Stunted research
I am trying to read and process things. Doing a lot of googling.
Some people online with this problem (very poor egg maturity during IVF) wrote that their doctors say it’s linked to PCO and insulin resistence. I have symptoms for neither of those. I do have a high antral follicle count and I am a very high responder in IVF, but there were no cysts, I have no cycle issues, and none of the other long list of symtoms other than acne. Insulin resistence… now I would think, if that were the case normally, that my pregnancy GTT would have shown something. My numbers were very low, not even borderline.
I found the article my doctors wrote. It was in fact not about me specifically, but about a woman with a very similar condition. After her karyotyping they found she has Turners mosiac X syndrome. That makes me twitch a little. I’m now quite interested to see if anything turns up on my karyotyping.
IVM (in-vitro maturation) is still experimental. To be honest it makes me a little nervous because we DID get one good embryo. And one good embryo is better than none. And, despite my slight OHSS symptoms, the whole IVF cycle wasn’t all that difficult. I’m more inclined to try experimental stim protocols to try to increase the number of mature eggs they get from me.
This study seems to indicate that normal fertilization in vitro may give better outcomes than ICSI, for cases like mine. This is a concern Den has. Ever since I found out that our first cycle flunked IVF 101 due to the eggs being immature (and, thus, un-ICSI-able anyways) I’ve considered ICSI on our second try to be superfluous. Den’s argument is, “But if we only have one mature egg, I want to make DAMN SURE it gets fertilized!” And, okay, he has a point. My only hesitation is that I don’t really like to be messing around with the things if it’s not necessary (they’re having a bad enough time as it is, stop poking them! They’ll get mad!), but if insurance is covering the cost I’m not really going to argue against it. I’ll discuss with the doctor when we get closer to actually cycling.
You know what annoys me the most right now? The fact that you have to subscribe to these journals in order to read the full article! Obviously, as someone who is just a patient searching for answers, I cannot afford to shell out hundreds of dollars on some articles to read. So, what, I have to comb forums for answers from other patients who likewise have no actual real clue either? I want facts. I want numbers. I want real research.
Apparently I should have become a doctor. Or at least an embryologist. As my dad said… hindsight.
Natalie, I have hope for you. I know all of us do. I’m guessing you feel like you are at the bottom of a very tall mountain. But I just wanted you to know that I have a lot of hope. I left you a pink rose award at my blog this morning.
Hi there. I’m not sure if you’ve thought of this – or if it helps any… When I was university and I couldn’t get hold of a journal article, I’d send an email to the author. I was amazed at how willing they would be to send me the article. Because many universities subscribe to so many different journals, it may pay to see if you can buy an article through the uni – could be cheaper than getting a whole subscription to the journal (or better yet, if you know someone there, they might be able to get hold of the article for you).
Good luck.
Natalie, I have electronic access to all of these journals by virtue of my work. Any time you want full text of something, please feel free to email me the links, and I will get you those pdfs.
In the meantime, here is the full text of a study I found yesterday: http://humrep.oxfordjournals.org/cgi/content/full/den210v1
It’s free full text access. The interesting thing with that study is that even though they are talking about IVM cycles, the differential treatment that increases the odds of getting a mature egg (even before IVM) is simply a slightly longer time period between the trigger shot and retrieval. The study is very new (though from a good journal), and I am not sure whether there are differences in an IVM protocol vs. straight IVF prior to retrieval. But if there aren’t, this seems like a modification to your protocol you can try without even doing IVM.
Sorry– forgot to say that simple insulin resistance is not going to show up as impaired glucose tolerance on a GTT if insulin levels are not also measured. By the time it shows up as hyperglycemia, it begins trending towards diabetes rather than just IR. So, actually, if your pregnancy GTT was on the low side, it is more of a reason to suspect IR. If you really want to know, the only way to find out for sure is to do a long GTT (5hrs, but 3hrs may do) with insulin levels. If you have IR, what you will see is a slight delay in insulin production, followed by sharp rise in insulin, sharp drop in glucose, and then insulin staying at an elevated level despite the drop in glucose.
Let me know if you want to talk more about this.
I have PCOS, with no cysts and only 3 cycles in my entire adult life that were delayed (and not for a pg). My doctor made the diagnosis with an inverted LH/FSH ratio. My latest blood tests say that has normalized, but I remain on Metformin. I have no IR either.
Not sure if that helps at all, but there you go.
I would think that if you had IR, you would have a high fasting glucose. But it looks like a previous commenter debunked that, so that could be totally wrong.
There’s a woman on the forums who has access to articles and shares her username and password on her blog so that others can read also and I’m sure she wouldn’t mind you using it too. She has a subscription to http://www.orgyn.com so it looks like you could read anything on there.
I don’t want to post her info on a comment, but here’s her blog: http://personalblog.blogdrive.com Go back a couple of pages to an April 30 post and she shares her username and password.
I hope that helps. Now I’m motivated to go search for articles myself.
Here via Blog Roundup- if you have access to a university library at all, they usually have general-access computer kiosks, and any computer with a Uni IP address will have access. PubMed Central is a free repository; if you search through there, all the articles are available. Likewise BioMed Central. And also, like Julia, let me offer to send you any PDFs you might want.
It may cheer you to know, if you haven’t heard, that the NIH (largest funder of biomed research in the US) has just started enforcing the rule that all publicly funded research must be deposited in PMC within 6 months. So that all the taxpayers can read it!
Thank you all for your fantastic help and advice!!
Julia, thank you for letting me know about the IR, I will have to get my blood tested for that, as right now I want to cover *all* bases. And thank you for offering to get me those articles…. I may just take you up on that!!
G – That’s interesting. My LH/FSH ratio was normal, though, so it sounds more like that’s not my issue.
Shannon – Thanks for sharing that link! I’ll check it out!
I know when I over stimmed I had immature eggs. My Dr said PCOS – he looks for 3 main symptoms and if you have 2 it’s PCOS. Since starting on Metformin I’ve had 3 further cycles and not over stimmed on any of them.