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I am 39 years old (ok, 40 in June) & the mother of a healthy, happy 5 year old that I conceived in only 6 months of tying at the age of 34. In the past 3 years, I have had 10 failed pregnancies (yes, ten). I carried 3 to 7-8 weeks, the others only 5 weeks (chemical pregnancies). I had a D&C with 2 of the longer pg & chromosonal testing revealed either a missing or additional chromosome, plus they were both fertilised by 2 or 3 sperm. We've had several immune tests, advanced sperm testing, karyotyping, & all are negative. I've had several SHG's & all is fine. Progesterone does not seem to be a problem either. RE says all tests point to poor egg quality, which I can accept based on the tests, but.. I get pg so easily! My FSH was 11 in a normal cycle, 17 in a CC test; AMH was dismal (0.5 or less I think). I'm moving on to IVF with the hopes of a decent response and at least 1 good egg. He has recommended an antogonist protocol for me along with AH & ICSI. Is there anything else I can ask for to try to achieve the best response & egg quality? Thanks
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We think most early miscarriage is caused by a bad egg, one that has divided abnormally at the time of ovulation. This occurs more frequently with advancing maternal age. However, since the quality of a given egg is not determined until you actually ovulate it, the period of stimulation is a time when we may be able to influence how the eggs develop. We think the standard protocols will often make the egg quality worse. These would include the micro lupron flare, the standard antagonist protocol (that was suggested for you) and protocols with a lot of Menopur or Repronex. We have developed a specialized approach that we believe will help you make better eggs. We call it agonist antagonist conversion with estrogen priming. We published our data in Feb 08 in Fertility and Sterility.
If you contact me directly, I would be happy to review your case and our approach with you in more detail.
Jeffrey Fisch
jfisch@sherinstitute.com -
Dr. Fisch, Thanks for the response. I will consider this. I have heard this protocol described here & in Dr. Scher's book. I'm assuming all the SIRM Institutes use this protocol? I'm in the midwest.
One more thing about protocols & egg quality.. I've read online that various clinics across the country are adding things like DHEA & human growth hormone (Saizen) to their protocols, specifically to enhance egg quality. What can you tell me about this? thanks,Comment
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We avoid DHEA because it is a male hormone precursor. This is also why we don't like low dose hCG or Menopur. There is no good evidence for using GH. In fact it is illeagal in some states for anyone but a pediatric endocrinologist to write for it. All SIRM's practice similarly, but slightly differently. Speak to the doc at the office you want to cycle at. Many couples ultimately choose Las Vegas, because we are the center of the research activity.
Jeffrey Fisch
jfisch@sherinsititute.comComment
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