cancel or not cancel?

zeynsom

I am a slow responder. My estroidol caught up (from 24 to 75 on the fourth day and to 225 today on the sixth day of stims) but I only have five growing eggs on the left and two minuscule ones on the right. My nurse told me that she discussed the results with my doctor. They are encouraged and think that I may be a slow responder but they will have a discussion with me on Saturday to continue or to cancel. They say tat I may end up with 4 or 5 eggs even after stiming for 12-13 days. The question is: should I cancel? My AMH is low and FSH is high and I wonder whether I will have a better reaction at all in the future. We are quite aggressive on the medicine (Follistim 300 x2 day) and microdose lupron, and the doctor tells me that this is the max they give anyway. If I am not reacting now, would I ever react? If my chances are about the same in the future regarding the number of eggs, should I go ahead and try with 4-5 eggs now? I am 34 so it is possible that I may have good quality eggs. Has anyone had a similar problem? Would you try?

Twinkie0612

It's a hard decision.  With low AMH and high FSH, 4-5 eggs may be all that you will ever get.  You could certainly ask your doc if he thinks you would respond better to a different protocol (Maybe an antagonist with estrogen priming?). 

That being said, FSH and AMH are generally indicators of reserve not quality.  Age is usually a better indicator of quality, which means you could have some good quality eggs in the bunch.  I will throw out there though that age is not always a perfect indicator, I am 31 and have poor quality eggs. 

Agian it's a tough decision to make.  GL.

Carol77B

This is your first IVF, right? It seems that for a lot of us the first IVF is like a trial to see how you respond to the meds and do during ER/ET. I'm not sure what your particular situation is (insurance coverage, OOP, etc.) but I am not sure I would cancel unless your RE strongly recommends it, because while 4-5 eggs isn't a lot, you may not be a high responder. For my first IVF I got seven eggs and when I tried a different protocol (it sounds very similiar to your current protocol) that was supposed to get me MORE eggs I ended up with just three, so you never know.

One thing I will add is that my RE thought the embryos from my second IVF were a slightly better quality than my first IVF, apparently due to the microdose Lupron. However, we are going to go back to a modified version of my first IVF to see if we can get more eggs and embryos for IVF#3.

Good luck!

pblge

It sounds to me like this may be about what you can expect in an IVF cycle, especially since you're already on a very aggressive protocol. It only takes one.

Good luck!!!

PrivateOne

Such a hard choice.  I'm sorry you are in this position. 

Your RE is prolly right that is the max dose however you could try different combinations.  For instance I do microdose Lupron and then its 450 Follistim (or Gonal-F) and 150 of Menopur.  Perhaps he can tweak the protocol a bit.  I guess it would be worth asking.  Are you OOP?  If so perhaps you do want to cancel and try again in hopes of getting better results in order to help you financially.  Regardless, it really is so difficult to decide what is the best course of action.  A lot of it is relying on your RE and their best judgement.  They are the experts.

Best of luck to you with whatever you decide!!

dp21

Hi,

I am in the same position.  I'm 29 with an AMH of 0.5.  I had 4 follicles showing, had ER today and only got 3 eggs.  I'm doing IVF #1, and I'm staying positive.  They will call me tomorrow about fertilization, we are doing ICSI because of DH low sperm count. They told me I was already on aggressive protocol, I was taking 225 Bravelle and 150 Menopur the last few days, estradiol only got up to 568 in the end. 

It only takes one, we are paying OOP for procedure, evaluation and meds covered through insurance.  Bill came out to 8900 today, put on credit card to get points! 

I just hope at least two make it and we transfer two on Sunday. 

The doctor seemed positive because of my age, hopefully good quality eggs, my uterus and all other hormones are normal....just low AMH and poor reserve.  So hopefully I will have good implantation results.

Praying for good fertilization results tomorrow and hopefully will have good implantation since I don't have any issues with scar tissue or other things. 

zeynsom

Thank you all! I appreciate the responses and the support. It is OOP and my first IVF cycle. I feel like the common answer is that unless the doctor discourages me to continue, I should try. Who knows maybe over the next few days I may end up with two-three more beautiful eggs. And, as one of you said above: it only takes one good embryo. Trying to be positive.

dp21

ps, We have been through so much with injections and everything.  Also my meds are capped at 5 grand through insurance, didn't want all these meds we used to go to waste.  We have been through a lot, just want to see it through and hopefully not regret any decisions made along the way.  Just trying to stay positive as much as possible.  Thinking of you, just gotta go with your gut!  Good luck. 

zeynsom

@dp21 Good luck! We have very similar cases. Hopefully the little ones are strong and stick. It takes only one strong embryo to get pregnant! Stay positive, we'll do this!

dp21

@zeysmom We got the fert report, 2 out of 3 are fertilized.  Plan to transfer both of Sunday!  Staying positive!!!  We can do this! 

zeynsom

@dp21 Woo hoo! Congratulations! And, best of luck!

gsancho

With a low AMH and high FSH, I'd keep going for now.  I say that after I had similar numbers and cancelled...but my AMH/FSH is a little better, I'd had better response in the past, and being 100% OOP I just didn't feel right about it...so to me the finances paid a big role.  I've still gone back and forth on my decision since my AMH is 0.78, but even my RE was indecisive on his recommendation.  

So if you RE feels confident, I think you're still on track.  I have a co-worker who got pregnant with IVF each time only having 3-4 eggs.  Maybe ask about his thoughts on a different protocol and if that may work better, just for peace of mind.

zeynsom

So I had the third ultrasound and blood work today. Ultrasound shows no follicles on the right and five around 8-12mm on the left. The doctor said that they will probably have 3-4 of these five follicles as viable eggs and we hope that all are in good condition and fertilize. He said that my body may react differently next time even to the same protocol but it can be better or worse. I guess I need to accept the fact that this is what it is. I am never going to have 10-15 eggs to fertilize. I am hoping that we'll have at least good quality eggs that fertilize and stick. The doctor thinks probably Thursday for my ER and Sunday for my ET. Wish me luck!

Carol77B

I'm sorry you didn't get a big boost on the other follicles. It is so disappointing. Very best of luck at ER/ET.

dp21

  @zeynsmom good luck!  Hoping you get your 3 or 4 or more!  My left ovary didn't respond at all, all three of mine were from the right.  Big transfer is tomorrow morn! eek....  Even though we have less eggs, hopefully our quality is good   Curious to find out how our two did over the weekend, we'll ask tomorrow before transfer!