Monthly Archives: November 2014

New Reasons To Consider Consecutive Cycle IVF- The 411

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baby- ivf

New Reasons to Consider Consecutive Cycle IVF

Published in the Summer 2011 issue of Resolve for the journey and beyond   (www.resolve.org)

Thanks to constant research and medical advances, infertility treatments continue to change and improve. As a result, what was sound medical advice or conventional wisdom even ten years ago may not apply today. When it comes to coping strategies, the best advice often comes from support groups and people who have gone through infertility. But medical advice changes quickly, so make sure your doctor is giving you the most current information.

An example of the changing approach to infertility treatment involves in-vitro fertilization (IVF). After an unsuccessful IVF cycle, the patient may be faced with the decision of when to try another IVF cycle. Previously it was thought that repetitive attempts could be detrimental to subsequent cycles by reducing the number of eggs. Here we will examine the reasoning behind previous research and take a look at more current research.

Freezing embryos is one way to increase your chances of obtaining a pregnancy by allowing multiple transfers from one fresh cycle IVF. However, many couples may not have any embryos to freeze and must undergo another IVF cycle. These couples have two options: either wait until a later date to perform another cycle of IVF or proceed directly into another IVF cycle.

The Old Advice: You Must Wait Between IVF Attempts

The theory behind waiting derives from the lack of research on the excessive use of follicle stimulating hormone (FSH) during IVF treatment to stimulate the ovaries to produce eggs. The FSH allows even the smallest of follicles to grow and become mature eggs. Initially it was believed that this increase in follicular development would deplete the pool of follicles available for the subsequent IVF cycle (Te Velde et al., 1998). For example, if the initial IVF cycle was unsuccessful, it was believed that the medications from the previous cycle reduces the number of eggs available for the next cycle. It was also speculated that the needle punctures used to retrieve the eggs from the ovary may cause a decrease in subsequent follicular production (Gobert et al., 1992). So, waiting between IVF cycles allows the pool of follicles time to replenish.

The New Advice: Repeat IVF Cycles May Be More Effective for You

More current research has shown little effect on the number of eggs retrieved in consecutive cycle stimulations compared to the initial IVF cycle (de Boer et al., 2004). However, one of the problems with comparing consecutive cycles is that if you are not pregnant and no embryos are frozen, your cycle was probably not optimal. Consequently the doctor may change your stimulation in hopes of creating a more ideal IVF cycle. The changing of stimulation will change the number of eggs retrieved and possibly embryo quality in the corresponding cycle. Furthermore, waiting too long to conceive may decrease your follicular pool by age related infertility. For example, if you underwent an IVF cycle when you were 38 years old that resulted in a negative pregnancy test and you waited 6 months before trying again, you could now be 39 and your odds of success have decreased simply because of your age. Some research indicates that there is no effect on repeat IVF cycles except for those seen to naturally occur with age dependent deterioration (Kolibianakis et al., 2002).

In the end, female age is one of the determining factors in IVF success. With consecutive cycle IVF, doctors change the stimulation drugs and drug dosage in order to yield a positive outcome. Talk with your doctor to find out how these changes may influence your IVF cycle.

References

  • Kolibianakis E, Osmanagaoglu K, Camus M, Tournaye H, Van Steirteghem A, Devroey P. 2002. Effect of repeated assisted reproductive technology cycles on ovarian response. Fertil Steril. 77:967-970.
  • de Boer EJ, Tonkelaar ID, Burger CW, Looman CWN, van Leeuwen FE, te Velde ER. 2004. The number of retrieved oocytes does not decrease during consecutive gonadotrophin-stimulated IVF cycles. Hum Repro. 19:899-904.
  • Gobert B, Barbarino-Monnier P, Guillet-May F, Bene MC, Faure GC. 1992. Anti-ovary antibodies after attempts at human in vitro fertilization induced by follicular puncture rather than hormonal stimulation. J Reprod Fertil. 96:213-218.
  • Te Velde ER, Scheffer GJ, Dorland M, Broekmans FJ, Fauser BC. 1998. Developmental and endocrine aspects of normal ovarian aging. Mol Cell Endocrinol. 145:67-73.

Hysteroscopy and Biopsy (Womb Scratching) Aiding in IVF Success – The 411

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baby - hysteroscopy

The procedure, known as womb scratching, or endometrial biopsy, feels much like a pap smear and costs approximately $200, hardly breaking the bank compared to other treatment-associated costs. When timed one month before an IVF cycle, a woman who receives womb scratching is twice as likely to become pregnant as a woman who does not undergo the 15-minute procedure.

baby - hysteroscopy 2

How is womb scratching done?

Laurence Jacobs, M.D. of the Fertility Centers of Illinois says the biopsy uses a Pipelle to lightly scratch the endometrial lining. “Local injury of the endometrium produces an inflammatory reaction resulting in increased white blood cells (leukocytes such as macrophages) which secrete growth factors and cytokines. These substances regulate blastocyst implantation and placental development”, he states. This stimulates the uterus’ receptivity to the embryo and increases the success rate of live birth. The most acceptable use of womb scratching is in women with good egg quality, but failed IVF cycles.

The procedure can be performed in-office by an OB/GYN trained in the “four quadrant uterine biopsy”, a method of cell collection similar to a pap-smear or cell collection for cancer screening. However, it is most efficient to combine womb scratching within a fertility treatment protocol or an already scheduled hysteroscopy if fibroids or polyps are suspected.

Dr. Jacobs claims the procedure carries little risk to the patient for pain or infection. In fact, doctors are so confident in the success that many, like Jacobs, offer it routinely to IVF patients who have failed previous cycles despite good embryo quality. Jacobs says, “At the present time, the endometrial biopsy should probably be reserved for those patients failing IVF despite good or excellent embryo quality, where uterine receptivity appears to be the major underlying problem.” Endometrial biopsy may not be the best option for patients of advanced maternal age with a history of failed IVF cycles due to genetically abnormal or poor quality embryos. In that case, genetic testing may be employed to verify the quality of the embryo and genetic soundness prior to embryo scratch.

How effective is womb scratching?

Several recent studies, including a British study published in Reproductive BioMedicine Online, confirm that womb scratching can double the success rate of pregnancy and live birth when performed at the right time.

“Timing is everything”, says Jacobs, “It’s very important to do an endometrial biopsy at the right time. In one study where the biopsy was performed at egg-retrieval, the women who had the procedure experienced lower pregnancy rates than controls.” It is currently believed that the best time to perform the scratch is once or twice in the month preceding an embryo transfer. It should not be done in the same cycle as ovarian stimulation for fresh IVF, or estradiol for a frozen embryo transfer (FET).

Consult your doctor to determine if womb scratching is an option for you.

Source:  http://www.fertilityauthority.com

Additional Resources:

http://www.dailymail.co.uk/health/article-2808964/How-scratching-lining-womb-double-chances-having-IVF-baby.html

http://abcnews.go.com/Health/WomensHealth/womb-scratching-technique-boost-ivf-success/story?id=17365332

http://www.thetimes.co.uk/tto/health/news/article4248667.ece

Saizen (Human Growth Hormone) for IVF – The 411

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baby- saizen

Saizen Growth Hormone Helps Infertility

Adequate growth hormone levels are critical for good ovarian follicle development, and growth hormone levels are known to decline significantly with age. Studies show that adjuvant growth hormone treatment during IVF can help older women to beat the odds and have a higher take home baby rate – even when their ovarian reserve is poor and previous cycles have failed – by restoring youthful hormone hormone production within follicles. Some studies show that younger women who are poor responders reap the benefits also.

The results are quite amazing. In one study (1) one hundred women, 40 years of age or older – all of poor prognosis – were studied as they pursued IVF, half received growth hormone with their ovarian hyper-stimulation medications, half did not.

The numbers of eggs, embryos and pregnancies were similar in both groups but the growth hormone-treated women had far fewer miscarriages and a higher take-home-baby rate. Women being co-treated with growth hormone had far less biochemical pregnancies, and a pregnancy rate of 26% compared to 6% in untreated cycles. The delivery rate was significantly improved also, 22% of cycles versus 4% in the untreated group.

During the stimulation phase of the IVF, treated women had higher estradiol and growth hormone levels within the ovarian follicles thought to lead to healthier eggs and higher embryo quality. The researchers of this study (1) concluded that:

“Administration of GH (growth hormone) during ovarian stimulation alleviates age-related decrease in assisted reproduction treatment efficiency. This effect appears to be mainly due to an improvement of oocyte developmental potential, but GH action on the uterus cannot be excluded…”

“In conclusion, this prospective randomized study shows that women aged >40 years undergoing assisted reproduction treatment and co-stimulated with GH achieve more ongoing pregnancies and suffer less pregnancy wastage, resulting in more deliveries and live births, as compared with women of the same age category stimulated with gonadotrophins alone.”

Previously in a study (2) on 20 women who had responded poorly to ovarian hyper-stimulation, 24 IU (intramuscular injection) of growth hormone was given on alternate days alongside gonadotrophin stimulation. The researchers concluded that:

“…in a subgroup of patients who respond sub-optimally to standard ovarian stimulation regimens for IVF-ET and who have ultrasound-diagnosed polycystic ovaries, systemic growth hormone is an effective adjunctive therapy.”

In another study (3) on growth hormone supplemented IVF cycles in poor responders, 159 women were studied as they pursued a total of 488 IVF treatment cycles between 2002 and 2006, comprising 221 cycles with growth hormone and 241 without. Growth hormone co-treatment was shown to increase pregnancy rates in fresh and frozen cycles in all age groups – especially younger age groups – the researchers concluded that:

“GH cycles resulted in significantly more babies delivered per transfer than non-GH cycles… (20% versus 7%). The data uniquely show that the effect of GH is directed at oocyte and subsequent embryo quality.”

Previous studies have shown that the levels of hormones within ovarian follicles – especially growth hormone – are critical for the development of normal healthy embryos that are able to implant. Levels of growth hormone are tightly correlated to an oocyte’s ability to be of high quality, with a high potential for implantation. (Mendoza et al. 1999,2002)

A large study on 100 couples where the female partner was over 40 years also showed benefit. The women were split into two groups, to receive growth hormone treatment (8 IU of Saizen from day 7 until the day after the hCG trigger) alongside IVF or a placebo. The study concluded that:

“this prospective randomized study shows that women aged >40 years undergoing assisted reproduction treatment and co-stimulated with GH achieve more ongoing pregnancies and suffer less pregnancy wastage, resulting in more deliveries and live births, as compared with women of the same age category stimulated with gonadotrophins alone.”

Another similar study (4) on poor responders who received co-treatment with growth hormone with ovarian hyper-stimulation found that:

“…the GH cycles had better performance in terms of the number of oocytes fertilized and the pregnancy rate.”

Different studies have used varying amounts of growth hormone but many such studies concur that co-treatment with growth hormone can give you better odds of succeeding, especially if your prognosis is poor.

This article is purely for educational and informational purposes and is not intended to substitute for medical diagnosis or treatment for which you should consult a physician.

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References:

1. Improvement of delivery and live birth rates after ICSI in women aged >40 years by ovarian co-stimulation with growth hormone. Tesarik et al. Hum. Reprod. (September 2005) 20 (9): 2536-2541. doi: 10.1093/humrep/dei066 First published online: April 28, 2005
Human Reprod. (1991)6(47):526-528 Co-treatment with growth hormone of sub-optimal responders in IVF-ET. E.J.Owen et al.

Growth hormone supplementation improves implantation and pregnancy productivity rates for poor-prognosis patients undertaking IVF. Yovich JL and Stanger JD.Reprod Biomed Online 2010 Jul;21(1):37-39
The value of human growth hormone as an adjuvant for ovarian stimulation in a human in vitro fertilization program. JObstet Gynaecol Res. 1996 Oct;22(5):443-50. Wu et al.

Source:  http://www.bellaonline.com

IVF #4 Upcoming – The 411

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baby - ivf egg and sperm

Last night, Dr. Robert Kiltz, who owns CNY Fertility Center and Spa, called me and said he wanted to schedule a phone consult with me for Saturday morning.  He said he was reviewing my file and would call me.  This morning, as promised, he called to discuss my latest failed cycle and to make a plan to move forward.

He wants me to try one more cycle with my own eggs prior to moving on to donor eggs.  He feels that I have good equality and is happy that he sees all my embryos making to blast.  He feels that I need to do a few things:

–  Add Saizen / human growth hormone to my cycle to improve maturation and egg quality

– Use neupogen post transfer

– Do a neupogen wash

–  Do a Hysteroscopy with biopsy

– Do an endometrial scratch on day two of my cycle to improve implantation

– Continue on an estrogen priming protocol

– Use 300 Gonal-F and 300 Menopur with Lupron for stims again

I have decided to give my own eggs one more last shot while I am saving up for a donor egg cycle.  I am going to detox my body first.  All of these hormones have take a toll on my body.   I am going to start a protein train on Monday (protein shakes only, apple sauce, sf popsicles, sf jello, water, diluted apple juice, oatmeal).  I will actually start by drinking only water with lemon, cayenne pepper and grade A maple syrup for two days to detox my body from my sugar habit.  It really does work !  By drinking loads of the lemon cayenne tea, it cuts sugar cravings and helps you follow the Bariatric diet more easily.

For those that did not know, I had gastric bypass surgery March 31, 2004.  When I follow a strict diet for short periods, it helps me refocus and I also drop weight pretty quickly.  I want to get back to my starting weight prior to starting stims.  I should be able to drop the few pounds I have gained due to the hormones.  It can only help with my quest to get pregnant.  Weight loss releases the hormones that are stored in body fat back into the bloodstream.  This is why a lot of women who became infertile due to obesity find themselves pregnant unexpectedly after gastric bypass, lapband, or significant weight loss.

Ironically, one of my friends out of the blue reached out to me late yesterday and said that God had laid on their spirit to relay to me to hold on…. that my bundles of joy were on the way.  I told my friend to go back and relay a message for me…  I will hold on, but can He speed up this timeline ! lol

IVF #3 8DP5DT and a BFN – The 411

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baby - hpt

This morning, I decided to POAS.  I went out last night and got the FRER, which is supposed to be the best HPT on the market to detect early pregnancy.  NEGATIVE.  Just one line.  Not a hint of a faint line….

I thought for sure that with everything done in this cycle to address my autoimmune issues that those embryos would definitely stick since they had a suppressed immune system to thrive in.  It appears that nothing has taken root.  I should be getting at least a faint line by now.

For now, this is going to be the end of my TTC journey.  I am not going to keep beating my head against a brick wall.  Thousands upon thousands of dollars in medications, even with finding bargains…  Thousands of dollars wasted at at a fertility clinic….   Now, to be able to go further, I would have to shell out with $18 or $32 thousand more dollars to CCRM for either and own egg cycle or a donor egg cycle.   The more I think about it, what is the point in me doing a donor egg cycle?  To give birth to children who will share none of my dna AND have no father?  Would these kids hate me?  I have no desire to use the eggs of my sisters, as that would be just giving birth to my niece or nephew and nothing about that appeals to me and seems a bit too cooky.  Even more hard to explain to a child….

I thought of trying IUI, which is a lot cheaper, but that is the equivalent of timed intercourse and thus a waste of time if IVF would not work for me.   At this point, I am not even going in for beta.  I will just wait for my period to start in the next week.

I am out of options and out of patience.   Now, I have to get rid of the arsenal of baby items I have been stocking for over a year now.

I am beyond angry.  My two best friends “accidentally” get pregnant.  I spend a mint trying to do this “the right way.”  Trying to do the “right thing” in the eyes of God and…. He laughs in my face.  What have I ever done to deserve this?  I guess what they say about life not being fair is true….  #done

IVF #3 6DP5DT – The 411

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baby - 6DP5DT

No, I did not POAS (pee on a stick), but this was the only image I could find with 6DP5DT.  So yes, today is 6DP5DT and I am feeling a lot of mild cramping.  It is akin to pre-period cramping.

Today, I took it a bit easy.  I made my famous mouthwatering meatloaf, mashed potatoes, fresh whole string beans, and roadhouse yeast rolls.  Everything turned out amazing !  I am now deciding if I want to cut the cheesecake that I made two days ago. I have not had the heart to cut it yet.

I am truly starting to go into freak out mode ! I am worrying about the cramping, although we all know that cramping is very normal during the implantation period and I have 2 more days of the implantation period.  By Wednesday, HCG should begin to show up in my bloodstream.  This suspense is nerve wrecking.   I have tried to keep myself occupied by baking, cooking and writing, but my mind wanders with every twinge and cramp.

Tomorrow is my mom’s first chemo session.  I am really nervous about her doing this course of chemo drugs, as it is reportedly extremely harsh and can damage the heart.  Her oncologist opted to spread her treatments out over a longer period instead of over 6 weeks, as to lessen the damage and hopefully be less harsh on her body.  She has already started her protocol requirements today.  I am just praying that these meds kill every single cancer cell in her body and that this is the last time she will ever have to deal with the big c.

IVF #3 5Dp5DT – The 411

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baby - 5dp5dt

Today is officially 5DP5DT (five days past 5 day transfer of my embryos to my uterus) and I am a hormonal, hungry mess !  Why do I feel like I am on the verge of tears all day?  I can not watch sad stuff on television and I feel like I am overeating to every fricken thing.

I am feeling more twinges and slight cramping/digging sensations. Other than having to pee every five minutes, I am starving!  I got up at 1 am and ate even though I made homemade fried apple turnovers at 9 pm and ate two of them.  I can not seem to get full.   I am craving veggies, chicken or beef.  I do not know if it is due to the prednisone or not.  I hope it is the babies digging in and being greedy.

I am now taking 175 mg of synthroid, 20mg a day of prednisone, prenatal plus, 8mg folic acid, baby asprin, B6, 1200mg Vitamin D, four Citrical with mag +d, and injecting lovenox, neupogen, and PIO.  I have to do estrace and Endometrin in the am and another Endometrin at night.

So far, everything is a routine and has not been a problem unless I want to go out at random times.  As long as I keep my same schedule, it has made it easy for me to space my supplements and meds out 3-4 hours per dose.  I have also been taking one Dulcolax per day as well as a Claritin.

My beta is this week and I am dreading it.  With my mom starting chemo this week, I would rather focus my energy on that and just wait it out.  I have not decided if I am going to do a HPT on Tuesday/ Wednesday or not.  I may just wait for beta.

IVF #3 4DP5DT – The 411

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baby - 4dp5dt

Last night, my sister, best friend Tereena, and mom went to Blues Alley in Washington, DC for the Jonathan Butler live concert.  My mom absolutely LOVES him!!!  I was worried that after her procedure to put the meda-port in that she would be groggy from the anesthesia, but she was awake and the pain had not set in.  We had the most amazing time.  Jonathan Butler is an amazing musician.

I still feel a bit queasy.  It comes and goes.  I am also STARVING !  All I have been doing when not sleeping is cooking something.  Today, I woke up early and made a vanilla bean cheesecake with a sponge cake base.  It came out gorg !  Perfect !!

cheesecake 2

I am feeling mild cramping, more like digging or twinges.  I am praying that it is my babies taking root.  I am glad to be feeling this, as with the second cycle, I really didn’t feel anything and I just knew that cycle was a bust.

I plan to continue to take it easy and just feed my face !   Tomorrow, I may go to a tea room in Warrenton with my mom and sister for lunch.  Other than that, I intend to stay on the sofa or on my bed writing a new screenplay about infertility.

IVF #3 – 3DP5DT – The 411

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baby - keep calm and hope for ivf pfp

Here we are, 3DP5DT (three days past 5 day transfer of embryos) and I have been feeling nauseous (probably from PIO), and very tired.  I am starting to feel twinges and little cramping like my little embryos are digging into my uterine wall.

I have been eating pieces of pineapple core and the trusty five brazil nuts per day.   I am making sure I drink plenty of fluids and eating every 3 hours.   I am craving mustard greens and yams.  I went out today and got 10 bunches of mustard greens, yellow squash, sweet potatoes, spring onion and vidalia onion.   I also picked up 2 slabs of ribs and whipped up Coca-cola BBQ Slow Cooker Spare Ribs.  I also picked up a pot roast, which I am putting in the crock pot tomorrow with a pack of dry ranch, a pack of dry italian dressing mix, and 2 packs of brown gravy mix and a cup of chicken broth.  It is delicious !   I ended up just piercing the sweet potatoes and putting in the crock pot for 3 hours and they came out amazing !

So now I am up to my ears in quart size bags of mustard greens, which I cooked with spring onion and onion slices.  I have no idea why I am going veggie crazy, but I hope the cravings are a great sign !

I had a pretty depressing day. Two of the ladies who have IVF the week before me both got BFNs today.  I was heartbroken for Kristina and Laara.  I really really hoped that this would be their cycle.  One had insurmountable odds against her and it seemed like they prevailed.  It is just so hard to see someone’s hopes dashed and then for them to make the decision to just not pursue this anymore.  I wanted this for them more than anything.  My heart is so broken for them.

I am trying to keep myself focused on other things so tomorrow I will bake a cheesecake when we return from the hospital, where my mom is going in for a portacath procedure. They are putting in a portal for her chemo which starts next Monday for twelve weeks. After she finishes that, then she has to radiation daily for four plus weeks.

My sister and I made plans to take her out tomorrow night for a concert in DC, not knowing she had the procedure scheduled the same day.  I am hoping she bounces back from the anesthesia and will be awake by 5pm to leave for the concert.