Coming up

It's been a while since I posted, but I've just been so busy with the twins. I am gearing up to get back to posting and continuing providing information about IVF and infertility in general. Even if I can help one woman with her cycle question, or provide at least some insight on what to expect from this madness of infertility - it's worth every minute because I've been there for 2 years and I know how painful and hard it can be! I wish this didn't happen to me or to you. I truly wish we didn't have to be here and I wish you did not want to read this blog because infertility would never touch your life. But you are. I wish I could give you a hug and tell you that this too shall pass. And here I am after 5th successful IVF cycle still trying to let go, still trying to heal the scar that was left so deep in my heart, still trying to rebuild all the bridges burnt by this cruel infertility struggle.

Poor Egg Quality...Really???

I always hear stories of doctors telling their patients after a failed cycle that their egg quality is not good. Usually a patient entrusts their self into the hands of a doctor and leaves the office with a prognosis of future donor eggs. I don't like when that happens. I truly believe that some doctors take advantage of patients that do not do their own research and believe everything they say.

First, let me ask you this - Did your RE explain exactly how your eggs are bad quality? What exactly is wrong with them? You should be able to find out that information.

For example an egg is comprised of a shell (zona pellucida or just“zona”) and the cytoplasm (ooplasm) which, after fertilization, will grow and develop into the embryo. Every lab inspects eggs upon retrieval and they usually have to make notes of their findings. For example, a good egg would have a zona that is perfectly round, that does not have any distortions/deformities and is most often tightly surrounds the actual egg inside. So, if you have a poor egg quality, your RE should be able to to tell you, whether your eggs have a zona that is way too thick or deformed, which can prevent normal fertilization, embryo hatching and thus implantation. Also, you may have a cytoplasm that is way too big to properly surround and "snug" the egg, thus the actual egg within could potentially become damages from “floating” around. There are many more standards by which your eggs are evaluated like fragmentation, color, etc. Poor eggs sometimes will have dark color and look “degenerative” under the microscope.

You must also know that currently, there is not one single test out there that can conclusively determine egg quality. There is no one perfect test for egg quality. Therefore most labs, and RE’s base their assumptions of your eggs ability to become fertilized and produce normal embryos. Therefore I also believe that just one or two failed IVF’s is not the end of the road, since in every cycle your eggs will differ depending on which particular eggs will be produced during that particular cycle. Each cycle is different with different eggs playing the game of baby making. Know that a normal looking egg may possess underlying genetic problems where an egg that appears “poor” may be chromosomally normal and go on to becoming a healthy baby.

So please, don't take one doctor's opinion and give up on having your own babies. Like I said before, having a PhD does not mean they are not human and can predict your fate...You are strong and can’t try again, go for second opinion, third, forth if you need to. Also there are some clinics that specialize in giving women that other doctors gave up on, their own babies. I've heard amazing things about Cornell Center for Reproductive Medicine and Infertility in New York; Colorado Center for Reproductive Medicine; SHER Institutes For Reproductive Medicine.

Do your research and stay strong, don't give up. This road is tough but your are a fighter and you will hold your baby in your arms someday.

Crinone - Once or Twice?

Well, someone asked me why some women use Crinone (Progesterone Gel) once a day and some use it twice a day.

I am not a doctor but I have some thoughts on this. Also, medical community still does not have a final verdict on what is better (as you can see by example studies below) so I believe it depends on individual cases.

For example, lets take my case. Usually one dose is sufficient enough because it is a very concentrated gel. I was originally prescribed only one. Once I became pregnant, I had unexplained bleeding for 2 weeks of bright red blood and passing clots. Freaky, I know. I decided to add one more dose just to be safe and my doctor agreed, but she said it might not have any advantages, but if I felt like it, just for my piece of mind, then go for it. After I started using two a day, my bleeding still continued, but at least I felt good about doing everything I can with respect to extra progesterone. Crinone 8% is generally used once a day though. Each doctor will individualize the correct dosing of Crinone 8% based on the patient’s needs and their situation.

First, it depends whether you are prescribed Crinone 4% or Crinone 8% gel.

Crinone 8% is generally used once a day though. Each doctor will individualize the correct dosing of Crinone 8% based on the patient’s needs and their situation.

Structure:

Each applicator delivers 1.125 grams of Crinone gel containing either 45 mg (4% gel) or 90 mg (8% gel) of progesterone in a base containing glycerin, mineral oil, polycarbophil, carbomer 934P, hydrogenated palm oil
glyceride, sorbic acid, sodium hydroxide and purified water.

Due to sustained release properties of Crinone, progesterone absorption is prolonged with an absorption half-life of approximately 25-50 hours, and an elimination half-life of 5-20 minutes.

Possible explanation

Assisted Reproductive Technology--Crinone 8% is administered vaginally at a dose of 90 mg once daily in women who require progesterone supplementation. Crinone 8% is administered vaginally at a dose of 90 mg twice daily in women with partial or complete ovarian failure who require progesterone replacement.

Further, Jobanputra et al, in a donor-egg IVF study, showed that 100% “in-phase” endometrial biopsies, reassuring pregnancy rates (46–48% vs. 41%) and mis-carriage rates (14–33% vs. 25%) were seen at both the twice and once-daily dosing levels compared to intra-muscular therapy. Pregnancy rates were as high with vaginal as with intramuscular therapy. There were no significant differences in clinical pregnancy and implantation rate using twice-daily Crinone or once-daily Crinone.
(Jobanputra K, Toner JP, Denoncourt R, Gibbons WE. Crinone 8% (90mg) given once daily for progesterone replacement therapy in donor egg cycles. Fertil Steril 1999;72:980–4.)

Although, In their study, Ho et al 1 report that using vaginal progesterone gel twice daily for luteal support resulted in better pregnancy outcomes than intramuscular progesterone. Vaginal progesterone gel seemed to offer more “targeted” delivery of progesterone to the uterus and improved endometrial receptivity.
(Ho CH, Chen SU, Peng FS, Chang CY, Yang YS. Luteal support for IVF/ICSI cycles with Crinone 8% (90 mg) twice daily results in higher pregnancy rates than with intramuscular progesterone. J Chin Med Assoc 2008;71:386–91.)

Whatever you may choose at the end, make sure you consult with your doctor first.

What now?

I am not going to blog about my pregnancy. I feel very lucky to get here but we've worked hard to sacrifice many things, emotionally and financially, sacrificed parts of our lives and relationships with friends and family. It was hard and it does not get easier until I hold my babies in my arms.

Having said that, I know your pain. I still feel it and instead of writing about my nausea and vomiting, I've decided I will do my best to try to find articles and new research information to try to help many many women that are still going through the nightmares of infertility.

Research was always important to me and by educating myself I tried to get what I needed and wanted from my RE. I don't take no for an answer. I don't believe of giving your reproductive future to a doctor. No matter how educated and specialized they are - they are us - HUMAN. They have their own opinions and many of them choose not to perform certain protocol "tricks" because they think it's not worth it. Well, it is!