What a great movie! What a great movie concept! Who would have ever thought of combining Groundhog Day (Bill Murray's best movie IMHO) with Starship Troopers (one of my all time favorite films but one with no redeeming social value)...what an inspired concept. In this movie, Tom Cruise actually does some excellent acting and Emily Blunt plays a hardened super-soldier which is playing against type to say the least. As you can probably guess from my description and the movie poster Tom Cruise ends up with the ability to relive his last 24 hours over and over again after being splattered with alien blood and gore on the battlefield. Like the Bill Murray character in Groundhog Day he grows as a person while becoming the soldier that he never thought he would nor wanted to be (he starts the movie and an unapologetic coward who is happy being a "talking head" for the military but completely uninterested in seeing war up close and personal). Tom Cruise doesn't draw the fans in as much as he once did so I convinced my daughters to accompany me to the multiplex last Sunday to catch the film before it was too late. My older daughter loves intense, kick-ass movies that feature the military fighting zombies, giant monsters, bad guys etc. She is seriously considering attending a service academy and her favorite new TV show is The Last Ship on TNT. However, after watching Edge of Tomorrow she definitely is leaning towards Navy and not West Point based upon how J Platoon fared in their hand to hand combat with the alien horde. My younger daughter took some convincing to see the movie and I kept an eye out for agents from Child Protective Services when purchasing our tickets (the movie is PG-13 but the Family Filmgoer described it as loud and intense but without blood and gore). They both loved the movie as did I so you need to go see this movie before it gets bumped out of the multiplex for Transformers.....Tell them DrG sent you.
So what does a 5'7" actor killing disgusting inter-galactic squid-like creatures have to do with infertility and IVF? I guess the point I want to make is regarding adapting and thinking outside of the box. To illustrate, let me share the stories of two patients pursuing fertility treatments.
L.P. is a 37 year old who came to see me after 3 failed stimulated IVF attempts at another IVF clinic. Her FSH was 14 IU/liter with an AMH < 0.16 ng/mL. Each of her 3 stimulated IVF cycles with had ended poorly without a single attempt at egg collection. In each case she had failed to meet the other clinic's minimal requirement of 3 large follicles needed to permit a patient to go to retrieval. Each stimulation essentially utilized the same protocol without much variation. Their recommendation was donor egg or adoption. When I met with L.P. she was uninterested in donor egg or adoption and thus only wanted to try Natural Cycle IVF. On the second attempt she was successful and delivered a full term healthy baby. She returned several years later and at the age of 41 was interested in another attempt at NC IVF. Amazingly enough, she was again successful on the second cycle and again delivered a healthy baby. Stim...fail to respond....repeat. Not a recipe for success. Kudos to her for hanging in there and believing that something so simple could be successful...twice!
The second patient had traveled a different path to Dominion. K.F. is a 35 year old who had also undergone 3 cycles of stimulated IVF at another clinic. However, she had been an excellent responder to medication so she represented the opposite end of the spectrum from L.P. Each of her stimulated IVF cycles resulted in over 20 follicles and she had over 15 eggs retrieved each time. However, her embryo growth was disappointing with most embryos failing to develop well and no pregnancies and nothing to freeze in any cycle. We discussed the situation and I explained that we were dealing with one of three issues: 1) an intrinsic egg issue that we could not fix; 2) an intrinsic sperm issue that we could not fix or 3) a stimulation issue. The only way to prove that the issue is an intrinsic one with the egg and sperm would be to a) use donor egg/donor sperm, b) do PGS to see if they could produce any normal embryos or c) get pregnant. Option (a) was not acceptable and option (c) would have been nice but seemed unlikely without assistance leaving us with option (b). Although we could do PGS, we needed to consider changing her stimulation in order to get adequate embryos to blastocyst. I recommended reducing her stim dose aiming to get 8-12 eggs hoping that the concept of quality over quantity would hold true for her. Fortunately, her stimulation went very well and several embryos made it to blastocyst and were biopsied for PGS. Two genetically normal embryos were transferred but she failed to conceive. So we had demonstrated that as a couple they could generate genetically normal embryos but these had failed to implant. At this point we discussed performing an endometrial biopsy prior to additional IVF attempts, gestational carrier IVF or repeating an IVF cycle now that we seemed to have a better protocol for her and skipping the PGS since we had proved that they were able to produce genetically normal embryos. This time we hit the jackpot and they conceived with IVF.
I hope that these stories indicate the benefit of modifying future IVF based on past IVF cycles. Sometimes these changes are significant such as changing to Natural Cycle IVF whereas other times the changes can be subtle such as adjusting stimulation meds or doing an endometrial biopsy or convincing a bad-ass like Emily Blunt that you need to call off the planned battle with the Mimics and look for the Omega (which is hiding under the Louvre in Paris) in order to save the Earth...oops, wait that was a movie....I think.
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