Can NC IVF work following a failed stimulated cycle IVF?
Posted Jan 27 2012 11:01am
When a stimulated cycle IVF fails it is devastating to say the least....all that money, all those shots, all those morning visits, the bloating, the cramping, the PIO shots....yikes, it's a wonder we can convince anyone to try it again. Thank goodness the husbands don't have to go through all that or our business would fold overnight!
So following a failed stimulated IVF it is typical to ask what other options do I have. In cases of poor responders who may have not even made it to retrieval the answer has been "not much." Some of these patients will still conceive on their own, others will try a new protocol (or add DHEAs or human growth hormone or snake oil or miracle grow..). Donor egg or adoption are great options but not every couple will consider these as viable choices. So can NC IVF work in such a setting? "Certainly not," the critics of NC IVF would opine! After all, this approach to IVF is a terrible choice for any patient and how could this approach work in cases where our best treatment has already failed.
Sound logic. However, it just happens to be disproven on a near weekly basis by our patients who pursue NC IVF. Last year I asked what readers wanted from this blog and the majority stated they wanted patient stories so here are 2 vignettes that illustrate the use of NC IVF in patients over 35 with diminished ovarian reserve and failed stimulated cycle IVF!
Patient #1: Bonus baby with NC IVF after being told FSH levels precluded another IVF attempt!
Just received a wonderful email from a lovely couple who traveled all the way from Georgia to do NC IVF here at Dominion. Having had a previous IVF/ICSI baby in 2006 they had returned to their RE for another attempt at IVF. Previously the response to medications had been poor and this time the response was even worse with no retrieval even attempted. Her FSH was 18.9 and they were told that essentially no good options existed in terms of IVF. Fortunately, they had heard about NC IVF and we had a phone consult in April with an IVF attempt in June. Her AMH was <0.16 consistent with diminished ovarian reserve.
Her NC IVF cycle was picture perfect and they ended up with a beautiful early blast for transfer then headed back home. I received the good news that the blood pregnancy test was positive and rising fast. Then came the first shock...it was a twin pregnancy. Yup identical twins. Then came the second shock...the twins were sharing the same sac (in medical terminology they were mono-amniotic, mono-chorionic twins). Then the final shock...there was possibly a third sac.....Fortunately, this last shock turned was not true...there was just a probable blood clot that ultimately went away.
Pregnancy went amazingly well and the girls were delivered at 32 and a half weeks. They spent 2 days in the Intensive Care Nursery and should be home soon. What a great outcome to such a surprising story...one egg, one embryo, TWO healthy babies!
Patient #2: Ongoing pregnancy with NC IVF at 40 with FSH of 17 and AMH of <0.1
Back in 2009 I met DM who was turning 38 and been referred to me by one of my patients who had succeeded with NC IVF after being told donor egg was her only option. We discussed NC IVF versus stimulated IVF and elected to try stimulated IVF. On a MDL flare protocol we got 3 follicles but only one egg and she failed to conceive with transfer of that embryo. I suggested we consider NC IVF rather than pursue additional medicated cycles.
Her first NC IVF cycle resulted in a pregnancy but unfortunately she had a miscarriage. The second NC IVF cycle resulted in a healthy full term baby. She returned this Fall to try again. On day 3 of that third NC IVF attempt her FSH was 17. But we got a nice egg, a beautiful embryo and she conceived again. That makes her 3 for 3 using NC IVF. Currently she had an ongoing pregnancy and here's hoping for another successful outcome.
Again this demonstrates the limitation of ovarian reserve testing when applied to NC IVF. When one eliminates the use of fertility drugs all bets are off when it comes to ovarian reserve. Makes our job difficult since patients assume that diminished ovarian reserve = poor egg quality and the relationship just isn't that simple!