It only takes one!

Now some of you that read my last post are thinking - "Sure it's easy for him to say that you only need one embryo but I KNOW that I need more than that..." But I remain steadfast in my view that measurement of ovarian reserve can only get you so far.

For example, here is another clinical vignette right out of our practice here at Dominion Fertility:

TM is a 37 year old with a history of slightly irregular periods who had been treated previously at another fertility clinic. She was successful in 2004 conceiving after a cycle of CC/FSH/IUI. In 2006 she returned to that clinic and underwent another treatment of CC/FSH/IUI but had a biochemical pregnancy. Later that year she had another cycle using the same medications and ended up with a quintuplet pregnancy. She ultimately delivered healthy twins but clearly wished to avoid that situation at all costs in the future.

When I initially saw her back in Oct 2008 her ovaries looked rather small with a low antral follicle count. Her AMH was 0.3 (low) and her FSH and E2 were 13.9 and <20. Considering her relatively recent quintuplet pregnancy, it seemed pretty surprising that her ovarian reserve was now problematic but so it goes.

So my thought was that we were looking at a one egg/month situation in a patient who wished to avoid multiples but had previous IUI success, and thus we elected to go ahead with IUI for a couple of cycles.....no luck after 3 attempts. At this point we discussed Natural Cycle IVF as an option.

Now, the advantage of Natural Cycle IVF over IUI in this setting remains unproven in radomized double blind clinical trials but anecdotally we have had success in such cases. The patient agreed and underwent a cycle of Natural Cycle IVF in May 2009. Although her betas rose initially they soon fell to <5. She went immediately into a 2nd Natural Cycle IVF and again conceived but this time all went well and her sonogram this AM showed a singleton pregnancy with good cardiac activity. Needless to say she was very pleased and agreed to let me tell her story on the website.

So what is interesting here..... Well a couple of points jump to mind. First of all, ovarian reserve can diminish rapidly in some patients. Here we went from hyperstim (quintuplets) to hypostim (low AMH, AFC and high FSH) in just 2-3 years. Secondly, IVF may be more successful than IUI even in patients with normal tubes, normal sperm and previous success. In this case, we were 0/3 on IUIs and 2/2 on Natural Cycle IVF. Go Figure! Thirdly, after a biochemical pregnancy the body is ready to go when you start cycling..no waiting necessary. Finally, it is a case of good things happening to nice patients. It would be hard to imaging a more pleasant and upbeat couple than these two and just remember that "you catch more flies with sugar than with salt." Not that we play favorites but always nice to deal with easy-going individuals.

So for those who say that Natural Cycle IVF doesn't work, I restate my premise that it only takes one good embryo to make a baby!