IVF questions before 2nd cycle?

[ivftreee]

Just looking for any advice on what to ask my doctor before beginning a second cycle.

I had two TFMRs that were naturally conceived - couldn't face the risk of trying naturally again so we decided to try IVF with PGT-A. The first cycle has not gone brilliantly - in the baseline scan i had half the follicle count as compared with a couple of months earlier (10 vs 21) but the Dr encouraged us to go ahead with IVF in that cycle as the lower AFC was more what they'd expect from my AMH - so it was possible that the higher one was the outlier, I didn't realise it could vary this much? The follicles then seemed to grow unevenly, so after 8 days of stims, 6 eggs were retrieved, 4 mature (the other two were over mature). Only 1 fertilised and although this did made a 5d blast, it was abnormal in pgta testing.

I will speak to the doctor about a different protocol that tries to ensure the follicles grow more evenly, so we can make the most of the follicles that are there, and also ICSI... Is there anything else you'd suggest I should ask /discuss with them to try to optimise the second cycle?

Hi @ivftreee, I'm sorry your 1st cycle wasn't a success. I'm not entirely sure what to suggest, although I did notice that you only had 8 days of stims - I wonder why? My 1st cycle involved 11 days of stims, and ended up with 6 eggs just like you. All were mature and 3 fertilized, 2 made it to to 5d blast. It's not an amazing result, so during my 2nd cycle, we'll increase the dosage of my injections and the doctors think it could lead to a better outcome. I'd recommend you check with your doctor if you should have stims for longer than 8 days and perhaps an increased dosage?

Hi @BelleCrescent thanks so much for your reply and wishing you all the best with your second cycle, and the tweaks to your meds. I think that some of my follicles perhaps grew too fast (and got over mature by my EC) while others didn't have enough days of stims to make it (I had 8 days of stims plus the trigger day). I'm not sure if they can make sure the follicles grow more evenly - I'll ask about having more than 8 days of stims. Thank you very much!

Thanks @ivftreee , I wish you all the best, too 😊 IVF is so complicated and it's difficult to know what's the best way to do things...but I guess we get more clever with each cycle!

Thanks @BelleCrescent - I've had the consultation now and the doctor recommends I go on the pill for 2 weeks from CD14 of the next cycle and then start stims again with the withdrawal bleed. And the follicles should be a more even size at the starting gate this way... So we'll see! We are going to try that plus ICSI and hope for the best. Absolutely agree re the hope to get more clever with each cycle!

Hi @ivftreee
I was also on the pill (norethisterone) from CD14 as they said that would help get more eggs. That month I had an AFC of 10
Then when I started stims I had 12 and a few more popped up after but in the end they didn't catch up. Only 8 were retrieved out of which 7 were mature and 5 fertilised. I am now waiting and hoping for at least 1 to get to day 5.

Might be worth also asking your doctor about calcium ionophore alongside ICSI. It is said to improve fertilisation rates. That's what our consultant recommended for us as we have severe MFI. Not sure if it helped or not but might be worth a try. Although I'm sure ICSI alone would increase the fertilisation rate anyway.

I was also only on 8 days of stims but high doses. I didn't realise that's considered too short... I suspect it's a fine balance and probably hard to get all follicles to grow at the same rate anyway. Although in my case it was more that the rest of them weren't responding at all. My left ovary only had 1 egg out of 5 follicles (the others stayed at <6mm). I also have endo so maybe that ovary is more impacted.

Hi @bububaby wishing you all the best with the limbo and wait to 5 days, and hope you have some great embryos from this cycle.

Thanks for mentioning calcium ionophore - we don't have MFI but had this poor fertilisation from the first round, the doctor seemed to think that ICSI will be enough to improve it but I will ask.

Yes the days of stims seems tricky I agree. They didn't think that 8 days was too few per se - only that I had smaller follicles that were responding but didn't have the time to mature by egg collection (which couldn't be delayed as most others were ready). I also had one ovary which responded much more than the other one. It all seems a bit tricky to predict and lots of guesswork I suppose.

Wishing you all the luck for this cycle