Infertility/Fertility/6 IVF Failure

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QUESTION: Hi Dr. Ramirez,

I am Kelly from Melbourne. It would be great if you can please suggest me a protocol to improve egg quality. I am 35 years old TTC since last 8 years. I have low AMH but normal FSH level.

IVF Cycle 1 : 2010 - Down regulation : 6 eggs - 3 Embryos - BFN (Gonal F:300IU + Synarel)
IVF cycle 2: 2010 - Down regulation : 2 eggs - 2 Embryos - BFN (Gonal F: 450IU+ Synarel)
IVF cycle 3: 2011 - Antagonist: 3 eggs - 2 embryos - BFN (Gonal F: 450IU + Synarel)
IVF cycle 4 2012 - Down regualation: 4 eggs - 3 embryos - BFN (Puragon: 300IU + Synarel)
IVF cycle 5 2013 - Down regualation: 3 eggs - 2 Embryos: BFN (Gonal F: 600IU + Synarel)
IVF cycle 6 2014 - Down regulation : 7 eggs ; 2 embryos : BFN (Gonal F:450IU + Synarel)

In my last cycle I was taking quite a few supplements : DHEA 75mg, ubiquinol 900mg, melatonin, VIT E, Vit D, etc.

I don't understand what else to try. Everytime there was embryo quality issue. My husband is in good health. He does not have any issue.

Can't take anymore failure.

Thanks

Kelly

ANSWER: Hello Kelly from Australia,

Unfortunately, there are no technologies currently available to enhance egg quality.  That is something that is inherent in the egg.  However, consider how young you are, I'm surprised that you have an egg quality issue.  Given the information you've delivered here, I can't gauge what the embryo quality was.  I should emphasize that egg quality is NOT dependent on the stimulation protocol used.  The number of follicles recruited and eggs retrieved are derived by the protocol.  Your stimulations have been low stim protocols and so not many eggs are retrieved.  Certainly there is room to stimulate stronger.

I also don't know if all these cycles were done in the same clinic.  If so, then you might want to consider changing clinics.  Pregnancy rates are highly variable and dependent,no only on the laboratory in that clinic, but on the Physician skill as well.

The only other recommendation I could make would be to use CoQ10 600 mg per day.  This is an antioxidant that has been shown to help with cellular health and in at least one study, has been shown to increase egg quality in mice.  Unfortunately, human studies have not been done.  I do have all my patients use this since there is no harm in it.

Bottom line is that by 6 cycles of IVF, you should have been pregnant at least once.  My pregnancy rate in under 35 years old is 73% with a 55% delivery rate.  I think you should consider trying in a different clinic.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

---------- FOLLOW-UP ----------

QUESTION: Thank you Dr. Ramirez for your time and opinion.

I have been using the same clinic for all my cycle. It supposed to best clinic in town. I used CoQ10/Ubiquinol 900mg a day in my last cycle. I could see the benefit of it. The egg numbers were increased in my last cycle. All the eggs were matured. I have heard that more FSH injection decreased the egg quality. So I am scared to increase my dose. I have read that estrogen priming protocol improves the egg quality. I am not sure how does that work. But do you believe that it may work for me?

Thanks again

Kind regards,
Kelly

Answer
Hello again,

I'm afraid that what you've heard is not correct.  Increasing the stimulation does not affect egg quality unless you are a PCO patient with ovaries that over-stimulate.  These are patients that make more than 20 follicles and so the stimulation is not even and the eggs don't come out as well.  In the normal stim patient, increasing meds does not affect eggs quality.

In addition, estrogen priming is a technique used to try to increase ovarian responsiveness.  It also does not affect egg quality.

As recommended, I would strongly recommend that you consult a different clinic, despite your current clinic's reputation.  I laud you for your loyalty to your clinic, but something is not working.  It's time for a change.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

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Edward Joseph Ramirez, MD, FACOG

Expertise

I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.

Experience

I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 19 years.

Organizations
American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society

Publications
American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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