Dear Robert,
My husband and I have not long gone through our first IVF cycle. Sadly this wasn’t our time to have a baby. We needed IVF using ICSI because my husband sadly had leukaemia when he was younger and his treatment left him with no sperm except the frozen sperm retrieved prior to his treatment. We were told after cycle that his frozen samples showed reduced head morphology, which they think may have been caused by the fact he was ill when the samples were taken. I am 23 years old and have already had a laparoscopy due to endometriosis laser treatment on the left side of my uterus. During the procedure they also did a hysteroscopy which all looked normal and treated a Cervical Ectropion. Due to my endometriosis until March this year I was using both the Pill back-to-back and the Implanon arm implant to control the bleeding (I had the implant for around 4years in total and the pill for around 2years on top).
Anyway before commencing our treatment they took blood for my AMH level which came back as 7.4 I believe and my AFC was 4 in total (I was still using both forms of contraception at this point). I was devastated! They commenced our first cycle in July using the long protocol and then in August I began stimulating. They gave me a 300iu daily dose of Gonal f. After my day 8 scan they reduced that to 225iu due to my hormone levels jumping. On Day 10 they reduced me again to 150iu which again was due to my hormone levels. They planned the egg collection after this, where they retrieved 11 eggs, 8 of which were mature and 4 fertilised. They replaced two embryos on day 3 one good quality and the second with slightly poorer quality. The embryologist felt my eggs were of mixed quality and stated that some were of odd shape.
Basically, I would like your advice on a couple of things if that is ok.
Firstly I have seen information on research completed in Germany which caused the AMH and AFC results to be lower readings while using the pill than non-pill users. Have you had any insight into this?
Secondly, I obviously produced a lot of eggs although the quality wasn’t good. There has been mention that this may be due to having a too higher dose of Gonal F?
We have also discussed with the clinic how to best preserve my husband’s sperm due to already using one of four frozen straws. They have provided us with two options:
1. Refreezing any left over sperm for use during another cycle but they are unsure if this would be successful or 2. My idea of egg banking then utilising as many of the sperm physically possible. However they have not had much experience in this.
Is there anything that you would suggest in general for myself to maybe help us improve our chances during our next cycle which we shall hopefully be commencing before Christmas.
Many thanks, C.

Reply…

Dear C,

From what you say, it sounds as if your treatment is very much on the right lines. I don’t think using the pill is likely to be relevant, or helpful or unhelpful, and I would suggest that the key to success in your case is likely to be better control of the drugs you are given to induce ovulation. So yes, the dose of Gonal F may be very important and sometimes measuring your oestrogen levels regularly during stimulation may help tailor your cycle more effectively. Some clinics do this routinely anyway. I am not at all impressed with egg banking – I assume you mean egg freezing? presumably by vitrification. Clinics claim that vitrified eggs are easily thawed successfully, but afterwards pregnancy rates are much lower than generally realised. And unfortunately, refreezing sperm is not a brilliant idea either.

I understand this is a very fraught and emotional process for you both and very much hope that things work out for you

Best wishes
Robert Winston

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