Monday, November 27, 2006

A clothes-on consult

We had our post-IVF - or more acurately IVZero - consult. We were happy to get it over and done with, and we suspect so was the doctor, though he was kind and generous with his time as ever. DH reckons he was expecting a tearful production and was relieved when I just peppered him with questions as per usual. (This might be my husband projecting his own relief though.) At one point the doctor did remark we were down-to-earth people before delving deeper into one issue or other. I'll take that as a complement.

I really appreciated that the doctor remembered one of my main concerns: is it an egg or a sperm issue? In preparing for the consult he called the embryologist that worked on our case to find out. Read on for the answer.

This is what we learned in question - answer format. Any similarity with our actual conversation is accidental.

How many eggs did we have?


Egg quality?
Good, 10 were mature, which is a good rate.
The polar bodies in some looked wonky, but they can't say that this means anything. It's just one of those observations embryologists like to put in their reports.

Sperm quality?
Scored normal in all aspects: count, morphology, motility. No indication at all that ICSI was necessary.

So, what went wrong?
The problem seems to be the binding between sperm and zona pellucida. Normally, one would expect to see a swarm of sperm around each egg, all trying to get in. In this case, the embryologist saw the sperm swimming about cluelessly in all directions.

Is it the sperm or is it the egg?
We can't say for sure. The egg may not be sending the right 'come hither' signal to the sperm. The sperm may just be too clueless to respond to the signal.

Are we just incompatible?
There's no practicable* test available.

-- Well, what did you expect, that he was going to tell you each to have an affair and see who procreates first? --

What now?
With ICSI you should have a good chance of creating embryos.

Is our condition hereditary?
Well, you've been tested for know genetic causes of infertility (Y-deletion, fragile X, balanced translocations, CF) and you have none of these.
Of course, there must be a gene somewhere that is the root of this problem, and the odds are you would pass it on, but we don't know what gene. Nor do we know whether the trait is dominant, but that is unlikely since it's such a rare condition.

What if the same happens again?
Then we'll have exhausted all our treatments options ...

... with our own genetic material.

What kind of donor options does the clinic offer?
Anonymous donation of sperm or eggs is a possibility, any form of known donorship is not.


-- Perhaps an affair is not such a bad idea after all. --

Moving back to matters at hand, how soon can I start again?
After one rest cycle. The cycle after that you can start with BCPs again in preparation of the next attempt.

Protocol changes?
Actually, yes. This time you can use G0nal-F, the synthetic drug, instead of Men0pur, a human derivative.

Why the change?
G0nal-F being synthetic has the advantage that we can accurately measure the dosage. In Men0pur, the vials all supposedly contain 75 IU, but in reality it ranges from 60 to 90 IU.

Don't some doctors claim Men0pur works better because it contains trace amounts of LH?
Yes, but those claims haven't been adequately substantiated. Your body will produce some LH throughout your cycle. We monitor this and can influence it by altering the Supre.fact dose.

What could have come up, but didn't:

*So, there are unpracticable tests?
Why yes, I'm so glad you asked.
In theory, after TFF, you could pipette the eggs into a fresh petri-dish, leaving behind all dh's sperm and add a fertile donor's sperm. Now mind you, no embryo's would form, because the eggs past their sell-by-date. But the zona pellucida is still fully functional for a while, and if the new sperm did make it through ...
Likewise, we could take some of dh's sperm and put it in a petri-dish with someone else's leftover eggs, and see if they can get in there. Of course, 'leftover eggs' are a rarity in practice. In future, we hope to mass produce artificial zona pellucida, so we can test sperm for their ability to hack it, so to speak.
Nice, swinging it in a petri-dish!

If any of the issues in this post have affected you, please don't call me, check out these great resources:

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At 27 November, 2006 01:09, Anonymous Anonymous said...

It sounds like you had a good consult and got some answers. I hope that this next cycle yields much better result. Hugs.

At 27 November, 2006 02:38, Blogger My Reality said...

It does sound like a good consult. I hope ICSI will be the trick for you. The uncertainty of it all just really sucks.

At 27 November, 2006 03:08, Anonymous Anonymous said...

Thanks for the info. And well done for being so "down to earth" - I think that's a compliment too.

I'm surprised the clinic doesn't do BYO donor cycles - I wonder why not? Hopefully you won't have to think about that for too long.

I hope your break doesn't seem too long, and that you feel the better for it.


At 27 November, 2006 03:21, Blogger Josie said...

Thanks for the info sheets - I have not seen them before (even in all my ask dr. google consults)

It is incredibly frusterating not knowing the source - sp or egg - that is where we are at right now.

Best of luck and I hope that next cycle will be here soon for you.

At 27 November, 2006 03:51, Anonymous Bebe said...

I'm glad you survived the consult. My guess is that ICSI will get you much farther. Does that mean that you are in your rest cycle now? Or would they want you to wait one more cycle?

At 27 November, 2006 06:41, Blogger Meg said...

Sounds very productive, Lut. That's great.

"Swinging it in a petri dish" - now that's an expression!

At 27 November, 2006 06:46, Anonymous Meri-ann said...

It really does sound like a good consult, I like that your RE has such a matter of fact attitude and a definite plan of attack!

At 27 November, 2006 09:17, Anonymous Anonymous said...

The Rescue ICSI Rarely Works information was not pretty, did I read that right?

Sounds like a great consult, reading between the lines it seems to me you are also looking for the Plan B. Understandably.

Doctors will not go there till they have to, unlike us. Why no known donor?

At 27 November, 2006 12:50, Blogger Thalia said...

I'm again wondering where you live, which would have the opposite legislation compared the way most other countries are going. Why allow anonymous but not known? IF anonymous is there at least some kind of registration so that children can find their biological ancestors if they want to?

Glad it was so informative, you sound as if you were scarily well-prepared.

At 27 November, 2006 15:25, Blogger ms. c said...

Your consult seems to have gone well, though it is frustrating not knowing if the issue was with the egg or the sperm...
Your doc does seem pretty confident about ICSI, so that's a good thing.
Thanks for all the additional info, and here's hoping for the next cycle!

At 27 November, 2006 20:13, Blogger soralis said...

Wishing you luck with your next cycle. Sorry that they couldn't answer all your questions.

Take care

At 27 November, 2006 21:13, Blogger Hopeful Mother said...

Sounds like a very productive consult. And certainly refreshing to get to keep your clothes on!

I would take the "down to earth" remark as a compliment too. I prided myself in not getting emotional in front of our doctor. Just the facts!

It is frustrating not to know if the issue is sperm or egg or some combination thereof, but at least you have a few answers and something new to try in the quest for more answers (and a baby!)

Interesting that you are moving to G0nal-F instead of Men0pur - all the docs seem to have different opinions on the LH factor...

I hate that we even (jokingly) think about swinging our eggs or sperm with someone else's (not our partner's)... just to get some answers. But I will admit that I've thought that too!

At 02 December, 2006 15:37, Blogger Beagle said...

You got your money's worth out of that consult.

With the egg swap thing then I guess you can't try to match features, traits, etc.?

Funny how different the rules are around the globe.

Good Luck with your next cycle . . .

At 06 December, 2006 16:33, Blogger fisher queen said...

I hope ICSI does the trick. I've seen it work for other bloggers.


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