Calling ALL IVFers - Advice Please!

KH826 · September 2013

So I posted about this in my TTT this morning, but I am feeling pretty obsessive about my seemingly low number of follicles at my u/s this AM, and I was hoping someone here who has been through stims and ER will know the right thing to say to calm me down...

So here is the deal: I had my first u/s since starting stims this AM.
I started with 225mg of follistim on Thursday 8/29, and then decreased the follistim to 150mg and added 150mg of menopur on Sunday following my blood work that day.
I was very disappointed to only have 10 follicles this morning, and only 4 of them were measurable.
My Dr had told me when she first discussed my protocol with me that she was going to take a conservative approach with me and start off low with dosages since she is worried about OHSS due to my age.
I am expecting her to increase my dosage starting tonight (still waiting for the phone call from the nurse with my instructions for tonight), but I am concerned that only 10 follicles after 5 nights of stims (tonight will be the 6th night) is a poor response.
Any of you with experience here have any comforting words for cycles that may have started out like this for you, but ended with a fair amount of mature eggs and some decent embryos?
I know it only takes one, but I was really hoping to have several embryos to freeze from this cycle as well...

I am now (b/c I am an extremist) even worrying that they might cancel my cycle if I don't have enough follicles...

The nurse that did the u/s this AM told me that 10 follicles at this stage of the race is normal/expected, but everything that I have read tells me otherwise.

Any and all encouraging words welcome!
Thanks!

Manada · September 2013

Well - you have only been stimming for 3 days so far, so you're definitely not out of the game yet. I don't see your AFC or your AMH on your siggie so I'm not sure what your reserve looks like, but if you've got a good reserve, there's no reason to think you shouldn't get more than 10 eggs retrieved, I'd be a bit concerned as well if H only had 4 measurable...

That said - we have also been really clear with our RE that we want more eggs even if it means risking OHSS, so we would be pushing them to increase the dosages...

Are you a slim or small person? Size can affect your response to stims as well, as we learned with my cycle - so if you're a bit larger, you may also want to weigh that into any requests you have of your RE to be more aggressive.

It's not too late though. I would see what they say about it tonight, but it's also perfectly within your rights to ask questions and make your expectations of what a "good result" would be (ie. more eggs retrieved the better) - known if you know that you would be disappointed with a number between 4 and 10 retrieved....

ball.and.chain · September 2013

My main message here is that I don’t think you need to worry, but I will write a longer response when I get home – I will also check my clinic’s patient portal and see if I can figure out how many follies I had at that point. My RE was also conservative and started slow; we did have to increase my dose at some point but it all worked out in the end (as far as egg retrieval, I mean – still waiting for everything to work out!). It’s in my siggy, but if you are on mobile, they retrieved 22 eggs from me, which is on the high side. More later! Chin up lady!

2MamazInSeattle · September 2013

As you know I used an egg donor, which knowing that you are technically "undiagnosed" with IF (i.e., nothing obvious or necessarily problematic) I think you aren't that far off. Remember it's about quality not quantity, though the attrition is scary. Our donor produced 19 eggs, 14 fertilized and we ended up with 4 viable embryos. But I've seen donors who produced 8 eggs and had 6 viable embryos! I think Manada's advice to ask some questions is wise; risking OHSS - while in a way can sound 'appealing' to get more eggs - sounds awful and painful, plus you end up doing a FET and not a fresh transfer (given the choice, I'd prefer a fresh transfer over frozen!). You are a smart cookie and I know you'll ask good questions.

One other thing - I know you don't normally post on IF, but really it's a nice supportive group and TONS of women have done IVF there; another spot might be Pregnant after IF - they don't mind a bit having people pop in with questions like these and most tend to like to tell their story.

Hang in there!!! I know you're going to do great!

KH826 · September 2013

Thanks everyone, you peeps are awesome!

First some responses... @manada, I have been stimming for 5 nights now, not 3. If it was only 3 nights, I wouldn't have been AS concerned... @herbabymama, it makes me feel better that your wife had 11 follicles at her first u/s. Sounds like a similar response to mine. Honestly, I don't need a zillion, but I know that the number of follicles will be more than the number of mature eggs, which will be more than the number of fertilized eggs, which will be more than the number of 5-day blasts eligible to transfer/freeze. Honestly, I just want something to freeze. @ball.and.chain, thanks for the support. I agree that it is too soon to worry. But I have a tendency to worry anyway!

Now for my update (the nurse called me back about an hour ago)...

* My Estradiol level is up to 391 (she said it is rising nicely)

* She said she wants to keep everything the same in terms of my meds for the next two nights and then my next appointment for blood work and u/s will be on Thursday at 7:30am

* I asked again about the "low number of follicles" and she reassured me that based on my protocol, what we saw today is normal, and she is expecting to see more on Thursday. She told me not to worry.

* She said possible retrieval date will be next Tuesday the 10th, but that it really is too soon to guess at this point. They will know more after my appointment on Thursday. She guesses that Monday the 9th will be just a little too soon for ER (which was the date I originally had my eye on for ER).

I have decided that I need to chill out, trust my doctors/nurses, and give myself up to the process and see what happens. The fact is that I don't know better, and I am basing my responses all off of what I have seen other people say online that their results where (and I am calling this "my research")... The more I push to be "more aggressive" the more my blood pressure it going to rise and I am going to be more worked up and less relaxed. My gut is telling me to just go along for the ride and trust that it will work out as it is supposed to. So that is what I am going to do. I am still a bit skeptical, but I am going to have faith in the process. In the end, my RE wants me to get pregnant as much as I do (maybe not quite as much -- but she wants another success for her statistics, at the least)....

So I shall try to be zen...

And maybe buy bigger pants...

KH826 · September 2013

Awww @2mamaz - you just made me feel warm and fuzzy for the first time all day! I didn't see your comment until after I had already posted my reply to the other folks who had commented. You definitely made me feel better, and yes it is quality and not quantity. I also really don't want to risk OHSS. I trust my Dr -- I feel that it will work out. Must.Stay.Positive!

ball.and.chain · September 2013

Here's my stimming history:

After Day 4: Estrogen 138, 14-19 follies total but only 4 measurable
After Day 7: Estrogen 628, 16-18 follies total but only 11 measurable
After Day 10: Estrogen 2202, 17 measurable follies
After Day 11: Estrogen 2300, 19 measurable follies

After that I triggered and had ER, at which they got 22 eggs. 20-21 were mature, 17 fertilized. We ended up with 6 great blasts. They were concerned about OHSS with anything over 20 eggs but I didn't get it (I was religious about the electrolyte + protein diet).

So I did have more than 10 at your point, but they were mostly small. I think things look good and since it sounds like you are right where your clinic expects you to be, that is a good sign that they know what they are doing and you are having a normal response.

Like @2Mamaz, I want to stress quality over quantity. Yes attrition is a little scary, but a greater percentage of higher-quality eggs will make it. I have a friend who did 2 IVF cycles. In the first, they retrieved 30 eggs but only ended up with 2 decent-quality embryos and nothing to freeze (they transferred both, resulted in a c/p). The second time they switched protocol expressly to produce fewer, higher-quality eggs. I think they got between 12-15 total, but they ended up with 4 blasts, of which 2 are frozen and 2 trucking along at 9w1d. More is NOT always better!

Keep growing those eggs, but don't stress too much about it!

KH826 · September 2013

Thank you, ball.and.chain, for checking your own response & for your encouragement. You are right, more is not always better. I am officially reassured. Hoping for more on Thursday, but staying calm about it. My ovaries literally ache tonight -- maybe my follicles are having a growth spurt!

KH826 · September 2013

Update on my pokey follicles!

I had a monitoring visit this AM. I now have 18 follicles total, 7 were measurable.

Dr said at least 3 more nights of stims.

They will call me this afternoon with my bloodwork results & more instructions...

Let the fun continue!

ball.and.chain · September 2013

Yay! You're right on track.

2MamazInSeattle · September 2013

Well done lady! Big ups to your rockin' ovaries!!

KH826 · September 2013

Aaaaand update (you can all start ignoring me any time you wish, but I am feeling the need to post these updates somewhere!): my estradiol level from this AM was 905. Nurse was very happy with that. Instructions are same med doses tonight and tomorrow night and next appointment is Saturday AM at 8. Slow and steady wins the race.... I think I am OK with this! Feeling positive tonight

KH826 · September 2013

Another update! Had my appointment this AM - still 18 follicles total but 13 are measurable today and 3 are over 18mm now. I have yet another appointment tomorrow AM. They will call me this afternoon with my blood work and instructions for tonight's meds, but nurse said she is 70% sure they will have me trigger tomorrow and ER will be Tuesday. Oh my goodness!!!

ball.and.chain · September 2013

I was hoping you'd update! Sounds perfect! You're sooo close KH...

KH826 · September 2013

My Estrogen level is now 2100. Same dose of meds tonight and going back in for another check tomorrow at 8am. Looks like trigger tomorrow night if all goes well at the u/s tomorrow...

2MamazInSeattle · September 2013

So transfer a week from tomorrow! OMG! Due June 3rd! Another Gemini in the world

and we'd only be 8 days apart on our EDDs!!!

KH826 · September 2013

Woah... You just jumped 3 steps ahead of me there, 2mamaz! But I like the way you are thinking

I hope we both have bambinos by June!

healz413 · September 2013

This is all so exciting! I hope you get great news tomorrow.

KH826 · September 2013

This morning all 13 measurable follicles are over 18mm, which means trigger tonight and retrieval on Tuesday. They will call me this afternoon to tell me what time to trigger. Here goes!

healz413 · September 2013

That sounds pretty darn good!

KH826 · September 2013

Thanks, Healz! Oh, and I forgot to mention my lining is measuring at 12.2, so that looks good. If I wasn't so darn exhausted, I would be jumping up and down with excitement!

ATXmommas · September 2013

Happy dance! <:-P

ball.and.chain · September 2013

Woo hoo!

2MamazInSeattle · September 2013

Woo hoo! FX for an awesome ET on Tuesday!

healz413 · November 2013

One of the best things about this board is the most people have previously been through whatever one is currently going through. I'm very grateful for this previous string that @KH826 started because I'm using it to calm my nerves. Today is day 7 (six days of stimming so far) and I have 4 follicles on the right and 6 on the right that they measured. They measure 8mm and bigger so I'm pretty sure some more of my 26AFC follicles are hanging out trying to make us nervous.
I'm doing more days of 225 gonalf and upping the repronex to 150. We are adding in cetrotide to prevent ovulation.
Next check is Saturday. Looking at egg retrieval around Thursday next week.

ball.and.chain · November 2013

@healz413, you'll do great! Can't wait to see how ER goes.

KH826 · November 2013

Sounds like you are trucking right along. Don't let the numbers at this point freak you out -- try not to over think it, quality over quantity & slow and steady wins the race!

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