- Christina produced 13 eggs – she donated six eggs and kept the rest for her own use
- ICSI was performed on six eggs, five achieved fertilisation and four embryos were frozen at the two pronuclear stage
Lister Fertility’s Dr Thum says following on from the last issue Christina has been matched with a recipient and started another egg sharing IVF treatment. After going through the data obtained from her last stimulation cycle, I have modified her stimulation protocol slightly; hopefully it will help to achieve a better outcome.
At Lister we routinely invite couples to come back for a follow-up appointment after a failed cycle. We will use the information that we obtained from their last failed cycle to tailor a better stimulation protocol for a future treatment cycle. In Christina’s case I agreed that she should have an endometrium scratch to enhance implantation.
Christina started her treatment cycle in November – she had 13 days of injection for stimulation and during that stimulation period she attended the Lister clinic five times to monitor her follicular growth, and she was subsequently ready for egg collection in mid-November. Her response to the stimulation in this cycle was very good: she had more follicles than in her previous cycle. At Lister we routinely monitor the patient’s oestrogen, LH and progesterone levels during stimulation cycles. We would only proceed to do vaginal egg collection when the blood test levels are at the optimum level with satisfactory follicular size.
After 13 days of stimulation Christina’s oestrogen levels were very good and had a good number of follicles. However, her progesterone levels were elevated. From our data and medical publications it shows that if the progesterone levels are elevated before egg collection the chances of achieving a pregnancy are significantly lower. This is most likely due to the endometrium maturation being out of synchronisation with the implantation of embryo. Therefore I advised Christina to proceed with egg collection but to freeze all the embryos at two pronuclear stage, instead of having fresh embryo transfer. From our experience of performing frozen embryo transfer in this situation the chances of achieving a pregnancy is as good as when having fresh embryo transfer.
Christina produced 13 eggs – she donated six eggs and kept the rest for her own use. ICSI was performed on six eggs, five achieved fertilisation and four embryos were frozen at the two pronuclear stage. The egg collection was uneventful and Christina had a speedy recovery from the procedure. Christina was understandably upset that she did not have a fresh embryo transfer. I invited her to come for a follow-up appointment to discuss the future plan for her frozen embryo transfer which will be done on her natural cycle. Christina is keen to get on with the treatment and I agreed that we would try to have this done in December… so, by the time you read this.
Christina called the nurses at the beginning of December when her period started – she had a baseline scan to assess her lining and her ovaries in view of planning for frozen embryo transfer in this natural cycle. The scan showed a satisfactory endometrium but her ovaries were still quite swollen from her egg collection. Christina was sent home and would go on to book another scan on day 10 of her cycle. The scan on day 10 still showed that her lining has not developed yet. I suggested that we continue to monitor her cycle and hopefully we can do the frozen embryo transfer in this cycle; if not we will do it in her next cycle. Christina has four embryos in storage which appear to be good quality embryos and I think she has a good chance to achieve a positive outcome for her forthcoming frozen embryo transfer treatment. If that is not the case, I will continue to work with the couple to help them achieve their goal.
Christina writes… We are now about to embark on our second round of IVF – we have been matched very quickly and cannot wait to get things started again!
As we have already gone through the procedure once before we feel more confident as we know what to expect.
After things didn’t work out the first time, we had our follow-up appointment with Dr Thum which we found very useful. He was able to look at our last cycle and modify this new one to suit our needs better as there was data to look at. Upon looking at our last cycle Dr Thum made changes which will hopefully give us the positive outcome we so desperately want.
Dr Thum increased our dose of medicated injections as he now knows how I respond to them without overstimulating me, and also said we should have the endometrium scratch to help with implantation. When we left we felt reassured that Dr Thum was making all the changes he could to help us this time round.
The first step into our IVF cycle was to have the scratch performed. This was quite uncomfortable but only lasted for a few seconds, and it was worth all the pain as it’s another step closer to making our dream come true. Once this was done we were called in to collect our bag of medication and start the injections the next day.
As we have done the process before the injections felt okay and quite normal. To be honest, it becomes part of a nightly routine. We had our routine scans throughout to check that the follicles were growing nicely, which they were. After 13 days stimulating we were ready for egg collection; we couldn’t believe how quickly it came around and that this was really happening again. For some reason we felt quite relaxed through the whole process this time; I think it’s because we knew what to expect at each scan.
On the day before we were booked in for egg collection we were called by Dr Thum who advised that everything looked great. We had more follicles this time, though unfortunately my progesterone level was slightly raised which meant that while we could go ahead with the scheduled egg collection the transfer would have to be postponed as my chances would have been significantly lower if we were to proceed straight away. On that note Dr Thum did the best thing for us and decided we do a ‘freeze all’ cycle so my eggs would be protected and we could still use them, albeit it at a later date.
I was a bit upset but realised this was the best thing for us to do and was happy Dr Thum checked the levels so our eggs would not be wasted.
Egg collection went well with 13 eggs collected – we gave six away and kept seven for ourselves. We were really happy that we had more this time. I had no issues with the procedure and went home a few hours later. We had the call the following day advising us that four were fertilised with ICSI and were frozen for us the same day. This was an amazing achievement for us: during the last cycle, only one had fertilised, so you can imagine how relieved and happy we were.
I wanted to move on to the next step as quickly as possible. I felt a bit empty and wanted my eggs back where they belonged so Dr Thum agreed that we would start on my next period. I was called in to go through the procedure as we haven’t done a frozen transfer before. It all seemed quite straightforward with no daily injections involved and a few scans to monitor my lining as this was a natural frozen transfer.
When my period started I went to Lister for my baseline scan to see how everything was looking. It was okay but my ovaries were still quite inflamed from the egg collection and a few bruises were seen, so I was told to come back to see if they reduced as we really wanted to go ahead whilst not risking losing our precious embryos. When we went back for our day 10 scan it still showed large ovaries and my lining had not thickened enough to continue with the frozen embryo transfer.
Again, this was quite upsetting but you cannot rush these things – I have realised that now. The body needs time to heal and my embryos need to be put back into the best environment possible. We really want this to work this time round so to wait a few more weeks to my next period is the best thing for them. Our journey continues but we are so close and we know that Dr Thum has done everything he can to make this work, and of course, we remain very optimistic and excited.
For more information on Listers Egg Sharing Programme visit their website www.ivf.org.uk