I'm at risk for Ohss, should I switch to lupron?

crazygirl7882

I'm on day 9 of stims and at this morning's monitoring session my dr told me that I have at least 29 follicles. He said due to the high number I'm at risk for ohss after my trigger. He said to reduce the risk I could switch from hcg trigger to lupron but he would recommend switching to fet. This would mean a delay of 1-2 months. He's willing to go forward with the hcg if that's what I want. I'm still waiting on the results from today's estradiol test. He also gave me an rx for cabergoline. Does anyone have any advice on this? I really hate to delay but I don't want to end up in the hospital either.

aliciafiggy

I had 26 follicles at egg retreival and they were concerned for me too. They switched me to a HCG/Lupron combo trigger. They also gave me cabergoline. They were going to make me do FET but they changed their mind because my insurance didn't cover it and they thought I might be okay because of the HCG/Lupron combo trigger and the cabergoline. My AMH levels were not that high either, so that was a plus. After the egg retreival I drank a ton of Gatorade and coconut water. They also recommend tomato juice and chicken broth.

I didn't get pregnant, so I don't know what would have happened if my hormones started to increase. But I was okay. My only recommendation is that if you do move forward with a fresh transfer you should take some sort of precautions not to get constipated. The constipation will make you feel like you have OHSS. You'll get very bloated. And if you are nervous you could get anxiety and make you feel like you can't breath. At least that's what happened to me. Good luck!

Justone13

I'll be at a higher risk for ohss this time because we are blasting the hell out of my eggs with hormones so I'm doing a freeze all cycle. Fet's have good statistics because your body has returned to normal. I've done 3 fresh cycles and had one cp. I never had any to freeze.

Cabergoline? For the ohss? That's interesting. I never knew they prescribed that for it. I take it for a prolactin issue twice a week vaginally because orally it made me crazy. Really loopy and out of it. Vaginally I'm fine though. GL

crazygirl7882

He basically told me adding lupron is going to reduce my chances of getting pregnant with a fresh cycle. I'm thinking of just taking my chances with the hcg. It's very difficult for me to take off time from work and the stars all aligned for me to take a week and a half off for my er and et.
@aliciafiggy- what did you do to treat the constipation?

I hate these decisions!!!

pblge

crazygirl7882 said:

He basically told me adding lupron is going to reduce my chances of getting pregnant with a fresh cycle. I'm thinking of just taking my chances with the hcg. It's very difficult for me to take off time from work and the stars all aligned for me to take a week and a half off for my er and et. @aliciafiggy- what did you do to treat the constipation? I hate these decisions!!!

**PAIF response** Hope you don't mind me responding

Well, that's a new one! I've never heard that using Lupron instead of HCG would reduce chances of pregnancy, and I'm not sure there's a consensus there. It may also depend on what all you'll be supplemented with after ER.

...Just found this, and it looks like you'd need both estrogen (not all clinics do this) and progesterone support with a lupron trigger.
https://www.advancedfertility.com/lupron-trigger-prevent-hyperstimulation.htm
My clinic did a Lupron/low HCG trigger with me, although it was planned. I had 33 eggs retrieved, but relatively low estrogen (~100/egg at time of trigger). I had no symptoms of OHSS, and apparently some women just aren't that prone to get it. It is a SERIOUS condition, though--I know a friend of a friend who lived in a rural area and died from it. If you start having symptoms, you do not want to mess around with it. If a lupron trigger is an option to you, I'd definitely take it, but perhaps ask about additional supplementation if you end up doing a fresh transfer.

In my case I was able to do a fresh transfer, but it was BFN. Anecdotally, I'm beginning to suspect that the high-retrieval cases are more likely to be BFN if a fresh transfer is done. There are studies that suggest that having too-high estrogen can reduce chances of success.

The first FET after the failed cycle worked for me. Honestly, part of me wishes I had done a freeze all. When a LOT of eggs are retrieved, your body is seriously whacked out for a while. It would have been nice to let my body recover fully without trying to sort out the wackiness from TWW symptoms.

To me, this wasn't a hard decision, but I could see why you would struggle with the change of plans. Good luck!!!

PS. ...Just read back. Why do you need a week and a half off for ER/ET? Most women take a day or two for ER, but that's it. If you do end up with OHSS, you'll need lots more! Also, for the constipation try lots of fluids, prune juice, and fiber. Having said that, nothing helped me for about three days after this ER. I would imagine this is something else that's worse with high egg retrievals.

crazygirl7882

Thanks for the info plge. I had to take a week and a half off because my RE couldn't give me exact dates and I have to take days off about a month in advance at my work. I also haven't told anyone at my work about the ivf. I definitely want to research the rates of high egg retrievals because I only paid for one cycle. My re said I can convert my fresh egg cycle to a frozen, but if the fresh fails I'll have to pay for any future frozens.

I guess on the plus side, if I do a frozen I should be able to plan for one specific day off.

It's my impatience that is the worst factor in all of this.

sweetpotato123

I was high risk for OHSS and did get it severely. It took me about 2 weeks to recover and about a month to fully feel back to normal. I know it's a hard decision that only you can make, but as @pblge‌ stated, it is a very serious condition that can be life threatening if untreated.

The waiting sucks (will be almost 4 months from start of stims to transfer for me), but in my case, it has been worth the wait to feel better and make sure I am at my best for the frozen transfer.

Whatever you decide, I wish you lots of luck.

kittenmittens9

yes to what @pblge said.  The thing that worries me about your situation is that you have 29 before you've even triggered.  If you do the HCG trigger you'll most likely end up with even more thus increasing your ohss risk.  I can't comment on the lupron trigger because I haven't done it.  But even 29 follicles is a lot IMO.  I had 24 retrieved for mine (15 on last u/s before trigger) and my ovaries were huge and I felt like a hot air balloon.  It's hard to wait when you've already waited for so long.  I hope that whatever you decide works out for you and I hope that you feel okay afterwards.  good luck!

pblge

One more thing to consider is your clinic's FET protocol. Some women have to wait months and months, but my FET was only 6 weeks after my ER, and I pushed it back by almost two because of my schedule.

Could you go back to work sooner if you don't end up needing all those days? That's a harsh use of time off!

crazygirl7882

Thanks for all the replies. I'm still waiting on my E2 level for today. I didn't ask what my priors were but he said they were normal. I'll post when I get them.

crazygirl7882

@sweetpotato123‌- How many follicles did you have on your last US prior to trigger? Were you prescribed cabergoline? What were your e2 levels prior to trigger? Thanks and good luck on your fet!

sweetpotato123

@crazygirl7882- I had 48 measurable follies in the last u/s. I took cabergoline starting night of trigger and took a cetrotide shot the night before trigger and another after retrieval. My e2 was 4936 day of trigger (cetrotide brought it down a bit) and I think it was close to 7000 day of retrieval.

gnl42

My E2 was over 7,000 at trigger and I had 23 eggs retrieved. My RE would not even give me the option to do the transfer. I did the Lupron protocol so I had to use hcg to trigger and I was also prescribed cabergoline. She was worried that if I did get pregnant, I was at high risk for late onset OHSS and refused to take that chance. It was very frustrating for me as I also have a major impatience problem. I did feel much better when it came time to finally do FET#1. I had to wait 6 wks to get there due to problems with a thin lining and travel plans. Its easy to say in hindsight that I'm glad I did the freeze all and avoided the possibility of severe OHSS, which can be very serious and terrible to go through. However, if my RE had given me the option at the time, I probably would have gone for the fresh transfer due to my impatience. It puts you in a tough position since you get to choose! Good luck with whatever you decide!

crazygirl7882

My RE just called and said my E2 is 3226. His recommendation is to go forward with a half dose of hcg and cabergoline. He predicts I will probably have mild OHSS. I'm going to go with his recommendation and hopefully I won't regret it. I trigger tomorrow with aspiration on Wednesday.
Thank you so much for all of the great info and good luck ladies!

gnl42

If your RE is comfortable with it and recommends going forward, then that definitely makes it an easier decision! I would do the same. Good luck!!

aliciafiggy

@crazygirl7882~ Good luck! If your RE is confident you'll be okay, trust him. I was a crazy mess thinking I was going to get OHSS and I never got it. You will make yourself crazy thinking about it. Just drink a ton of Gatorade and other fluids. My best advice is to rest as much as possible. You will feel pretty good but if you overexert yourself you will feel pretty crappy. My nurse kept reminding me " you just had surgery." Also, I would recommend trying to avoid constipation in advance of the egg retrieval. Prune juice does work. It even worked for me with just 5 sips. Or you could take a mild stool softener, like colace. Just don't take too many!!

yvonne0001

@crazygirl7882‌ I too have been at risk for OHSS. My dr is going ahead with the ET on saturday.

I had over 30 follies (retrieved 24eggs) and my e2 was over 7880 before trigger of hcG. They kept me on lupron for a few days and then they gave me ganirelix which lowered my e2 to about 1100 and I was told to trigger next day. They also started me on dostinex (cabergoline) and it seems to be helping a lot.

After my ER I am super bloated and backed up (wish I had known before that that would happen!)and am really uncomfortable. But mostly I don't feel any of the OHSS symptoms other than some pain in the ovary area(expected considering they were over 6cms each and poked a lot a few days ago) - but improving - and the bloating (I look about 4-5months pregnant...!).

I would listen and follow your drs recs. I did and am but am also listening to my body. I had to tell myself to do that and remind myself they do this for a living but also I know my body best. It is a balance.

GL!! I recommend starting colace as well and slowly add some fiber in before your ER and lots of fluids. I did a lot lf gatorade and I think it is helping with my OHSS.

crazygirl7882

@yvonne0001‌ thanks for the advice! I had my er this morning and I have been super bloated. I've been chugging Gatorade and had some prune juice earlier which helped a lot. I thought coffee was a nono but I read an article this morning that said coffee may help prevent ohss so I'm drinking a cup each morning. I'm crossing my fingers that it doesn't get too bad.