@acleverusername Thank you so much! I really appreciate your going to the effort of writing such a careful reply. There's a lot of think about there and some fertile ground (sorry sorry) for piecing together some of my own questions for my doctor. I'll also definitely check out the EMD Serono thing.
The choosing my clinic/travel thing is complicated. For a couple of what feel like fairly weighty reasons (my mom's cancer, my somehow finding myself stuck with the job of walking my family though a complicated real estate/legal thing that seems like it will never end), I feel like I need to stay close to home. I would consider going down to the bay area, since it's only about 6 hours drive from where I live and I have friends that live there, but I'm guessing price-wise my better bet is in Oregon. But then, as you say, I may be getting what I pay for. But I do like the folks at the clinic I've started going to. They seem attentive and are the first doctors I've ever dealt with on this issue who actually seem to listen to me and also treat me like I am a competent and educated person who can, with a little concentration, make sense of the science. I have no idea what their reputation is or how their stats stack up against other clinics.
Unfortunately I do have DOR. My AMH as of December is .36. Back when I first had it tested a couple of years ago and it was .54, I convinced myself that this wasn't really such a dismal reading. After all, I only have one ovary... And if like most women I had a 2nd ovary churning the stuff out, my AMH level would have been 1.08, and that's not really such a bad number! For some reason I found this little leap in logic quite comforting for a while (don't ask me why), but my most recent blood work was kinda took the wind out of that sail. The whole problem, of course, is that I don't have that 2nd ovary and so all that remains is the one, and whatever eggs it has left to give. My first round of bloodwork, I had normal FSH levels on day 3, somewhere around 7.5, if I recall. My level this time around was a disheartening 13.2.
On the other hand, my first injectables cycle, I managed to get a purportedly decent crop of follicles to grow on a standard dose of menopur (2 vials/day) after only 6 or maybe 7 days of stimming. So I guess I have going for me that the ovary does seem willing to play along without too much coaxing.
History
I am doing this on my own. Left ovary and fallopian tube removed due to cyst/necrosis just after birth. Right ovary and tube still purport to function.
Began TTC in Aug '18 @ age 35
5 or 6 (or 7?!) cycles using frozen donor sperm, ICI. All BFN
Mar-Jun '19 IUIs, all BFN
Began process of referral for RE in spring of '19, blood tests confirm low AMH (.54) but all else is good.
May '19 HSG shows open tube, but ultrasound suggests fibroids
MRI in June '19 confirms two large fibroids, one growing through wall of uterus
In June '19 I move from California to Oregon, disrupting my insurance, referrals, etc. 5 months spent piecing it all back together.
Nov. '19 attempted myomectomy (vaginal approach) failed. 2nd surgery using laparoscopic method in Jan '20 is successful.
April '20 --> June '20, natural IUIs, all BFN.
July? saline ultrasound and bubble test demonstrate open tube
July '20 clomid cycle cancelled for thin lining
Aug-Oct, 3 femara cycles, all BFN
RE referral. While waiting to set up an appointment Nov-Jan,I continue with natural cycles and ICI, using a known donor, BFN...
Jan '21 more bloodwork, AMH is worse (.30), FSH high albeit not catastrophic at 13.2. hysteroscopy all good. "looks cozy!" says the RE.
Feb '21, injectables (menopur, novarel), iui, BFN (doc said the frozen donor sperm sample had the "best numbers she'd ever seen!")
Mar '21, injectables, iui cancelled due to lack of follicles, converted to at home-insem. BFN
May '21, first IVF round cancelled due to cyst.
July '21 IVF: standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 7; 6 days of stims. 8 eggs retrieved, 7 mature, 5 fertilize, 4 made it to blast. 3 are 4AB, 1 is 4BB. PGT-A results all abnormal. Oct '21 somewhat improved AMH (.51) and significantly improved FSH (8.9). Maybe it's all the pills I swallow. Dec -21, standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 5; 11 days of stims. retrieval yields 5, 4M, 2 reach day-6 blast (4AB & 4BB). 1 low-level mosaic (chr. 3 deletion), 1 complex abnormal. Feb '22 FET (low-level mosaic): CP. May '22 egg retrieval, lupron flare protocol. HGH priming for 1 month before stims; md lupron 20/20u daily; menopur 225, follistim 225, 10k trigger after 8 days of stims; AFC 10; 13 retrieved; 10 mature; 8 fertilized. All frozen at 2PN for later thaw, grow, and biopsy. July '22 egg retrieval same protocol: 9 days of stims; AFC 8; 10 retrieved, 8 mature, 4 fertilized and frozen. Sept '22 ER same protocol: AFC 10; 12 retrieved, 11 mature, 11 fertilized. From the 3 retrievals, 7 survived to day 5-6 blastocyst, from which I have 2 normal embryos! FET scheduled for Jan 20. Fully medicated, baby aspirin, dexamethasone, acupuncture, and as much woo as I can stand (which isn't very much). BFN.
I would think about two things before starting treatment, to help guide how you want to structure things:
1. How many kids? Are you ok with just one, or would you really rather have 2+? Part of the reason we are doing back-to-back retrievals is that we want more than one more kid, and we want a good crop of frozen normal embryos (if possible) in addition to whatever we transfer. (With DOR, we don't really think we will get another shot at this in 2 years). In some ways, I think most clinics are set up to get you pregnant in the fewest cycles possible, but not really for fertility preservation. If you do want more than one kid, I would definitely discuss it with your doctor and probably plan on doing duostim or back-to-back retrievals.
2. How do you want to trade off money and waiting around? Our insurance covers most things, and we are pretty well cushioned with money for the OOP stuff, so for me the most important thing was to not wait around-- if it was going to work I just wanted to bang out the ERs as quickly as possible, and if it wasn't going to work I wanted to know now and not in a year and a half after three failed cycles. But we weren't paying OOP. You can certainly plan to do back-to-back and just cancel the second cycle if you get a lot of embryos and want to go straight to transfer, but it's a tight turnaround (On the plus side, you can plan to do this from the get-go since you won't be held up by insurance). I'm already having to order drugs fo next cycle before I know how many embryos we will have to biopsy. And we won't know how many are PGT-A normal until I'm well into cycle #2. I'm ok with this because (a) I want more than 3 euploid embryos anyway (greedy! but true), (b) I *really* don't want to waste a cycle in between waiting around, and (c) I am ok with wasting the money on meds I don't need (doing this one no matter what, but could be true for the next cycle).
On costs-- I will tell you that they'll probably start you on ~300 or more follistim/gonal-F and those things are expensive. The OOP price for a 900 IU cartridge in my pharmacy (ships out of Phoenix) is almost $500 for each 900IU cartridge (I ordered 4 and needed a refill). They also ordered my lupron in case I needed it for trigger, that I didn't even use. The meds are definitely expensive and it's good to shop around.
Thanks so much @bumblebee0210. That's all super helpful, especially your explanation for what back-to-back retrievals do. And apologies if my long messages should have been put in spoilers. I'm obviously still getting the hang of the culture around here. Also I have no idea how to do a spoiler, so will have to research that at some point.
I am quite certain that I would be content with one kid (single parenting seems overwhelming enough! 😬) but I see the logic for a couple or an ambitious single person who wants more. Since I've never even had a detected chemical pregnancy, I do worry quite a lot about the quality of my eggs, and wonder how many I would need in order to produce a viable blast (on the flip side, I also wonder if there has been some undiagnosed structural issue that has resulted in all those bfns. When I had my myomectomy in jan of '20, the surgeon found some endometrial adhesions holding my ovary against my abdominal wall. he released her, but of course new adhesions could have formed).
I appreciate your thoughts on the tight decisionmaking turnaround re: buying more meds for the second cycle before you have learned news about the results of the first retrieval. I feel like I can sympathize. It reminds me a little bit of what my monthly sperm-purchasing dance. Because especially during covid the sperm bank has not always had immediate turnaround on their shipments, it can be tricky to get the bfn, make a choice about which sample I want to purchase this time around, and then make a purchase in time for it to arrive for the next IUI.
Lots to think about. I appreciate all that you've shared.
History
I am doing this on my own. Left ovary and fallopian tube removed due to cyst/necrosis just after birth. Right ovary and tube still purport to function.
Began TTC in Aug '18 @ age 35
5 or 6 (or 7?!) cycles using frozen donor sperm, ICI. All BFN
Mar-Jun '19 IUIs, all BFN
Began process of referral for RE in spring of '19, blood tests confirm low AMH (.54) but all else is good.
May '19 HSG shows open tube, but ultrasound suggests fibroids
MRI in June '19 confirms two large fibroids, one growing through wall of uterus
In June '19 I move from California to Oregon, disrupting my insurance, referrals, etc. 5 months spent piecing it all back together.
Nov. '19 attempted myomectomy (vaginal approach) failed. 2nd surgery using laparoscopic method in Jan '20 is successful.
April '20 --> June '20, natural IUIs, all BFN.
July? saline ultrasound and bubble test demonstrate open tube
July '20 clomid cycle cancelled for thin lining
Aug-Oct, 3 femara cycles, all BFN
RE referral. While waiting to set up an appointment Nov-Jan,I continue with natural cycles and ICI, using a known donor, BFN...
Jan '21 more bloodwork, AMH is worse (.30), FSH high albeit not catastrophic at 13.2. hysteroscopy all good. "looks cozy!" says the RE.
Feb '21, injectables (menopur, novarel), iui, BFN (doc said the frozen donor sperm sample had the "best numbers she'd ever seen!")
Mar '21, injectables, iui cancelled due to lack of follicles, converted to at home-insem. BFN
May '21, first IVF round cancelled due to cyst.
July '21 IVF: standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 7; 6 days of stims. 8 eggs retrieved, 7 mature, 5 fertilize, 4 made it to blast. 3 are 4AB, 1 is 4BB. PGT-A results all abnormal. Oct '21 somewhat improved AMH (.51) and significantly improved FSH (8.9). Maybe it's all the pills I swallow. Dec -21, standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 5; 11 days of stims. retrieval yields 5, 4M, 2 reach day-6 blast (4AB & 4BB). 1 low-level mosaic (chr. 3 deletion), 1 complex abnormal. Feb '22 FET (low-level mosaic): CP. May '22 egg retrieval, lupron flare protocol. HGH priming for 1 month before stims; md lupron 20/20u daily; menopur 225, follistim 225, 10k trigger after 8 days of stims; AFC 10; 13 retrieved; 10 mature; 8 fertilized. All frozen at 2PN for later thaw, grow, and biopsy. July '22 egg retrieval same protocol: 9 days of stims; AFC 8; 10 retrieved, 8 mature, 4 fertilized and frozen. Sept '22 ER same protocol: AFC 10; 12 retrieved, 11 mature, 11 fertilized. From the 3 retrievals, 7 survived to day 5-6 blastocyst, from which I have 2 normal embryos! FET scheduled for Jan 20. Fully medicated, baby aspirin, dexamethasone, acupuncture, and as much woo as I can stand (which isn't very much). BFN.
@optimistgardener. The spoiler thing is easy if you're not on a phone-- it's in the dropdown under the paragraph symbol. But I wouldn't really worry about long responses here. I think people do it often when their response to one specific person is really long, because maybe no one else cares, but I for one typically read everything on this thread because it's all like useful information about other people's experiences.
@bumblebee0210 WOOHOO! Congrats! Those are fine looking embies! Good luck with testing. 🤞🏻Also, girl... what pharmacy are you using?! The cheapest price for Gonal-F I've seen is around $760 (900IU pen). Give me your deets!
@optimistgardener got some more morning thoughts for you! In spoiler:
First of all, I didn't realize your were an Oregonian and hence another west coast buddy! I would NOT recommend coming down to Bay Area for IVF since you'll pay much more than in Oregon; I've actually considered going up to Oregon for IVF, but the fact that I don't have a place to stay is a barrier; whereas in AZ, my FIL has a house we can use.
The other benefit of staying with your clinic/doctor, is that they already know how your body responds to medication. One question to ask your RE is: how is the information we learned in my IUI cycles going to inform my IVF protocol? For example, before I got my latest FSH results (12), my RE was going to start me off with about total 450-500IU of meds (my previous highest FSH was 12). However, this last cycle we realized my FSH was higher. When I asked what that would mean for an IVF cycle, she said that she's instead start me off with a much higher meds dose in order to recruit the most amount of eggs. She also pointed that with 10mg of Letrazole, my ovaries only recruited 4 follicles out of available 16. So higher doses would (hopefully) recruit more.
Another thing is: what vitamins are you taking for egg quality? The Egg Whisperer (TEW) highly recommends that anyone with DOR take: NAD, high-dose of COQ10, and Pterostilbene. You should also have your testosterone checked and supplemented with DHEA might be something for you. There is some colloquial evidence that taking NAD actually raises your AMH levels. This has happened to a friend of mine who's been doing egg retrievals through the latter half of last year + this year.
I *swear* the Follistim 900 was half that price ($479 or something) the last time I looked. Do they have sales? Am I hallucinating? My insurance pays for it so I wasn't like paying the $479 or whatever, so I could be mistaken.
Thanks for all this @acleverusername. I'll be sure to ask about getting a testosterone level done next time they get after my blood. I'll look into the NA, COQ10, and Pteristilbene recommendations as well. At present I'm just taking my standard pre-natal with what seems like a nice wide spectrum, and extra vitamin d as I came up with a severe deficiency there.
I think the folks at the clinic initially assumed I was going to need high levels of stimulation after seeing my FSH levels. One of the docs in discussing my case after initial workup said they might start me (I think I have this right) at 4 vials of menopur/day), but when it actually came to medicated cycle 1, I had a different doctor who was confident I only needed 2. I responded very quickly to that, so I'm really glad they started things out on the low end.
History
I am doing this on my own. Left ovary and fallopian tube removed due to cyst/necrosis just after birth. Right ovary and tube still purport to function.
Began TTC in Aug '18 @ age 35
5 or 6 (or 7?!) cycles using frozen donor sperm, ICI. All BFN
Mar-Jun '19 IUIs, all BFN
Began process of referral for RE in spring of '19, blood tests confirm low AMH (.54) but all else is good.
May '19 HSG shows open tube, but ultrasound suggests fibroids
MRI in June '19 confirms two large fibroids, one growing through wall of uterus
In June '19 I move from California to Oregon, disrupting my insurance, referrals, etc. 5 months spent piecing it all back together.
Nov. '19 attempted myomectomy (vaginal approach) failed. 2nd surgery using laparoscopic method in Jan '20 is successful.
April '20 --> June '20, natural IUIs, all BFN.
July? saline ultrasound and bubble test demonstrate open tube
July '20 clomid cycle cancelled for thin lining
Aug-Oct, 3 femara cycles, all BFN
RE referral. While waiting to set up an appointment Nov-Jan,I continue with natural cycles and ICI, using a known donor, BFN...
Jan '21 more bloodwork, AMH is worse (.30), FSH high albeit not catastrophic at 13.2. hysteroscopy all good. "looks cozy!" says the RE.
Feb '21, injectables (menopur, novarel), iui, BFN (doc said the frozen donor sperm sample had the "best numbers she'd ever seen!")
Mar '21, injectables, iui cancelled due to lack of follicles, converted to at home-insem. BFN
May '21, first IVF round cancelled due to cyst.
July '21 IVF: standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 7; 6 days of stims. 8 eggs retrieved, 7 mature, 5 fertilize, 4 made it to blast. 3 are 4AB, 1 is 4BB. PGT-A results all abnormal. Oct '21 somewhat improved AMH (.51) and significantly improved FSH (8.9). Maybe it's all the pills I swallow. Dec -21, standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 5; 11 days of stims. retrieval yields 5, 4M, 2 reach day-6 blast (4AB & 4BB). 1 low-level mosaic (chr. 3 deletion), 1 complex abnormal. Feb '22 FET (low-level mosaic): CP. May '22 egg retrieval, lupron flare protocol. HGH priming for 1 month before stims; md lupron 20/20u daily; menopur 225, follistim 225, 10k trigger after 8 days of stims; AFC 10; 13 retrieved; 10 mature; 8 fertilized. All frozen at 2PN for later thaw, grow, and biopsy. July '22 egg retrieval same protocol: 9 days of stims; AFC 8; 10 retrieved, 8 mature, 4 fertilized and frozen. Sept '22 ER same protocol: AFC 10; 12 retrieved, 11 mature, 11 fertilized. From the 3 retrievals, 7 survived to day 5-6 blastocyst, from which I have 2 normal embryos! FET scheduled for Jan 20. Fully medicated, baby aspirin, dexamethasone, acupuncture, and as much woo as I can stand (which isn't very much). BFN.
Re: IF Testing & Treatment w/o 3.29
Oct '21 somewhat improved AMH (.51) and significantly improved FSH (8.9). Maybe it's all the pills I swallow.
Dec -21, standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 5; 11 days of stims. retrieval yields 5, 4M, 2 reach day-6 blast (4AB & 4BB). 1 low-level mosaic (chr. 3 deletion), 1 complex abnormal.
Feb '22 FET (low-level mosaic): CP.
May '22 egg retrieval, lupron flare protocol. HGH priming for 1 month before stims; md lupron 20/20u daily; menopur 225, follistim 225, 10k trigger after 8 days of stims; AFC 10; 13 retrieved; 10 mature; 8 fertilized. All frozen at 2PN for later thaw, grow, and biopsy.
July '22 egg retrieval same protocol: 9 days of stims; AFC 8; 10 retrieved, 8 mature, 4 fertilized and frozen.
Sept '22 ER same protocol: AFC 10; 12 retrieved, 11 mature, 11 fertilized.
From the 3 retrievals, 7 survived to day 5-6 blastocyst, from which I have 2 normal embryos!
FET scheduled for Jan 20. Fully medicated, baby aspirin, dexamethasone, acupuncture, and as much woo as I can stand (which isn't very much). BFN.
1. How many kids? Are you ok with just one, or would you really rather have 2+? Part of the reason we are doing back-to-back retrievals is that we want more than one more kid, and we want a good crop of frozen normal embryos (if possible) in addition to whatever we transfer. (With DOR, we don't really think we will get another shot at this in 2 years). In some ways, I think most clinics are set up to get you pregnant in the fewest cycles possible, but not really for fertility preservation. If you do want more than one kid, I would definitely discuss it with your doctor and probably plan on doing duostim or back-to-back retrievals.
2. How do you want to trade off money and waiting around? Our insurance covers most things, and we are pretty well cushioned with money for the OOP stuff, so for me the most important thing was to not wait around-- if it was going to work I just wanted to bang out the ERs as quickly as possible, and if it wasn't going to work I wanted to know now and not in a year and a half after three failed cycles. But we weren't paying OOP. You can certainly plan to do back-to-back and just cancel the second cycle if you get a lot of embryos and want to go straight to transfer, but it's a tight turnaround (On the plus side, you can plan to do this from the get-go since you won't be held up by insurance). I'm already having to order drugs fo next cycle before I know how many embryos we will have to biopsy. And we won't know how many are PGT-A normal until I'm well into cycle #2. I'm ok with this because (a) I want more than 3 euploid embryos anyway (greedy! but true), (b) I *really* don't want to waste a cycle in between waiting around, and (c) I am ok with wasting the money on meds I don't need (doing this one no matter what, but could be true for the next cycle).
On costs-- I will tell you that they'll probably start you on ~300 or more follistim/gonal-F and those things are expensive. The OOP price for a 900 IU cartridge in my pharmacy (ships out of Phoenix) is almost $500 for each 900IU cartridge (I ordered 4 and needed a refill). They also ordered my lupron in case I needed it for trigger, that I didn't even use. The meds are definitely expensive and it's good to shop around.
BFP 11/30/2017 | MMC 12/31/2017
BFP 6/22/2018 | CP 6/27/2018
BFP 10/5/2018 | EDD 6/14/2019
Baby girl born 6/19/19
TTC #2 Since May 2020
BFP 7/18/2020 | MonoDi Twins | MMC 9/10/2020
BFP 11/7/2020 | CP 11/9/2020
RE Consult January 2021 | Dx "borderline DOR"/RPL
IVF with PGT:
Standard Antagonist:
ER #1 3/27/2021 7R | 5M | 3F | 2B | 1 PGT-A Normal, 1 low-level mosaic
ER #2 4/22/2021 10R | 7M | 3F | 2B | 0 normal, 2 aneuploid
ER #3 5/19/2021 2R | 1M | 0F
Estrogen Priming Antagonist:
ER #4 7/10/2021 5R | 4M | 3F | 1B | 1 PGT-A Normal
Duostim (Standard Antagonist):
ER #5 9/22/2021 13R | 11M | 8F | 5B | 2 PGT-A Normal, 1 low-level mosaic, 2 aneuploid
ER #6 10/9/2021 9R | 6M | 4 F | 1B | 1 aneuploid
FET #1 11/5/2021 | EDD 7/24/2022
BFP 11/30/2017 | MMC 12/31/2017
BFP 6/22/2018 | CP 6/27/2018
BFP 10/5/2018 | EDD 6/14/2019
Baby girl born 6/19/19
TTC #2 Since May 2020
BFP 7/18/2020 | MonoDi Twins | MMC 9/10/2020
BFP 11/7/2020 | CP 11/9/2020
RE Consult January 2021 | Dx "borderline DOR"/RPL
IVF with PGT:
Standard Antagonist:
ER #1 3/27/2021 7R | 5M | 3F | 2B | 1 PGT-A Normal, 1 low-level mosaic
ER #2 4/22/2021 10R | 7M | 3F | 2B | 0 normal, 2 aneuploid
ER #3 5/19/2021 2R | 1M | 0F
Estrogen Priming Antagonist:
ER #4 7/10/2021 5R | 4M | 3F | 1B | 1 PGT-A Normal
Duostim (Standard Antagonist):
ER #5 9/22/2021 13R | 11M | 8F | 5B | 2 PGT-A Normal, 1 low-level mosaic, 2 aneuploid
ER #6 10/9/2021 9R | 6M | 4 F | 1B | 1 aneuploid
FET #1 11/5/2021 | EDD 7/24/2022
Oct '21 somewhat improved AMH (.51) and significantly improved FSH (8.9). Maybe it's all the pills I swallow.
Dec -21, standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 5; 11 days of stims. retrieval yields 5, 4M, 2 reach day-6 blast (4AB & 4BB). 1 low-level mosaic (chr. 3 deletion), 1 complex abnormal.
Feb '22 FET (low-level mosaic): CP.
May '22 egg retrieval, lupron flare protocol. HGH priming for 1 month before stims; md lupron 20/20u daily; menopur 225, follistim 225, 10k trigger after 8 days of stims; AFC 10; 13 retrieved; 10 mature; 8 fertilized. All frozen at 2PN for later thaw, grow, and biopsy.
July '22 egg retrieval same protocol: 9 days of stims; AFC 8; 10 retrieved, 8 mature, 4 fertilized and frozen.
Sept '22 ER same protocol: AFC 10; 12 retrieved, 11 mature, 11 fertilized.
From the 3 retrievals, 7 survived to day 5-6 blastocyst, from which I have 2 normal embryos!
FET scheduled for Jan 20. Fully medicated, baby aspirin, dexamethasone, acupuncture, and as much woo as I can stand (which isn't very much). BFN.
BFP 11/30/2017 | MMC 12/31/2017
BFP 6/22/2018 | CP 6/27/2018
BFP 10/5/2018 | EDD 6/14/2019
Baby girl born 6/19/19
TTC #2 Since May 2020
BFP 7/18/2020 | MonoDi Twins | MMC 9/10/2020
BFP 11/7/2020 | CP 11/9/2020
RE Consult January 2021 | Dx "borderline DOR"/RPL
IVF with PGT:
Standard Antagonist:
ER #1 3/27/2021 7R | 5M | 3F | 2B | 1 PGT-A Normal, 1 low-level mosaic
ER #2 4/22/2021 10R | 7M | 3F | 2B | 0 normal, 2 aneuploid
ER #3 5/19/2021 2R | 1M | 0F
Estrogen Priming Antagonist:
ER #4 7/10/2021 5R | 4M | 3F | 1B | 1 PGT-A Normal
Duostim (Standard Antagonist):
ER #5 9/22/2021 13R | 11M | 8F | 5B | 2 PGT-A Normal, 1 low-level mosaic, 2 aneuploid
ER #6 10/9/2021 9R | 6M | 4 F | 1B | 1 aneuploid
FET #1 11/5/2021 | EDD 7/24/2022
@optimistgardener got some more morning thoughts for you! In spoiler:
The other benefit of staying with your clinic/doctor, is that they already know how your body responds to medication. One question to ask your RE is: how is the information we learned in my IUI cycles going to inform my IVF protocol? For example, before I got my latest FSH results (12), my RE was going to start me off with about total 450-500IU of meds (my previous highest FSH was 12). However, this last cycle we realized my FSH was higher. When I asked what that would mean for an IVF cycle, she said that she's instead start me off with a much higher meds dose in order to recruit the most amount of eggs. She also pointed that with 10mg of Letrazole, my ovaries only recruited 4 follicles out of available 16. So higher doses would (hopefully) recruit more.
Another thing is: what vitamins are you taking for egg quality? The Egg Whisperer (TEW) highly recommends that anyone with DOR take: NAD, high-dose of COQ10, and Pterostilbene. You should also have your testosterone checked and supplemented with DHEA might be something for you. There is some colloquial evidence that taking NAD actually raises your AMH levels. This has happened to a friend of mine who's been doing egg retrievals through the latter half of last year + this year.
TTC #1 since 02/2020
2009 | Dx PCOS; likely a misdiagnosis
07/14/20 | Dx Hashimoto's Thyroditis
07/21/20 | 1st RE appointment
07/2120 - 08/20/20 | so much testing; no signs of PCOS
08/20/20 | Dx Unexplained; AMA
09/08/20 | IUI #1 Clomid + Trigger + Prometrium | BFN
09/30/20 | Urology consult; more testing required
10/2020 | Clomid + OPK + TI + Prometrium | BFN
10/26/2020 | Starting 2nd IUI cycle, with Letrazole and with a new RE / different clinic
11/03/2020 | New Dx "poor egg quality"; IUI cancelled in favor of Trigger + TI + Prometrium | BFN
11/26/2020 | Combo IUI (Clomid + Menopur) + Trigger + Prometrium | BFN
12/20/2020 | Combo IUI (Clomid + Gonal-F) + Trigger | IUI Cancelled due to thin lining; TI only | BFN
01/14/2021 | Combo IUI (Letrazole + Menopur) + Trigger | BFN
02/06/2021 | Switched to a new RE (TEW) ; trying naturally until we complete additional testing
03/14/2021 | Hybrid Double IUI, with Zymot (Letrazole, Gonal-F) + Trigger + Endometrin | Ovulated 4 mature eggs but still a BFN ☹️
04/07/2021 | Natural cycle while we regroup | BFN
04/09/2021 | Employer announces fertility benefits starting 05/01/2021! | Search for a new doctor who accepts insurance
05/10/2021 | New RE consult & plan for IVF
05/13/2021 | Mid-luteal IVF cycle #1 interrupted; had to get cancer genetic screening done to make sure I didn't have the same SDHA gene mutation as MH.
06/10/2021 | Aygestin priming IVF cycle #1; opted to Cx after 9 days of stims since only 5-6/12 follicles responded
07/26/2021 | Attempt #2 at IVF cycle #1 (mid-luteal start): 8 retrieved, 8 MII, 6 fert (1 PN3), 3 Day 5 & 6 blasts: 3AA, 3AA, 6AB; 3 euploid
08/09/2021 | Rest cycle / unmedicated TTC | Shockingly, a BFP! EDD: 5/25/202 | CP at 4w4d
09/23/2021 | IVF cycle #2 (mid-luteal start): 14 retrieved, 13 MII, 11 fert, 5 Day 5 & 6 blasts: 2 x 3AA, 2 x 3AB, 3BB; 2 euploid
11/12/2021 | IVF cycle #3 (mid-luteal start): cancelled due to ovaries being on vacation
12/20/2021 | Rest cycle / unmedicated TTC + Pregmune Immunology Testing; BFN
01/22/2022 | Rest cycle / unmedicated TTC + understanding uncovered immunological issues; BFN
02/18/2022 | Mock transfer cycle! ERA, ReceptivaDx, EMMA/ALICE; start Prednisone to address NK activity
03/16/2022 | Final, "Hail Mary" super-ovulation + TI cycle before FET; BFP! EDD: 12/21/2022 | MMC 05/08/2022
05/20/2022 | D&C; recovering...
06/21/2022 | Trying naturally until October 2022
07/21/2022 | BFP! EDD 04/02/2023
https://www.avella.com/specialties/fertility/fertility-medication-pricing
I *swear* the Follistim 900 was half that price ($479 or something) the last time I looked. Do they have sales? Am I hallucinating? My insurance pays for it so I wasn't like paying the $479 or whatever, so I could be mistaken.
BFP 11/30/2017 | MMC 12/31/2017
BFP 6/22/2018 | CP 6/27/2018
BFP 10/5/2018 | EDD 6/14/2019
Baby girl born 6/19/19
TTC #2 Since May 2020
BFP 7/18/2020 | MonoDi Twins | MMC 9/10/2020
BFP 11/7/2020 | CP 11/9/2020
RE Consult January 2021 | Dx "borderline DOR"/RPL
IVF with PGT:
Standard Antagonist:
ER #1 3/27/2021 7R | 5M | 3F | 2B | 1 PGT-A Normal, 1 low-level mosaic
ER #2 4/22/2021 10R | 7M | 3F | 2B | 0 normal, 2 aneuploid
ER #3 5/19/2021 2R | 1M | 0F
Estrogen Priming Antagonist:
ER #4 7/10/2021 5R | 4M | 3F | 1B | 1 PGT-A Normal
Duostim (Standard Antagonist):
ER #5 9/22/2021 13R | 11M | 8F | 5B | 2 PGT-A Normal, 1 low-level mosaic, 2 aneuploid
ER #6 10/9/2021 9R | 6M | 4 F | 1B | 1 aneuploid
FET #1 11/5/2021 | EDD 7/24/2022
Oct '21 somewhat improved AMH (.51) and significantly improved FSH (8.9). Maybe it's all the pills I swallow.
Dec -21, standard antagonist. 225menupur/225gonal-f/cetrotide/5000u trigger, AFC 5; 11 days of stims. retrieval yields 5, 4M, 2 reach day-6 blast (4AB & 4BB). 1 low-level mosaic (chr. 3 deletion), 1 complex abnormal.
Feb '22 FET (low-level mosaic): CP.
May '22 egg retrieval, lupron flare protocol. HGH priming for 1 month before stims; md lupron 20/20u daily; menopur 225, follistim 225, 10k trigger after 8 days of stims; AFC 10; 13 retrieved; 10 mature; 8 fertilized. All frozen at 2PN for later thaw, grow, and biopsy.
July '22 egg retrieval same protocol: 9 days of stims; AFC 8; 10 retrieved, 8 mature, 4 fertilized and frozen.
Sept '22 ER same protocol: AFC 10; 12 retrieved, 11 mature, 11 fertilized.
From the 3 retrievals, 7 survived to day 5-6 blastocyst, from which I have 2 normal embryos!
FET scheduled for Jan 20. Fully medicated, baby aspirin, dexamethasone, acupuncture, and as much woo as I can stand (which isn't very much). BFN.
TTC #1 since 02/2020
2009 | Dx PCOS; likely a misdiagnosis
07/14/20 | Dx Hashimoto's Thyroditis
07/21/20 | 1st RE appointment
07/2120 - 08/20/20 | so much testing; no signs of PCOS
08/20/20 | Dx Unexplained; AMA
09/08/20 | IUI #1 Clomid + Trigger + Prometrium | BFN
09/30/20 | Urology consult; more testing required
10/2020 | Clomid + OPK + TI + Prometrium | BFN
10/26/2020 | Starting 2nd IUI cycle, with Letrazole and with a new RE / different clinic
11/03/2020 | New Dx "poor egg quality"; IUI cancelled in favor of Trigger + TI + Prometrium | BFN
11/26/2020 | Combo IUI (Clomid + Menopur) + Trigger + Prometrium | BFN
12/20/2020 | Combo IUI (Clomid + Gonal-F) + Trigger | IUI Cancelled due to thin lining; TI only | BFN
01/14/2021 | Combo IUI (Letrazole + Menopur) + Trigger | BFN
02/06/2021 | Switched to a new RE (TEW) ; trying naturally until we complete additional testing
03/14/2021 | Hybrid Double IUI, with Zymot (Letrazole, Gonal-F) + Trigger + Endometrin | Ovulated 4 mature eggs but still a BFN ☹️
04/07/2021 | Natural cycle while we regroup | BFN
04/09/2021 | Employer announces fertility benefits starting 05/01/2021! | Search for a new doctor who accepts insurance
05/10/2021 | New RE consult & plan for IVF
05/13/2021 | Mid-luteal IVF cycle #1 interrupted; had to get cancer genetic screening done to make sure I didn't have the same SDHA gene mutation as MH.
06/10/2021 | Aygestin priming IVF cycle #1; opted to Cx after 9 days of stims since only 5-6/12 follicles responded
07/26/2021 | Attempt #2 at IVF cycle #1 (mid-luteal start): 8 retrieved, 8 MII, 6 fert (1 PN3), 3 Day 5 & 6 blasts: 3AA, 3AA, 6AB; 3 euploid
08/09/2021 | Rest cycle / unmedicated TTC | Shockingly, a BFP! EDD: 5/25/202 | CP at 4w4d
09/23/2021 | IVF cycle #2 (mid-luteal start): 14 retrieved, 13 MII, 11 fert, 5 Day 5 & 6 blasts: 2 x 3AA, 2 x 3AB, 3BB; 2 euploid
11/12/2021 | IVF cycle #3 (mid-luteal start): cancelled due to ovaries being on vacation
12/20/2021 | Rest cycle / unmedicated TTC + Pregmune Immunology Testing; BFN
01/22/2022 | Rest cycle / unmedicated TTC + understanding uncovered immunological issues; BFN
02/18/2022 | Mock transfer cycle! ERA, ReceptivaDx, EMMA/ALICE; start Prednisone to address NK activity
03/16/2022 | Final, "Hail Mary" super-ovulation + TI cycle before FET; BFP! EDD: 12/21/2022 | MMC 05/08/2022
05/20/2022 | D&C; recovering...
06/21/2022 | Trying naturally until October 2022
07/21/2022 | BFP! EDD 04/02/2023