# Is this a good sign?



## betty

Dear Peter

I apologise for the length of this message, but hope you can help or reassure me.

I am 31 and my DH is 37. Our problem is tubal damage but I believe my DH's sperm count is on the low side but also has very low abnormality. The clinic always say his samples are 'fine'.

On my first IVF cycle 4 months ago I had 22+ follicles 3 days before egg collection.
12 eggs were retrieved, but only 10 were mature.
7 of these fertilised.
On day 2, 5 were considered good enough for transfer and freezing. (we were not given a grade but know that they were these 5 were all 4-cell and only 2 of the fertilised 7 had fragmented - probably the 2 immature eggs).
We had a positive but unfortunately at the 6 week scan it was discovered to be ectopic.
The ectopic embryo had a strong heartbeat and was still very much alive.
No biopsy was done after the surgery to remove the embryo, so we don't know if it was 'normal'.

I'm about to start my 2nd cycle very soon and really I'd like to know if I can take the ectopic pregnancy as a good sign that we can produce a viable embryo - if only it will implant in the right place! Or does this experience make no difference?

I would also know if our number of eggs and fertilisation rate sounds okay and your views on the effects of hydrosalpinx on embryo implantation; just before I started stims a hydro was discovered on one of my tubes (for the first time). 
I lost my other tube with the ectopic embryo and the hydro was drained from the other at the same time. My clinic don't seem to think hydros are a cause for concern, but I've read alot of research citing them as a reason for IVF failure and see that most clinics routinely remove, clip or drain affected tubes before treatment. I'm worried in case it has returned and will damage any embryos I may have transferred.

Thanking you in advance
Betty


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## peter

dear Betty,

I am sorry to hear about the ectopic.

The fact that you have been through an IVF and achieved a pregnancy (albeit ectopic) is a good sign and you should continue with the highest of hopes. Are you going to have your frozen embryos back first? This would make sense before another full cycle.

Your 70% fertilisation rate is very good, no worries there.

It is routine in all of the clinics I know to drain a hydrosalpinx prior to treatment. This is a clinical decision which must be made by the physician treating you.

Hope this helps,

Peter



betty said:


> Dear Peter
> 
> I apologise for the length of this message, but hope you can help or reassure me.
> 
> I am 31 and my DH is 37. Our problem is tubal damage but I believe my DH's sperm count is on the low side but also has very low abnormality. The clinic always say his samples are 'fine'.
> 
> On my first IVF cycle 4 months ago I had 22+ follicles 3 days before egg collection.
> 12 eggs were retrieved, but only 10 were mature.
> 7 of these fertilised.
> On day 2, 5 were considered good enough for transfer and freezing. (we were not given a grade but know that they were these 5 were all 4-cell and only 2 of the fertilised 7 had fragmented - probably the 2 immature eggs).
> We had a positive but unfortunately at the 6 week scan it was discovered to be ectopic.
> The ectopic embryo had a strong heartbeat and was still very much alive.
> No biopsy was done after the surgery to remove the embryo, so we don't know if it was 'normal'.
> 
> I'm about to start my 2nd cycle very soon and really I'd like to know if I can take the ectopic pregnancy as a good sign that we can produce a viable embryo - if only it will implant in the right place! Or does this experience make no difference?
> 
> I would also know if our number of eggs and fertilisation rate sounds okay and your views on the effects of hydrosalpinx on embryo implantation; just before I started stims a hydro was discovered on one of my tubes (for the first time).
> I lost my other tube with the ectopic embryo and the hydro was drained from the other at the same time. My clinic don't seem to think hydros are a cause for concern, but I've read alot of research citing them as a reason for IVF failure and see that most clinics routinely remove, clip or drain affected tubes before treatment. I'm worried in case it has returned and will damage any embryos I may have transferred.
> 
> Thanking you in advance
> Betty


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## betty

Dear Peter

Thank you for your reply and reassurance. I know nothing is guaranteed in IVF but it's good to hear we're still in with a chance. My clinic is very busy, so I've never had the opportunity to ask what our future chances are.
We decided not to freeze any embryos on our last cycle (as we only had 3) so we will be starting a fresh cycle.
I'm hoping my tube has remained 'clear' after it was drained at the time of surgery to remove the ectopic!

Many thanks
Betty


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## peter

Dear Betty,

It is interesting that you decided not to freeze. Unless you have very specific objections to freezing and assuming that the embryos are of sufficient quality freezing is always the best option. This then gives you the opportunity of another try without the cost and stresses of a full cycle. If I was undergoing treatment I would certainly want any good spare embryos frozen.

Your tube will be checked again during your scans so they should be able to re-assure you that all is well.

Regards,

Peter



betty said:


> Dear Peter
> 
> Thank you for your reply and reassurance. I know nothing is guaranteed in IVF but it's good to hear we're still in with a chance. My clinic is very busy, so I've never had the opportunity to ask what our future chances are.
> We decided not to freeze any embryos on our last cycle (as we only had 3) so we will be starting a fresh cycle.
> I'm hoping my tube has remained 'clear' after it was drained at the time of surgery to remove the ectopic!
> 
> Many thanks
> Betty


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## betty

Jac - thanks for the link, but unfortunately I couldn't open it! I have acrobat reader but the pages appeared with an error message and were completely black! 

Peter - I had some reservations about the safety of embryo freezing with regards to a higher risk of a resulting child developing leukaemia or deformity. My clinic are very cautious of it. While I feel I can take chances with my own health, I felt I couldn't take that risk with my child's. 
I'm still uncertain about freezing. I know it's a very common place practice but I would be happier if it had been established for longer like IVF. 
I know the risks - if any - are very small but with my track record of bad luck I would be very worried about the health of any child I might have through FET.
We did chat with an embryologist on the day of egg collection, but I was still very woozy from the meds and felt better not agreeing to freeze the remaining embryos.


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## peter

dear Betty,

You can be rest assured that the abnormality rate following FET is no higher than fresh transfer. There is a slightly lower pregnancy rate, depending on the clinic, but the rates are still good and it's worth trying. The incidence of leakaemia does not relate at all to frozen or fresh embryos. You might find my message on umbilical cord stem cells interesting in this context. Enbryo freezing has now been established almost as long as IVF itself and it is in fact a **** requiremeent that all clinics offer embryo freezing. At the end of the day it is your decision but I can strongly recommend freezing to you.

I am a little surprised that they chose to talk to you about such an important topic immediately after your anaesthetic/sedation! Not very good timing! You should ask for an appointment to discuss this matter fully.

Hope this helps!

Peter



betty said:


> Jac - thanks for the link, but unfortunately I couldn't open it! I have acrobat reader but the pages appeared with an error message and were completely black!
> 
> Peter - I had some reservations about the safety of embryo freezing with regards to a higher risk of a resulting child developing leukaemia or deformity. My clinic are very cautious of it. While I feel I can take chances with my own health, I felt I couldn't take that risk with my child's.
> I'm still uncertain about freezing. I know it's a very common place practice but I would be happier if it had been established for longer like IVF.
> I know the risks - if any - are very small but with my track record of bad luck I would be very worried about the health of any child I might have through FET.
> We did chat with an embryologist on the day of egg collection, but I was still very woozy from the meds and felt better not agreeing to freeze the remaining embryos.


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