Wednesday, April 14, 2010

Tick Tock

We met up with Dr. Hopeful for our post-IVF conference yesterday.  Overall it was a good meeting.  There wasn't anything shockingly new that I didn't expect already.  Overall, Dr. Hopeful thinks the reason why this cycle failed was due to egg quality issue.

Surprise, surprise.... NOT.

Tick tock, tick tock ..... can you hear the biological clock ticking?

See this earlier post for a recap of this cycle, and some answers I was looking for at this post-IVF conference.

This is what I found out from Dr. Hopeful at our meeting:
  • Dr. Hopeful was surprised that no one had mentioned about my right ovary being in a difficult position.  It is high and posterior (behind) my uterus, or other organ.  It would have required a needle to go through the uterine cavity to access it for egg retrieval.  She thinks the location of the ovary will remain and will not change in the future.
  • It is possible to fix the ovary but it would require surgery to fix or retrieve eggs from it.  Did you know that in the past, laparoscopic surgery was used to retrieve eggs for IVF?  Dr. Hopeful does not recommend surgery to fix this.  She thinks that based on my body's response to the meds, I should be able to produce a decent amount of eggs in the left ovary.  However, this also means that I probably will only have ONE ovary to work with in the future.
  • A day-3 transfer was not considered since my embryos were not at a 7 or 8 cell stage.  If there were, they would have a day-3 transfer.  My embryos arrested at 2-cells and 4-cells stage on day-5.
  • Assisted hatching is only done for day-3 embryo transfers, and are not done for day-5 blastocyst transfers.
  • There were no issues with my Babe's sperm numbers.
  • There were an increased number of vacuoles (fluid or bubbles) in my eggs/embryos, indicating that they may not be healthy (signs of post maturity or degeneration).
  • ICSI could be an option in the future.  However, ICSI does not help a compromised (low quality) egg.  She would rather not do ICSI if there is an egg issue.  Performing ICSI is performing surgery on an egg, so she would rather not do it.
  • It is an option to do half ICSI and half natural fertilization, or all ICSI in the future, assuming egg quality is not a factor.
  • I asked Dr. Hopeful if one year would make that much of a difference in the quality of eggs.  She said no one really knows, but she doubts it.
  • If we did a future cycle (which we will), we will switch our protocol and do an Antagonist protocol, meaning I won't be using any Lu.pron.
  • I asked about additional testing and Dr. Hopeful suggested doing Karotype testing for me to determine if there are any issues with chromosomes.  It will check for 46XX chromosomes, to see if there would be issues with chromosome imbalance in my embryos (not me).  I still have to research more about this.  She will test me first since she suspects the issue is with my eggs.  Karotype testing is not cheap, about $900 a pop!  I will have to find out if our insurance will cover at least part of it.  It will take about a month for the results to come back.
  • According to Dr. Hopeful, there is an 8% chance of chromosomal imbalance.  The other 92% chance is egg quality, i.e. my biological clock is ticking.  If the test comes back and I fall into the 8% chromosome imbalance, then she would suggest donor eggs (my Babe and I have never even discussed DEs yet) since it would mean that our embryos would arrest, fail to implant or we would miscarry.  If we do not have chromosomal imbalance, then it is a matter of finding good quality eggs.  
  • Based on my hormone levels this cycle, it looks like I do not have diminished ovarian reserve, i.e. I still have some eggs to work with.  We just have to find the good ones!
  • Dr. Hopeful wants to try again. My uterus was "perfect".  I responded well to the meds.
  • If I wish, Dr. Hopeful would consult with one of her other RE partners about my case and see if there is something else that she missed, or something different that could be done for the next cycle.
  • I will be scheduling a phone consultation with the IVF lab director to go over the outcome of this cycle.  Hopefully this will give me an idea about what happened to my eggs/embryos.  
Overall, we had a good discussion at this meeting.  I think Dr. Hopeful was impressed with the questions  we had for her, and we had a good hour long discussion.  She took her time and read through my list of typed up questions to make sure we got everything answered (she did that the last time too).

She said when we were ready, we should take the Karotype test, and then come back for another try when the test results were in.  Before we left, Babe and I decided that we would take the test anyway, so I had my blood drawn for the Karotype test before I left the clinic.  Since the results won't come back for a month, it would probably be June before anything else happens.

So now we wait.  Again.

Obviously, we hope the Karotype test come back normal so we can try again.  If not, we will need to have a discussion about donor eggs. I don't think we will do donor eggs, but we have never even considered it or discussed it.  We'll have to at least talk about it.  We'll have to see how things go.

We've all heard the cliche of the biological clock ticking.  Well it's ticking REALLY LOUDLY for me.  With each tick, it feel like my eggs are getting crappier and crappier.  With less than 4 months to my 37th birthday, it feels like a time bomb!


  1. the tick tock thing is madness, yes? just wanted to say that i've heard about sooo many girls who have egg quality issues one round, and then the next --> pregnant. so, chin up!!

    i have high hopes for you :o)

  2. I am glad that you were able to get some answers! Fingers crossed for you!

  3. I'm glad you had a good and informative consult with your RE. I hope the tests comes back normal and you get to try again soon.

  4. Wow I read all your post and my heart went out to you. It must have been hard to hear that the reason it didn't work could have something to do with your egg quality. I heard about how diminished reserve (what I have amongst other things) goes hand in hand with poor egg quality. I didn't know you could have one without the other. Anyway I hope your test come back and show that there are no chromosome imbalances and that it's just a matter of finding the super healthy eggs! I am keeping you in my prayers and hoping that once the results come out they'll indicate that you can start a new cycle. I have faith!

  5. What an informative glad that you had the time to talk to Dr. Hopeful and get your questions answered. Best news??? She is still hopeful for you, as am I!!!!! I know it's hard to wait, I'm there now, least we can wait together!!!

  6. Wow your doctor sounds awesome! Waiting and more tests really stink but it helps to have someone who is truly looking for you and trying to get you pregnant.

  7. i feel for you... I'm 2 weeks shy of my 37th birthday with 4 IUIs & 1 IVF under my belt & on my 2WW for the 5th IUI.... Hope all of us find the babies that were destined for us... I'm trying to stay optimistic even though my levels are approaching peri-menopause but with only 2-3 follicles per cycle its hard... Hang in there & keep smiling...

  8. That was a really thorough appointment. I'm glad that she went through so much information with you and thank you for posting. It helps me, too. I also think I have egg quality issues.

    I'm really glad that there's still hope and I know that the antagonist protocol is good for creating better quality eggs! Good luck on the next cycle.

  9. Glad you got some detailed info (though gotta love maybe an egg issue....maybe? Do doctors think we don't pay attention to how old we are???)

    Continued prayers for wisdom and guidance for you...especially with the testing and DE issues....when we started IVF and they were talking diminished reserve, we thought about --but not much since it didn't get to that point. A year later, and after Matthew...I can say I've thought very seriously about with my husband and knowing what we now know (sadly) about pregnancy, we agree that we are completely ok with it. It's something as I said...prayers for direction in your steps!

  10. Sounds like a great consult, and your Dr. sounds very invested in you which is great!! I know the waiting sucks, but hopefully you can get a little more info on your body which will only help your next attempt. Thinking of you, and hoping the time goes by quickly!!

  11. So happy you have such a wonderful Doctor. I think her saying she would consult with other RE's is a wonderful gesture, as she has your best interest at heart :)

    From one crappy egg girl to another, we will make it! As for June...that is when I have an RE appointment. Yes, I will have waited 2.5 months for an RE appointment, so what does that tell ya? There are lots of us out there with issues :) We aren't alone :)

    On a "happy" note, you have a "good uterus and ovary", now its off to find the "golden" egg, which IS THERE....

    Much Love as you journey on...and I'm cheering loudly for you!


  12. HUGS. This journey is not easy, but it is also not over. Although I know the waiting completely sucks! Just FYI, we had 3 day transfers only on all three IVF cycles, and had ICSI done all three times too due to hubby's sperm quality. The only time I got prego was when they added AH to the mix the last two times. Hope any of that info helps!
    Glad you have such an informative doc...I hope they step it all up this next time....praying for you xxxooo

  13. I think there are a lot of positives in there. Firstly -- you don't have dominished ovarian reserve!! YAY, so that should quieten the ticking clock! And it is certainly a very big piece of good news! I am someone who has egg quality issues too so I know that ticking clock but my Dr always says that there are good eggs in there somewhere, it's pure statistics. Eventually we will find a good one. Well that's my story and I'm sticking to it!
    Dr Hopeful sounds lovely, she sounds like she is really on your side and seeing things from your perspective.
    Fingers crossed that the karotyping comes back normal so you can get a plan together.

  14. Your doctor sounds amazing. I think all your questions were amazing too. Glad you got a lot of things answered. I'll be praying that the test comes back ok and they find some good eggs next time! :)