Navigating through the IFs of IVF!

So, here I am just popping BCPs (and of course Metformin and prenatals)… but no fix of syringes every night! How I miss them! My life seems to have been taken over by my RE’s protocols. It has (almost) been 5 months since the actual treatment started (i.e. first IUI) and I don’t seem to remember how life is without injecting medications or creating an IF POA for the next several weeks to come. Now that I have officially started the IVF cycle and will be enjoying the BCPs for the next 3 weeks, I had to at least get my fix of information overload to comfort myself. Topics related to IVF addressed below: BMI, E2 levels, SCSA, HBA, PICSI. I will keep updating this post as I find more information…

High BMI & IVF

Having a high BMI, in simple words, being overweight/obese can cause fat deposition in abdomen area… supposedly this can distance your ovaries from the vagi.na. So, during the ER, when they try to reach the ovaries, sometimes they have trouble retrieving the eggs. Hence, there is a cut of limit for BMI for a person to qualify for IVF (varies from clinic to clinic).

Now, I have never been skinny, but I am not obese either (as per the BMI). My right ovary, which is the one which seems to do most of the work… seems to go high up in my abdominal cavity (especially when hyperstimulated) towards the end of a cycle… the RE somehow has to make it come down (by pushing on my abdomen area) for it to be visible in the u/s. My left ovary is never ever a problem. I hope this is not going to be a major issue during ER! I need to work out a little in the next 3 weeks before I turn in to a zombie (with the medications)… may be that will help? I don’t know… but at least I will be satisfied that I tried to help my ovaries… and of course not being lazy and working out is always good!

E2 Levels

I knew Estrogen (E2) levels are pretty important in any cycle, but I never seemed to have registered them in my brain during the CD3 b/w. My FSH has consistently been around 3’ish at CD3. Which supposedly indicates good egg quality and quantity (ovarian reserve)! Similarly, having a very high E2 level on CD3 could indicate poor ovarian reserve or an active cyst (active ovarian cyst secrete Estrogen). Higher E2 at the start of the cycle might also indicate a shorter stimulated cycle and hence poorer follicle/egg quality (not enough time for the eggs to mature). Dr. Google also informed me that a very high E2 during an IVF (ER/ET) could lead to a cycle cancellation, because it could indicate a severe OHSS in the making or some studies even seem to show that E2 levels above 4000-6000 units seem to reduce the chances of implantation. I have read blogs where in spite of good embryos (and good ET), it was a BFN and RE (possibly) attributed it to high E2 at the wtf meet! For more information see the following links: estrogen affects fertility window, poor egg quality and E2 levels, E2 levels, estrogen and progesterone levels for ivf.

This piece of info sent a chill through my spine! What are my E2 levels!? I have been “assuming” that my ovarian reserve is (supposedly) “good”… but maybe E2? I emailed my nurse and it seems that my E2 levels ranged from 50 to 75 at CD3 (during the last 6 cycles). Higher levels (relatively) were noted whenever cysts were identified in the ovaries (or so I would like to believe… I am sure if there are super active cysts, they probably give out tons of Estrogen and not just 10 and 15 units more). The lab cut off for my clinic is 100 units (FertilityPlus says 75 is upper limit in the normal range)… so I guess I am okay (had it not been okay, I would have probably already heard about it from my RE). E2 levels rise as follicles grow… the more the follicles, higher the E2 levels. My nurse mentioned that they do not cancel a cycle for high E2 levels (she didn’t reconfirm the piece of information that I gathered – that very high E2 reduces chances of implantation), however if they are very high, it could lead to severe OHSS (thus cancelling a cycle).

So, I still have "hope"… my FSH is good and E2 is not high-high. I have stopped believing in luck… everything seems to be random and coincidental… or else if luck really existed, I would have already been pregnant (and carried it through) after so many tries! We are doing all we can to shape our future, our destiny… so hopefully we will never have to say that we never tried!

DHA

For the last 1.5 years I have been taking the prenatals that my OBGYN had prescribed (sigh, it’s been that long)! However, the prescription ran out and I had requested my RE to refill it. When I went to pick up the prenatals, I noticed that my nurse had asked for the same prenatals that I had been taking all this while, but with an additional tablet of DHA. Now, I had vaguely heard about DHA, but never really researched about it (every time I come across something new, I realize that there is still so much that I don’t know and there is still so much I could do). So now that I am going to be adding DHA (supplement) to my diet, I decided to look it up. General information about DHA can be found here: Docosahexaenoic Acid (DHA). The DHA prescribed to me is algae/plant based. Now, this is not really an IVF related entry, but I am just trying to summarize all the information I am gathering (so here it is)!

Some of the facts about DHA:

• Advanced Attention Span in Babies Whose Mothers Eat More Essential Fats
• Current research suggests adequate levels of DHA may help increase a developing baby's cognitive functioning, reduce the risk of pre-term labor and decrease the risk of postpartum depression. (DHA Intake During Pregnancy and Breastfeeding)
• DHA can be found in seafood, nuts, meat (organ) products, but is generally not adequately consumed by pregnant women. Average American diet is known to be low in DHA.
• DHA can lower triglycerides (PCOS women tend to have high tryglycerides).
• Fish based DHA could have ocean borne contaminants – mercury etc.
• Low levels of DHA have been correlated with memory loss, mood swings and other mental and visual conditions.

SCSA, HBA and PICSI

I recently came across Murgdan’s post about abnormal sperms and some of the diagnostic and procedures associated with it! (You might already know her and might have read this already.) She has done an absolutely fantastic job in describing SCSA, HBA and PICSI. I am not going to try to steal the show from her... here are the links for her posts (if you haven’t checked it out already): SCSA and PICSI


Just a brief background:

Sperm Chromatin Structure Assay (SCSA): Research indicates that sperm with high-levels of DNA fragmentation have a lower probability of producing a successful pregnancy. SCSA is able to identify DNA fragmentation in sperms.

Hyaluronan Binding Assay (HBA): HBA is a qualitative assay proposed to determine the maturity of sperm in a fresh semen sample. The assay is based on the ability of mature sperm to bind to the substance hyaluronan (a major component of the external coating of female ova (eggs)) necessary for proper sperm function.

PICSI: In ICSI, an individual sperm is selected and injected into an oocyte to achieve fertilization. The PICSI device makes it possible to select a functionally competent sperm (mature, with less DNA damage and fewer chromosomal aneuploidies), indicated by its ability to bind to hyaluronan. Preliminary clinical trials suggest that sperm selected by PICSI may improve clinical pregnancy rates and reduce miscarriage rates.