Happy New Year!

Well, here we are at the start of another new year and I have a bucketful of New Year's Resolutions that are unlikely to last until the Spring but you never know....2 years ago I did the Special K diet for an entire year. Dr. D would make fun of me every day as he enjoyed delicious lunches and I had my little bowl of Special K. Of course, by dinner time I was so darn hungry that I would wolf down an excessive amount of food thus defeating the purpose of the Special K diet.

This year I also resolve to blog more frequently. Ha! We'll see how long that lasts but I still have to catch up with work here at the practice since we did an extensive remodel with new wallpaper and carpets. All former patients who wish to view the changes are more than welcome to visit.

I thought that it may be informative to profile some interesting patients. I will omit the names and identifying details but there may be some interesting aspects to these cases for those 7 people who read this blog. Of course, I will still comment on fascinating developments in the world of fertility and readers are always welcome to post questions to me on the INCIID bulletin board at this INCIID forum.

Clinical Vignette #1: Secondary Infertility Can Be Tough to Treat

Although many of our patients have never been pregnant there are a significant proportion who suffer from secondary infertility. To illustrate just how unpredictable fertility treatment can be here is the story of SG.

When SG initially presented for discussion of fertility treatment, none of us thought that her case would be very difficult. She was 30 years old and she and her husband had 2 previous pregnancies (one resulted in the birth of her son and the other was an early pregnancy loss). However, she and her husband had failed to conceive after a year and were getting frustrated.

Initially the thought was that this was a timing issue but when she failed to conceive after 3 clomid/IUI cycles in spite of all the tests (HSG, semen analysis, hormones) being normal it was time to up the ante and consider IVF.

She elected to enroll in the financial guarantee program (FGP) and I felt very confident that we would soon see success. Her first IVF went well but the stimulation (luteal lupron with 125 Follistim and 75 Menopur) was failrly mild and 7 eggs resulted in 3 embryos. Interestingly, sperm attachment to the eggs appeared poor suggesting that perhaps their issue was inefficient fertilization. Unfortunately, she failed to conceive and very soon afterwards attempted IVF again.

The 2nd IVF cycle was better both in terms of eggs and embryos. We switched to microdose lupron flare and the cycle yielded 14 eggs and ultimately 4 excellent blastocysts. We transferred 2 but again the pregnancy test was negative. Finally, we did a natural cycle FET and she conceived. She delivered a full-term healthy girl earlier this year.

So what lessons can we learn from this story? First of all, it is tough to predict what treatment will yield success. If you had told me after initial testing that this couple would require MDL flare IVF with ICSI to have another child, then I would have shaken my head in disbelief. Yet, that is exactly what we needed to do to gain success.

Secondly, the benefit of the FGP approach can be seen here as the couple clearly received more treatment than they paid for initially with 2 fresh IVF cycles and an FET.

Finally, their story demonstrates that physicians need to look at each couple with fresh eyes when treatment is not yielding the desired results. Additionally, I did tell this couple to use birth control if they didn’t want any more children as I have seen spontaneous pregnancies in such cases.