Happily Ever After

Archive for June 2008


ER (egg retrieval) was on the 20th and ET (embryo transfer) was on the 22cnd

As stated in my last entry I had 16 follies at trigger. E2 ended up being 2,655 the day before I triggered.

They retrieved 10 eggs. At first I was a tiny bit upset with that (since I had 16 follies) but first of all they almost never retrieve eggs from all the follicles. The other reason might be because they used a different kind of HCG for trigger. it was 1/2 the dosage I normally get (I think). So that could be another reason.

Out of the 10 eggs 9 were mature and 6 fertilized on ICSI.

By day 2 (transfer day) we had 5 remaining. To my surprise 2 were great quality. Both had 4 cells, all cells were the same size and each cell had 1 nuclei! The 3 remaining embryo’s weren’t to good but they were MUCH better then my last IVF. Here are the stats on those:

embryo’s kept to grow in lab:

day 3:

embryo 3 7 cells uneven cells no nuclei present
embryo 4 5 cell even cells no nuclei present
embryo 5 5 cell fragmented no nuclei present

Day 5:

embryo 3 morula by day 5 but poor quality and not good enough to freeze
embryo 4 made it to 10 cells & arrested
embryo 5 arrested at the 5 cell stage

Most of the time my embryo’s arrest (stop growing/die) around the 5-7 cell stage. The fact that I had a 10 cell AND a morula (that is what it should actually be by day 4. By day 5 they should all be a blastocyst) was GREAT. even though the morula was poor quality and a day behind schedule I am still excited that I had an embryo make it that far! None survived to freeze though but I’m ok with that. What I’m excited about is I had NO embryo’s that were multinucleated! Multinucleated embryo’s are a LOT worse quality wise then embryo’s with no visible nuclei.

the nuclei holds the DNA so it’s important that each cell have ONLY one nuclei. Embryo’s with more then 1 nuclei in each cell is chromosomally abnromal and usualy don’t survive very long before they arrest 😦

Looks like the new protocol worked great for me. I’m so happy that we had 2 good quality embryo’s to transfer. My RE and my embryologist are both very excited and hopeful for me. I’m not as hopeful as they are but how am I supposed to feel after all the failures? At this point I don’t get excited. I’m just taking it day by day.

Even if this IVF doesn’t work at least now I have renewed hope. And here I was thinking this would be my last IVF. Knowing that I DO have a chance and I CAN make goood quality embryo’s gives me the hope I needed to keep enduring.

on a not so good note my husbands count was VERY low. It was 33million when I normal count has around 80 (I think don’t quote me on that) However his results have always proven to be linked with stress. When he was not in school and just took a summer off to work his results were MUCH MUCH better. I just need to get him on a suppliment. I want him to go on fertility blend for men but it’s kind of expensive. Worth it though because I’ve seen lots of woman on FF (fertilityfriendonline) tell success stories.

I should probably get back to work. A lot has happened in the past few weeks. My BIL and his wife and 13 month old are staying with us. I’m on vacation from 6/27 (my b-day) and don’t return to work till the 7th of July! Unfortunately however my husaband stil works at his campus job (still looking for work now that he’s graduated) so he doesn’t get paid time offf. I will probably still have him take a Friday or Monday off though so we can do something together. At least I have Jon, Beth and Owen around to hang out with and go on day trips….now if I could only convince my mother in law that she had to take a day off to go flower shopping and yard saleing (not even sure that’s an actual word)

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E2 results

Posted on: June 18, 2008

Well my E2 yesterday was 2,655. Not as high as I hoped but still higher then it’s ever been. My guess is we will have 12-13 mature eggs out of the 16 follies. My E2 could continue to rise but my past IVF’s have shown that the last E2 draw always seems to indicate how many mature eggs I get. IVF #4 & 5 my E2 was around 1,500 before trigger and we had 8 and 9 mature eggs retrieved.

ER is Friday at 9:30 AM. I’m just ready to get this over with.

It’s been a while since I wrote. I’ve had a lot going on at work and at home and just haven’t taken the time to post in my blog.

Here is the break down thus far from my IVF

6/7 Baseline Lining = 3.5
start 0.10ml of Micrdose Lupron

6/8-6/11 0.10 Microdose Lupron 2x a day. 225 Gonal F 2x a day (max dosage my RE will do) – Total = 450 FSH

6/12 (4 days of stims)
E2= 442
Lining=7.5mm – weekday tech
Follies= 1@11mm

6/12 & 6/13 450 FSH & 0.10 microdose Lupron

6/14 (6 days of stims)
E2 = 936
Lining = 13.4 – weekend tech measures larger then weekday tech
Follies = R 3@11mm 1@ 12mm
L 13mm, 10mm, 11mm

6/14 & 6/15 450 FSH & 0.10 microdose Lupron

6/16 (8 days of stims)
E2 = 2,445!!!
Lining = 11.5 week day tech
Follies = 12 between 12mm-16mm

6/16 -225 FSH & .10 microdose Lupron in AM

150 FSH & .10 microdose Lupron in PM

The E2 for my last IVF cycles were around 1,500 and each time. IVF #4 I had 12 eggs retrieved (12 follies) but 8 were mature. last IVF I had 13 follies and 9 eggs retrieved (all 9 mature).

e2 for me seems to be about 200 per mature egg so I’m willing to bet I have about a dozen mature eggs right now. I decrease my evening dosage to 150 (total for the day will be 375 down from 450). Then I do my microdose lupron in the AM and go in for more b/w and another ultrasound.

I’m on the microflare protocol. I’ve been on .10 units of microdose lupron 2x a day as well as 225 gonal f 2x a day. (max dosage my RE does).

I’m not getting my hopes up though because even if by some miracle we end up with 12 eggs (and if my fertilization/ICSI stays as great as it has been we will have 12 embryo’s) they could all still be abnormal/multinuclated so we shall see.

I’ve recently gotten lots of comments on my blog in regards to the SCSA test. Lots of doctors (and thus their patients) seem to think this test is a waste of time. I have done a little research on the topic and found a good web site that explains the procedure and how it can effect fertility.

There may not be ways to fix sperm DNA problems but it certainly will tell you why you are not pregnant. It’s like egg quality…there is no real way to fix egg quality but it would be nice to narrow down what the problem is. Unlike eggs sperm regenerates every 90ish days. Thus sperm quality CAN be helped to some extent. Woman are born with their eggs. Some say you can fix egg quality and some don’t.

Here is what I found on that web site. I personally don’t think this test is a waste of time. CCRM does this test on all couples and their statistics are through the roof. (then again they do all kinds of tests that other RE’s don’t want to “waste” their time doing. Personally I think the more tests you get done the better. I’d rather find out exactly what my problems are before I do IVF. Here I am doing a 6th IVF and we still don’t know for sure what is causing my embryo’s to be abnormal. Here is the link to that web site if you find the below quote hard to read:

http://www.malereproduction.com/sperm_chromatin_structure.html

Also oddly enough the way they describe what happens to the embryo’s due to Sperm DNA problems is exactly what happen to mine. They all arrest around the day 3 stage. It could be sperm issues, egg issues or a combination of both but I for one would like to know what is causing the issues so we can try to fix it or at least accept it and move on.

The Sperm Chromatin Structure Assay (SCSA) and DNA Fragmentation: What Is It and What Does It Mean?
This article from a Resolve 2006 newsletter
Until several years ago the belief among most reproductive specialists (including myself) was that if a man had live sperm then they were suitable for use with IVF / ICSI and if the female partner didn’t get pregnant or a miscarriage ensued then it was probably an egg quality issue. Several studies had implied that the conventional sperm parameters (count, motility and morphology) as measured on a routine semen analysis had no bearing on success when ICSI was used. Many couples pursued egg donation after failed IVF attempts because the husband’s semen parameters were relatively normal and yet conception hadn’t occurred.
Some of these same couples were still unable to conceive even with the “better quality” donor eggs leaving both the doctors and the couples frustrated and perplexed. Some couples then went on to use both egg donors and surrogates thinking it was both an egg quality and implantation issue, again without success. The only commonality was the husband’s sperm.

About a year and a half ago a relatively new concept was introduced to clinical practice; sperm quality was dependent on the amount of damage to the sperm DNA or DNA fragmentation. Simply put, DNA is arranged in a double helix or ladder configuration with side rails and rungs. If the rungs are broken, then the ladder is unsteady and won’t function properly. What has recently been shown in several studies is very interesting and in some ways unexpected. Sperm DNA fragmentation has little or nothing to do with the parameters that we measure on the routine semen analysis. It has little to do with the shape of the sperm or whether the sperm are moving. It is a completely independent variable. Men with otherwise normal semen analyses can have a high degree of DNA damage and men with what was called very poor sperm quality can have very little DNA damage. More importantly what has also been demonstrated is that the degree of DNA fragmentation correlates very highly with the inability of the sperm to initiate a birth regardless of the technology used to fertilize the egg such as insemination, IVF or ICSI. Sperm with high DNA fragmentation may fertilize an egg and embryo development stops before implantation or may even initiate a pregnancy but there is a significantly higher likelihood that it will result in miscarriage. By testing for sperm DNA fragmentation, many cases of formally “unexplained” infertility can now be explained. Many of those couples who have been previously unable to conceive with what would be considered extreme measures have been diagnosed with high sperm DNA fragmentation and treated. It is now very clear to see that having this information about the quality of the sperm can be tremendously helpful to couples and their physicians.

There are several ways to test for sperm DNA fragmentation; the most widely used and statistically robust test is called the Sperm Chromatin Structure Assay or SCSA. The patient semen samples are frozen and shipped in a liquid nitrogen container to the SCSA reference laboratory in South Dakota. The sperm are thawed out and a stress is applied (low pH). The sperm are then labeled with a special orange colored dye that only attaches to the ends of broken DNA within the sperm cell. If the DNA is intact then no dye will attach to the sperm. A machine called a flow cytometer is used to analyze ten thousand sperm from the sample. The sperm are passed single file by a beam of light that hits the dye inside the sperm cell and reflects light at a specific wavelength causing the sperm to appear either orange (damaged) or green (normal). A computer counts the percentage of green versus orange-labeled sperm and software allows for creation of a graphic plot of the percent of damaged sperm giving an index known as the DNA fragmentation Index (DFI).

The data from thousands of patients has been analyzed and correlated with the patient’s clinical outcomes and references ranges were compiled. A normal sample has less then 15% of the sperm with DNA damage. Men with poor fertility potential have greater then 30% of their sperm damaged. A DFI Between 16% and 29% is considered good to fair fertility potential but becomes poorer as it approaches 27%. These numbers are thresholds meaning that above 30% the outcome for most couples was failure to have a birth even though only 30+ percent of the sperm were damaged. Under 15% most couples achieved success. The logical questions that arose were: what about the rest of the undamaged sperm in the sample? Why don’t those sperm work? What causes sperm DNA fragmentation? Can the DNA fragmentation be reduced and the sperm improved? If so, How?
DNA fragmentation can be thought of as a marker for other types of damage to the sperm. It is a kin to seeing the tip of the iceberg. Apparently, in semen samples with greater then 30% DNA fragmentation, other abnormalities are occurring with the non-fragmented sperm that the SCSA doesn’t measure and that is why samples used with DFIs above this level do not usually result in births.

The causes of high DNA fragmentation are those same causes of male factor infertility that we have known about for years such as chemical/toxin exposure, heat exposure, varicocele, infection, age, smoking, testicular cancer, radiation, and anything that increases the free radical levels in the semen among a list of many other things. It is very important to understand that sperm DNA fragmentation can change with time and it can be improved in many cases. The goal of a male factor evaluation is to seek out the causes of poor sperm quality and try to correct them so conception can occur naturally or to improve the sperm quality for IVF and maximize the chances of success. In situations where DFI can’t be improved there is evidence to suggest that removing the sperm directly from the testicle via biopsy and using it with ICSI may lead to better outcomes then using poor quality ejaculated sperm. Other options include counseling patients regarding the use of donor sperm either by insemination or fertilizing a portion of the eggs harvested for ICSI with donor sperm and a portion with the patient’s sperm, once again to maximize odds.

The clinical utility of the SCSA is readily apparent. All men with an abnormal semen analysis are candidates for this test as well as men with normal semen analyses who have failed IVF for unexplained reasons. Those couples using egg donors or surrogates may also benefit from screening prior to going thru the procedures because the effort and costs are so great. Men with poor DFI should have a male factor evaluation including a physical examination by a male reproductive specialist. These new concepts have a significant implication on how we practice and what we recommend to couples but we must bear in mind that this test does not have a predictive values of 100% as healthy babies have been born from men with high DFI but this is fairly uncommon.