My last days at New Hope were a whirlwind of emotions and many sad goodbyes.
Fortunately, one good-bye was a happy one: I was able to graduate AG!
AG had a beautiful ultrasound heartbeat on 3 separate occasions and the
fetus was growing appropriately, so it was time to move her on to her
obstetrician. AG is 36 y/o. If everything goes well this will be her second
baby with New Hope. The most interesting thing is that she is menopausal
and this pregnancy was from an embryo created from her OWN egg, not a
donor egg. How can this be?
AG ‘s story starts 2 years earlier. She came to us after multiple
centers in New Jersey and New York City told her that IVF was not possible
because her baseline FSH was too high and her reserve was too poor. She
was repetitively counseled to have an egg donor. She had never been pregnant
before, but her work-up was all normal and her cycle was fairly regular.
Unfortunately, timed intercourse and inseminations were not working, but
no one was willing to try IVF.
On her initial visit, her FSH was indeed high, but it was because she was
ovulating. Despite the suddenness of the whole situation, she desperately
wanted to retrieve the follicle that was there, so we performed a natural
cycle retrieval. We were able to retrieve an egg which fertilized and
2 days later I performed an embryo transfer. She did not become pregnant.
After the transfer failure, we had a long discussion. Because of her particular
situation, I made one major suggestion: Embryo Banking. If her reserve
was truly poor, then the next follicle she developed could be her last
egg. Even if we were fortunate enough to help her conceive, there was
a strong possibility that it would be her only genetic child. Surprisingly
(maybe not so surprisingly), 80-90% of my patients return to see me for
a second child, no matter how difficult it was the first time around,
and many of them regret not having saved a few embryos for the future.
Through embryo banking, we could optimize AG’s chance of having 1
child and, if we were lucky, we could have a few extra embryos for the
future. Is there any downside to banking? Of course! More treatments,
more money, but the hope is that minimal stimulation IVF with less medication,
less side effects and less cost would allow patient to undergo more treatments
and optimize her chances. AG was all on board for this.
The next cycle did confirm what she had told us; her FSH was 18 IU/ml and
she had only 2 antral follicles. Based on this information, we proceeded
with Clomid only IVF which resulted in the retrieval of 1 egg (under local
anesthesia, of course) which resulted in 1 embryo. Because our concern
was our ability to retrieve eggs, as oppose to egg quality, we froze the
embryo as a 6-8 cell embryo as not to risk damaging it.
This continued for next few months. Occasionally, AG’s FSH would
increase dramatically (it peaked at 85 IU/ml) and we would perform Natural
IVF so “Overstimulation” would not occur. Once AG was comfortable
with the number embryos she had banked (or when she was just tired of
the whole banking process), we performed a natural cycle frozen embryo
transfer( no medications, no hormones, until ovulation occurred) and we
were successful the very first time!
After a smooth pregnancy and delivery, AG returned to try for baby number
two. Even though she was done with breastfeeding, she had not resumed
her period. A test of her hormones revealed an FSH of 128 IU/ml; she was
most likely in menopause which meant “No more eggs”. Fortunately,
we had banked a few embryos so there would still be an opportunity for
baby number two. Since AG was in menopause, we could not repeat the natural
cycle frozen embryo transfer which worked before. This time we had to
create an artificial hormone environment commonly known as a Hormone Replacement
Cycle (HRT). Once again, we were successful on the first try!
So, good luck AG! I hope to receive a birth announcement this summer!