Stims have begun....

lhcooper

Had my baseline IVF appointment this morning: lining was thin, estradiol (is that E2?) at 41, ovaries quiet--so I just stimmed with my fancy Follistim pen at the highest dose, 450, for the first time tonight.  Glad I've done Ovidrel before so the needle didn't freak me out, though the whole dialing the dose thing kind of did (though it is easier if you just have to go up all the way!). 4 nights and then first follow-up is Monday morning.

Couple of things: first, my IVF coordinator said that every vial of Follistim has a little more than the actual number on the vial (I think the box even says as much).  Her idea was that I see if I can get every drop of the meds out of each vial, so that even after two days (theoretically using up one vial in my case), there should be a little more left for the next night.  Anyone else have any luck with that sort of thing?

Second, did anyone else who has done IVF have the nurse do the mock transfer instead of the doctor? I was a little peeved not to see my RE at all today.  After all, my understanding was that she does the actual transfer, so what's the point in having the nurse do the mock one??  I mean, the nurse clearly knew what she was doing and was super nice (I almost like her more than the RE!), and said my transfer will be really easy so I guess it's not a big deal, I just thought it was a little odd.  

Third:  I know everyone asks this kind of question all the time, but: I have a cup of decaf coffee every morning (switched to decaf back in January when I got my AMH result).  Do I have to stop that? Yes, I know decaf has some caffeine.  But honestly, I will be a wreck if I can't even have my one decaf cup....

Finally: I asked the nice nurse about my antral follicle count.  So she showed me the screen pics of my ovaries:  the right one was smaller and looked like it had (she said) 2-3 follicles, while the left had 5-7.  Again, I wish the doctor had been there to verify that part.  I know--from Dr. Google--that antral count and actual eggs retrieved really don't necessarily correlate (read a few anecdotes today of folks having an AFC of 10 and retrieving 20 eggs, for example, and the nurse said it can go the other way too).  But anyone else have anything like this and with what result at retrieval?

Off we go!

Mrs.McIrish

Hey there,

Congrats on getting started!  The follistim needle is easy. Alternate sides of your belly each night so you can minimize bruising.  I can only comment on the follistim overfill. I always use the extra. The 900iu cartridge consistly had 125 extra in it.  When you are nearing the end, this is what happens. Dial your full dose.The pen will let you dial the entire thing even if there is no enough left in that particular cartridge. Do the injection. The pen will stop when there is no more drug in it. The remaining dose you need will stay registered on the pen. (ie you dial 450, inject 300 and it stops. The pen will stop on 150, meaning you need another 150 to finish the dose). Take out the needle and used cartridge. Put the new one in. Use a new needle and dial the remaining dose you need.  The only negative if you have to stick yourself twice that day but it's worth it to get that extra medicine for "free".

Your AFC sounds fine to me. I never have more than 2 on each side. It makes me nervous for the future. I think you are fine to have your coffee. I have one a day. I really don't think that is going to prevent me from getting PG. I've actually heard the decaf is worse because of what they do to remove the caffeine. Just a thought.

What protocol are you on What else besides follistim? I need to learn about the protocols for mine.

lhcooper

Hi McIrish -- thanks for reassuring me re: the Follistim! I just got freaked out by how little might be left in the cartridge after I technically "use up" the 900 tonight and whether that would change how the magic pen works (I really think of it as "magic," I don't understand how it "knows" things).  I don't know why someone over on the IF board who responded to me said that her clinic had her use a separate syringe to draw up leftover meds and inject that way.  As I think about it, the dial goes from "0" and so clearly the pen can read even just a little bit.  I will totally do this!

My RE has me on the antagonist protocol, which for her is: BCP for 13 days, 2 days off (or in my case, really 1 day because of when we made my baseline for, the morning after my last BCP), then Follistim at 450 (or lower if something changes) for 10-14 days, adding in Ganerelix (the antagonist) at 250 for what looks like the last 6 days or so (if the meds they had me order are any indication), or really when the largest follicle reaches 14.  That's it, up until the Ovidrel for the ER.  (I did too much Googling the other day and found that Geoffrey Sher in Nevada is absolute about the fact that no one should go right from BCP to stimming and that Ganerilix should overlap with the Follistim for a couple of days at the start.  So that freaked me out, but he's not my RE!)

The interesting thing is that the other RE at the practice, who happens to be my RE's husband, apparently prefers to first try the micro-dose flare protocol with DOR patients, which involves 2 days of Lupron between the BCP and the Follistim (but no Ganerelix at all).  He told me that there is really no reason scientifically so far to prefer one over the other, but that he "intellectually" prefers the micro-dose first.  But I'm working with his wife, so I do the other one first! Just goes to show you how much all of this is really trial-and-error.  Too bad it's trial-and-error with a gigantic price tag attached to it!

Re: decaf, yeah, I have read that too.  But on my RE's website right now there's yet another study about the dangers of caffeine to fertility.  Here it is:

https://eivf.net/caffeines-impact-on-fertility-back-in-the-news/2011/05?utm_source=rss&utm_medium=rss&utm_campaign=caffeines-impact-on-fertility-back-in-the-news

It still sounds like one cup is fine--but I'm used to the decaf now so I guess I'm taking my chances with the chemicals instead.

lhcooper

(sorry, I was just trying to edit my post to add the thing about coffee.  I have no idea why it posted as a whole new post instead!)

Mrs.McIrish

You hit the nail on the head: .  Too bad it's trial-and-error with a gigantic price tag attached to it!

I swear they just"try" things to see what works. It's crazy how differing people's approach it to this.

As for the coffee, again it depends on who you talk to. It could change tomorrow. It's like the "red wine is good for you" one day and then next a study says no.  do what you are comfortable with! It's such a crap shoot I think.

Wishing you tons of luck for success!! 

boymamaco

Hey Coop! I was just thinking about you this morning and wondering how things were going. I am envious of your AFC (mine was 4 and 1 earlier this week.) Not envious of the needles but sounds like you have it all under control.  Sending you tons of positive thoughts, prayers, hugs and bump dust that this will work for you! Keep us posted!

lmydogally

Coop! I'm so excited for you. I did 450 of gonal f which is the same thing. I saved all my pens and at the end of stims I sucked the remaining out into one needle and am saving it in case this IVF doesn't work. My office doesn't do mock transfers and this morning will be the first time I've seen my Dr. Since we decided on IVF 3 months ago. His partner did my ER. So weird, I'm not sure I remember what he looks like. Keep your spirits up, it will be over before you know it. I am rooting for you!

TotallyLoCo

So, I responded to your thread on IF and McIrish wrote practically the same thing here! Too funny!  I just wanted to let you know that I had pretty much the same exact protocol as you (450 of Follistim + Ganirelix), except they had me do baseline/start stims on my 3rd day off BCPs.  My whole process went great with lots of embryos, and I ended up with 2 high quality ones to transfer and 4 frozen ones. If I end up not pregnant it'll just be luck more than anything else. I know everyone responds differently, but I just wanted to let you know that you are on a protocol that can work great.

I was also googling way too much during my cycle and found the Sher site, and his views seem super conservative/extreme versus other places I looked, so I wouldn't worry about it. For example, I was concerned about my lining only being a 7, and his feelings are you shouldn't even do a transfer if it's under 8. Everywhere else I looked said at least 8 is ideal but there are plenty of pregnancies with linings sized 6-8, and my RE feels anything over 6 is fine.

CityPixie

good luck coop!   I did lupron flare for my first try with zero follies but I had much better success on the antagonist protocol like what you are doing.  I put back three good embies.   As for the overfill on the vials,yYes it does mean two sticks but use the "free" medicine!!  and if you end up doing another cycle (but I hope this one works for you) remember to put your pen in the fridge.  I ended up wasting a vial b/c I thought it was fine in the pen...but it is only fine in the pen for about 30 days.

Love2Hope

lhcooper:

(sorry, I was just trying to edit my post to add the thing about coffee.  I have no idea why it posted as a whole new post instead!)

This is the first time I heard anything about not drinking coffee and now  I am worried that I missed something. Are we supposed to not drink it while on fert injections/meds? Doc said to live life like I normally do. I drink a couple cups a day. Uh oh.

lhcooper

@Love2Hope: don't panic.  As McIrish said above, the jury is really out on this one.  Some studies have shown that caffeine may affect fertility.  Others have shown that 1-2 cups a day doesn't matter.  In my case, if I recall correctly, my RE said a cup a day would be fine, but then after that conversation I got so freaked out by my diagnosis of DOR and my AMH of .42 that I decided to go all the way to decaf and cut out alcohol pretty much completely in the hopes of at least improving egg quality a few months later--i.e., now.  It's just what I needed to do -- along with acupuncture which really I never would have done otherwise -- so that if the cycle fails, I feel like I did everything I could and can't wonder "what if I had just...." etc.  But that is more about psychology (mine) than it is about science.  I would go with what your doctor recommends and what you are comfortable with!!

lhcooper

Also, for what it's worth: I drank regular coffee all through my IUI's and I did get pregnant on the last one (albeit ectopic).  This for me is also about the much bigger step of IVF.

Love2Hope

lhcooper:

@Love2Hope: don't panic.  As McIrish said above, the jury is really out on this one.  Some studies have shown that caffeine may affect fertility.  Others have shown that 1-2 cups a day doesn't matter.  In my case, if I recall correctly, my RE said a cup a day would be fine, but then after that conversation I got so freaked out by my diagnosis of DOR and my AMH of .42 that I decided to go all the way to decaf and cut out alcohol pretty much completely in the hopes of at least improving egg quality a few months later--i.e., now.  It's just what I needed to do -- along with acupuncture which really I never would have done otherwise -- so that if the cycle fails, I feel like I did everything I could and can't wonder "what if I had just...." etc.  But that is more about psychology (mine) than it is about science.  I would go with what your doctor recommends and what you are comfortable with!!

OK, that makes sense. For a minute, I thought that it had a negative effect on the meds. I have lost some faith in my doc since he did the u/s and said I would not have a period this month and he was wrong. I am kinda freaked that if he can make that mistake then what if he is wrong about everything else. I think the medication is making me a bit emotional and the pressure of one time only.. Thank you for responding!! Best of luck!!!

MelleTX

Good luck Coop! So excite for you. Please keep us posted along the way as some of us will be followinfg in your footsteps shortly.