# implantation today should be happy but a bit disappointed



## melon (Jun 25, 2009)

Hello, I would be really grateful for some advice for next time please
I'm 45 this month, just having first time IVF with donor eggs and ICSI at BCRM. We're really disappointed because our donor is a healthy just turned 26 year old with six children including one set of twins!!!!
We really hoped for lots of eggs and embryos, but in fact she hyperstimulated and though she produced around 30 follicles on the short protocol, they only harvested 13 eggs, of which only eight were mature enough to fertilise, producing 4 embryos. Yesterday was Day 2, and the embryologist contacted me to say 2 looked quite good and were 4 cell fast cleaving, and suggested implanting those. The others were 2 cell with a bit of fragmentation, she didn't say the grade but felt that it wasn't good enough to go to blastocyst and we are implanting two today. As we are private patients, I understand we can have the other two frozen and will check the grade and have that conversation today. I know that we are lucky, and we are hoping for the best of course, but wonder if the clinic should have managed her differently in view of the obviously high risk of hyperstimulation. I have heard of so many younger donors producing large quantities of eggs with lots of frosties left and just feel soooo disappointed. What do you think??


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## marthah (Apr 7, 2008)

its hard not to be disappointed   but i guess you cannot force a donor to do specific things to prevent OHSS... what i mean is if it were you and your eggs, you would be drinking 2 litres of water every day minimum to do the best to avoid OHSS but i'm not sure what incentives are put in place for donors? maybe there are incentives i don't know. i think there is a Donor Egg thread/board on this site so you might be better posting there to see what other experiences are? but it may just be the 'unluck' of the draw - maybe every other time she has ovulated she has produced a healthy number of follies. no 2 cycles are the same on IVF it seems from what i've read from friends on here, there are no guarantees. 

but what i do know is many MANY ladies on here with their own eggs would be really chuffed with 2 good embies and i think in this situation you've just got to put the 'what could've been's' in the bin as you have to keep positive and focus on what you DO have. i  think we all have a perfect scenario in our heads, as we all like to plan, but you just can't with IF issues, you've got to go with the hand you are dealt and make the most of that.
2 embies is good with the possiblity of 2 frosties     keep positive! and good luck x


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## Caz (Jul 21, 2002)

Hi melon, I am sorry you're feeling a bit disapointed by only having the two embryos after such high prospects to start with. 

It's difficult to say whether they managed your donor's stimulation effectively, without knowing the full background and having the appropriate medical knowledge on what happened. 
If I were to speculate (and I am not medically trained so purely just speculation) I would say that it seems quite a large number of eggs were immature, which might imply the timing of EC was not quite right. Possibly that was an attempt on their part to prevent more serious OHSS developing. Had that happened they may haave needed to abandon EC altogether and then, you would be in a situation of having no embryos at all so perhaps it was a case of making a sacrifice of some to "save" the cycle from abandoment.    
You don't mention if she was egg sharing (i.e. keeping half her eggs herself) or if the clinic was sharing her eggs bewteen two patients. I know, often, this is the case, in which case 13 eggs from 30 follicles would be a great number for one of two recipients; I know as an egg sharer myself my recipients never got more than 6 eggs from me and, if they followed normal fertilisation rates, I doubt they always had any for the freezer. 

The problem with OHSS is it's really difficult to predict who will get it; I mean, ladies with PCOS tend to be more likely to get it but, beyond that there's often no rhyme or reason why it develops - especially if it was the first time she has been stimulated. 

The question of whether they managed her stimulation properly or not is one you can raise in a follow up review should it become necessary. However, you can do nothing about the eggs/embryos you haven't got now, so please try and put it out your mind and focus your positive thoughts and energies of the two excellent embryos you are currently PUPO with and hope the other two are good enough to freeze too.  

 


I'm going to move this post to the Donor boards where I think you may get some more responses. 

C~x


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## melon (Jun 25, 2009)

Thanks, ladies I am absolutely sure I am not pregnant, though of course will do a day 11 blood beta HCG next Tues just to be sure. Do you think that the eggs maybe being immature prevented a better outcome? All the eggs were ours  Do you think other clinic factors may be part of it - eg not sure if they use USS guided embryo transfer at BCRM and didn't think to ask on the day? I just thought there must be something wrong. Our donor was on the SP because she was in a hurry to complete the cycle and the clinic told us it would not affect our chances if we agreed to it. Do you think we should go straight into another cycle with the same donor but long protocol and careful monitoring, same thing but at another clinic in Bristol, or take the chance of Reprofit treatment for which we have a slot in May? Sorry to bombard you with questins but you seem to know all about this and it's so hard to know what to do next
Melonxx


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## Caz (Jul 21, 2002)

Hi melon, sorry it's taken me a while to reply to you.

Firstly, how did your pregnancy test go? Have you had a result yet? 


It's really hard to say if other factors were contributoory but if you don't feel comfortable with the treatment you received and you think the cycle was mismanaged then your first port of call is bring it up at the review. If it dones't give you the answers you seek you can make a complaint - or at least speak to the person in charge at the clinic who handles complaint, they should have a complaints procedure in place so you can follow that. Failing a satisfactory resolution to that you can contact the HFEA to put in a complaint / discuss the matter, although it's likely they won't be able to interfere with standard clinic protocol. 

As for what to do next; it really is up to you. Is this a known donor? If not and chosen by the clinic then it's unlikely you will be able to move clinics and keep her as your donor. If so then, really, what's to say she might not be in a hurry again this time?   If you feel that your chances with this donor are not good then it might well be worth looking at your options, including treatment abroad if needs be. Do what your heart tells you iss he right thing to do. 


C~x


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## melon (Jun 25, 2009)

Dear Caz, thanks for your reply. It was a known donor and at 25 with 6 kids incl twins and all bloods good, me with 2ndary infertility only due to age, should have been excellent chance don't you think? Is it normal for the dr to be really disapproving that you have found your own donor through advert and say she will have to consult her conscience b4 she can treat you? Shouldn't she have let me know b4 agreeing to let this donor have SP that it would increase the risk of OHSS and decrease chance of pregnancy? We would certainly not have agreed if we had been told this and were in a position to have put our foot down, as it was we weren't even consulted? And shouldn't she have at least scanned her every couple of days rather than waiting a week by which time she had incipient OHSS with 30+ follicles? Including donor expenses we spent about £10K on this cycle. I don't want to be unreasonable, and I know there is an unavoidable element of chance, but I want to complain but would like opinions and advice about what I may get out of it and if I am right to feel so let down by this dr and this clinic? Thanks for looking, and for the support which is a lifeline as no one knows..... 
Melonxx


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## Caz (Jul 21, 2002)

Hi again melon,  I take it the cycle was a negative then? 


Yes, you would think you have an excellent chance with that but, sadly, what looks great on paper sometimes isn't. It's very frustrating but that's IVF for you. 


Personally my thought about your clinic/consultant would be that what does it matter to the clinic who are treating you; if you come with a donor, you come with a donor! How you met/found her is entirely your business. It's not actually illegal to find your own donor as far as I know (although it is illegal to pay someone to do it - out of pocket expenses aside, of course) and I think I'd be a bit affronted if I was presented with that attitude from a doctor I am paying to treat me...but that's just me!  It sounds very much to me like you got off on a wrong foot there and haven't been able to rescue that relationship at all during treatment. I think having a good relationship between patient and clinic is essential for a good cycle. And in your case a good realtionship between yourself and the donor, and the donor and clinic is essential too. 
 
I'm not sure, never having had a donor, what sort of say the recipient gets in the donor's treatment protocol. As an egg sharer/donor myself I'm not sure that my recipients got any say, although, obviously, they were notified at all stages. Having said that, my recipients were all supplied by the clinic who matched egg sharers to recipients so the contract the recipient would have had with the clinic would probably have been to supply a minimum of 4 eggs or there's no fee to pay - which is slightly different from coming along with your own donor. 

For what it's worth, on the four egg share cycles I did I got between 9 and 13 eggs total (so between 4 and 6 eggs for the recipients) and that's about standard response and before any fertilisation rates are taken into account so I don't think 13 eggs is necessarily a bad number to start out with; it's just why so many were not mature and why only half of those that were fertilised and why of those the quality was not good enough to get any frozen. 

I think it's fairly rountine among the majority of UK fertility clinics not to scan or test bloods before 6 or 7 days after starting stims, even on a first cycle. I'd agree that I think closer monitoring is probably needed for ladies on their first stim cycle but it's all too common for that not to be the case. Unfortunately, clinics can only go by a patient's FSH levels and determine the correct dose of drugs/protocol to start them on and that is not always indicative of what they need to get the best response from them. So sometimes it's spot on first go but more often than not it's a case of tweaking as they go along or learning a hard lesson for next time. 

I think the real question is, would the clinic normally put a patient with her profile on short protocol like this or did they bow to her pressure as a donor to get it done? If it's the latter then you probably have a good case to complain but I would also ask some searching questions of your donor to ensure that the same thing won't happen again. I'm a little concerned that she was in such a hurry and how this might affect your future cycles if you continue to use her. 
I would also ask what size her follicles were when harvested? How many days of stimming did she do? it might indicate if they went in too early for EC? 
You also need to ask about the quality of the eggs and embryos too and, if not great, did the overstimmng affect the quality. 

I think it's worth raising your concerns and seeing what they say and, if you still feel it necessary, make a complaint. You may get something out of it by way of financial reibursement but, honestly, if you do it would likely be something towards the cost of your next cycle there and, if your confidence and relationship with the clinic is that bad, you're not going to want to be treated there again so you may be just as well to cut your losses and move on. Sorry if that's not what you want to hear but sometimes I think you're better off concentrating on what you can do rather than dwelling on what could/should have been done. 

If you really want to persue a complaint, your first port of call would probably be to speak to someone at the HFEA and ask some advice on whether you have a valid complaint and how you go about making one and what you might expect to get from doing so. 

In terms of your next move. You mentioned reprofit in May. Personally (and this is just my opinion) given that it's almost April already, I would take up that option and keep your donor (if possible) on the side just in case, perhaps with a tentative plan to cycle somewhere with her in June/July (you can always cancel WHEN you get your BFP from Reprofit  ). This also gives you a bit of time to either sort out the issues you have with your current clinic (they don't need to know you are going to Reprofit at this point and I would not tell them) or research and find another suitable clinic in the UK who will treat you with a known donor. 

I hope that's helpful for you.

C~x


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## melon (Jun 25, 2009)

Dearest Caz, thanks so much, have put in the complaint and the big man is now taking charge, Will see what he says but all hopes now for Reprofit on 20th May. 
You are so very kind God bless you and your little man
Melonxx


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## drownedgirl (Nov 12, 2006)

My friend/donor was put on the short protocol (I think it's a lot less intrusive and seems to be fairly standard at my clinic)

The first scan was after a week I think, and she overstimulated, we almost got cancelled. 36 eggs colkected, of which 30 fert, and she did get OHSS, was quite poorly. However, this gave us enough embryos for the fresh cycle (BFN) as well as two FETs so far (both BFP) and we still have 8 frosties. So in our case, the protocol worked to my favour, somewhat to the risk of my donor's health, TBH.. though she was just glad not to have to go through a second cycle I think (needle phobic!).. once she was over the OHSS, at least.

IVF isn't a 100% predictable thing.. it does seem though that it didn't turn out well.. and you deserve an explanation for decisions taken. I regard the comments of the dr as being quite serious, you really deserve to have proper support and respect.
Let us know what they say.

xxx


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## melon (Jun 25, 2009)

Hi hon, we are rooting for your scan, let me know
If the eggs weren't mature enough and that's what b***ered up the cycle how could we tell? If not I guess it could be the sperm  
Thanks again for support, 
Melonxx


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## drownedgirl (Nov 12, 2006)

Melon, it does sound like in your case the maturity of the eggs was affected by how the cycle went. And I know they didn't deal well with you at all. I do think at the very least you deserve a proper explanation!

Thanks for the well wishes. Clinic wouldnt move my scan date but have booked one somewhere else for tomorrow. Spotting a little and another week and a half is just too long to wait!


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