cancelled ivf.. questions

thishappyhouse · March 2014

Im visiting from the preemie board and hoping some of you can help me.

My 1st IVF was cancelled today. I have a history of PCOS, blocked tube + possibly damaged 2nd tube, and very preterm birth. My AMH is 5 and all other labs normal. My doc wanted to take a very conservative approach as to avoid OHSS and since our goal was to do an eSET.

I was on a long lupron protocol and started stims at 75 follistim / 75 menopur and 5 units lupron.

Day 5 I went in and had 26 follies between 9-10 and e2 of 589. They immediately dropped the follistim and I went down to 75 menopur and 5 lupron.

Day 7 there was growth and e2 was up to 715. meds stayed the same

Day 9 there was a little more growth but e2 dropped to 140 (WTF?!)

They thought it was a lab error and had me come back day 10. NOT a lab error e2 was 174 with a little more follicle growth - cohort follicles were around 14. They added back to follistim

Day 11 - e2 up to 280 decrease number of follie - CANCELLED

So- Im pretty sure that the carpet was just completely pulled out from under the cycle since I was on such low meds from day 5-10. agree?

Anyone know how they will handle the cancelled cycle? Will I go on BCPs? Any idea of when we can restart?

Those with PCOS, high AMH or high response- what type of protocol or meds were you on?

Any other thoughts? I will go in to discuss with doc either tomorrow or tuesday.

boymomstrong · March 2014

I am so sorry ab this! I have PCOS and was a super responder to! I had 60 folicles 40+ eggs, and 13 made it to freeze day 5/6 stage.... I had such secer OHSS i was hospitalized for 2 weeks and had my belly taped and drained 3 times to remove the fluid...
If you can avoid that uts best, but if your willing to risk this then maybe tell the doc that you dont want to cancel and want to push through!

I know its frustrating, but what did your doc say? What are his reasons? How did your WTF appointment go?

Also, i was always on BCP for 10 to start every cycle...

Ruthie04 · March 2014

I have a different history, but my first IVF was canceled due to a dominant follicle. Initially, they thought I'd be a stellar responder from my past response with IUIs...not so much. I was a "high responder protocol" (antagonist with Lupron Trigger), but ended up needing a more unusual Lupron Stop protocol. With the canceled cycle, I ended up triggering and moving right into Lupron for suppression. So, my ER was the next month. In all honesty, I think my body needed to rest and that I shouldn't have moved into another cycle so fast. My second full cycle was on the same Lupron Stop protocol (they discovered that I suppress really easily on Lupron, but not BC, so they did a little adjusting with my meds) and I had a much better response.

In all honesty, I think the first IVF is a little bit of a crap shoot. They really have no idea how you will respond until they start those monitoring visits, so they put you on protocols that work for many women...but not all. I happen to be one of the women with "temperamental ovaries," as my RE called them. I just need someone to think out of the box for a protocol and dosages that will work for me. IMO, I think your doc needs to do the same. A protocol change and some serious dosage adjustments may be just what you need! GL!!

kmc84 · March 2014

I'm so sorry you got cancelled-it sucks

My best guess would be that the smart thing to do would be start bcps with your next bleed and give your ovaries one cycle to 'simmer down'. They will need to check E2 levels to see if any cysts are causing issues. I would think after one bcp cycle, you should be good to start again.

I do not have pcos, however, my ovaries do not respond kindly to meds

my cancelled cycle was our first IVF. After 4/5 days on stims my E2 and follie count were very low, they upped my meds to get more of a response. My E2 shot way up along with follie count. I wound up getting cancelled 3 days before retrieval because my E2 was ~4000 and follie count was >45! It hurt! Ohss is nothing to mess with. My 2 ivfs after, we did a low and slow grow method. I stimmed for 15 and 16 days using Follistim and menopur. I dropped the Follistim near the end of each cycle.

Good luck!

thishappyhouse · March 2014

Thank you all for your responses! Its so helpful to hear from other people that have gone through this. My clinic only has a 3% cancellation rate and the majority of those are DOR ladies, so this completely blindsided me... I just never considered it as a possibility.

The goal even when we restart will still be to avoid OHSS at all costs. Along with not wanting to get sick, my clinic does not have very good FET rates so I absolutely want to have a fresh transfer.

@bellalou32 my tubal problems are a result of a major hematoma bleed after my emergency c-section. I have had 2 subsequent surgeries (a TAC and another septum resection) and both surgeons said my tubes looked really good despite having a blockage on the HSG. They have never seen fluid on ultrasound or CT, so despite asking several times the RE doesnt want to take the tube out. I REALLY dont want to have another surgery as I have had 4 in 3 years but I also don't want to compromise this upcoming cycle. Do you know if most REs leave the tube if it isnt showing hydro?

Im anticipating that even if they say I can cycle after one round of BCPs that with 24ish follicles right now it may not do the job and I might be looking at 2 cycles before I can start again. Not the end of the world..

What do you all think a reasonable med dosage is going forward? I was on 75 follistim/75 menopur for 4 days and then just 75 menopur for 6 days. Obviously the 37.5u of FSH that is in the 75 menopur was not cutting it. Do you think I need a different protocol all together?

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