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Struggling to concieve
Hi
I'm 37 and have been trying to concieve for 12 months. We have seen a specialist and have had all the relevant fertility tests as has my partner and it's all normal apart from eggs. I've a medium to low reserve. Is there anything apart from IUI or IVF that I can do to try and help us concieve naturally or will we need help. Also to note my cervix is flat due to treatment for abnormal smears and I have high vaginal walls. Is this also having an affect on conception as the Dr who we saw said it wasn't helping.
Thank you
Our Expert's Answer
Please note that all the answers we give are on a generic basis only, as we cannot provide more in-depth answers without access to your medical history. If you need a more detailed response, tailored to you, we would recommend a consultation with one of our Fertility Specialists for more comprehensive medical advice.
In relation to your cervix and vaginal walls, please, don`t worry, having normal sperm quality and regular intercourse is enough for sperm to find their way to the egg. Please check if you had tests like fallopian tube patency test, ovulation test (home ovulation predictor kit and progesterone blood test a week after ovulation), Vitamin D level test.
If your partner`s age is over 45, or maybe a smoker or diabetic, or having other significant medical condition, I would recommend sperm DNA fragmentation test as high fragmentation level can significantly reduce pregnancy chances.
You may benefit from reading about lifestyle: Rebecca Fett: It starts with the egg.
Please note that the only effective treatment is IVF, and IVF chances do decline rather quickly in your age and with your given egg reserve.
Advice about a recent cycle
I was wondering if you could offer me some advice about a recent cycle of gentle IVF I have been through which was unsuccessful. We only retrieved 2 eggs which I was surprised at as I had previously responded very well on a long protocol IVF on 125 Gonal F with oestrogen and progesterone support.
The gentle protocol was originally meant to be 0.3ml of Buserelin and Gonal F starting from day 1 of period (100 Gonal F for the first 3 days then the dosage was to be reduced to 75 for the last 7 days). The only other drugs were a HCG trigger and booster shot.
However due to the clinic wanting to delay the cycle they asked me to take Buserelin for 10 days before starting the Gonal F. My worry is that there was no other drugs used to support my hormones after my system was shut down by the Buserelin.
I'm just looking for another professional opinion as to whether this method could have worked?
Our Expert's Answer
Please note that all the answers we give are on a generic basis only, as we cannot provide more in-depth answers without access to your medical history. If you need a more detailed response, tailored to you, we would recommend a consultation with one of our Fertility Specialists for more comprehensive medical advice.
Buserelin preparation is often used in IVF cycles. However in mild stimulation protocols it is not something often used. Especially for patients with very low ovarian response it is not ideal. Your stimulation dose was reduced from 125 to 100 unit, which is quite significant. (We normally use 75 unit to achieve single follicular development.) So it may have had more an effect on your response than the Buserelin preparation.
Gentle/Mild stimulation protocols are aiming to retrieve 3-4 egg maximum anyway. If you'd like any more information then please give us a call.
Empty follicles?
Hi there, I am quite upset as just had my egg pick up last week and they retrieved only two eggs (which appear to be not right either). This is my second cycle. Our history: 3 miscarriages in 9 months (all very early), then moved on to IVF to try to bank some embryos to implant later with immune treatment.
First IVF cycle, no pill prior to it, Puregon 225IU daily and a day 10 collection and 5 eggs retrieved, though they were very different in sizes and only two over 17mm at trigger. None made it to blast. They did a 3 day transfer of a 10 cell embryo with mild to moderate fragmentation which didn’t work.
Second cycle, (current) they put me on the pill for 21 days, I then came off it for two days and started stims right away on second pill free day – 300 Puregon, 75 Menopur. I also was on Growth hormone for 8 days – 2.5iu daily.
My ultrasounds were showing six follicles that appeared to be mature (one in the left ovary and the rest in the right), sizes 14,15,16,17,19 and 22. Others were under 11mm. My oestrogen was 2045 pg/ml (I thought this would mean at least 4 mature eggs). However, they only got 2 eggs! This was a freeze all cycle, but seems like it was all for nothing!
I am 35 years 8 months, have an AMH of 8.6 (in Australian measurement which is 1.2 in USA measurements), my day 3 FSH has been between 6-8 (6 was more recent). Do you think this protocol is what has caused such a bad result? What do you think went wrong??
A blood test four hours post-egg pickup showed 140IU HCG (i.e. trigger worked), LH 0.1, Progesterone of 15.1. So I guess this is genuine empty follicle syndrome? What would you suggest in future? Should I bother going on the pill to cause more even growth?
I don’t know if there is any point doing IVF for us. The only things they have found is high uterine NK cells and homozygous MTHFR. All my T cell surface markers and cytokines have been in normal ranges last 2 months. Any help is very much appreciated!
Our Expert's Answer
Please note that all the answers we give are on a generic basis only, as we cannot provide more in-depth answers without access to your medical history. If you need a more detailed response, tailored to you, we would recommend a consultation with one of our Fertility Specialists for more comprehensive medical advice.
My impression is you have been not lucky in this cycle. Although your follicular response appeared reasonable, the oestrogen level remained relatively low. As eggs were collected, it is not empty follicle syndrome. There is some evidence that contraceptive pill may reduce follicular response. In this way next cycle I would recommend no pill preparation. You could try higher dose (450 unit to start with) as well. Best of luck!