# Lots of eggs, few/no blasts??



## Madeline Rose

Hi

We've just had 2 failed cycles of ICSI and pretty much the same issue each time - although I don't have PCOS, I respond to Gonal F by producing lots of eggs. About 50% of the mature eggs fertilise and are doing fine on Day 3. When we get to Day 5 and transfer, we're left either with 1 blast (1st cycle) or none (2nd cycle) and nothing to freeze.

Has anyone had a similar experience?

Thanks

MR
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## Loop

Hi 
Yes this is what happens to me and I don't know why either.
First full IVF cycle = 15 eggs, 11 mature, 8 fertilised all going strong day 3 only 1 blast at day 5 =BFN
Second full cycle = 11 eggs, 8 mature all going strong day 3, 2 xd3 transferred, 5 good enough to freeze = BFN and then for FET we had to defrost all 5 for 2 good enough to transfer = BFN.

I've got follow up appts this week and if I find out any more I'll let you know... likewise if you discover whether this is egg or sperm related pls share?
Good luck X


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## lisa n

Eve ladies

Madeline + loop - Im the same as you - on my 1st and 2nd icsi cycles i produced eggs in the mid to high 20s and always ended up being in hospital with ohhs so on my 3rd and last cycle we changed it to a short protocol with cetrotide as they think i show syptoms of pcos when stimming even though i don't suffer as a rule and this time got 19 follies but only got 3 eggs which didn't fertilise anyway    they think it could be age related but my AMH was at 20 when tested back in september    

Loop - good luck with your appointment 
lisa x


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## Madeline Rose

Hi Loop

Thanks for your message. Good to know I'm not alone!  You say in your signature 'mild PCOS' - were you aware of that before you started treatment? I am a bit confused by what I have told about this you see - I've never had PCOS symptoms, but when I have Gonal F, I am told I have polycistic ovaries as a result of the stimulation (which is apparently different....)

When we found out this time that we had no blasts, I asked the Dr whether this was likely to indicate a fundamental pb with either the eggs or the sperm. I was told while this was poss, it was v. unlikely and that they could probably get us better results by changing the drugs - hopefully find out more when we go back in.  Can't help thinking tho that producing so many eggs must affect their quality?

When is your appt?  Do you mind me asking which clinic you're at?

MR
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## Madeline Rose

Hi Lisa

Thanks for your post and so sorry about the outcome of your 3rd cycle  

For my 2nd cycle, we did the short protocol on cetratide too and prevented the OHSS ( had it mildly in my 1st cycle).

Will you be trying again?

MR
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## Madeline Rose

Hi Loop

How did your appointment go this week?

MR


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## leinlondon

Wow this thread is exactly what has just happened to us. We just did our first cycle, I have an AMH of 30 which they think is high but have no signs of PCOS. We didn't get as many eggs as you all did, though I had about 25 follicles on low dose Gonal F we only had 12 eggs, of which 7 were mature and 5 fertilised (IVF converted to ICSI on the day due to a random, hopefully one-off, poor sperm sample). All 5 made it to grade 1 8-cells on day 3 so they suggested going to blast but none made it. I was supposed to be going in for day 5 transfer yesterday, it was put back to today to see if they would catch up but they all perished overnight   we are obviously pretty raw. 

As we were right outside the hospital ready for transfer when they called with the news I asked to see a consultant to discuss what went wrong and what we could change. They also said to me what they said to you Madeleine, which is that although I don't have PCOS I have "polycystic tendancies" while stimming. She has suggested next cycle we do short protocol with Menopur instead of Gonal F, plus Cetrotide, but this sounds as though it also did not work out for you Lisa & Madeleine... if you were to try now subsequently would you change anything?

So helpful to find others who have been through this, I just don't understand what happened... it was all looking so positive until yesterday...  

Leah xxx


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## LHR72

Hi

i've always produced lots of eggs too and had lots fertilise. on my second fresh ivf attempt i had 2 put back at day 3 and they suggested taking the rest to blast to increase the chances of FET success - however none of them made it to blast. clinic didn't make any suggestions as to why this might be.
we'd pretty much given up by our last go using frozen embies, and hey presto i am now pg! 
sorry can't give you any answers but thought i would share my story nonetheless x


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## leinlondon

Congratulations LHR72! Always gives hope to hear of stories where things work out, it sounds from your signature as though you went through a great deal to get there. Thank you for sharing xx


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## Loop

Lhr - congrats ! Great news and gives us hope x

leinlondon - sorry you've had a similar experience.X

In my case, last tx (fet) I had immune tx alongside and asked both ivf consultants why good looking embryos don't make it to blast and the answer was pretty much same from both. It could be fundamental sperm or egg problem but it's more likely that the results reflect nature ie if it takes on average 12 months to get preg you may only actually produce 2 viable embryos in that time (out of 12). So if I had 8 embryos and only 1 blast that's not bad odds... One consultant did offer to do a sperm DNA fragmentation test on h but said he didn't expect a problem. In my follow up last week the consultant again recommended a lap and hysto. So on 16th I had a ga and they found endo and confirmed the pcos. Now we've got to decide about follow up tx ie ivf or try naturally, with or without immunes etc

mr - what's your next step do you think? Xx


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## Madeline Rose

Hi Leah, hi LHR

Congrats LHR!

Thanks for your posts. Have been madly googling all day in preparation for our appt on Weds at the Lister. There seems to be a lot of info out there for people with similar issues to us - some of it about large quantities of eggs potentially meaning poor quality and some about the poss impact of oversstimming on endo quality. Some sites suggest acupuncture can help with both so might look into this.  Also wondering about trying a natural cycle to see if that might help - although I guess statistically then the chances if success must be low?

Leah, I havent tried Menopur yet.  Some threads suggest that development after Day 3 is own to 
sperm quality, but I don't know whether this is right 

Loop, sorry what's ga?

Am planning to go for f/u at Guy's as well as looking at the Lister....

Hope everyone's w/es have been ok

MR


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## Loop

Hi mr good luck for your follow up appt and other appt. Ga = general anaesthetic. I've got my follow ups this week and then h & I will decide what to do too but my heart and head are saying another fresh ivf with immunes is way to go xx


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## Madeline Rose

Thanks Loop. Good luck with yours too!

MR


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## Madeline Rose

Loop

How did you get on with your f/u?

We went to the Lister this week to talk about maybe moving there for treatment.  V. positive experience.  Lots of info, but in case it's helpful for you or anybody else, for us:

-	In both our previous cycles, there was a high percentage of egg degeneration, indicating likely fragile eggs – a particular issue with ICSI/IMSI for us as the injections had damaged the eggs.  The egg quality issue is likely to be inherent, although a different stimulation protocol may produce better egg quality results.  
-	In both cycles, the embryos that fertilised looked fine on Day 3, but by Day 5, on the first cycle just one (a BC blastocyst) and on the second cycle none of the embryos had reached anywhere near the stage of development that they should have been at.  This is slightly uncommon for my age group and may be linked to either poor egg or poor sperm quality (or both).
-	In both cycles, I bled 1 week after Day 5 transfer – apparently this was early, even for a failed cycle and may indicate lining quality issues
-	To check the quality of the endometrial lining, I have been recommended have a hysteroscopy in the first two weeks of my cycle, to biopsy the lining
-            For our third cycle, we have been recommended IMSI for two thirds of the eggs and IVF for the rest, due to egg fragility issues
-	In terms of stimulation, they recommend that we switch from Gonal-F to Menopur, with a view to trying to get fewer eggs.  I could also take Metformin (for my PCO-type response to treatment) – although they are not sure that this will help, apart from possible nausea, there is little downside.  A long protocol on a smaller dose (maybe for longer than before) will not be harmful  and will likely be beneficial, perhaps alternating between 225 and 150
-	Acupuncture may be beneficial for the lining and blood flow
-	Sperm testing – DH will have a DNA Fragmentation Test, which will also test for Aneuploidy 
-	In vitro maturation – according to the leading researcher at Oxford, this is unlikely to make any difference to eggs of poor quality
-	Other possible testing we might consider:
o	Karyotyping (doesn’t often show abnormalities) 
o	Immunology/NK celles testing (controversial as to whether works, but will not do any harm) 
o	Anticoagulation testing (usually for recurrent miscarriage, but no harm in us testing)
o	PGD – very costly and unlikely to be useful (can damage embryos)
-	Sperm & egg quality – caffeine and alcohol – 1 coffee a day and 10 units or less of alcohol per week is not detrimental.  Other than vitamins, there is nothing else they are aware of that could help us to improve egg or sperm quality  

All the best

MR


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## Loop

MR thanks for sharing all that info from your f/u. Really useful!!  I'd found some similar info out and been told a little bit of some of this but not all.

In terms of my next steps and recent relevant updates, which I hope will result in more blasts on any future cycles:

I has full immune testing via dr g (all info in the FAQ in the immune section of ff). This showed a hidden c infection which was treated with a course of anti bios. I also had high killer cells which will be treated with steriods, blood thinners and intralipids on future cycles. I had a hysto and lap op to see what my womb & abdomen was like, endo was found and treated. I'll take v low dose met for my pcos on next cycle. H has been recommended a sperm DNA frag  & anuploidy test. We had karyotyping tests done which were fine (and v bloomin expensive!).

There's some interesting info about failed cycles and possible poor egg quality and things that can be done future results in the immune FAQ. Eg change of drug protocol, particular supplements etc.

Best of luck, what are your next steps fo you think? Gave you decided when to cycle again? I've been told that it's better to cycle sooner rather than later after getting endo treated so will be starting againsoon x


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## winterberg

Hi ladies
i've just read your full thread with interest as I had a very similar outcome from first round of IVF in Jan this year.

I was on Femerol / Gonal F (220) / Cetrotide and produced 15 follies, 10 eggs (9 mature), 8 fertilised, 7 cleaved and on day three i was told all seven were 'looking great' but on day 5 on way to ET I was told they were 'slow' and to come back the next day. On day six, they'd perished.

Had nothing to transfer and the clinic were shocked and said this was very very rare. They haven't come back with anything that we can use to take forward other than 'bad luck'. 

Have been trying to get to the bottom of what happened and have been to see another consultant for feedback too - just this week which is 2 months after treatment. New Dr has diagnosed polycystic ovaries (never heard this before) and suggests that this a)was possibly responsible for the pain I had during stimming and after collection and b) could mean that I have insulin issues. And that can apparently affect egg quality. 

So firstly, i'm going to have my insulin levels checked (tomorrow) and also really need to understand how my ovaries have suddenly become polycystic - they look exactly like they did during stimming as though they haven't gone back to normal. 

It sounds like we all have very similar case histories - I'll definitely let you know what I find out and would love to hear more about your situations.

Wishing you all luck and success - I'm planning to try again in May and really want to get off to a flying start (hopefully with a lot less pain and to at least get to the ET part!) - maybe we can help each other somehow.

Wb xx


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## Alison75

Good morning Ladies!!

I was wondering whether I could join this thread?  I have read all your very interesting posts, and am so glad to see that I am not the only one this has happened to.

I have just completed my first IVF cycle (at Queen Mary/The Bridge Clinic), and although my OTD is sat 2nd April I have been testing all week including today, and each time I have got a BFN.  AF sort of started yesterday (sort of beacuase it is not a normal AF due to dyclogest pessaries which I have now stopped). I am therefore now accepting it is all over for me this time round.

I am naturally extremely disappointed, but want to use this as a learning exercise for when we embark on our second IVF cycle.

I was pretty surprised and excited to find out that they had collected 20 mature eggs, of which 13 had fertilised.  The clinic called me on Day 3 to say that all embryos had split into 8 cells, and as they couldn't choose the best 2, they said we would need to go to blastocyst.  We were pretty pleased, but also slightly cautious, since we were having IVF for a reason!  In just over 2 years of trying I had never fallen pregnant, and all the standard tests has indicated we had unexplained infertility.  Something, somewhere was clearly not working!  Anyway, we got to Day 5 and were shocked to find out that 12 of the embryos hadn't moved on at all since day 3, but there was one that had developed extremely well.  We had that one put back in on 19th March, but sadly none to freeze, and sadly this one didn't make it either.

I am hoping to book my follow up appointment asap but really have no idea what happened here.  Some of you girls mentioned various test (immune tests, genetic tests etc).    Perhaps the eggs weren't very good quality, or weren't mature enough, or matured too quickly?  I guess one possibility would be to lower the dose of Menopur next time and to produce fewer eggs?  I think some of you mentioned that?  DH has no sperm issues but perhaps he should have the sperm analysed?  The embryologist mentioned that perhaps the embyos had genetic defects...  I have heard that genetic tests can be done on the eggs, sperm and or embryos but they cost about £5000!

Like me I really hope that you get some answers so that you will all have better luck next time round!


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## winterberg

Hi Alison
Really sorry to hear about your situation - I don't think you should give up hope though yet - you might still get a positive result.. I really hope so - fingers crossed for you  .

Went off for my insulin test today - quite nice to be told i wasn't fat or hairy enough to have insulin issues.. the reality of Dubai doctors.. scarily un-pc. Anyway, think I'll wait for the results to come through before I tuck into the chocolate cake 

Three things that seem to come up quite a lot when researching failed blastos (but hard to prove/quantify I know) seem to be 
1) lab issues/errors - ie wrong mediums/dropping the embies/temperature issues etc - really rare but it must happen? 

2) the clinic not being advanced enough to take an embie from 3-5 days which apparently takes a lot more experience/expertise.

3) the fact that some embryos just do better in a more dynamic environment - ie a uterus. I can't find any evidence to support this but it does make sense - when you think of a prem baby and all the help they need to survive in a hospital, versus the support your own body gives the baby inside your womb it does make sense. It can change every couple of seconds to provide the optimum place.

I'm really nervous about trying again and it not working - and still not finding out anything more that could help but I sort of feel now that it may just have been bad luck.. or one of the above and it is definitely worth giving it another shot, with a lot of healthy eating, positive thinking and acupuncture 

What are you ladies thinking? And what sort of timeframes are you working to? 
wb xx


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## Alison75

Hi Wb,

thanks for your encouraging words, and I really do hope that things work out for you too!  I am sorry to hear that you had a really disappointing experience.  We just have to focus on the next round and see what we can do differently to ensure a positive outcome.  Like you I was pretty uncomfortable for the whole week after EC.  Cramps and bloated feeling! 

I was interested to see that you also have PCO and that your consultants have recommended insulin tests, since you said insulin levels can affect egg quality.  Have you ever been tested for diabetes?  Are you doing any other tests?  I will definitely mention insulin tests when I have my follow up on 12th April, when we will go through the embryologists report with the consultant.

It's tricky to try to self diagnose or even research what might be the cause of the embryos not developing since (I assume)  none of us are medical experts in the field!!

I will try to get as much info as possible from my consultant and come back to you.  Like you I really want to get going again straight away, when my next cyle starts early May, so we might be cycle buddies?!  I am so confused as to when AF will be due next month...the drugs have messed everything up!  I have one more funded cycle so I want to get things right this time.


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## Madeline Rose

Hi Loop

Thanks for your info too.

Am planning to start a new cycle at the Lister ASAP but also want to have some tests done, so will have to see how all of that fits together.

Hi Winterberg

We were v surprised to hear PCO being used about me too - from what I've read it can be connected to insulin levels or to thyroid issues - am going to be tested for both.  Incidentally I also had pain and bloating after stimming.  Have you had the results of your insulin test?

Hi Alison

Have you done your test now?
The Lister suggested to us changing the stimming drug eg you might try Gonal-F?  They also advise that embryo issues like ours (and yours) can be due to male and/or female issues.

Thanks everyone for sharing your experiences so far and hope you're haing a good w/e

MR


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## Alison75

Morning Ladies!

Thanks all for replying to my posts.  It's a medical mindfield out there isn't it?!! 

I also have mild PCO (produced 22 eggs), I will mention the insulin and thyroid issues to my consultant when I have my follow up next Tuesday 12th April.  I will let you know if he tells me anything useful.  As we are NHS funded for second and final cycle they don't carry out any tests on site, but I guess they could suggest ones we could do privately if necessary.

It's an odd arrangement since I have most of the treatment/scans at the ACU at Queen Mary, but ET takes place at The Bridge...

Good luck girls!


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## Madeline Rose

Hi Alison

Had a further appointment today - am going to take Metformin to counteract any insulin issues (so no need to test for this). Thyroid seems a no brainer for us - am going to check whether the GP will do this test for free ( well as a couple of the others).

MR


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## Madeline Rose

Hi Alison

How did you get on with your appt this week?

Anyone else got any updates?

Afm we have decided to stay with Guys but change consultants to someone vpro-active who  thinks he can get us a better result - seeing him tomorrow am

MR
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## winterberg

Hi ladies,
hope you're all ok and looking after yourselves x

On my first round I was taking a tiny amount of thyroid meds (.25 micrograms) but this was a precautionery measure as my thyroid is in the normal range. 

Have now had thyroid rechecked again (and it's fine) and insulin levels checked (and they're fine too) - thank goodness..

I live in Dubai and the doc said that PCO and insulin issues are hugely linked but primarily with the Asian population (he said around 85% of Asian ladies with PCOS that he treats here had insulin issues and yet only 15% of his European patients..). 

I've decided to put my failed cycle down to bad luck as the analysis is making me go slightly crazy! I'm going to give it another go in May and just hope and pray that I have a bit more success. I'll let you know how it goes - and hope you all get some answers.

Let me know how you're all getting on - and if you get any other good pointers 
wb xxxx


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## Loop

hi ladies

No major update from me, I'm persevering with tx soon (have an appt next week and should start to d/r week after I think).  Quite excited about it which is a bit silly given it's not exactly the first time...  Still it's the first cycle since I had endo diagnosed and treated AND will be my first fresh cycle taking immune tx all the way through... So the odds should be better.

Only stuff I'm doing differently as prep is taking an even wider range of supplements (see Agate's FAQ on immunes thread for info) including some specifically for egg quality like Q10, resveratrol and pycnogel (sorry if any of those aren't spelled properly!!). I'm also on a low gi diet (south beach) and have lost some weight - 6 lbs so far - and have been exercising more regularly.  Other than that H is going to get his sperm dna frag test done and then as long as that's ok, it's just a matter of keeping everything crossed and hoping for the best.  Not sure how many more txs we'd do really.  I think this might be the last one or poss one more. It's just too emotionally draining and I've put my life on hold for 4 years....

MR - any idea when you might have more tx?

Alison - how was the follow up?
WB - good luck for May x


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## Madeline Rose

Hi Both

Am starting d/reg mid-may - W/b, I guess we should be cycling together?

I also think there is a PCO- insulin link although not q sure what it is. Am taking Metformin alongside stimms in May to try to help PCO and the leaflet says it is for insulin management issues.

Other things we are doing to try to avoid the previous pbs:
- v close monitoring - from day 4 of stimms, daily
- day 3 transfer (taking remaining envies hopefully to blast - to freeze)

Also did NK cells test - debatable apparently whether valid but as a result will likely try steroids aspirin and heparin after transfer.  Will also take more progesterone to try to stop previous early bleeding.

According to Guys, the issue we've all had isn't all that rare and with the right stim regime they can improve the results.

MR
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## Alison75

Hi everyone,

how are you all feeling?!

Michelle - Don't loose faith yet!  It is not over until OTD.  Keep positive.   

Loop - I should start d/r around the same time as you on 2nd May. I am on d/r for 28 days this time which seems really long.

So we went through my results at the follow up at Queen Mary.  The first thing the consultant said was:- "You should be pregnant."  I had 13 grade 2-3 embryos but they are just putting the fact that only one made it to blast down to bad luck.  Hmm, not sure I like that explanation.  

I took a thyroid test with the GP and it was all normal.  I haven't taken any insulin tests or an other tests at all for that matter, as Queen Mary are simply not advocates on tests and investigations!  It seems crazy, but maybe that's because it's a funded cycle?  Although I reacted to Menopur (stimulation drug) in a "polycycstic way" by producing 22 eggs, they do not put the failure of the embryos developing down to that.  Lab culture and environment can sometimes be a factor in hindering embryo development although apparently the Bridge had no other cases similar to mine on the same day.  As I have never been pregnant ever, it is clearly an issue with the embryos.  As 13 eggs fertilised we can eliminate the issue of "incompatibility" between myself and DH.
  
The drugs will be reduced a little so that I produce fewer eggs.  Fingers crossed, as it's our second and last funded cycle, at which point we will have to go private.  

xx


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## Alison75

Loop - you mentioned you are taking a supplement called Q10 for egg quality?  Has that been specifically prescribed to you by your private clinic?  Wish I knew if there was something I could take, other than Pregnacare vitamins!


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## Loop

Loop said:


> Only stuff I'm doing differently as prep is taking an even wider range of supplements (see Agate's FAQ on immunes thread for info) including some specifically for egg quality like Q10, resveratrol and pycnogel (sorry if any of those aren't spelled properly!!). I'm also on a low gi diet (south beach) and have lost some weight - 6 lbs so far - and have been exercising more regularly. Other than that H is going to get his sperm dna frag test done and then as long as that's ok, it's just a matter of keeping everything crossed and hoping for the best. Not sure how many more txs we'd do really. I think this might be the last one or poss one more. It's just too emotionally draining and I've put my life on hold for 4 years....
> 
> MR - any idea when you might have more tx?
> 
> Alison - how was the follow up?
> WB - good luck for May x


Alison - Thread that I was referring to is here http://www.fertilityfriends.co.uk/forum/index.php?topic=242395.0 if you go to the FAQ (hope it works) then look at the list of supplements you can take your pick. Agate is a fab FF who put all this together and it even lists which are supposed to be good for egg quality/development.I'm taking LOADS of them but will stop taking some for stims as the effect isn't known. Sorry you are goign through this too. I agree, I'm not a believer in 'bad luck' for this stuff either. Hence having gone through more investigations (lap & hysto) which threw endo into the pcos mix!
Still, I'm not quite sure what the problem is (and my never know) but I definitely think something is afoot. Hence I'm getting h's sperm dna frag test done & also taking all this supplement stuff & will take immune tx alongside my 'regular' ivf. For PCO/PCOS/PCO tendancy people most docs now seem to think that quality is better than quantity so my dose of gonal f was reduced on cycle 2 and will be again for cycle 3. No one can really tell me what the problem is but all I can do is my best & I'm happy with my current approach. I've never had a BFP in 4 years of TTC either 

Best of luck xx


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## Madeline Rose

Hi Girls

Can't seem to see Michelle's post this morning any more?!

Spoke to consultant today about insulin and PCO - he said there is no link with diabetes, it's just that both are (completely separately from each other) insulin -related.

I am also taking part in a trial where you get either a free in-depth scan or free hystoscopy as they are seeing what impact having these procedures has on pregnancy rates. 

Am also going to start on Royal Jelly supps.

MR


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## Loop

I'm sorry mr but I completely disagree with your consultant. My mum has pcos and is a typical apple shape (ie big barrel tummy/fat carried around midriff) and developed type 2 diabetes. Everything I've read says that pcos causes insulin resistance which is a precursor to potentially getting type 2 later in life. The metformin used for pcos (to bring improve situation re periods and ov & egg quality) is given to tackle insulin issues same drug as for diabetics but no doubt different dose. Hope that doesn't upset you in any way  as I wouldn't want to do that but it makes me v cross that pcos is so little understood by medics in uk. Xx


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## Loop

Ps mr your trial sounds interesting hope it helps. I recently had a hysto (&lap) 4 weeks ago sp hops selfishly it does help!! X


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## XxMichellexX

Hi all


I removed my last post as didnt reliase that i was posting in the negative cycle section (got thread out of 'show unread posts' ) and i was still in 2ww. Well i ended up having a Chemical pregnancy. 
I briefly explain my story again. Got 18 eggs, 14 fertilised but only 1 made it to blast. When i started ivf my biggest fear was not the outcome but not getting any eggs and if i did none making it. I know i got one but i was hoping for more, especialy after getting 18. Got my review on the 11th may and is there anything i should mention?


Good luck to all xxx


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## Madeline Rose

Hi Loop

Interested to see your comments. Am personally more pear-shaped than apple and I have a PCO response to stimms rather than having PCOS. I have at times wondered about my blood sugar levels tho - have to be careful what time of day I eat sweet stuff.

Fir the trial I got put in the group having hysterosonography rather than hysteroscopy. Apparently it can still have beneficial side effects.

Hi Michelle

Sorry to hear your news.  

A bit earlier on this thread there's a list of what I discussed at f/u.  Our consultant feels that with v close monitoring (every day), we can get better quality eggs and so also better quality embryos. We will also probably go for Day 3 transfer to see whether they do better "back home" so to speak.

Hope everyone's ok and had a good Easter

MR
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## star27

Hi All,

I had very similar experiences to you all and was also told that I must have PCO tendencies (even though I don't actually have PCOS) and was given metformin.

For those of you that want to jump back on to the rollercoaster please bear in mind that I was told that Metformin needs 3 months before it will have a good effect on your embies
Sj


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