, not sure of exact grade, and I don't have a pic of this, but it really was a very tidy looking one)


IVF/ICSI#7 (age 42.2): antagonist, 150IU Gonal F (but started at 225 for two days before dropping to 150) + 75 Luveris + Dexamethasone, 4 follies, 4 eggs, 4 embies: 2 x 8-cell grade 5 compacting, 1 x 7-cell grade 4 compacting, 1 x 4-cell grade 4

Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket Photo Sharing and Video Hosting at Photobucket


Now, was it the low stims that helped? I'd been doing acu for a year and was finally in good TCM shape by IVF#3, according to my acu. I've been on DHEA since IVF#2. Perhaps my eggs are like a fine red wine, getting better with age? LOL. No, I guess I find the evidence pretty compelling.

Of course, there's still only a slim chance this will end up as a BFP, but I guess I am more hopeful about IVF if I can get quality like this. I had assumed that the quality we were seeing before was what I was getting in natural cycles too, but I guess not, huh?

Thanks for listening to me prattle on and on and on ...
Kiwichick


ttc.png


Me 42.2, DH 45
Highest FSH 19.6 (8/2003); latest FSHs 9.6 (4/05), 9.7 (6/05), 12.4 (10/05), 8.5 (1/06), 18.8 (2/06), 16.4 (4/06), 9.0 (7/06), 12.1 (10/06), 9.0 (4/07 w/E2V), 8.1 (5/07 w/E2V)
DD nearly 3 yrs (IUI/Clomid high FSH baby)
ttc#2 2+ years, two failed IUIs (Clomid)
IVF#1 (MDL) cancelled, no response (July 2005)
Chemical pg on a break cycle (Aug 2005)
IVF#2 - 4 follies, 2 eggs, 2 embies, BFN (Nov 2005)
Chemical pg on a break cycle (Jan 2006)
Chemical pg on a break cycle (March 2006)
IVF#3 - 6 follies, 6 eggs, 4 embies, 3 t/f, chemical pg (May 2006)
IVF#4 - 6 follies, 3 embies, BFN (Aug 2006)
IVF#5 - cancelled, one follie (Nov 2006)
Natural BFP in Feb 2007; m/c @ 7wks
IVF#6 (low stim) - 2 follies, 2 eggs, 1 embie (frozen sperm, no ICSI), BFN (Apr 2007)
IVF#7 (low stim, with Dex and ICSI) - 4 follies, 4 eggs, 4 embies t/f, beta 6/23
Doing acupuncture, Chinese herbs and supplements, baby aspirin, 5mg folic acid. DH doing acu, herbs, vitamins (under duress).


    
This message has been edited by kiwichick145 on Dec 3, 2008 4:20 AM


 
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paris
(Login bsjunior3)

This is unbelievable !!

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June 14 2007, 7:57 PM 

Wow, what a journey and then look at your recent gorgeous embies.

I just went to ER and out of 5 eggs, none fertilized. I was on high stim BTW. It worked for me before (well not really since I only got a BFP once, then miscarried). But I thought I was playing the odds since my embies wee usually pretty perfect.

Now I'm trying to see if I have the guts to do low stim or just halve it from before. I did respond well previously with really perfect embies but went from there to zero fertilization this time. So who knows. I was so depressed today, then spoke to my RE and feel better. Obviously it is either a fluke or egg quality issue. If it is the latter, certainly your history points to quality issues.

Thanks so much for spending all this time on the board helping us, Kiwi. I hope your 2WW is restful and enjoyable. Your story is amazing.

BTW how much DHEA are you taking and did you take it through your cycle or stop when you started Dex? What else did you take? I recall you took wheat grass too.

hugs,
paris

 
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Kiwichick
(Login kiwichick145)

Hi Paris

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June 14 2007, 8:18 PM 

That is soooo gutting to go through all that drama and have five eggs not fertilise. I am so sorry. It does make some sense that stims affect an egg's ability to fertilise; I am not sure why we have had good luck with fert rates.

How high was your high stim? 600IU? 450IU? If you;re nervous about dropping too low you could try moderate stims, like 300 or 225. Also, doing a slightly higher dose for the first couple of days seemed to help me dredge up an extra follie or two, so maybe try that as a compromise?

I started off taking 75mg DHEA and took that for a year starting straight after IVF#2. I dropped it to 50mg after IVF#5 and then dropped it again to 25mg after I had my androgens checked and thought they were maybe fractionally high. I took them right through all IVFs except for this one. Someone posted a fairly compelling argument about why DHEA wasn't compatible with Dex, so I stopped DHEA altogether when I started stims.

I haven't taken wheatgrass for ages. We can't buy it frozen here and the fresh is too far away, so the best I could do for a while was buy a tray, juice it, and freeze it myself. But I haven't been bothered for ages, maybe a year?

I've been taking a bunch of supplements including multivit, Vit C, Vit E + Se, CoQ10, fish oil, folic acid, zinc. I recently switched my CoQ10 to a supposedly better type.

Good luck,
Kiwichick

 
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paris
(Login bsjunior3)

thoughts?

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June 14 2007, 8:29 PM 

I started off with 600iu follistim, and 150 menopur and dropped to 425 follistim and kept at 150 menopur after 3-days. Maybe that killed me. Gawd, that sounds so high compared to you !! other cycles where I had good looking grade 1 embies (that is your grade 5) were without the step up, just 425 and 150 and then ganerelix at 14mm to ER.

I wonder if when you lowered your DHEA, you actually saw these improvements along with the low stim and Dex? I think it is Ellie that posted today about how DHEA may have something to do with her whacky cycles but she can't be sure.

Anyways, I was so down but seeing your pics and success so far has certainly given me hope again.

What would you recommend for me?!

hugs,
paris

 
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Kiwichick
(Login kiwichick145)

Well ....

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June 14 2007, 8:36 PM 

I was taking DHEA right through IVF#6 and got a really nice looking embie out of that one. And I continued to take it right up until I started stims on this cycle.

It's true that I dropped my DHEA dose down to 1/3 after IVF#5. But it's also true that I wasn't taking any DHEA during IVF#1-2 and look what I got there - one cancellation and one cycle with the worst embies I've ever had! Plus, I was so much younger then (18-24 months is a long time in fertility terms when you're over 40).

Given that, I am not seeing any evidence to point to DHEA as a culprit. Perhaps it's actually helped me a bit.

Even 450 follistim and 150 menopur is very high - that's 600 FSH plus 150 LH. I would be inclined to halve that and see what happens. 300 FSH + 75 LH (225 Follistim + 75 Menopur) is a decent moderate dose. Not enough to drop your yield by much, I don't think (maybe you'd get 3-4) but it might really help with the quality.

Maybe you should ask about trying Dexamethasone too? I am sure it got me an extra follie or two compared to IVF#6.

Kiwichick

 
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paris
(Login bsjunior3)

Thanks, as always, your logic is sound !!

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June 14 2007, 8:39 PM 

nt

 
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Pam
(no login)

WOW

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June 14 2007, 8:06 PM 

That is some very compelling information - and I can't imagine the strength it takes to go 7 rounds - but those embryos look amazing.

I am now nervous as I am about to start a 450 Gonal F IVF/ICSI cycle. I had no idea there was a risk of "fried eggs" from high stims. And what does "antagonist" mean???

I think you have the makings of a White Paper here! Thank you for sharing the info.

Pam

 
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Kiwichick
(Login kiwichick145)

Antagonist

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June 14 2007, 8:24 PM 

An antagonist protocol is one where you use Antagon or Cetrotide to prevent ovulation instead of Lupron or Buserelin (which is what the flare and long protocols use).

You know, I don't regret trying a 450IU cycle. I needed to know if I'd get numbers of eggs that might possibly make up for the loss of quality in one or two (if indeed there is a "fried eggs" effect - something which hasn't been established clearly but there's a compelling theory and some anecdotal experience like mine).

Good luck with your cycle!
Kiwichick

 
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anon
(no login)

looks good

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June 14 2007, 8:10 PM 

It certainly has made a difference.
One can't rule out that the photo quality may be what makes them look better.
I recently had an u/s on a brand new machine and boy did my ovaries look ten times better and fuller. I also had an IVF with the newer camera and my embies were the same quality and cells as the previous but they looked ten times better......also a newer camera.
The results will be the real indicator.
Best of luck to you....that first one looks promising!

 
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Kiwichick
(Login kiwichick145)

Camera quality

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June 14 2007, 8:28 PM 

Yeah, the first set of pics (IVF#3) they didn't have a camera hooked up to the microscope, so we just took pics of the screen using a digital camera. But, the embryos were still graded by the same lab, so I consider the grades assigned to be data that triangulates/supports the eyeballable quality.

The next two sets (IVF#4 and IVF#7) were taken with the exact same camera attached to the lab microscope, so any variation there is not due to photo quality. And again, we have the grades assigned by the embryologists, which support the visual difference.

But, looks aren't everything, and as you say, the results are what it's all about ...

Kiwichick

 
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Pam
(Login psbassin)

Big difference huh?

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June 14 2007, 8:16 PM 

Amazing to see the transformation. I think the Dex also has something to do with it. I'm wishing the best for you!!!

best, Pam

 
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Kiwichick
(Login kiwichick145)

Yeah, and I am soooo glad we had the Dex discussion too!!!

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June 15 2007, 2:24 AM 

This board has helped me in soooo many ways. Talked me into low stim as an option, convinced me to do ICSI, suggested DHEA and Dex and acupuncture and ... the list goes on! I am quite sure every little thing has helped get me the improvements I am seeing, and I'm so grateful.

Thanks!
Kiwichick

 
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ellie
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Fascinating

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June 14 2007, 8:33 PM 

Thank you for the info. and "no" you are not boring us. I think this is

very exciting and am keeping my fingers crossed for you.

Please continue to keep us updated.

Ellie

 
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Kiwichick
(Login kiwichick145)

LOL

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June 15 2007, 2:25 AM 

We are like geeks with this stuff, aren't we? Thanks for not being bored.

Kiwichick

 
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SydneyGal
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Similar story here too

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June 14 2007, 8:44 PM 

Thanks for posting the pics, I love the blue hue, very pretty! I haven't done low stim yet but my two medium stim cycles produced embies that were heaps better then the high stim ones. I don't have my notes with me right this moment but I don't think I ever had a grade 1 embie in all my high stim cycles (5 cycles, eek!), but nearly all of the embies have been grade 1 since I switched to medium stims. I'm pretty happy with that. I'm too chicken to try low stims but I seem to be in a good place with medium stims right now

I feel exactly as you, I know the chances are still slim but IVF seems so much more hopeful when the embies are improving in quality. Surely our chances are improved over the "old" days, despite our advancing age, now that we've found what seems to work best for our bodies.

Cheers,
SydneyGal

 
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Kiwichick
(Login kiwichick145)

Wow, didn't realise you were getting all grade 1's - that's great!

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June 15 2007, 12:05 AM 

I wouldn't move off medium stims either if that was the case. One of these days, one of these days, one of those grade 1's is going to come through for ya. It just makes sense.

When are you cycling again? Great to see you back from Hawaii and all recharged!

Kiwichick

 
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SydneyGal
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Cycling again later this month

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June 15 2007, 12:50 PM 

Starting stims on the 25th. And its interesting that I'll be doing something a bit similar to you, in that we are starting off with higher stims for the first few days and then dropping back to medium for the rest of the cycle. We're doing the tweak because my follies were stalled last time until the 2nd week of stims, and my RE thinks we may be able to recruit an extra follie this way. So I'm glad to see that you got great results with a bit of a boost at the start.

 
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Kiwichick
(Login kiwichick145)

Yay!

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June 15 2007, 3:01 PM 

Yeah, I can't remember, was that your idea that I do that? I think it was. I think that probably got me one more follie and the Dex got me the other. That's great you are starting so soon! Here's to IVF#8 being the charm? 8 is a seriously lucky number for the Chinese, you know. We have lots of immigrants here and you can spot them a mile off because their car number plates say 888888.

Kiwichick

 
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SydneyGal
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Oh yeah, I forgot about 8 being lucky

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June 15 2007, 3:41 PM 

I was so bummed out about lucky 7 not being the BFP cycle and dreading the 8th (seems like such a high number, and it is I suppose) that I forgot about the 8 being lucky for the Chinese. I am half Asian so that should count for something! That makes me happier about attempting #8!

It was sort of my idea about a boost, I asked my RE during the previous cycle would a boost for a few days help with the stalled follies and overall slow start and he said "maybe", and so when I talked to the nurse after the last failed cycle about what my RE thought we should do next, she said he has written in my file to start me on a few days of higher stims before dropping back to medium again. Don't know about Dex, maybe I'll bring that up and see what he thinks. Gotta love an RE that listens and is flexible. Sounds like you really scored in that department!!

 
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Kiwichick
(Login kiwichick145)

Totally! (child ment)

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June 15 2007, 5:05 PM 

I just love having a flexible RE. He finds the interaction more interesting too, since I roll in there armed with ideas and we debate stuff. Yeah, you should totally ask about Dex.

Half Asian, huh? That bodes well for mega-cute kids!! [My DD's half Asian too.]

Kiwichick

 
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