These differences somehow lead to the following differences in IVF results:
1. Fewer eggs retrieved
2. Fewer mature eggs
3. Lower fertilization rate
4. Lower survivorship to day 5
5. Lower quality
Here's what I come up with when I compare this cycle (bad) to my last cycle (good):
1. NCCRM vs University of Michigan- UM is a university hospital, and NCCRM is a private clinic. I used to get frustrated with UM because their protocols were so conservative, but I'm beginning to think they knew what they were doing. Not to mention their IVF facilities were more state-of-the-art and sanitary/sterile than NCCRM. Either way- neither of them managed to get me pregnant but the embryo results were so much different. So- could the different outcomes be from facility practices?
2. Roughly 1 year later (Dec. 2013 vs Jan 2015)- can your fertility (or what's left of it) really change this dramatically in one year? From age 28-29? With a sample size of 2, this also could be "normal" cycle to cycle variation.
3. Shorter suppression phase with birth control- This is a red flag for me, and really is one of my top two candidates for why this cycle went so poorly. At UM, after 24 days of birth control suppression, my blood estrogen levels were still high (52), so they continued suppression for 8 more days (totaling 32 days) until my estrogen was below 12. At NCCRM, they only tested my estrogen levels 4 days after they had already taken me off birth control. Estrogen was 71, and after another day of waiting went to 69 (not statistically significantly different in my book). But NCCRM cleared me to start stimulating my ovaries. I'm worried that in those 5 days being off birth control, my follicles started growing- and because they didn't all get whopping stims early, there was probably uneven growth that created early lead follicles. Maybe I needed longer suppression to make sure estrogen was low and follicles would grow more evenly.
4. Higher doses of follicle stimulating hormones (Gonal, Follistim, Menopur)- theoretically, higher doses should lead to more eggs retrieved, but it didn't. Why? I think that because there were early follicle leaders from being off birth control that the increased stims only worked to make the big follicles bigger.
5. Stimulated follicles longer amount of time- At NCCRM, I was given higher doses for a longer time than at UM. Again, shouldn't that have increased egg yield? But it didn't. I think if they had triggered 2-3 days earlier, they would have ended up with about the same eggs as I got in my previous cycle. This is in my top two suspects for this cycle's failure but hindsight is 20/20.
6. Antagonist added later- I don't know how much this matters, but the antagonist is supposed to keep you from ovulating. It was added later in this cycle than my previous one.
7. Estrogen levels higher at trigger- This past cycle at trigger, I don't even know what my estrogen levels were because NCCRM didn't test them in the last three nights of stimulations. If it didn't plateau, I think it was between 3-4 thousand. At UM, my estrogen stalled out at about 1,000, which prompted them to trigger. At the time, the said stalled out estrogen is bad for egg quality. So- I'm wondering whether my estrogen levels stopped rising this cycle.
8. Lupron trigger vs HCG trigger- I think that Lupron is a weaker trigger than HCG, but that is just from internet searches. NCCRM claims that they trigger all their infertility patients and donors with Lupron.
9.Took DHEA and CoQ supplements- I'm going to come right out and say that supplements don't work :/ I didn't take any for my "good" cycle and had more mature eggs, higher fertilization, higher quality and better survivorship. But I'm going to keep taking them anyway just in case (grumble, this is how people are making money off of infertiles).
10. Can you think of anything else? I have no thought whatsoever that SuperUterus had anything to do with our failed cycle. Her lining was perfectly fluffy, and welcomed our little embie with love.