June 1, 2009

Answers to IVF Questions

We meet with our RE last week for an IVF consult. The RE explained in detail what the IVF procedure would be like. He also answered several questions that I had come up with (see post Q for IVF for background information). Below is a summary of all the questions he answered:

Do we need to do a Clomid Challenge Test and Basal Antral Follicle Count?
No! My day 3 FSH has been < 5 for the last 5 tests (indicating good quality/quantity). I seem to have tons of eggs during every scan and they have had to watch out to make sure that they did not over stimulate me during IUI. So quality and quantity should not be a problem and we do not need to do any more diagnostic as of now.

What are the chances of me having endometriosis? How can we confirm?
Minimal, nothing (cyst/scars) seen in u/s and I do not have any pains and aches.

What are the standard IVF protocol (lupron/long, flare, antagonist) used at the clinic? Which one suits me best and why?
Lupron, since that seems to suit the best for PCOS patients.

How many minimum mature eggs required to continue with IVF (egg retrieval)?
4 minimum

Will we be doing a Mock Transfer?
Mock transfer was already performed prior to IUI and it’s an all clear.

What is the optimum lining of the uterus for implantation? Have I had triple stripe lining?
Optimum lining is 6 mm. I have had at least 8-9 each time. I have had triple stripe lining (also called as Type A) during the pre ovulation u/s.

Should we be doing a PGS/PGD?
PGS/PGD is not recommended unless there is a genetic disorder identified in the family or if there are multiple miscarriages. RE will not recommend this now. When all chromosomes are screened there is 97% reliability in the screening results.

Do I qualify for the clinic’s Embryo Quality Study?
I do not, since I have PCOS.

What are the success rates for IVF and FET?
IVF success rate in my case is approximately 60% and FET success rates is approximately 50%.

For IVF - ICSI or Assisted Hatching? GIFT/ZIFT an option?
GIFT and ZIFT are rarely used since the success rates are very low. ICSI is the way to go. Assisted Hatching is performed when a day 3 transfer is done, this helps in implantation.

My progesterone level 4DP-IUI has been around 6 units? Is it something to be worried about?
Progesterone level of 5 is required for implantation (which is also supposed to be the level indicating that ovulation has occurred). With IF treatment the RE’s like to see a 9. Since I am taking Prometrium, I should not be concerned about low progesterone and lack of implantation.

Should I be concerned about OHSS during IVF? How is that monitored/controlled? Does OHSS lead to IVF cancellation?
During egg retrieval (ER), all the follicles (mature or not) are emptied, therefore the chances of hyperstimulation post retrieval is very low. There will be some discomfort since the ovaries are large, but severe OHSS is probably not a concern. Regular u/s and b/w will help in monitoring the ovaries.

Day 3 or 5/6 Egg Transfer (ET)?
RE recommends transferring 2 embryos in my case (assuming 2 good embryos are identified). Day 3 transfer will be performed if two really-really good embryos are identified (remaining will keep growing in the lab for a possible FET). It’s quite obvious that uterus is the better incubator (as compared to the lab), so transferring the really-really good embryos in the better incubator early makes sense than leaving them out (in the lab) for the next 2-3 days. If there are several embryos doing well and it’s hard to tell which ones are the really-really good embryos, we will be waiting till day 5/6. This will give a chance for the really-really good embryos to stand out… these two will then be chosen and transferred (remaining will keep growing in the lab for a possible FET).

Is Baby Aspirin recommended?
RE’s clinic prescribed Baby Aspirin to patients for two years (after studies showing increased successful pregnancy rates). However the clinic did not see any increase in pregnancies, where as they noticed increased bleeding and bruising in patients. They no longer recommend Baby Aspirin.

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