IVF Failure&FET:Question for Ghost(preg mentioned)

[Wantababe]

What is the recommended time to try a FET after IVF failure?

My problem's always implantation, always have so called "good" eggs but cycle always ends with bleeding b/w days 9-11.

Had only one cycle that was successful and the one thing different about it was that pregnyl was administered after ET.

The other docs are always afraid that I will have OHSS so they skip the pregnyl, do you think this has anything to do with the failures?

I feel this may have an impact on the cycle as my 1 successful cycle threatened to end with bleeding also on day 9, only difference was that I was positive and had more pregnyl administered after day 9 and the pregnancy stuck. Please can you give me your opinion on this issue.

Looking for solutions
Wantababe

[Ghost]

Pregnyl is a brand name for hCG.

Taking hCG does increase the risk of OHSS. hCG causes granulosa cells to release VEGF, and VEGF seems to be the mechanism of OHSS. So your doctors were justified in their concern.

There are many papers on using hCG for luteal support. I just checked a few and I'm not convinced it has much benefit to the general population of IVF patients. Maybe it helps some, I don't know. If it does help some, then you just might be among them. I cannot know. I am skeptical, though.

hCG closely mimics LH, which your body already produces. It is also the exact compound they check for in a pregnancy test, so taking hCG just before the pregnancy test will cause a positive test result even in the absence of any embryos. I'm sure your clinic knew this, as it is completely obvious.

Some references:

http://www.ncbi.nlm.nih.gov/entrez/quer ... t=Abstract

http://humrep.oxfordjournals.org/cgi/co ... /11/7/1552

Just one question: In all of your cycles, you did use hCG (Pregnyl or whatever other brand name) to trigger ovulation, right? You did not use a single shot of, say, Lupron for that?

[Wantababe]

Thanks for your reply, it feels good to have some answers to my worries.

Yes in all my cycles HCG was used to trigger and not Lupron. What is Lupron? Is it a brand name or generic name? I've heard of it several times in wesites but have never used it.

Just for clarification, in the successful cycle I already had a blood test and pregnancy was confirmed but I was still bleeding, not excessively like in a period but it was steadily increasing. My doctor then gave me more HCG. This is what makes me wonder if that may be the key for me. Why do you think he gave me this injection? Do you think it may be for luteal support?

Is there a way to find out if I need more luteal support and if I do on what days should the drugs be administered?

I understand that my current Docs don't want to jeopardise my health but I'm just trying to understand my body and in the process maybe I can figure out a way to help it along.

Thanks again for taking the time to read and answer my post.

[Ghost]

Thanks for your reply, it feels good to have some answers to my worries.

Glad to help.

Yes in all my cycles HCG was used to trigger and not Lupron. What is Lupron? Is it a brand name or generic name? I've heard of it several times in wesites but have never used it.

Lupron is a trade name for leuprolide acetate. It is in a family of drugs called GnRH agonists. Your hypothalmus gland controls your pituitary gland with a hormone called GnRH (gonadotropin releasing hormone). In your natural cycles, it's a bit of GnRH from your hyothalmus that causes your pituitary to release the LH surge, thus triggering ovulation. Lupron, being a GnRH agonist, does the same thing. It stimulates the pituitary. In a single dose it can cause a surge of natural LH. By far the most common use of Lupron in IVF, however, is a series of small doses over many days that keep the pituitary so stimulated it cannot save up a meaningful amount of LH. Thus it is suppressed (cannot surge) because of constant stimulation. Other GnRH agonists, like Buserelin, will do this too. Suppressing the pituitary is important in order to control the moment of ovulation.

There are also GnRH antagonists, like ganirelix acetate (Antagon). These directly shut down the pituitary from the very first injection. Antagonist cycles are generally shorter than agonist (Lupron) cycles, and require fewer injections.

In a cycle regulated by an agonist (like Lupron), there is no choice for ovulation but to use hCG to trigger "ovulation" (technically, final oocyte maturation). However, in antagonist cycles, you have the choice of using hCG or, you guessed it, an agonist like Lupron. hCG mimics LH, and Lupron triggers a surge of LH. I suspect only a few percent of cycles are triggered with Lupron, and almost all of them are in extremely high responders (those 50 follicle types) in order to prevent OHSS. But it has implications for the pregnancy, so I had to ask.

Just for clarification, in the successful cycle I already had a blood test and pregnancy was confirmed but I was still bleeding, not excessively like in a period but it was steadily increasing. My doctor then gave me more HCG. This is what makes me wonder if that may be the key for me. Why do you think he gave me this injection? Do you think it may be for luteal support?

hCG can be used in the luteal phase, just like LH can. We don't do that, so I don't know much about it.

Is there a way to find out if I need more luteal support and if I do on what days should the drugs be administered?

Your physician monitors your progesterone and estradiol levels. I know they try to keep the progesterone above some threshold. Typically you are kept on some progesterone supplements, such as PIO (progesterone in oil) injections, a vaginal suppository, a vaginal gel (like Crinone), or oral supplements. Your physician will typically moderate the dosage based on your serum levels. The threshold varies among clinics. We use 15 ng/ml. Some use 10, and somebody here once posted their clinic uses 100. I think it's the progesterone that prevents your period during pregnancy.

[Wantababe]

Thanks again Ghost, your reply was very insightful and the links very useful.