IVF Scorecard

Right up front, here's the good news: although it didn't end up falling on a symbolic day, my egg retrieval did go well. It produced an egg. And, amazingly, that egg matured into a five-day blastocyst ... again.

Again, I'm shocked at this good news! And relieved that the choice to return to the far-away clinic seems to be working out. Here's my IVF scorecard so far:

• Nearby clinic: 1 IVF on max-dose stims  ->  2 unfertilized eggs
• Far-away clinic: 3 IVFs with no stims  ->  3 top-grade blastocysts

(source)

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Wow. I'd like to understand more about WHY these results have been so different.

My RE at the nearby clinic thought that the BCPs in the antagonist protocol may have "over-suppressed" me, making the cycle extra long and thereby damaging the egg quality.

As I understand it, some form of suppression is required at the beginning of a cycle, to keep the body from picking a dominant follicle and producing only one or two mature eggs at a time. On the other hand, too much suppression can make it hard to wake up the ovaries again. Choosing the right amount of suppression is always a balance. Maybe an estrogen-priming protocol would have been better in my case ... but each woman is different, and the only way to know what will work best for someone is to start experimenting.

For what it's worth, I've read lots of comments by women who believe that long, high-dose cycles "fried" their eggs. I've also come across this article (and another, similar one that I can't easily find now), which suggests that when high-dose meds are used, "the resultant eggs have a higher proportion of chromosomal abnormalities than would be expected in untreated women of the same age group."

That research is just getting started. But if high-dose meds are a concern, I wonder how much they can damage egg quality even in cycles much shorter than my epic IVF at the nearby clinic. And here's the main thing I wonder: if meds can damage egg quality AT ALL, then why wasn't I told much, much earlier? It was clear all along that I'd never produce many eggs. It was clear that the quality was probably already poor. Why not prioritize keeping what's left of the quality over (at most) slightly increasing quantity?

Medicated IVF maximizes egg numbers while—potentially—decreasing quality. Of course, no-stim IVF is not a perfect solution either, even for women with DOR. It takes a while to collect several eggs, and fertility keeps declining over time. Also, more egg retrievals will probably be needed than with medicated IVF, and retrievals have some risks. I just wish I'd been better informed about the egg-quality issues. With more info this summer, I probably would have made different choices.

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But back to the three embryos mentioned above.

The first resulted in my pregnancy and miscarriage last winter. The two from this fall have now been biopsied and frozen. There's still a very long way to go. I'll do at least one more round of no-stim IVF, then test to see if any of these embryos are chromosomally normal.

I can't forget that my first, doomed embryo looked "beautiful," too, according to clinic staff. It still looks beautiful to me, in the transfer-day photo I saved.

I should also remember that—even with the outcome so uncertain—the results of these last two cycles so far are as good as they could possibly be. They're the best-case scenario. They literally could not be any better.

For today ... let that be enough.