At what point do they call it?

BananaPancakes02 · August 2014

I went in for another ultrasound today, CD15, and my follicles have done nothing. I would think if something was gonna happen, they would have increased in size at least a little bit in the last 4 days. So, I guess I want to know, at what point do they call it, and say "You are not going to ovulate" and let you just move on to the next cycle. I can't keep going back every other day just to see no progress, and not lose my damn mind. So, I'd love some insight from you ladies, when you didn't respond, at what point did your RE call it a day?

catlover790 · August 2014

I'm not sure what they always do, and I think it varies with different REs. What did they say at your ultrasound today? How big are the follicles?

I have heard that sometimes they can give you additional meds so that you don't have to completely scrap the cycle, I think it's called "stair-stepping".

I don't have first hand experience, this is just what I've read on here. I'm sorry you're not responding though. I would definitely call your RE and ask them what you should do!

BananaPancakes02 · August 2014

None were bigger than 6mm. I only saw the U/S tech, I won't talk to the nurse until this afternoon. I got the feeling though that they are just gonna have me keep using the OPKs, and I'm sure come back in a few days for another U/S.

catlover790 · August 2014

BananaPancakes02 said:

None were bigger than 6mm. I only saw the U/S tech, I won't talk to the nurse until this afternoon. I got the feeling though that they are just gonna have me keep using the OPKs, and I'm sure come back in a few days for another U/S.

Hmm, yeah that does seem small. if they were around 10+ I'd say maybe they would wait a couple more days. Since you're only taking 2.5 I'd ask about trying another round. I'm sorry you're dealing with this!

AnnaClaire256 · August 2014

One cycle I had two follicles that stopped growing at 11mm. That's where they were at CD10 and again CD12...one even looked like it had regressed. RE told me he didn't think they were going to grow anymore but gave me the option to do a repeat u/s in 2 days. We decided to go ahead and call it.

AnnaClaire256 · August 2014

I agree with @rainbowbridge14‌ if stair stepping is an option I would definitely ask about it. It has worked for me on several occasions. Sorry you're dealing with this...no growth can be so frustrating!

BananaPancakes02 · August 2014

catlover790 said:

BananaPancakes02 said:

None were bigger than 6mm. I only saw the U/S tech, I won't talk to the nurse until this afternoon. I got the feeling though that they are just gonna have me keep using the OPKs, and I'm sure come back in a few days for another U/S.
Hmm, yeah that does seem small. if they were around 10+ I'd say maybe they would wait a couple more days. Since you're only taking 2.5 I'd ask about trying another round. I'm sorry you're dealing with this!

Yeah, that's what I figured. If they were even an 8 or 9, I would have been ok with that. That would have been enough to show me they are at least doing SOMETHING. But to basically do nothing in 4 days, just tells me nothing is gonna happen. I'm trying to trust my RE and his nurses, and don't want to come off as difficult. But if they just tell me to keep using the OPKs and come back in a few days, I think I'm gonna have to disagree with that plan.

jencity9 · August 2014

The one cycle I had canceled was canceled by this time... Probably after about 3 u/s like pp said. I had an 11 that just refused to get bigger. Have they told you to come back for another u/s?

BananaPancakes02 · August 2014

jencity9 said:

The one cycle I had canceled was canceled by this time... Probably after about 3 u/s like pp said. I had an 11 that just refused to get bigger. Have they told you to come back for another u/s?

Not yet, they don't say anything for sure until the labs come back. So, the nurse will call in the afternoon sometime.

jencity9 · August 2014

It's totally up to you as well since you are paying for all this. If I were you I'd ask to move on to the next cycle.

BunnyBerry · August 2014

I'm so sorry you're dealing with this!

I would just stop monitoring and keep using OPKs in case I catch a surge later in the cycle, but that's because my insurance only covers up to 3 ultrasounds/cycle.

I would definitely ask the nurse/RE if it is too late to stair-step on Femara this month, though. With the lowest dose to start, it seems worth it to try!

I had only one slowish-growing follie on my first month of Femara (5mg) so I thought the RE would increase to 7.5mg but he didn't, it seems strange that they are so conservative about dosage but then again I suppose other women here end up with multiple follies on low doses, so it seems like it's just a guessing game! I hope you do end up O'ing or the stairstepping works so this cycle isn't out for you.

BananaPancakes02 · August 2014

My doctor does not stair step apparently. So, I'm going in on Wednesday for another U/S. If no growth, I'm calling it even if they don't want to.

catlover790 · August 2014

BananaPancakes02 said:

My doctor does not stair step apparently. So, I'm going in on Wednesday for another U/S. If no growth, I'm calling it even if they don't want to.

Ugh, that's frustrating! I'm sorry!

lebradford · August 2014

Wow, that sucks that they don't stairstep. That "saved" two cycles for me. (The quotation marks are because while I did end up ovulating, I did not get pregnant.) I agree, if they won't stairstep, I'd consider cancelling soon.

Maybe you can check into starting at a significantly higher dose (like the max dose) next time instead of just increasing a little? I'd hate for it to take you several anovulatory medicated cycles in a row to decide that Femara isn't working for you. Or maybe you could ask about a Femara + injects combo if you have no response or a poor response next time?

I hate to be such a downer, but in my experience, doctors are not in a huge rush, and they'd be willing for you to try something like this 3-4 times unsuccessfully before they'll recommend something else, but if you advocate for yourself, they're willing to try something different sooner if you bring it up. I generally lean towards a more aggressive approach though, so your feelings may be different. Good luck though. I'm sorry you're not responding, I know that really sucks.

BunnyBerry · August 2014

So sorry that stair stepping is not an option. I agree with @lebradford, I would really push for 7.5mg next time since there was so little growth, and if they insisted on 5mg, I'd want to know the reason why.

I hope your follies decide to do their job!!

BananaPancakes02 · August 2014

Thanks @lebradford and @BunnyBerry.

I want to push for something more aggressive than just going to 5 mg of Femara. I am just struggling with what exactly I want to push for. I am the one who asked for Femara in the first place after my lining thinned out on Clomid, and it didn't work....so my trust in myself is down. I have to find out if I can try injectables now, or if I have to have a 3rd IUI with oral meds before my insurance will cover it. But, I don't know if I want to do a higher dose of Femara, injectables, a combination of both. Or what DH suggested, trying Clomid again with an estrogen from the beginning like they were going to have me do before I asked for Femara. I just don't know what to do at this point.

DharmaChick · August 2014

I am a fairly slow responder (though more so on Clomid than Femara) so that wouldn't be particularly late for me, but if there has been no response at all, it sounds like something else needs to be done. It's too bad that they won't stair-step to a higher dose. Does this also mean that they won't do another round of meds? Don't be afraid to push the RE to indicate what your next options are.

lebradford · August 2014

How many follicles did you have with 150mg of Clomid?

BananaPancakes02 · August 2014

On my first cycle, I had one 24, and 3 16mm before trigger. The second cycle same dosage, I had one follicle at 18, and I was slower to ovulate, and thinned lining.

BananaPancakes02 · August 2014

@Rainbowbridge14 It was my lining issue that made me want to switch, plus I took longer to respond the second cycle. My lining was an 8 the first cycle, and it went down to a 4 the 2nd cycle.

BananaPancakes02 · August 2014

rainbowbridge14 said:

Hmm, it sounds similar to what happened to me on 7.5mg femara. First cycle I had two follies (one mature one maybe), then one next cycle, then no response the cycle after that. I have no scientific proof but it seems like the oral drugs can lose effectiveness over time, as if our bodies get used to it and don't get fooled as easily.

I have had a good experience with injects since it is pure FSH so it will work its just about finding the right dose. But with PCOS over response is such a big possibility. Good luck with whatever you decide.

That is my only real concern with moving on to injects is the possibility of over responding. But I guess that would also make my decide of whether I should just move on to IVF a bit easier. But we will see tomorrow, I guess.

BunnyBerry · August 2014

@bananapancakes02 Aw I'm so sorry, that is really complicated.

I didn't realize/remember that you'd already had that difficulty with Clomid. If it makes you feel any better, Femara is an excellent choice of oral meds after Clomid thins a lining. It was your doctor's choice to start you on a low dose, so I don't think you have to feel responsible for that. Maybe if O doesn't occur, that's a good time for another consult and your RE giving you real life data based on research to support their choice of Clomid + estrogen, Femara 5mg, Femara 7.5mg, or injects or a combo. I would want to know exactly what data is going into their decisions and how they applied the research to your individual situation.

Good luck, hopefully insurance is willing to support whatever option your RE recommends as best!

lebradford · August 2014

My vote is to move onto injects. I know that can be a hard leap to make though.

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