Any chance of saving this cycle?

jessimi06

This is out first ivf cycle, and my first cycle with injects and it's not going so well. After 4 days of 150 gonal f and 75 menopur I have my first u/s that showed 47 follies all under 11mm and my e2 was 89. I went back two days later (Sunday)and I had 1 follie at 12.4, about 10 between 10-12mm and 15 around 9mm and my e2 was 370. RE decided to start cetrotide and that's where it goes to crap. When I went back Tuesday I had about 15 follies 10-12 mm but my e2 crashed to 140, which the nurse said can happen when you start cetrotide. So they raised my dosage to 225 gonal f and 75 menopur with the cetrotide still and when I went back today I have 9 follies 12-13mm and 4 around 10mm and my e2 dropped to 119.

I was pretty sure that they were going to cancel this cycle but they want me to stay on the meds tonight and tomorrow night at the same dosages and come back Saturday and Sunday. Is there even any hope of salvaging this cycle? I feel like this is a crap shot and even if we can get my ovaries to go, that the eggs won't be good quality at this point.

RunCC37

I'm confused about starting the Cetritide so soon. Perhaps you'll get a clearer picture this weekend. Good luck!

jessimi06

@RunCC37‌ I was a little surprised when they started so early as well, but I guess she likes to start when the lead follie reaches 12-13mm?

RunCC37

Well, the point of the Cetrotide is to slow things down, which it did. Give it a chance! I hope you're surprised on Saturday.

On a side note, my doc always started the Cetrotide at the first 15-16.

AMShark

How long have you been doing stims?  It took me 12 days of injections to grow my follicles enough for ER, but it felt like 100.  Are you much past 12 days?

jessimi06

@AMShark‌ tonight is day 11 of stims

@RunCC37‌ thanks! I hope so too, and if not, I want to bring up my concerns about starting the cetrotide so early at our wtf.

AMShark

I don't know much about e2 levels - I guess that's something that wasn't a problem for me, or I would have known more about it (right?)

... .but as far as follicle size and number of days stimming, I'd say there's still hope for this cycle.

FYI - for my ER I had 28 follicles retrieved, but only 7 were mature, which felt low to me.  I don't know if it's because I was a slow grower in the first place, but I'm hoping you end up with more.  (but more importantly, I hope you end up with *the ONE*).  FX.

pblge

Yes, this is about how all of my cycles have gone. It sucks. (((hugs)))) I wish I had a magic bullet for you, but I've yet to make it through stims, even before I tried IVF, without crashing.

Doctors disagree on how much the length of stims affects egg quality. There are published reports that say long stims are bad, but my current fancypants RE doesn't think it's that big a deal to have long stims. I'm not sure there's a lot published about how crashes affect egg quality, but my last RE seemed to think it could be a big problem. FWIW, my first IVF was salvaged after a crash and I got a BFP, but I ended up miscarrying a normally karyotyped fetus, and my RE's theory was that there were microdeletions in the DNA, possibly from "problems during stims." But who knows? There could have been something else wrong, so you may still have a shot at your take home baby, even after bumpy stims! I've read of ladies who had crashes and ended up with sticky beans, so maybe I was just unlucky.

I agree with the others that it seems your cetrotide came early. Is this an experienced clinic/RE? I broke up with my last RE because he couldn't get me through a stim cycle without a crash. The new RE also chose an antagonist protocol, which he was sure is the best choice for me even though I thought it was a train wreck in IVF #2.0. Having had two bad IVF cycles, I'm really uninterested in a retrieval that isn't my best.  I just took my first shots tonight, so I can't say if it will work or not. I do think I'm in better hands at a clinic that does 3000 cycles per year (compared to my local one that does 300), so that difficult "brittle" cases like yours and mine are not as novel.

You're right--this is a crap shoot, and I don't have the answer yet. If you're out of pocket, I think cancelling might make more sense. The big money is spent on ER and ET, so you want those to be the greatest number of the best eggs you can produce.

Feel free to PM me if you want more info on this. Good luck!

jessimi06

Thanks @pblge‌! I feel good about the clinic and my RE- they don't do as many cycles as your fancy pants RE (lol) but they do about 600 cycles a year and have about a 45% live birth rate/47% pregnancy rate for my age group. I do think my RE jumped the gun on the cetrotide, but I've never had an inject cycle before and I know she was really worried about ohss since I had so many follicles at baseline and get multiple follicles on letrozole alone. Now if this keeps happening, then I'll have to look at other options that are likely out of state.

I'm actually partially OOP- it's about $7k per cycle, as insurance will cover some things. So, if I don't show improvement by Sunday, this cycle will be cancelled.

It sucks to get this far and have to cancel, but it'd be for the best.

I hope your cycle goes well this time around and fancy pants gets it right!