Slightly different IVF protocol this time.

amicably · Jun 19, 2014

Hi ILites,

I am sorry on the first line itself as this is going to be a long post..

I have gone through 5 IVF failed cycles in the past. I have changed to a relatively not-so-well known doctor in my own city now. He has advised me a slightly different IVF protocol than what I had done in all my past IVFs.

All my past IVFs were fresh cycle IVFs - It started with down regulation, followed by stimulation, then ER, then ET after 2 days and then the 2WW.

My current doctor told me what he would like to create two set of embryos - 3 embies in each set. That means a total of 6 embies. The current one started just like any other IVFs. Since I am a poor responder to stimulation injections, only 6 eggs were retrieved and only 3 matured into grade1 embies. No ET was done for two reasons - Firstly, doc is prefering FET over fresh ET coz all my past cycles had fresh ET. Secondly, he was expecting we would get atleast 5-6 embies (which he didnt) to make two sets to minimize risk of failed cycle.

Now, after ER for first set, doc has advised a minimal IVF procedure wherein he will give me oral medicine for 5 days for stimulation and if required a few (may be one or two) stimulation injections. This time there is no down regulation. From day2 after my AF, he told me to start Clomipure 100mg once a day for 5 days and then see him the next day.

I am not sure if this entire thing will work, but we feel he is giving us individual attention which we were not getting in past. Also, rather than starting all over again, he is picking up from where we left from my last doctor and suggesting alternative approaches.

But since its a new protocol for me, there are many doubts -

- Is anyone aware why is Clomipure 100mg is given? (Content: Enclomiphene)
- Considering that I am already a poor responder to external stimulation, will just oral tablets help grow more no. of follicles?
- What I can do on these days of treatment that will increase my chances of success which I have been waiting.
- Has anyone had implantation failure issues? Thats the thing thats haunting my mind these days as none of my past cycles were success. If anyone has any info/help on this pls pls share.

Indianwife2000 · Jun 19, 2014

Hi Amicably,

Sorry to hear the trouble you have been going through. I hope this ends soon with a positive end result.

Regarding your new protocol, unfortunately, I have no clue. I have been through an IVF once, which eventually failed and it was a traditional IVF....just like the ones you have had in the past. However, after reading your post, it occurred to me whether you have done any testing regarding implantation failure? Since you have had 5 IVFs....that too with grade 1 embies and none of them stuck....so that makes me think that there might some other underlying problem...like you mentioned "implantation failure"? I am not sure but it might be worth discussing and exploring.

Also, do you have any other issues like Thyroid or any autoimmune disorders or any other uterus/ovary related problems? Do they check your uterine lining during your cycles? Sometimes, these and many other such factors can interfere with implantation.

Additionally, please maintain a high protein diet with less or no caffeine. This really helped in my case.

Wishing you the best.

sumalynux · Jun 19, 2014

Dear Amicably.

First thing, hugs dear. Let god show mercy on all TTC (including me)

My doc does something called IVF pooling...

In 1st IVF, if anyone gets just 1-2 embryo's, she freezes
them, and immediate cycle does one more IVF, retrieves
couple more eggs, and did 4 embies transfer..

She did this for two of my fellow IVF'ers who were poor responders
and got only 1-2 embies .. 1 got BFP, and 1 is in 2ww..
Looks like your doc is doing something like this.. But may be
he chose to just give basic tablets/injections for 2nd set of follicles.

All the best dear, let this be your cycle..

gayushiru · Jun 19, 2014

Dear amicably,

First off hats off to you for going through 5 IVF cycles. I really hope you get your BFP soon.

I am not sure of Enclomiphene is same as clomiphene. I was given clomiphene for my IUI cycles. Even with the highest dose, I could only produce 2 follicles max. Whereas, with injectibles in my 2 IVF cycles, I produced 9 and 15 follicles. I was also considered to be s poor responder to stim meds. So I personally dont think tablets will produce more follicles.

For impantation failure - have they done chromosome analysis on both of you? Have you had an endometrial biopsy done to check the health of the lining? If you are not already doing this, ask about taking low-dose aspirin during the 2WW.

Regarding what you can do during your cycle - just try to relax. I know its easier said than done. In my second cycle, I had more and better quality eggs. The only difference I had made was to my diet - I ate more whole grain, protien and natural foods, cut off all white products (white rice, white bread, etc), completely avoided soy products.

Good luck to you.

amicably · Jun 20, 2014

hey indianwife2000, sumalynux, gayushiru.. thanks so much for some wonderful inputs.

Endometrium lining: Yes, it was checked before every ET. After my last ER also, they checked my lining and docs say it is good. Also, I do take a low dose aspirin during my 2ww.
Gayushiru, No endometrium biopsy is done. Can tell me what it is? Is this same as Hysteroscopy? I have undergone hystero twice.

Implantation failure: Me and my DH both have done our chromosome analysis and its normal. No abnormalities found. No doc has put forth the possibility of implantation failure, its causes and remedy. So we are trying to gather as much info on it from the net. I have a doc visit planned tomorrow, planning to talk to him about it. Are there any other tests, treatment for implantation failure?

Other health issues: I have undergone many tests in the past, all are normal. No pcos, regular periods, HSG results were normal. Thyroid was detected 2 yrs back, I was taking medicines for it. Since last 3-4 times (I tested every two months) its coming normal, so doc told me to discontinue it. My hubby has sperm issues - low motility. But his chromosome analysis were normal, no issues found there.

Enclomiphene: Gayushiru, even I doubt that Enclomiphene will help, I am just going by what doc is saying. He says its his area of concern - to get much follicles as possible. He says, "Give ur worries to me and you stay relaxed and stress free."

Food/Diet: Arent soya products good source of protein? Can we have soya nuggets as I use them often in my meals. I have reduced intake of tea/coffee/chocolates, no pickles, papaya, preparing not so spicy food.

To summarize, we are still not sure whats the problem and whether we will get the result positive this time.
If anyone of you know pls throw more light on the implantation failure problem

Last but not the least thanks for sharing your knowledge with me and hats off the the ladies here.. Salute!!!

Indianwife2000 · Jun 20, 2014

Hi Amicably,

I can understand your concerns and I think you are doing a great job by staying strong and doing a thorough research on these issues....hang in there and you will be blessed soon.

Regarding thyroid, you mentioned that you have discontinued the medicine because your levels were coming normal. Based on what I have heard from my doctor is that one can not go off of thyroid medication once you have this problem. When your levels were normal...were you on the thyroid medication? I would strongly suggest you to get that checked again....just to be sure.

Also, when I was diagnosed with hypothyroidism, my endocrinologist had ordered a test to check my thyroid antibodies levels and they came out to be super high. He told me that I have an autoimmune disorder called "Hashimotos". He said this can sometimes interfere with implantation and if my IVF failed, then there is a test called "NK cells" test (Natural killer cells) that can be done to check whether or not I had this issue. Fortunately, I conceived immediately after a failed IVF, so I didn't get the test done....but just wanted to share this info with you so that you can discuss this with your doctor.

Also, if I remember correctly, an endometrial biopsy is different than hysteroscopy. You can google it and find tons of info on it.

Yes, soya is a good source of protein but as per my endocrinologist, it is not a "friendly" type of protein. Also, most of soya that we get is genetically modified and can also block production of thyroid hormone. I have also heard it contains some toxins and high usage of soy has been linked to breast cancer. I am not sure how much it is true but I have completely stopped eating soya for a long time now. Even my DD's pediatrician asked me to not give it to my daughter.

I also agree with others here that injectibles are much better than oral medicines...but I am sure your doctor knows the best.

I hope you are maintaining a healthy life style....make sure you exercise at least 30 min every day to increase your blood flow to the pelvic region. Eat fresh and eat right. If you eat nonveg, include eggs, chicken and fish in your diet. If you are a veg, have lots of lentils and legumes etc. Quinoa is another excellent source of protein. Cut out sugar, white bread, caffeine and junk food from your diet.

Regarding your DH's sperms issue, have your done a test called DNA fragmentation test? There is an IL member here who mentioned this test a couple of months ago. You can check with your doctor. And I can also suggest a natural remedy for your DH's issue...give him one fig everyday in the morning. Apparently, it helps. I am sure you know that he should avoid sitting for long hours, no laptop in his lap, avoid hot showers and avoid wearing tight fitting clothes.

Hope you get good news soon. I will pray for you!

Vasumathy · Jun 20, 2014

Hi Amicably,
With IVF, individual attention is what is important.
Not everyone responds to the injections or tablets equally. Some are good respondents to clomid and some are with injections ans some to both. Since you didn't respond well with injections, doc wants to give it a try with Clomid. One side effect with clomid is endometrium thinning. Since you are going for ET in separate cycle, i hope it won't hurt you much.
I have one fresh and frozen cycle failure to my record and the next fresh cycle after 2+ years helped me. I don't know why those cycles failed irrespective of god conditions. I had proper individual attention in last cycle and that worked. IVF needs lot of care in growing embryos and endometrium thickness. If both are good, things may fall in place.
Hope this time you will see success. :thumbsup
All the best.

amicably · Jun 23, 2014

Hi Vasumathy, Indianwife2000, thanks for your response.

Had been to doc, he advised not to take clomiphene now as it was not yielding good no. of embryos. He says keep this a rest cycle, allow ovaries to rest in this cycle. New ER process will start from next cycle. Long wait still .

Indianwife2000, I tested thyroid twice after stopping, but it came to be within normal range, so doc advised not to start again. I have been checked for T3, T4, TSH levels for thyroid. Is this different from the thyroid antibodies test you have mentioned?
Thanks for the useful info you shared on soya product, didnt knew its effects!!!!. No soya products for me now.

DNA fragmentation of my DH showed no issues. Will start giving fig to DH, thanks again for that indianwife2000.

Couldnt talk to doc on NK cells test and endometrial biopsy as I had not done my bit of gathering the info. Will talk about it in next visit.

Indianwife2000 · Jun 23, 2014

Hi again,

Yes, thyroid antibodies test is different than TSH, T3 and T4. There are two thyroid antibodies that my doctor had checked for me - Thyroid Peroxidase Antibody (TPOAb); Thyroglobulin Antibody (TgAb).

Now that your TSH levels are normal.....I am actually amazed. In fact, this is really wonderful!!!! I had never heard of any such case till now. You should count yourself lucky on this issue. Based on my knowledge, once your thyroid gland malfunctions, you have to take its medication for the rest of your life. I am so glad this turned out to be wrong in your case. Just wondering...if yours was a borderline case...meaning your TSH levels were just a bit off? And did you do something like yoga, changing diet or anything else to bring your TSH under control without medication? Please let me know.

I am also happy to hear that your DH's DNA fragmentation was normal.

Also, wanted to check if clomiphene is the same as clomid? If so, discuss with your doctor about taking Letrozole instead. My ob/gyn was never a fan of clomid since it causes many issues like the thinning of the uterine lining and in some cases not producing enough eggs. She always prefered Letrozole over clomid, although clomid is way cheaper. The cycle in which I conceived was an IUI with Letrozole (CD3 to 7). I was also given some injectibles during that cycle.

Best wishes!!!

amicably · Jun 23, 2014

Hi Indianwife2000,

I had gained almost 8-9 kgs in a span of 6-8 months and at the same time I was diagnosed with thyroid, may be a side effect of hypothyroidism. I did follow a health routine to come back to my original size. And the routine included - daily walk for 10K steps (1 hr approx). declared two days in a week as fruit day and vegetable day - only fruits or only veggies (Salad) or combination for dinner. Lunch as usual, just more of salad and no or less rice. I did manage to come back to my original size with this. However I am not following this strictly now

It was approx 19 when first detected. It later reduce to 7.2 I guess. I will check my thyroid numbers and post here and also the antibodies you mentioned about. I have done so many tests that I don't even remember now if I have done it or not

Sick and tired of these tests and treatments. Want to come of out this soon. Loosing patience by each passing day ;-(

Clomiphene is clomid, I just checked. Even I had a doubt whether just tablets will help, considering that I am poor responder to external stimulation. Good that the doc told to not take more.