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  1. #1
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    Default Disaster cycle... was it the Menopur??

    Long post, sorry. Hoping that someone in the know might have some useful input...

    I'll start off by saying that I've always had bad egg quality, even though no one knows why. Here's a brief summary of my ICSI cycles while TTC #1. All of these cycles were using Gonal F:

    1: 6 eggs, all mature, 1 fertilised, BFN (bad sperm)
    2: 10 eggs, 6 mature, only 1 sperm found, 1 fertilised, BFN (again bad sperm)
    3: 7 eggs, 5 mature, 2 fertilised, embryos slow, Day 5 morula transferred and Day 6 erratic blast frozen, BFN (donor sperm),
    4: 8 eggs, 7 mature, 2 fertilised, embryos slow, Day 5 morula, other emby didn't make it, BFN (donor sperm -- new donor)

    Then we threw everything we could at cycle 5, including 3 months of CoQ10, DHEA, acupuncture, etc. I stimmed with 600iu Gonal F, and I used Saizen (HGH) during stims as well.

    5: 15 eggs, all mature, 10 fertilised, 4x Day 5 blasts, 1x Day 6 blast, BFP and live birth (donor sperm -- same as cycle #3)

    We've just gone back for our first stim cycle for TTC #2, and it was awful. We are at a new clinic, in a new country. The FS wasn't allowed to offer me any more than 300iu Gonal F, so instead asked me if I'd like to try Menopur instead, as he could bump me up to 450iu on that. I agreed, as I'd heard Menopur can be good for bad eggs. Also, they weren't able to offer me Saizen, and from what I can tell clinics in UK don't prescribe it. I was apprehensive about not using it this time, but thought it was worth a shot anyway. I spent 3 months doing all the same things as pre-cycle 5 again, same supplements (and then some), acupuncture, everything.

    Here's what happened...
    I went to my baseline scan on CD 2 and already had two follicles that were nearly 10mm and nearly 8mm. But my e2 was less than 150, so I was cleared to start stimming the next day. I stimmed for 6 days and went to my CD 8 scan, where I only had four follies and two were already the right size to trigger (18-19mm). The other two were 13-14mm. The nurse went to speak to her superior to ask whether I should trigger that night or not, and got the nod. So I triggered on CD 8, had EPU on CD 10, and got 3 eggs.

    The next morning the lab called to tell me that 2 of the eggs were mature and were ICSI'd, but neither of them survived the ICSI process. They couldn't give me reason for it, just said it was "really bad luck". To my knowledge, this has never happened with any of my eggs before. Terrible fertilisation, sure, and I was expecting to hear that none had fertilised. But to be told they didn't even survive having the sperm injected into them was a horrible shock.

    So was it the Menopur? Was it the fact that those follicles grew too quickly? That my body was screwy to start with by having measurable follies on CD 2 (why would this be happening??), and I probably should have been cancelled before I even started stims? I'm all-too-familiar with having bad cycles, but this one takes the cake by about 500%.

    I'm yet to even book my follow-up, I don't even want to set foot in that place again TBH. But I guess I will have to at some stage if only to hear what the FS has to say. Plus we will get a tiny fraction of the whopping huge cycle fee refunded for not making it to transfer, so I guess I'll need to arrange that too (because of course there's no way they will contact me of their own volition!). But in the meantime I need some reassurance that whatever caused this is fixable, that we do still have a chance at having a second child, that my eggs aren't 100% screwed at only 34...

  2. #2
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    @Sariele - I really feel for you. This happened to a degree with my first cycle - where I had 17 mature eggs and 10 of them ' disintegrated' on being injected. I still had 7 but only two got to day 5 one tested abnormal on PGD and the other bit frozen untested. I was on Gonal f for that cycle and as a result changed to menopur 225 and 300 respectively on the next two and my fertilisation rates improved to 50% and 70% respectively on the menopur. However I am 42. It's by hard to pinpoint what make a cycle go wrong. There are so many mixed views on menopur - some things you read say it's bad and others say it can give a better result. Hopefully in your review discussion with the FS, they will be able to give you their opinion and of course importantly suggest changes to try and improve your next cycle.

  3. #3
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    I am so sorry to hear. My last cycle was on menopur because i didn't react well with gonal f. 300IU to start. I didn't have the baseline scan but blood. On my first can at CD10 (?), i had two big ones. They all grow quite unevenly. My FS decided to let the two to go over mature and let the rest caught up. Her conclusion was that some of my follicles respond too quickly. Guess what? The two turned out to be cyst. It was good that we waited to do the EPU so i had some eggs to retrieve. I wasn't a particular good responder with menopur either but because the dosage is so much higher than what i had with gonal-f, i got a lot more eggs but still not what we aimed for ( >10). Perhaps it was a bad call that they triggered too early.

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    bbhope - I'm so pleased I read your post as it's given me hope. How many eggs did you end up getting that cycle? Were the little ones mature by then?

    My last scan on a Friday during my last cycle I had a couple of big follies (about 16.5) and the rest were 10-14. Based on that, they brought my trigger forward a day earlier than planned, which I didn't really want to do but trusted them. So I triggered on Saturday night for Monday EPU. We got 6 eggs (from about 8-10 follies on scan), but only 2 were mature & neither fertilised. Transfer was obviously cancelled. Waste of a cycle. I thought I was triggered too early and a day or 2 longer would've made all the difference for the small ones, and the big ones may still have been ok.

    This cycle my EPU is planned for next Wednesday so I can have a final scan on Monday (they're not open weekends) and I can stim a couple of days longer if needed. I had my day 7 scan last Thursday. On the left I already had 2 at 18 and 2 at <10. My right side I had a 9, 10.5 and 12. Nurse said based on that I was ready to trigger on Saturday for Monday EPU. But then she said they've grown way to fast and it's quite possible they were cysts, especially given what happened last cycle. I had a blood test & she said she would talk to the doc when the results came in.

    Basically I could trigger & do EPU on Monday before the big ones got too big, hope they weren't cysts & had mature eggs inside & waste the little ones, or I could stim for longer (at least till my next scan on Monday), likely lose the 2 big ones, and hope the little ones catch up. That's what I opted for. My estrogen came back at 2620 which is inline with how many were seen on the scan. She said my baseline estrogen level was normal so I had no estrogen-producing cysts before I started this cycle.

    This cycle seems identical to the last one, my estrogen is pretty much exactly the same and the follies are the same size (the big ones are a smidge bigger & the small ones are a smidge smaller). My second scan last time showed the small ones had grown at a normal rate too, they probably just needed longer. I hope I've done the right thing & this cycle doesn't get cancelled again :/

    I have been on 150 Gonal F and 250 Cetrotide with an Ovidrel trigger for all 3 cycles.

    Quote Originally Posted by bbhope View Post
    I am so sorry to hear. My last cycle was on menopur because i didn't react well with gonal f. 300IU to start. I didn't have the baseline scan but blood. On my first can at CD10 (?), i had two big ones. They all grow quite unevenly. My FS decided to let the two to go over mature and let the rest caught up. Her conclusion was that some of my follicles respond too quickly. Guess what? The two turned out to be cyst. It was good that we waited to do the EPU so i had some eggs to retrieve. I wasn't a particular good responder with menopur either but because the dosage is so much higher than what i had with gonal-f, i got a lot more eggs but still not what we aimed for ( >10). Perhaps it was a bad call that they triggered too early.

  5. #5
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    @MissMegan: 150 gonal f is on the low side. I was on 120 gonal f on my first cycle, bumped to 200 (? don't remember) half way through. I had only 3 follicles on the first scan!!! 5 eggs in the end. I was a poor responder for my age with normal ovarian reserve. FS didn't waste time with gonal f on my second stim and tried menopur. Different protocol as well. I started with 300 in the hope of getting >10 eggs. I ended up with 8 eggs. A bit disappointed but the quality helped in the end. I did a lot more prep on my second cycle, though.

    I think E2 gives you a rough indication of how many mature eggs are in there? ~1000 E2 level per mature egg when you trigger.


 

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