# ivf poor quality eggs & IVF - what do I ?



## ritas (Oct 31, 2005)

Hi,

I am a 39 year old Indian women with a history of gynae issues. These include fibroids - resulting in a myomectomy at 23; mild endometriosis which has been treated; left tubal blockage and mild ovarian dysfunction.

Having said all of that ! My health and gynae health has never been better. Regular periods + all indication of the womb being healthy with normal FSH, LH levels.

Being a gay woman, I initially decided to go through IUI using donor sperm. Seem to respond to treatment of Puregon injections with an appropriate ovarian response. Having had no success, decided to move to IVF.

My IVF drug regime initially started with down regulation using Seneral (4 sprays/day) and then moved on to Puregon injections 200iu and Seneral dosage reduced to 2 sprays/day. Initial scans revealed a slow ovarian response so my dosage was increased to 300iu 6 days in to the treatment wit Seneral the same. Scans again revealed a slow response with 3 dominant follicles and 3-4 very small follicles. For last 3 days, Puregon was again increased to 350iu with Seneral remaining the same.

My egg retrieval was carried out last Wednesday - they retrieved 2 eggs. Th next day found out that the eggs did not fertilise. We met with doctor today. She explained that the embryologist had indicated that eggs were poor quality - I think she used the word granular. Also went on to say that he had indicated that I use donor eggs.

I was shocked that after only 1 try we seemed to be already discussing donor eggs. She believes my chances are very slim but understands my needs to try all that I can.We finally agreed to go for another IVF cycle with a new drug regime - Puregon at 300iu + Orgalutran 0.25mg + use of ICSI.

I really want to be able to go into the cycle as positively as possible whilst still mainting a level of reality.
What, if anything can I do to optimise my chances - particularly the number of eggs and quality ?
IF I were able to increase the number of eggs produced - is there not hope of some being an OK quality.

Sorry for the long story but any advise would really be appreciated.


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## Catspyjamas (Sep 26, 2005)

Hi there

Sorry to hear everything that you've been going through.  I'm no expert but just from reading these boards I've seen some women talking about L'Arginine to help improve the growth of eggs.  Do a search and see if that's right or would be of benefit to you.  I'm sure some of the others will be able to help you more.  Good luck with your treatment x


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## madison (May 6, 2005)

HI,

I am a bad responder also, I this time had.,.. solgar wey to go protein powder, I took it all thro my stims.. It didnt help me get anymore eggs but the ones I got were much better quality, I cant think of anything else that could have caused it.

I am now on the 2ww .

Love Katy. xxxxxxxxxxxxx


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## Janny (Jun 19, 2005)

Hi Ritas

I am 2 days away from EC on a cycle of Puregon (starting at 400iu and decreasing) with Orgalutran from day 10 to suppress my LH surge. I obviously have no idea about egg quality yet but this is a vast improvement on my last / first cycle which was Menepur and synerel. Like you I didn't respond well and after trying increased dosage, the cycle had to be abandoned because I produced only 4 follicles and only one of those grew.

My doctor believes that sometimes you respond better if the puregon works with your natural cycle to boost it (rather than supressing it with the synerel). It certainly seems to be true for me - this time I have 11 follicles in total of which 9 are a good size. 

Sorry I can't help on the question of quality but I hope you have a similar experience to mine with the quantity resulting from your new regime. 

Jan


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## manders (Nov 10, 2005)

Hi I'm new to all this and just gone through my first failed IVF cycle.  trying to be positive and looking at ways I can improve my chances next time round.  

I seemed to respond well to Puregon and had lots of lovely looking follies when I had my scan, but only produced two eggs!!! miraculously both fertilised and had both my embies (grade 1 + 2) put to their rightful home!!! but got a   yesterday.

Anyway, do any of you girls know anyway I can improve on number of eggs for next time??

thankx
manders


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## Morvern (May 16, 2005)

Have a look at this:
http://www.centerforhumanreprod.com/premature_ovaries.html

It's about DHEA - it's a hormone precursor, that your body converts into various other hormones. A lot of people are very excited about it because it seems like it can make older women's ovaries behave like those of a younger woman . Trials are ongoing. Only use a brand that is labelled "micronized" if you decide to try it.


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## Alvie (May 26, 2005)

Hi Morvern
That link about the DHEA is really interesting...thanks for posting it.  I have never heard of it before but it sounds very promising for those of us with prematurely aged ovaries (and lets face it we don't often hear anything positive on the subject!).  Are you thinking of trying it?
Alvie
x


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## Morvern (May 16, 2005)

Hi Alvie

I think DHEA work best whilst stimming and I haven't got that far yet so I haven't tried it - I might be tempted to though - a lot of a ladies at a US board I post on take it under the supervision of their doctors. You can get it over the counter in the US but I'm not sure how easy it is to get hold of in the UK.


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## Clare_S (Aug 9, 2003)

Hi All

I would strongly advise against taking any drugs or herbal medicines during your IVF cycle unless you have agreed it with your consultant.  Some drugs work well in some combinations but in others prove to adversly affect things.

Good Luck

clare


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## Morvern (May 16, 2005)

Obviously people should consult with their doctor before taking anything.

Here is an interview with Dr Norbert Gleicher if anyone is interested:

*Is the dosage 75 mg per day?:*
Yes, 75mg is daily and we usually prescribe it as 50mg in AM and 25 mg in PM.

*Period of time to be taking DHEA before trying another stim cycle:*
DHEA peaks in its effects after at least 4 months (maybe even a little later). Consequently, if the patient's age allow it, we will wait for 3-4 months before starting a cycle. In this waiting period we have seen more spontaneous pregnancies than in subsequent IVF cycles. We, therefore, encourage relationships during this time. If patients are over age 43, and we don't have time to wait, we try to get at least one month of DHEA in before cycle start.

*What protocol do you put the patients on after they have been treated with DHEA:*
We always use a microdose GnRH-agonist protocol, followed by stimulation with 600 IU of gonadotropins daily, with those split between FSH (450 IU) and hMG (150 IU). If patients are above age 42, we do not pretreat with OCPs; if they are younger, we do.

*What is the treatment with OCP's before hand. Is that birth control pills?? And why do you treat with these?*
We pretreat most patients with 10-14 days of Aygestin, though this is not absolutely necessary and, indeed, in many, especially older, patients we don't do this because of its depressive effects on the ovary. The potential benefit is less cyst formation and therefore less cycle cancellations for cysts. (Aygestin is a form of progestin, a synthetic substance that chemically resembles progesterone, that may be prescribed in ovulation induction therapies to inhibit ovulation and quiet the ovaries in advance of egg stimulation using injectable hormones. This "down time" helps the ovaries respond better to treatment. In much the same way that oral contraceptives prevent pregnancy by inhibiting normal ovulation, Aygestin is used in IVF and related procedures to turn off the body's natural ovulatory cycle).

*When do patients stop taking DHEA?:*
"Patients stop their DHEA once they have a confirmed positive pregnancy test".

*Does DHEA cause any problems to a developing fetus?:*
"There is no evidence to suggest that DHEA is harmful. PCOD patients, who get pregnant all the time, have very high DHEA levels".

"Pregnancy, itself, is a high DHEA state since the placenta is a "DHEA factory."

*Is there any change to the luteal phase support with DHEA?:*
"DHEA does not change the routine luteal phase support".

*Have any of your patients to date suffered any adverse side effects from taking 75mg of DHEA per day?*
The one side effect we have seen is transitional acne.

*Will I need some kind of monitoring (ie blood tests) whilst taking the DHEA?*
We don't recommend any blood tests because normal ranges for DHEA are very wide. We do recommend, however, that our patients be sexually active while taking DHEA as we have seen a very significant number of spontaneous pregnancies in patients waiting to go into IVF.

*Not sure that I want to know the answer to this question, but here goes, have there been any of your patients who have shown no improvement in cycles after being treated with DHEA?*
Yes, there are some patients who don't respond but they are more frequently seen amongst the older patients.

*I know that number of eggs retrieved relates strongly with the success rate with IVF, does this apply to those taking and responding well with DHEA?*
Retrieved egg numbers, indeed, correlate to success in pregnancy.


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