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  1. #1
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    Default Recombinant LH or testosterone gel

    Interested in anyone's experience using these in their regimes or protocols or other suggestions. After 2 failed IVF/ICSI cycle, we don't know what to do i.e. keep trying or give up. DH has severe MFI with only 1% normal out of 1 million. We have had 6-8 eggs at EPU in the last 2 cycles with 4-5 fertilised but none of them make it to blastocyst at day 5. Cell division is good up to day 3-4. I have only transferred very poor looking morulas with vacuoles at day 5-6 and with negative results. Rest of the embryos arrest or regress between day 3-5.

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    I've done DHEA, which is essentially testosterone enhancement, with no success over a number of cycles.

    I've done recombinant LH (Luveris) with ecstatic success. (I was also on DHEA, but only for only a month or two that same cycle, I'd been off it for only a month or two prior to that.)
    Like you, I average 7-8 mature eggs per stim. We did 8 egg collections all up.
    I average about 70-80% fertilisation (wide variability across cycles though, but may have been sperm-related), which is appropriate for my age, as that is an appropriate age-related percentage to expect with correct spindle formation.
    Only once did have have a blastocyst (early blast) at day 5. That was a cycle using low-dose (150) Pregnyl every 3 days - for LH support. Other day 5 transfers have been morulas. We also had 2 earlier transfers along the way.
    Our growth usually slows markedly around day 3-4.

    Now for the Luveris cycle, we had 5 fertilise. Of those 5, all of them were morulas on day 5 - yes, still just morulas which was disappointing, but all 5 made it which had never happened before.
    We did our usual 2x day5 morula transfer - and I'm now pregnant with twins.
    Of the 3 left in the lab until day 6, two formed poor quality early blasts, not suitable for freezing, and the other died.

    Now for something I noticed on the previous Pregnyl cycle. We introduced assisted hatching with that cycle. The embryo growth started to slow down like usual, but after the hatching (they thin the egg-shells on day 3) growth picked up again. The slower one that reached 8cell last picked up first and became the early-blast, and the quicker ones that had paused for longer took longer to recover and resume growth.
    We didn't get daily reports on the Luveris cycle, so I don't know if the growth patterns were repeated.
    Makes me wonder if my eggshells are not permeable enough. It probably wouldn't have mattered if we'd done IVF/IUI/natural instead of ICSI, because bombardment by so many sperm would have thinned the outside of the egg anyway.

    Hope that helps, feel free to ask for any more details.

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    Kenta  (31-03-2012)

  4. #3
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    Thanks so much Felicita for sharing your experience. Did you do ICSI as do you still need hatching if you do ICSI? Also did you have any sperm issue as I am being told our problem seems to be more sperm related but improving the egg quality may help still? Also what type of cycle have you done? Was it a long down regulation?
    Last edited by Kenta; 01-04-2012 at 10:56.

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    We tried quite a few variables in our cycles.

    ICSI.
    All cycles were ICSI.
    We tried microdissection for DH sperm, so were going to use ICSI there.
    Our related donor did surgical sperm collection due to vasectomy, so needed ICSI there too.
    The anonymous donor was also listed as ICSI only, I think because the clinic was stretching donor samples as far as they could go so probably not sufficient numbers for IUI or plain IVF.

    Types of cycles.
    #1, #7, #8 down reg.
    #2-#6 antagonist.

    #1 used frozen eggs. That was the stim we discovered DH had no sperm at all and never would, so the eggs were saved for 14 months and were fertilised with donor sperm at the same time as stim #2. After the thaw we had 7 thawed and 7 fresh eggs to play with, so it was interesting seeing the direct comparison in how they went. As expected, fresh eggs do work better than frozen. eg. 3/7 fert from frozen, 7/7 from fresh.

    #1-#5 used related donor sperm. But the quality was really very terrible.
    #3-#5 used digital high magnification on the sperm. They were hard-pressed to get a half dozen good fellas. Our fert rates actually dropped after introducing high-mag, but given that shocking quality had been proven we continued to use it for related donor samples. On #5 they thawed the last two vials and still couldn't find any motile sperm. As it was from biopsy those vials just happened to have more architectural cells and less tubule and sperm cells.
    Sperm related? Improve eggs/embryos anyway?
    #1-#5 we were told the sperm was the problem, and that I was fine. But after #3 (after only two failed transfers because #1 and #2 were fertilised at the same time) I was put through the girly tests. NK results were equivocal, so FS treated me for them anyway. He put me on DHEA to try to improve egg/embryo quality because we couldn't do anything about the sperm side of the equation. DHEA is a precursor molecule to both oestrogen and testosterone. The DHEA "side effects" (for me it was mostly pimples, including a lot of back-pimples) are due to increased testosterone, which is why I said DHEA was essentially testosterone enhancement.

    #6-#8 used anonymous donor sperm.
    #6 we expected to work so much better, so was really, really upset (that's an understatement) to do D5 morula ... again. I had low dose Pregnyl when LH began to drop too low. FS presented our case to large meeting of colleagues to get many opinions before next cycle.
    #7 Dropped DHEA (FS conference was 50:50 split on DHEA for us so we opted for change). Introduced assisted hatching (why not try everything). Pregnyl (150) every 3rd day preemptively for low LH, rather than wait for it to start dropping. Back to down-reg. After this cycle FS consulted a small number of colleagues, and I was transferred to one of them for the last cycle. We were advised by multiple FS that #8 should be our last attempt with my eggs.
    #8. Restarted DHEA. Down reg. Assisted hatching. Luveris (daily from some point, I don't recall the detail) for low LH instead of Pregnyl. Puregon instead of GonalF. Pessaries instead of crinone (just because we were tweaking everything, not because it would make a difference. Crinone supplemented my P4 just fine). Lots more travel - 2hr public transport to new FS/clinic. Ditched fancy TTC multivitamins, just took folate. Prednisolone and clexane for NK cells. ET with different FS returned a microscopic amount of endometrium to dish, whereas that never happened with original FS (maybe it made a difference to implantation, maybe not).

    Assisted hatching.
    FS says they normally only start adding that after a few failed blasty transfers. Since we were never going to achieve multiple blasty transfers we added it anyway just in case it was another problem we just hadn't been fortunate enough to have been in a position to diagnose yet. As I wrote in the earlier post, it seemed to have a beneficial effect.
    Last edited by felicita; 01-04-2012 at 17:22.

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    Kenta  (01-04-2012)

  7. #5
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    I have tried LH recombinant but it didnt work for me. If you are trying it, I can gladly send you two boxes which I have left FOC. I got them for 130 per box.. They are very expensive stuff if you dont get it foc in your cycle. Let me know if you are interested.

  8. The Following User Says Thank You to Mom2TwoDSs For This Useful Post:

    Kenta  (01-04-2012)


 

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