XP: Help!!!! Considering self-cancelling IVF cycle

pblge · February 2014

Hi Ladies,

I posted this in the infertility forum, but it's a weird situation so I thought I'd expand the size of the crowd from which I was sourcing my information. If any of you ladies had experience with this sort of thing, I'd love to hear it.

Thanks!!!

My doctors haven't cancelled my cycle, but I'm wondering if I should. It's going very badly. I do have insurance coverage for IVF, but it's with a lifetime cap of $50K, not including meds. I think that's about 3-4 cycles total for all our procreative needs. IVF#1 was a bust in the final analysis, with nothing frozen, so I really need a good cycle. I have an AMH of 6.0 and an AFC = 20-25, so theoretically I should get lots of eggs, but it doesn't work out that way. IVF#1 was almost cancelled at the last minute because my E2 crashed by about half. This cycle has gone even worse:
Days 1-2:     150 Gonal-F                  D3 E2: 222
Days 3-4:       75 Gonal-F                  D5 E2: 482
Days 5-6:    37.5 Gonal-F                  D7 E2: 92!!!!!!
Days 7-8:     150 Gonal-F                  D9 E2: 322

322 at day 9 seems pretty terrible, especially when I was higher at day 5. I'm also thinking of these two things:
1. Longer stims are associated with less chance of success. The doctor in whom I have zero faith told me that this isn't true for those with PCOS profiles (I don't have PCOS but I act like it during stims), but I don't know if I believe him. Does anyone know?
2. Problems in stims are associated with increased genetic abnormalities, meaning a higher chance of failure AND a higher chance of miscarrying even if I do end up pregnant.

I'm strongly considering scrapping this cycle, and perhaps even giving up on my clinic to go elsewhere, but that's a separate post. The docs told me to hold steady at my current dosage and come back in for another E2 test on Monday.

Any advice?????????????

Roeni · February 2014

I stimmed for 14 days and had high quality eggs.

firesiren · February 2014

Best thing I ever did was switch REs. I would not have had success if I would not have switched. Your E2 is concerning. We were told 200 for every mature follicle. I would wonder what your follicles look like. Good luck to you.

Peanutz21 · February 2014

i think if there is any hesitation whatsoever from your end you should do what you think is right. you don't want to be constantly second guessing your decisions- IF is tough as it is.

i agree with PP - no harm in switching to another RE. if it doesn't feel right in your heart it may be best to look for another clinic.

FloridaSun82 · February 2014

So, obviously, I'm not a doctor, but I stimmed for 15 days. My follicles grew extremely slowly. However, has the dr mentioned other medications to you?? I did follistim/gonal-f which helps get the follicles to pop out and Menopur, which is supposed to help mature them. Again, not a doctor and only did one cycle, but it's a little weird to me that you aren't taken any other meds. As we went forward in my stim, they lessened my follistim significantly (I was on 25iu by the time I finished) and they would increase the menopur. My E2 went up very slowly, but the dip is strange.

However, if you're needing to suggest meds or question other meds, maybe it's time to see someone else. However, it would be awful to scratch your cycle when you've been taking meds for a week. I'd hope there would be a way to salvage it.

pblge · February 2014

Thanks to all of you for posting. It's very helpful to hear from people who have gotten this thing to work! I decided to follow instructions, meaning to do two more days of shots and see what my E2 does on Monday. My regular doc,in whom I do have trust, will be back then. Just for contrast my D9 E2 in IVF#1 was over 4000, so this is a pretty terrible response for me.

FloridaSun82 - My clinic uses diluted HCG (which apparently acts just like LH) alongside the Gonal-F or Follistim. I've only ever seen one other poster mention this, so I don't know what the deal is.

1983lindsey - 20 days of stims?! I didn't even know that was possible!

Ironmom2be · February 2014

**lurking**

I wanted to say my RE does low dose hcg (10u) with my cycles, too. Whats one more shot, right?

I hope you find answers tomorrow with your E2 levels. I don't have any experience but wanted to wish you lots of luck.

auntjessy · February 2014

I'll go with a couple of the other ladies and say do what seems right to you, even if that means switching REs. I'll also add, though, that when I was unsure about the advice my RE was giving me and asked my OB, he reminded me that my RE probably wouldn't go forward with a cycle that they felt had a low chance of being successful. Low success rates affect their SART data, which affects how people view their practice, etc. With that in mind, we went forward with her recommendations and got our BFP.

becomingmommyagain · February 2014

Good luck today!

The dip in E2 looks like it could be related to the lower dose of meds (stepping down from 150 to 75 to 37.5). Did they say anything about your first E2 being higher than expected and wanting to slow things down so the eggs mature more slowly?

Without a better explanation of your protocol it's hard to compare yours to those who have had success. My best piece of advice is if you dont like the RE, switch. Its a huge financial investment to make. And if your cycle fails you'll always have doubts on whether it was an issue with your RE.

If this cycle doesn't go as you'd hoped, find a new RE. Investigate the different protocols very closely and make sure that your doctor considers your input. Fertility medicine is still full of trial and error.

pblge · February 2014

Just wanted to provide a quick update: my E2 went to 980, and my doctor didn't want to discuss cancelling before we did an u/s tomorrow, so I have one more day of limbo....GAH!!!

ETDK1105 · February 2014

I don't have any input about E2 levels but I stimmed for 16 days this cycle and had my BFP. Last cycle I stimmed for 18 days and had 3R/3M/3F. I respond slowly and always need a few extra days of stims to make sure they are mature.

Good Luck!

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