IVF#3 - Canceled - High Prolactin

IVF#3 - Canceled !!!!!

I have high Prolactin - 36.6

Additionally to being diagnosed with our unexplained infertility, that affects only 20% of all couples that stuggle with infertility, I have another unexplained syndrome.

After excluding all the possible causes like prolactinoma for which I did MRI, to by doing various blood test and excluding PCOS and hypothyroidism, in which an inadequate amount of the thyroid hormone is produced - I also fall in about 30% of the cases, in which the root cause of high prolactin is also unexplained.

What! Can you beleive that!

It's either I have some mysterious biological functions or our medical diagnostic test are not advance enough for my alien body!

PUREGON vs. GONAL-F

Tottaly Obsessed!

I start stimming this Monday. I am also very interested on the outcome of my ER this time. I think I am definitely on higher stim dose now, just a slightly different medications. I am on totally different protocol and being a nut like me, I spent most of my weekend researching medical data available on the net. Not like it will help me have better results, just being nosy. Here is some of the stuff I put together for anyone else interested.

It is long, sorry, just had to share

Before I WAS ON:

Gonadotropins (Follicle Stimulation) injections of:
Puregon 200 IU

GnRH antagonists (Ovulation Prevention) injection of:
Orgalutran 250 mg

Result: 5 eggs retrieved, 3 mature, 2 embryos transferred on day 3 (both 8 cell grade 1 no fragmentation, even cell division)

I WILL NOW BE ON:

Gonadotropins (Follicle Stimulation) injections of:
Gonal - F 225 iu
Menopur 150 iu

GnRH antagonists (Ovulation Prevention) injection of:
Cetrotide 250 mg

Result: Coming Soon


I did some research and gathered some information from various published medical studies/articles, since I have to know everything as to what I’m injecting into myself. I guess I am a control freak! Anyhow, here is some general info on my follicle stimulation drugs if anyone interested:

PUREGON: Follitropin beta belongs to a class of medications called gonadotropins. Follitropin beta contains a hormone similar to the human hormone, FSH (follicle stimulating hormone). For assisted reproductive technology procedures, the usual initial dose is 150 IU to 225 IU daily.

GONAL-F: Follitropin alpha belongs to the class of medications called gonadotropins. It is a synthetic version of the naturally occurring follicle stimulating hormone (FSH), a hormone produced by the pituitary gland that helps egg development in the ovaries. Doses usually range from 75 IU to 450 IU (5.5 µg to 33 µg) per day. For Assisted Reproductive Technologies, therapy with Gonal-f® should be initiated in the early follicular phase (cycle day 2 or 3) at a dose of 150 IU per day. Treatment is usually started at a dose of 150 IU or 225 IU (depending on your circumstances) once a day. Usual range is 150-300. Doses larger than 450 IU of FSH per day are not routinely recommended.

MENOPUR: Menotropins are a mixture of naturally occurring hormones that include follicle stimulating hormone (FSH) and luteinizing hormone (LH). The recommended initial dose of menotropins is 225 IU injected under the skin daily for a maximum of 20 days. The dose may be adjusted according to your response, but should not exceed 450 IU.

PUREGON vs. GONAL-F: Both of these medications are made from highly purified human Follicle Stimulating Hormone prepared by recombinant DNA technology. Both are non-urinary products and contain only FSH. There is no LH component. Meanwhile, two published direct comparisons between both follitropins (Tulppala et al., 1999 ; Harlin et al., 2000 ) justify the conclusion that the slight differences between the two molecules do not have any clinical significance. The fact that in the IVF studies, the odds favor follitropin alpha and not beta appears to be mainly due to the fact that, compared to the follitropin beta studies, the control patients perform significantly worse in the follitropin alpha studies (difference: –5.5%; 95% confidence interval: –10.7 to –0.3%; two-tailed P = 0.037). This should have been recognized by the authors.

American Journal of Obstetrics & Gynecology. 189(2):342-346, August 2003. Williams, R. Stan MD *; Vensel, Theresa MD; Sistrom, Christopher L. MD; Kipersztok, Simon MD; Rhoton-Vlasak, Alice MD; Drury, Ken PhD

Abstract:
OBJECTIVE:
Our purpose was to assess the efficacy of two recombinant follicle-stimulating hormones, follitropin beta (Follistim, Organon, West Orange, NJ) and follitropin alfa (Gonal F, Serono, Norwell, Mass) on pregnancy rates in varying age groups of women undergoing in vitro fertilization (IVF).
STUDY DESIGN:
Three hundred sixty-five IVF cycles were retrospectively compared, 233 by use of follitropin beta and 132 by use of follitropin alfa, both after gonadotropin-releasing hormone agonist down-regulation. Assignment to each medication was indiscriminate. The primary outcome measured was pregnancy evidenced by fetal heartbeat on ultrasonography. Secondary outcomes included days of stimulation, ampules per patient cycle, estradiol level on the day of human chorionic gonadotropin administration, total follicles present on the day of human chorionic gonadotropin administration, follicles greater than 14 mm, oocytes retrieved, mature eggs, fertilization rate, and embryos transferred. Outcomes were stratified by age, including women less than 36 years old, 36 to 39 years old, and more than 39 years old.
RESULTS:
There was no significant difference between follitropin beta and follitropin alfa in either the primary or secondary outcomes, although the pregnancy rate was significantly decreased with advancing age.
CONCLUSION:
Success rates are similar, when stratified by age, in women undergoing IVF with either follitropin beta or follitropin alfa.

Here we go again...IVF#3

Had my follow-up/review appointment with RE today. So once AF arrives from this "natural" cycle, which I am not hoping will work...

We are doing it again! Yep! All over again!

July 2008 - IVF#3

Hoping to get more eggs and this time, not going to be on BCP or any kind of pre-suppression because last IVF did not do any good for me and I was over suppressed. Also, if everything goes well, we're going for a 5 day transfer this time.

All of my medications were switched, which is good. So now I will be on:

Gonadotropins (Follicle Stimulation) injections of:

• Gonal - F 225 iu
• Menopur 150 iu

GnRH antagonists (Ovulation Prevention) injection of:

• Cetrotide 250 mg
  

Trigger injection of:

• Ovidrel 250 µg (10,000iu)

After ER

• 81mg Aspirin

After ET

• Progesterone (intramuscular injections) 50 mg daily

Implantation Failure???

I think I might be...nuts

I am doing something weird and yes I know it, so please don't be shy if you think I've gone bonkers

Somewhere deep down in my heart, I believe that the reason why I am not getting pregnant is because I have implantation failure. I think that even though my eggs get fertilized with my husband’s sperm and create normal embryos (as shown by IVF) they are just not able to implant either due to NK natural killer cells or because of blood-clotting.

My RE will most likely will not agree to go the blood-clotting test and NK activity test which have been studied as the cause of many unexplained infertility cases. In fact, some researches believe that it is "implantation failure”, and not poor egg/embryo number or quality that is often the root of the problem.

“Considering its importance, it is not surprising that failure of proper function of this immunologic interaction during implantation has been implicated as a cause of recurrent miscarriage, late pregnancy fetal loss, IVF failure and unexplained infertility. A partial list of immunologic factors that may be involved in these situations includes: anti-phospholipid antibodies (APA), antithyroid antibodies (ATA), and, perhaps most importantly, activated natural killer cells (NKa). Presently, these immunologic markers can be adequately measured by only a few (less than a half dozen) highly specialized reproductive immunology laboratories in the United States, from patient blood samples.”

So,

I did a research about therapeutic doses of aspirin and now I am taking 81mg everyday. I am also going to be using Pre-Seed when we BD and I am taking something to help with CM (Guaifenesin). Aspirin is suppose to help with uterine lining and help with even blood-flow (decrease clotting).

“For these patients, and even many without endometrial lining issues, we will typically recommend that she take a baby aspirin per day (81 mg) starting with gonadotropin stimulation. The rational for the use of baby aspirin is that on a micro-vascular level, vasodilation and decreased blood platelet aggregation occurs and therefore improves blood flow to the uterine lining, providing a lining with functional improvement. Blood platelets are the blood cells, which promote blood clotting. Two well designed studies confirm the benefit of baby aspirin use in improving pregnancy rates for patients with endometrial linings <8mm.>

Also an interesting fact that it has been found that aspirin, when taken 12 hr prior to donation of the blood sample causes an 80-100% reduction in the NK cell activity.