# Lots of questions - opinions appreciated x



## marieclare (May 10, 2008)

Hiya girls, sorry in advance, this is a long post. Am hoping to take advantage of everyone's experiences to get some thoughts on my questions. I know a lot of these I will ask at follow up but my thoughts are a bit all over the place, and it would help to see what other people think in advance - it might also give me more questions but I don't mind. I am also hoping to see Lyndon.

Ok so me, as you know: _AMH:50, one or more ovaries possibly polycystic but never been confirmed as having the syndrome. ICSI #1: Long protocol Gonal F, 20 eggs retrieved, mild OHSS. Out of my 10 eggs: 6 mature, 4 fertilised. 2x 3 day embies transferred. BFN. 1 further embie was frozen at day 6 (but later perished on thaw). _
_ICSI # 2, took Metformin 2 months prior to treatment, antagonist protocol with Menopur, 8 eggs retrieved. Out of my 4: 2 mature, 1 fertilised. 1 x 2day embie transferred. BFN. _
_We are using a frozen sperm sample obtained via TESE._

EGG QUALITY
Is my maturity rate normal or below normal? What are the reasons for eggs being immature? Is timing of EC an issue? Is this due to PCO / AMH level? Is there anything I can do to improve this? Am I right in thinking DHEA not recommended due to AMH? 
PIX did you ask JE about the bee pollen / royal jelly? Are you taking this? Do you think it has helped?
I understand the metformin was supposed to improve egg quality. Has this worked given I had less eggs but they were not more mature?

Is it worth me finding out what the "other half" of the egg batches were like ie were they mature, did they fertilise? _I do not want to find out if the recipients got pregnant_

STIM RESPONSE
Could my AHM have come down since being tested? I think I have only had it done once when we first started with clinic which possibly 2 yrs ago? Should I get bloods repeated?
I seemed to respond better to gonal F (in terms of number of eggs), what do you think?

FERTILISATION
Is our rate normal or below? Is this to do with eggs, sperm or both? Does frozen sperm do less well than fresh? We have made good embryos and one day 6 so does that mean we have just been unlucky? Could there be a genetic problem? Are there any tests for this?

SPERM
There is nothing I can do about the frozen sperm quality, but thinking ahead (or in cloud cuckoo land lol). I am thinking about getting DH on vits incase we run out and he needs another op, or by some miracle some sperm gets through. 
PIX did you get DP on the bee pollen, do you know if its made any difference? Does anyone know what else I could give him to help?
Would it be a total waste of time to get another SA done? We have only ever had one which was 3 months after reversal. Does anyone know how much clinic charges for this?

IMPLANTATION
I have never been pregnant, could there be a physical reason why embryos are not implanting, are there investigations I should have at this stage to rule this out? Endo? Dodgy uterus? Are there any tests / scans where you could have a better look?
Could it be an immune issue? Would you recommend an nk blood test? Does anyone still do biopsys? Should I get level 1 tests done?
Do you think clinic will give me steroids anyway on #3 just to chuck everything at it? If so is there any point having level 1's done?
Would asprin help?
Could it be my fault embryos not implanting ie doing too much? is it true you should just get on with normal life or should you lie in bed?

Why was I spotting 7 days after transfer for 5 days? Grace saw the erosion on my cervix at transfer and said it bleeds on touch. Is this what bleeds before my period for 5 days every month? It must be hormonally controlled as it stops on suprecur and it seemed to stop on gestone? What can i do to get to the bottom of this without delaying treatment?

After transfer I had period type pain and cramps. Can I have something to stop this? i have heard of using HCG after transfer to stop this, would it help?

Can you explain in a normal pregnancy, what stops your body bleeding when the embryo has implanted? If it is the progesterone why do I bleed through it? If its hcg how does that work if I start bleeding before there would even be any being released, what is supposed to stop the bleed?

On our next cycle would assisted hatching help? I would like to keep all my eggs and try for blasts, would this be possible?

Is there something wrong with my left ovary? Ever since I first took stimulation drugs in August 09 I have had a niggly ache / stitch regularly on my left hand side, even months after treatment was finished. It feels active on stims and then turns out to have less follicles.


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## jk1 (Aug 26, 2009)

Hi Marie,  my cycles were really similar to yours - long protocol, mild OHSS, then antagonist with lower number of eggs.  I have confirmed PCOS though.

I asked loads of questions at my follow up - most of which you already have here.

I would find out how many of the other eggs were mature...on my first cycle i had 16 eggs and they decided on the day to do 8 ICSI and 8 IVF - 4 ICSI fertilised and none of the IVF ones did (which didn't surprise us as we'd been trying for 3 years and never fallen!) I was put on antagonist on my second cycle because she said my eggs were not mature...after our second BFN i queried this decision as she said for my third they would try short protocol as they don't really know what the problem is.  I queried this and made her look back in my file and turns out that on my first cycle 11 out of the 16 eggs were mature - so she then changed her mind and said that my third cycle would be long protocol again as that works well for me!!  Felt like my second cycle was a waste of time as they must have known this before.

Sorry for the massive long reply but i just wanted to let you know how much of a difference it made for me knowing how many mature eggs i had....its changed the type of cycle i will be on next time. 

Jo xx


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## kara76 (Dec 14, 2004)

good questions hun and you know what, questions like that need a professional answer, we could all give our our opinions but i do feel that these questions are very individual and deserve answering by a consultant, yet i can answer 1 and not it is in no way your fault that the embryos are not implanting and even though you may feel it is, there is no way it is your fault. we often blame ourselves but you must not do that ok?


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## jk1 (Aug 26, 2009)

good advice Kara - you are good at this xx


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## marieclare (May 10, 2008)

Thanks guys thats great. Jo thanks for the info    I will make sure to find out about the other eggs maturity and if it makes a difference. I don't really know if the antagonist has helped me or not, although I didn't get ohss I don't think it went as well. I don't want to understate how bad some people get ohss and I understand its important to avoid it, I would almost say I wouldn't have minded feeling a bit less comfy to get a better result I think.

Thanks Kara, I know no one can give me 100% answers but I am interested in everyones opinions of the questions, knowing what its like going into follow up and wanting to make sure you get the most out of it. I know there is so much info I am not aware of, i just want to go in armed and ask the right things. 

I do think if they were going to stick they would, but I would like to ask the question at the FU just to clarify the advice about stuff like lifting shopping etc coz me and dh has some different opinions so i just wanna check.


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## Sam76 (Mar 23, 2009)

Hi Marie

excellent list of questions - my advice - and it might seem obvious but i know i've prepared for things in the past in advance only to leave the info behind on the day!....don't forget to print off, take them with you and ask them all (tick them off as you ask them - i had loads of questions and kicked myself after coming out because there were some that I hadn't asked (e.g. why might spotting have started 9dpt?) Consultant may say something that you're not expecting - with us it was about trying the gonapeptyl for 3-6 months as it improves success rate by 4 times for people in my situation   - put us off stride a bit a totally weren't expecting it.

as for the steriods, i did remember to ask about them   in my FU and janet seemed quite open to that so think it's just a case of raising it and reminding them xx

good luck hun xx


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## jk1 (Aug 26, 2009)

Marie - i'm like you - i didn't feel that the antagonist cycle worked as well for me as the long protocol and although i was in agony with the OHSS (even though they said it was MILD!!.....i have v v v low pain threashold!!) I am looking forward to doing long protocol again on the next cycle and I kind of wouldn't mind if i get it again to get more eggs and more mature eggs so i know what you mean.

Jo xx


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## Jule (Oct 12, 2008)

Hi marie.I have pcos and I think when u have this they told me it was trial and error.I have had long protocol both times and had menopur.I seem to respond well to menopur so they don't want to change it.my amh is 82 so high same as yours.last cycle I had 300 menopur for 7 days and I had 40+ follicles and only 11 eggs.this time I'm doing 300 for 5 days in the hope ill have more eggs but not so many follies.
I don't know bout chromsome/genetic prob.after I miscarried for 2nd time I went with a list of bloods I wanted.I can't remember them all but one was the chromosomes and the other clotting.u could ask for clotting incase your blood is not quite right.
Your list of questions is huge so like the girls said I would tick them off as u ask cause I'm sure what je doesn't answer lyndon will.who knows it could just be one of those things and nothing u do can change the outcome.
Just thought now my dh takes zinc for his sperm.


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