Question:
Dr. Ramirez:
I am a 44-yr old with a history of numerous IVF attempts. Miraculously, cycle 1 (2007) with my own egg (yes, only one egg was retrieved) resulted in a healthy baby. 1 additional IVF attempt (2009) with my own egg - unsuccessful. Subsequently, 4 IVF attempts with two different donors (some fresh, some frozen cycles) were also unsuccessful. With each attempt, the blastocysts were high-grade, and other recipients of same donor's eggs resulted in pregnancies.
For my current cycle, which begins this week, we will be using a cryopreserved embryo, and physician is adding two medications: Prednisolone 25 mg daily, starting 10 days before transfer, and Lovenox 40mg daily, starting 2 days prior to transfer. If successful, plan is to continue both meds (along with Estrogen and Progesterone injections) for the first trimester. This seems like an extremely large dose of prednisolone and lengthy duration. I am concerned about the potential side effects on me, as well as the developing fetus, assuming a positive outcome. Do you have any experience and/or information regarding the prednisolone and Lovenox? Thank you, C. from the U.S.
Answer:
Hello C. from the U.S.,
In my patients that fail 2 IVF cycles, I automatically add prednisone, Heparin (lovenox can be used as well). All my IVF patients get the prednisone (I use medrol), low dose aspirin, progesterone and estrogen, so in reality the only thing that is new is the heparin/lovenox. Because of the potential effects on the developing fetus, I do not use the prednisone longer that the first pregnancy test. The heparin, aspirin, progesterone and estrogen are continued until the patient reaches 10 weeks gestational age. In patients that have a history of recurrent miscarriages, I will sometimes continue the medications until 12 weeks gestational age.
I start the heparin (lovenox) with the start of the IVF cycle, just like I do with the prednisone and aspirin.
Incidentally, your experience with a pregnancy in the first IVF cycle with only one embryo transferred, at the age of 40, is the reason why I DON'T ever cancel a cycle if there is only 1-3 follicles. My belief is that this one egg may lead to the one perfect embryo left and I would hate to lose the opportunity to get a pregnancy from it. It may be a lower chance, but it is still the best chance that you've got. So I am glad to hear that your docs continued the cycle and did not cancel it like so many do!
Good luck with your upcoming donor cycle.
Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
http://www.montereybayivf.com/
Monterey, California, U.S.A.
Comment: Thank you very much for your expert opinion and extremely timely response! I greatly appreciate your time and expertise.
