PCOS Immune Help

fertilethoughts

0 Posts
Reply PCOS Immune Help Posted on: May 9, 2011 at 12:21am
Hi Dr. Braverman:

I am trying to repost and get some answers. I'm not sure why the May 3 post didn't go through.

One of my friends suggested that I visit this site.

I am 35 1/2 nonsmoker and have been Dx with a mild form of PCOS in Nov 2009. I have been through 3 IUI and just completed an long lupron IVF cycle with Dr. Zouves in California with no luck.

Prior to starting my IVF cycle, we had some tests performed and it was discovered that I tested positive for APAs, my NK levels were high (22.2) and that I was heterozygous for MTHFR, A1298C. Sperm was analyzed on 3 occasions; no male fertility factor suspected.

Additionally, the following were determined.
FSH = 4.6 (2/4/2010); 3.7 (3/21/2011; Day 3 immediately following IVF failure)
Antral follicle count = 18

Below is the protocol I followed:

Prior to starting the long lupron,
* 1 birth control QDx3w
* Prenatal vitamin, FABB, Metformin (1500mg), Levothyroxine (50mcg), baby aspirin, Increase to Ca2+, 1000mg/QD

Lupron:
* 10units/day, 10days, decreased to 5units/day for 9 days (stimulation period)

Stimulation (Days 1-8)
* 150 IU Gonal F, 75 IU Menopur; 8 days
* 0.5 dexamethasone
* Cipro, 1XBID for 5 days pre-retrieval and post retrieval
* Day 2 of stimulation = intralipids; retested later and NK dropped to 6.1; which he said was normal; so no further intralipids were done on day of egg retrieval

* Day 7 of stimulation thru 2nd beta
- Started bromocriptine & Lovenox QD
- Stopped baby aspirin

"Day 9"
* Coasted - no stims

"Day 10"
* Novarel HCG trigger vs. Lupron

Egg Retrieval/Fertilization/Transfer
* ~40 hours following trigger
* 27 retrieved; 23 matured; 19 fertilized via ICSI; "sticky shell"
* Day 3 - "normal distribution"
* Day 5 - "slowed down"
* 1 frozen - grade 2, XB
* Transferred 3
* lining = 9 mm

Beta 1 = 17
Beta 2 = 14

Yoga, modified diet (whole grain, no simple sugars, caffeine) and acupuncture throughout and day of transfer.
Vitamins: prenatal, folate,

Just discovered though, which is to my huge surprise, that I'm allergic to ginger and pineapple (2 out of 4 on 4-point scale) which I ate a considerable amount prior to transfer for bromelia, so will eliminate next round as well as other items to be determined over next several weeks.

Just switched to almond milk.

Talked to acupuncturist regarding additional supplements. Was suggested to take DHEA and L-arginine, fish oil.

Questions:
1. What positive things can be said about the cycle?
2. What seems to be the driving force to the failure of the IVF? What about the decrease in number of embryos to Day 5? Is it just egg quality?
3. To what degree can food allergies impact the embryo? How large of a factor is this here?
4. Is it okay to be continuing with the allergy tests? At what point should one stop?
5. What can one do to enhance egg quality? Any other supplements to consider?
6. What about Saizen? What are your thoughts about this for me? Protocol?
7. What about Total Fertility supplement? Is this preferred over others?
8. What's the likelihood of success after a failed IVF for someone of my age and condition?
9. What else can one do to improve one's odds?
10. What else can male partners do? What supplements do you recommend?
11. At what point should one realistically consider donor eggs?

Dr. Braverman

2026 Posts
Re: PCOS Immune Help Posted on: Aug 13, 2011 at 12:24am
I dont know why I missed this post , how are you doing ? Have you been successful yet? PCOS is such a complicated topic and so many systems are involved from endocrine to immune to thrombotic that a careful , multidisciplanary approach must be made. It is not unusual to get many eggs and so few embryos to transfer, and there is so much that can be done to improve this. If you still need my help(again dont know how I missed this) feel free to call my office for a consultation and I would be happy to guide your entire management for you.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.