Planning a Baby  Discussion Forum

Hi Ashy,

I got to know that u r a doc by some threads here on this message board.

If you can guide a lil bit, it' ll a gr8 help.

I was to undergo IVF in this month. I had only two follicles in my left ovary n my right ovary was silent. But after stimaulation (taking Gonal F -300 IU for three days and menopur- 375 IU for three days and then again Menopur - 450 IU for two days), the doc found out that my follicles are not maturing as they shld. She stopped medications saying that she has already given me enough n asked to wait for three days. After that she found out that the follicles have now matured n she gave me injections for keeping them intact--( 3 no. menoper - 75 IU and 3 no. orgalutin - 0.25 IU). She called me after three days n in the ultrasound, she found one of my follicles out of only two had shrunk (inspite of taking injections). She decided to drop IVF in this cycle. I dun blame her in any case. But what i wud like to know is that, I have been told that that due to endometriosis, much of my ovarian tissues are now degraded n hence the ovaries are not responding much. Only max two follicles are produced every time n each cycle.

My question is, I' ve heard n read a lot about the technique called \" IVM--in vitro maturation\" . Can this be done in my case where two follicles can be taken out n can be matured in lab??

Can they take out two follicles in one cycle n cryopreserve them and then take out two more in another cycle n then start the procedure of IVF in the second cycle with these four follicles??

I' m really depressed n helpless. I had asked my doc about this but cudnt find a genuine reply. Kindly help. I' ll be very gr8ful to you.

all the best n god bless ashy replied. The recovery of immature oocytes from unstimulated or low dose FSH-stimulated ovaries followed by IVM represents an alternative to conventional controlled stimulation in IVF protocols, especially for subjects at risk of ovarian hyperstimulation, in spite of somewhat lower pregnancy rates per cycle (Mikkelsen et al., 2000 Yoon et al., 2001 Child et al., 2002). Priming in vivo with low dose FSH during the early follicular phase seems to have no beneficial effects on results among women with normal ovarian function (Mikkelsen et al., 2000). Adequate cumulative pregnancy rates with IVM, compared with conventional techniques, can, however, be achieved, since couples can undergo many consecutive cycles without any adverse medical effects.

Diminished ovarian reserve with a poor response to controlled ovarian stimulation is a frustrating condition in IVF practice, yielding low success rates. Poor ovarian response in IVF has been characterized as a low number of follicles seen in ultrasound scans and high basal serum FSH concentrations and fewer than five oocytes obtained in a stimulated cycle (Bancsi et al., 2003 Goverde et al., 2005 Hendriks et al., 2005 Penarrubia et al., 2005). In recent literature, a follicle count less than five at the beginning of the cycle has been used as a predictor of poor response in IVF (Durmusoglu et al., 2004 Kailasam et al., 2004 Klinkert et al., 2005).

Many different approaches have been tried to treat poor ovarian response. Flare-up protocols using oral contraceptive pills and shorter down-regulation with GnRH agonists are well known, although the results are conflicting and somewhat disappointing. Protocols involving co-treatment with steroids, growth hormones and anti-diabetics have also been tried (Surrey and Schoolcraft, 2000 Tarlatzis et al., 2003 Loutradis et al., 2003). Natural cycle with aspiration of mature oocytes does not increase the pregnancy rate in poor responders (Kolibianakis et al., 2004). One approach has been the use of IVM for immature oocytes obtained during stimulated cycles before cancelling the treatment (Liu et al., 2003).

Our patient initially initially had seven oocytes after FSH stimulation, but only one cleaved embryo. In the next attempt only one oocyte was obtained in spite of the high dose of FSH (450 IU). Using a particular poor responder programme, eight oocytes were subsequently obtained, but no more than two embryos. She had fewer than five follicles in her ovaries at the beginning of her cycles, and high basal concentration of FSH towards the end of the treatment period. She can therefore be regarded as a patient with poor prognosis and diminishing ovarian response.

What was even more striking with our patient was the low fertilization rate and low number of embryos obtained (1/7, 0/1 and 2/8), probably also reflecting poor oocyte quality. It has been suggested that in all women, even towards the end of the reproductive period, there are some oocytes of good quality among poorer ones and that gonadotrophin stimulation may not result in increased numbers of good quality oocytes in these women and is therefore of no advantage (Khalaf et al., 2002). This appears to have been the case with our patient.

Use of IVM in natural cycles in low-responding women may bring benefits. The numbers of oocytes retrieved from women with poor response were comparable using IVM or stimulated cycles, and directly comparable to the numbers of follicles >5 mm in the ovaries (Requena et al., 2000). Apart from being more economical, it is possible to retrieve non-atretic oocytes in repeated, consecutive IVM cycles without the discomfort and cost of hormone treatment. The treatment therefore may increase the chances of finally achieving a good quality oocyte for fertilization.

Maya replied. hi there

am ery sorry to hear about your experiece , i sincerely hope you find an answer and solution to your problem.

i do have a question for you, as i read in one of the earlier threads..that u have been visiting Dr. Mahajan, what is the experiece you have had with her. do u think she is a good doctor?

i do know that Dr Firuza from Jaslok hospital in bombay is considered the best if you can afford to go to bombay to take a second opinion or treatment.

god bless u .and lots of luck and love