What do you think about cancelation rates?

LALASEPT05 · August 2009

I just wanted to ask what you make of cancelation rates at clinics. My cycle was just canceled and of course I'm very angry. I was doing some research on the SART website and noticed that my RE's cancelation rate is twice the national average rate in my age group. And just spot checking various clinics in my area they're on the high end.

I guess it could go two ways - either 1. the success rates are inflated because they cancel when the cycle doesn't look optimal or 2. the cancelation rate is higher because they don't necessarily turn cases away.

I am just curious on your thoughts if you have any!

yodasmistress · August 2009

I read your prior post about your E2 skyrocketing and being canceled. I was curious but didn't think it appropriate to ask in that setting what your age and meds dosages were... however, I am now so that I can respond to this question.

MBandBud · August 2009

Sorry you were cancelled. Do you think it could be because they don't have a good protocol for stimulation? Would it be worth another consult with another clinic to see what their protocol would be? And I don't mean just meds but how often they do follie scans/bw to be able to adjust if need be? GL to you!

Tryingtogetpregnant · August 2009

I swear I will email you back asap (my day has been nuts!), but my old clinic's cancel rates are SUPER high too - at least double the national average as well. Coincidence? I don't know.........

LCB34 · August 2009

yodasmistress:
I read your prior post about your E2 skyrocketing and being canceled. I was curious but didn't think it appropriate to ask in that setting what your age and meds dosages were... however, I am now so that I can respond to this question.

This! Hearing your age, protocol, and med dose would better help me answer this question.

jamie217 · August 2009

I just responded to your page and they did end up canceling me today because E2 levels cont. to go up too.

I don't think my RE cancels very often with IVF - but he usually starts people off with injectables and than IUI so he has a feel for how they respond to meds prior to starting. H's insurance had zero feritility coverage, so as soon as we switched to my mine we jumped right into IVF because my left tube is blocked, so he has no idea I was respond so well to the stims even at a lower dose.

Also your age, weight, etc. does play a part if you are fairly young you will be prone to your levels increasing and if you are fairly thin I was told you have a greater risk of becoming even more sick your ovaries we to balloon up.

terraflora · August 2009

I suppose it could be either explanation for the cancelling rates. You could always ask the RE and see what they say. You have a right to ask.

I also just wanted to say I'm really sorry about your cancellation. They are talking about the same for me right now for the same reasons (see my post above). I am getting so worried about it. Argh! Nothing is ever easy with IF.

LALASEPT05 · August 2009

Thanks everyone. I just turned 33 yesterday. My protocol was long lupron. I started out on 225 folistim and then after 3 days went to 150 folistim and 75 of menopur. Things were going ok until about day 9 or 10 when I went from 2600 to 4050 over night and then started coasting but I continued to rise to 5500, 6600, and 7200. I was doing blood and ultrasound every other day until about 5 days in then I was there every day for blood work. So I was monitored pretty closely. I don't have PCOS and had an AFC of 15. I had never used injectable meds before so they said they were not sure how I'd respond. I'm small too...about 5'2" and 110lbs. I' definitely be curious to hear your feedback.

Jamie i'm going to respond to the other post.

yodasmistress · August 2009

Given your age, diagnosis, AFC and protocol, I would not have expected you to hyperstim. HOWEVER, the general rule of thumb is that E2 doubles every one to two days. Earlier on in the cycle doubling times are generally slower and towards the end of the cycle the doubling time gets faster. As such, having your E2 go from "2600 to 4050 over night" from stim day 9 to 10 is not surprising at all. In fact, it is precisely what I would expect.

What did your follies look like on days 9 and 10? What were your E2 levels at the other monitoring appointments?

LALASEPT05 · August 2009

yodasmistress:
Given your age, diagnosis, AFC and protocol, I would not have expected you to hyperstim. HOWEVER, the general rule of thumb is that E2 doubles every one to two days. Earlier on in the cycle doubling times are generally slower and towards the end of the cycle the doubling time gets faster. As such, having your E2 go from "2600 to 4050 over night" from stim day 9 to 10 is not surprising at all. In fact, it is precisely what I would expect.
What did your follies look like on days 9 and 10? What were your E2 levels at the other monitoring appointments?

Thanks for the response. My doubling times were slower in the beginning and speeded up towards the end. My E2 levels were

day 3= 162, day 5= 359, day 7 = 935, day 9 = 1941, day 10 = 2649, day 11 = 4050 then I coasted but they continued to rise.

On day 9 I had 3 follies about 17mm and the rest 13 and 14 and day 11 I had 3@22mm, 3@18mm, 2@17mm, 3@14mm, 6< 10mm. I felt like I could've triggered then but they wanted me to coast.

yodasmistress · August 2009

It seems really weird to me that you had an E2 of 2600+ on stim day 10 with only 3 mature follies. I have to wonder if you were over-suppressed out of the gate?

In regards to your original question of what I think about having the cycle canceled: Your E2 was basically doubling every other day like it was supposed to. IMO, by stim day 9, your doc should have been able to look at your follie growth and your E2 and known that you were on a collision course and started coasting you then to avoid cancellation.

That said, coasting is a dangerous business in and of itself. It certianly works for some people, especially if it is very important to salvage the cycle. However, it is just that, a "salvage" maneuver. It's what you do when things are going awry and you don't want to cancel. But there are studies that have shown lower egg and embryo quality, and subsequently pregnancy rates for cycles where coasting is done, especially if there is a precipitous E2 drop (this is more typical in PCOS'ers). Regardless, in a well executed cycle, the goal is not to have to coast.

When you talk with your RE at your regroup I would ask:

1.) If he thinks you were over-suppressed by the Lupron and perhaps an antagonist protocol might work better for you?

2.) What your starting stim amounts would be for that upcoming cycle?

3.) In your next cycle, at what E2 level would a decision be made to coast (hopefully sooner).

4.) In your next cycle, if you have rising E2 but follies aren't developing, what will he do? (Sometimes I have heard of women being given mini-shots of HCG throughout the cycle to help mature the follies - perhaps this can be done with you?)

I, personally, would ask these same questions to a second RE as well as your current one. Usually first consults are very inexpensive or free so I suspect that in your circumstance, the info gathered from such a meeting would be well worth it.

Best of luck to you!!!

LALASEPT05 · August 2009

Now I see why you are Yoda...very wise!

Thank you - that is great and I've made notes of the questions you had. You mentioned being over supressed...doesnt' that mean you have poor response versus hyper response?

I agree that had I started coasting two days earlier my results could have been different. I kind of feel like not enough attention was paid.

yodasmistress · August 2009

LOL. Thanks. I'm not wise. Just an information junkie.

Over suppression does mean that you are having a poor response so I can see how that would be confusing since the problem was that you hyperstimmed. However, sometimes, Lupron can cause the follies to not grow even though E2 is rising. Which means the docs keep giving you stims to make your follies grow with an end result that you hyper stim.

Often in such cases a switch to an antagonist protocol (use Ganirelix for suppression instead of Lupron) will remedy the problem.

Given that you're 33 I assume your FSH is in the normal range? Just asking because I have noticed that sometimes in women with DOR they will have very high E2 even though they have few/small follies. (I do not know much about this, I just have the anecdotal observation.)

I would feel the same way were I in your shoes. The whole reason you're paying them the big because is because they are supposed to have the experience to recognize the situation as it's evolving instead of just reacting to it after it's happened. Unfortunately, in my experience, most docs are content to linger on the latter (aka lazy) side.

LALASEPT05 · August 2009

Thanks again...I have made note of using ganirelex.

I don't have high FSH and by high E2 at day 3 I mean like 83 so not very high but a little over the preferred 50 or 75 I've heard of. I have something going on because even on clomid 4 to 8 I would ovulate day 11 or so.

My big fear is that my RE has too high of a case load. The office is always packed and it i've had ultrasound appointments run an hour and a half late. I am wondering if they are stretching themselves too thin and that my situation got lost in the shuffle.

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