Triggering tonight for IVF#1 and need reassurance(long)

LuluK1102

After a bit of a slow start, I finally started responding to stims(menopur) late last week and over the weekend. Yesterday my estrogen went up to 950 with several(7-8) follicles in the 14-15 mm range and 3-4 around 12-13 mm. My dose was lowered last night(10th night of stims) and in addition I took my second injection of ganirelix. Today I went back to bw and u/s and my follicles were basically the same size as yesterday. My RE told me that he felt we would one more night most likely and trigger tomorrow (Tuesday) but would wait for bloodwork to confirm. Well this afternoon, I get a call from the nurse that I'm triggering tonight because my estrogen is going down(836) and I have a few mature follicles. I'm just confused(and I told her this) because my u/s didn't show anything that my RE felt was 100% mature and if my estrogen is dropping. Shouldn't they raise it again before triggering me. I can't help but feeling like lowering my dose last night stalled my follicles and now they are scrambling to save my cycle. The nurse assured me that she has seen this happen before with women who have had successful cycles and I'm trying to be positive but I can't shake the feeling that this cycle is already a bust. In my mind the numbers don't lie...I had nothing that looked mature on the u/s and my bloodwork isn't really screaming that I have a bunch of mature follicles either. I have been crying ever since I got the call because I already feel defeated. Please tell me that there is still hope for this cycle and that I just have first time IVF jitters or something. I'm just so scared....

Thanks ladies.

 -Lindsey

theworms

There is hope   I've known girls who have had crappy cycles and wind up with only one embie and get KU.

I hope you are pleasantly surprised and have some great mature eggs.

GL!!!

yodasmistress

Woah.  Falling E2 is a big red flag.  Also, just in absolute terms, your E2 is pretty low for an IVF cycle.  Just yesterday my nurse was saying that they consider anything at 15 mm or above the day of trigger as having the potential to be mature at ER.  If the 200 / follie rule holds true, you'll probably get 4 or 5 good eggs.  For some women, this is all they get.  The real question is, are you one of those women? 

 How old are you?  What is your diagnosis?  What is your FSH?

LuluK1102

yodasmistress:

Woah.  Falling E2 is a big red flag.  Also, just in absolute terms, your E2 is pretty low for an IVF cycle.  Just yesterday my nurse was saying that they consider anything at 15 mm or above the day of trigger as having the potential to be mature at ER.  If the 200 / follie rule holds true, you'll probably get 4 or 5 good eggs.  For some women, this is all they get.  The real question is, are you one of those women? 

 How old are you?  What is your diagnosis?  What is your FSH?

 Thank you for your candid response. I know my estrogen was low which was why I was so suprised they were triggering me. I'm 26, my dx is hypothalamic amenorrhea and because of my HA my hormone levels are all very low(including FSH). I'm not 100% sure of the number though. I had a lot of residual follicles so they were anxious about overstimming me and were cautious with my dosages of menopur(262.5 until last night when it was dropped to 225).

yodasmistress

You certainly don't fit the typical "poor responder" profile.  And if your AFC was high, it seems weird to me that you would have so few follies at maturity.  That said, 225 Menopur is not actually that "low" of a dose.  I mean, it's not high, but it's not super low either.  I kind of wonder if maybe the problem is in some way associated with the meds... some folks do better with a protocol with less LH - i.e., part Menopur and part Follistim...  but that is usually not a "given", it's learned via trial and error. 

I guess, the biggest question in my mind is, are you OOP?  We are OOP and if I was in your shoes, and known what I know, I'm not sure I would be interstested in spending the requisite $10K+ to finish the cycle.  However, if I had insurance and knew I could get another shot relatively inexpensively, I would move forward with the knowledge that the chances of success aren't high this cycle and chalk it up to the learning curve.  

HarleyQ8

Yes, the falling estrogen is red flag. But that doesnt mean it is over. They cant always see everything on the u/s. Plenty of women have gone in for ER and they end up with several more mature eggs than they anticipated.

Try not to give up hope. It aint over til its over! 

PS This is coming from someone who had the worst cycle my dr has ever seen so I personally know the ups and downs, the fears and anger etc. 

LuluK1102

We are OOP and while I hate to make this about money, certainly it does factor into our decision. I know that in reality for this cycle our chances of success aren't that great. Not that it makes a difference, but I go to one of the supposed best clinics in the country in NYC and would like to think though that they would have canceled me if they felt there was no chance. Although certainly there is a difference between having NO chance and less of a chance. Everything you said though are things I have been considering since I got the call this afternoon. I think I will trigger tonight and then try to speak to my RE tomorrow when I go for my pre-op physical.

Thanks again for your responses. I'm so sorry for your cp and wish you the best of luck on your upcoming cycle.

LuluK1102

HarleyQ8:

Yes, the falling estrogen is red flag. But that doesnt mean it is over. They cant always see everything on the u/s. Plenty of women have gone in for ER and they end up with several more mature eggs than they anticipated.

Try not to give up hope. It aint over til its over! 

PS This is coming from someone who had the worst cycle my dr has ever seen so I personally know the ups and downs, the fears and anger etc. 

Congratulations on your pregnancy! Thank you for sharing your story. IF makes us all so focused on numbers and ideals, it's hard to remember that every person is different and there are exceptions to the rules. I guess my H and I need to sit down with our RE and figure out what is best for us and if we are willing to take the chance.

SweetDahlia

Hey, I really don't know anything about IVF. I am sorry you think it's not going well. I really hope your RE is doing the right think and this will be the only IVF you will need. Lots of luck.

--chrissy (My co-workers still talk about your zebra banana bread)