Questions with Second IVF Cycle: Fertile Thoughts
by Carlene W. Elsner MD
Q: I have just gotten a negative result to my first pregnancy after my first IVF cycle and transfer of two embryos on day three. I am thirty-nine years old and prior to this IVF attempt, I did three unsuccessful rounds of IUI. This IVF cycle produced seven mature eggs retrieved, five of which fertilized, of which only two made it to transfer—the rest I was told didn’t do the proper cell division. My doctor advised me that he would have liked the two to be transferred on day three to be further along. I don’t really know, maybe he was referring to the cell division. What if anything should I ask him before I proceed to my second IVF cycle?
A: It sounds to me like egg number and egg quality are a problem for you. Do you have adequate ovarian reserve? (Is your FSH less than ten and your estradiol less than seventy on your day of cycle two or three? This should have been measured within the past few months: if not, have these tests repeated.) If either of these levels is high, you may have impaired ovarian reserve (a common finding in thirty-nine year old women). Women with impaired ovarian reserve do not respond well to stimulation. They produce fewer eggs and poorer quality eggs than do their counterparts with better ovarian reserve. Poor quality eggs lead to poor quality embryos (as yours were). Few poor quality embryos result in lower pregnancy rates.
Ask your doctor what if anything can he do to change your stimulation protocol to increase the number and quality of eggs that you produce. Sometimes a change of protocol can dramatically improve the outcome. Sometimes it makes no difference, but to do the exact same thing again for you will not improve your chances of a successful outcome. If he tries a more aggressive protocol and your response is no better, perhaps you should consider the use of donor egg because that will give you a much better pregnancy rate.
Remember, we know that at age forty, at least half of the eggs you produce will be abnormal; that is, they will produce embryos that are chromosomally abnormal. Abnormal embryos, especially if they are chaotic (with multiple chromosomal abnormalities) are frequently slow in their development as yours were. The question I have is whether you produced any normal embryos at all in your last cycle. There is of course no way to know that about your last cycle and you don’t produce enough embryos to make PGD a reasonable option unless you do much better in your next cycle.
If changes are made in your stimulation protocol, it makes sense to try another stimulation, but if your response is no better the next time, you should consider the use of donor egg. Best of luck!
Fertile Thoughts is published monthly. Each column features a real question from a reader, and we invite other readers to respond with their thoughts and insights by posting comments. If you have a question for Dr. Carlene Elsner, please send it to her care of the editor at firstname.lastname@example.org. Your question will be kept in the strictest of confidence.
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