IVF#1: Post-failure consultation

We had a fabulous consultation yesterday. We left the appointment feeling like our clinic has a great understanding of IVF and is really tweaking out next cycle to give us the best chance of success. These are some of the answers to our questions:

FET cycle
• How fragmented was our 6-cell embryo at freeze?
They gave it a score of 2 (with 0 best and 6 worst). The symmetry was 1 (with 0 best and 2 worst)
• What are the chances that this embryo will survive the thaw?

There is a 60% chance that it will survive the thaw, and then a 10% chance it will result in a live birth. By law, I must use up all my frozen embryos if I want my next fresh cycle to be funded by health insurance. They quickly signed me up for a clinical trial of Menopur-versus-no stimulation for my FET cycle. I am in the Menopur arm, but I can opt-out and just go the no stimulation with monitoring route instead. I am not sure which option I will take.

Next fresh cycle
• Given my poor response, and that no embryo reached the 8-cell stage, what are our chances of success in future fresh cycles?

At my clinic, 9 eggs is not a poor response - they only aim for 10 eggs retrieved. I guess as 6 fresh cycles are funded, they prefer to have fewer patients with OHSS. They said 6-cell and 7-cell is not that far off from 8-cell, and that we have a very good chance of success in future fresh cycles, especially with a change of drug regime (see below).
o Does our history of a chemical pregnancy and miscarriage influence this?

One chemical and one miscarriage, sadly, falls within the 'normal' range and doesn't tell us anything.
• Will I be on a different drug regime next time around?
Absolutely. My LH was too high throughout the whole cycle, indicating that I was not properly suppressed. He even asked me if I had trouble using the nasal spray. So instead of Suprefact nasal spray for suppression, I will be taking an injectable lupron-like drug instead. Then, instead of urine-derived Menopur I will be taking the recombinant Gonal-F. He said that in order to reduce costs, they put first-time IVFers on the cheaper Menopur, but then after that keep them on Gonal-F, which has a better quality control and is easier for the patient to use.

• How many eggs should we transfer next time?

By law I am now permitted to transfer two embryos, but I am leaning towards elective single embryo transfer. The increased risks associated with twins makes me uncomfortable.

• Can we squeeze in another fresh cycle before New Year's?

Probably. I need to ask them if they want me to have a break cycle after my Menopur-FET.

Donor embryos
• Can you tell us about your frozen embryo program?

They were very unwilling to talk with us about this program. They said that they usually suggest it as a last resort, and no on has ever asked so early on in the process. The process is completely closed, even if the child turns 18, and even if the child requires a bone-marrow transfer.
o Does the six month waiting period apply for every frozen donor embryo transfer?

No. It takes six months for the psychological tests, and after that, we are permitted a 'virtually unlimited' number of donor embryos.
o What criteria do you use to match couples with embryos?

I couldn't get much information on this. From the web, it appears that no matching is conducted (I'm not sure about blood-type).
• Can we sign up for donor embryos now while still attempting our own cycles?

Not yet. They suggest we try a few more time with our own gametes first.

• Will they transfer in donor embryos shipped from abroad?

This question really confused the guy. To clarify, I said, if we had a frozen embryo shipped from the Czech Republic (thinking of Reprofit's bank of cheapish embryos), would you conduct the transfer? He then looked really confused, asking me if I wanted a Czech baby? I laughed, and said, no, we just want one good embryo. We don't care where from. My husband said that we'd even be happy to take a baby if they have any of those laying around. The poor guy just looked more confused and I had to tell him that my husband was joking.

So that's that. Most of my questions answered, and a shiny new drug regime waiting for me for our next fresh IVF cycle. I feel hopeful and happy.

Now it's off to the UK for a week!