**siggy warning - photo** IVF cancellation & PCOS protocols

thishappyhouse

Visiting from the preemie board. 

I had my first IVF cancelled on Sunday after 11 days of stims.  Long story short is that I had 26 follicles and an E2 of 590 after 4 nights of stims so they cut my dosage in half.  I went from 75 follistim/ 75 menopur/ 5 lupron to just 75 menopur/5 follistim.  By day 9 my e2 took a nose dive and by day 12 they cancelled the cycle.

I know this is an unusual reason for being canceled.  They have put me on BCPs to quiet everything down and said I can start again with the completion of the BCPs.  Has anyone ever used BCPs to cancel?  Im worried about those follicles going away but also worried about cycling right after this mess.  

Those of you with PCOS, can you share your protocols and dosages?  

pblge

I don't have PCOS, but I act like I do during stims. It's called a "brittle" response, and some doctors would say you have "brittle PCOS." They CAN get it right, but it's a lot harder. My first IVF was going okay until they coasted me for a couple of days (removed all the stim drugs, just doing Lupron), then my E2 crashed. They salvaged it, but I got far fewer eggs than they should have. I also did an injectables + TI cycle that was going to be converted to IVF, but I had a crash like yours and the cycle was cancelled.

The key is to have the right amount of drugs at the beginning for good follicle recruitment, then lower the dose to sustain even growth without shooting E2 levels through the roof. BUT, it can't be too low or you'll crash, as you and I have.

In IVF #2.0, they lowered it too much, and I ended with with just a couple of follicles, so it was converted to IUI.

I have not had a good cycle yet, so I won't bother to share my protocol. It would be different for you, anyways, because they have to find your "sweet spot." I also never used BCP to shrink the follies--I just waited for it to happen on my own. It probably doesn't matter much, and it might be quicker with the BCP. Just make sure your doctors have a good understanding of what went wrong and what the parameters for your dosing are. I gave my docs three chances to get this right with me, and they never did, so I'm seeking treatment elsewhere.

Good luck!

thishappyhouse

Sorry you have been on such a rollercoaster! @pblge  What has your new RE said about how to approach "brittle ovaries"?  

 

I met with my RE today and he is going to think about whether to switch protocols from long lupron to antagonist.  I see advantages to both but always assumed that I would respond better to long lupron.  

If we are to stick with long lupron he suggested starting out with 37.5 or 50 of follistim and 75 of menopur in hopes that we can stay on the same dosage for as long as possible.  

pblge

I hope the antagonist protocol works better for you than me. That's what they used last time for me.

I haven't seen the new RE yet--still another month to wait. I hate the waiting!!

thishappyhouse

@pblge reviving this post to get your thoughts again.  TIA

It appears that I have very similar stimming problems.  

So after my canceled cycle I went on BCPs for 6 weeks and then started another long lupron cycle.  Starting meds were lower by about 25% (41 follistim and 75 menopur)  My e2 was pretty low throughout the cycle and topped out around 1000.  At trigger there were 11-12 follies 15-20.  I was definitely expecting a more robust response but was feeling ok until we got to retrieval today and they couldnt get to one of my ovaries.  So now we just have 6 to work with.  

Have you found any difference between stimming with just FSH as opposed to FSH/LH? 

Have you had problems with low E2 in comparison to your follie count? 

pblge

Argh. I'm sorry your second experience wasn't much better. I'm on day 1 of BCP for the next IVF, so we'll see how the FSH + LH goes. New doc was INSISTENT that we use the antagonist protocol; I'm struggling to be optimistic about it.

I got preggers from my 7 egg retrieval, so this could still work for you. Mine didn't stick, but that's unrelated I think. FX you get good news in about two weeks!

I'll update with my experience soon. Please keep your fingers crossed for me. If I get through the stims without a crash it will be a freaking miracle!

thishappyhouse

Lots of good thoughts for you.  I hope they are able to stim you well.  The antagonist protocol give you so many more options if you start to hyper stim.  If we need another cycle Im going to push a straight FSH antagonist.  

So all 6 were mature and 5 fertilized.  They are still watching the 6th.  It makes me wonder if my e2 is just at the lower end irrespective of maturity since all of those were mature.  The follicles that they couldnt get to during retrieval were our "winners" and were all around 20 at trigger.  So assuming they would have been mature I would had 11-12 eggs with an e2 of 920.  Confusing....

Ive got everything crossed for you.  please keep me updated