Proper Intro and Question * Update in OP*

AndyMSchneider · December 2014

Met with the dr - who as someone asked below, is an RE. He pretty much diagnosed my wife with type 2 PCOS (he called it PCO though, which confused me) and said that the last 2 months have been educational. The first month he said he tried early-loading (using the follistim on CD3), which produced too many follicles. Mid-loading (last month) produed the right amount, but without additional injections, they fizzled.

So the wife took the progesterone shot, and will get the heating pad out tonight to try and reduce the discomfort. Next month it'll be femara on cd3-7, follistim on days 5,7,9 and then menapur on days 11 and 13. His hope is this is the timing of drugs to get her to produce the right amount of follicles to actually try an IUI. We'll start that whole process in about 10 days.

Any menapur tips?

Thank you for all of your advice about questions, I tried really hard to slow him down, explain things and slow down more.

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I started a thread yesterday with the hope of getting some advice. The advice I got was to not use my real name and to do a real intro post. So here it goes.

My wife (29) and I (30) are hoping to conceive our first child. We've been married for a bit over a year. Early this year my wife went off of her birth control pills with the intention of us eventually working to have a child. We called this period not trying to prevent having a baby. About 3 years ago my wife's obgyn switched her BC brand (formula?) because my wife felt like the pills made her moody. After switching her cycles stopped completely, but her OBGYN said it was normal and not to worry. When my wife went off BC her cycle never started again. At first the OBGYN said not to worry, then after a few months they tried progesterone pills and shots to kickstart her cycle. After 2 months of that failing we decided to make an appointment with a fertility expert.

The fertility dr has not given us a formal diagnosis other than amenorrhea (spelling?). Blood tests showed that the LH/FSH ratios were off, but he made it seem like an easy fix. Very confident.

In the 4 months we've been working with him my wife has had one period and zero ovulations. She had one cycle with just femara with no significant follicle growth. The next cycle the dr added follistim (75, 5 doses, every other day, starting on CD5). She grew a couple of follicles that measured about 15 mm, and the doctors decided to see if mother nature would do the rest. Mother nature did not, and instead the follicles went away, with no ovulation and no period. The third cycle didn't work out timing wise because of Thanksgiving, so instead they gave her a high-estrogen BC pill to see if that would cause a period. The good news it did cause a period, her first one in years. But, still no ovulation.

That brings us to this latest cycle. Started with 5 days of Femara, then 2 shots of follistim over 3 days (75 again). The ultrasound came back with 7 follicles measuring about 11 and another 10 or so at about 8mm. We considered this great news. The dr decided to let us "coast" over the weekend instead of doing more injections. They were afraid of creating too may follicles (makes sense, right?) We came back on Monday to find that almost all of the follicles went away, leaving 2 at about 11mm. They had her do two more shots of follistim over 2 days, then come back in. That third ultrasound found one follicle at about 11 and nothing else. They canceled the cycle, devestating my wife and leaving me without answers. We're meeting with the dr tomorrow, but they didn't give us any indication about what we'll talk about, the next line of strategy or anything. It could be a pep talk, new drugs, we have no idea.

So that's where we are today. My questions are

1) How likely is it that follistim doesn't work?

2) are the other options to follistim?

3) would switching from femara to clomid make a difference?

4) Could this just be a timing issue?

5) what questions should I be asking tomorrow?

6) if you were my wife, who feels like, in her words, is broken, what would you want me to do?

7) is this even the right board to post this in?

Thank you all ahead of time.

BunnyBerry · December 2014

Welcome! PPs have given great advice already, but I am loving this organized (male-oriented?) way of discussing complicated question, so here are my thoughts!

1) It sounds like the doctor's choices, not the Follistim, that was the problem. More regular monitoring and more aggressive dosing sounds like a good start.

2) Yes, but I think the big issue here is to try stopping the Femara and doing an injects-only cycle with any of the inject types.

3) Without a good response on injects, I would not bother trying another oral med.

4) Yes - The doctor gave your wife a couple of typical "cookie cutter" protocols but didn't make the best choices in real time in the cycles. Better timing/dosing should make a difference, especially since a response was seen to some extent in both cycles.

5) Questions to ask: Is there a good reason to continue with oral meds? What is the plan to prevent canceling a cycle? What will be done differently? How much bloodwork and ultrasound monitoring is needed? At what point should IVF be considered as more cost-effective?

6) I think you're doing what I would want - getting informed. Perhaps I would be ready to seek a second opinion after 2 cancelled cycles, just to make sure that the doctor is on the right track. And the #1 thing that I wish is that MH would be willing to talk about it more - it's such a constant, consuming thing for a woman dealing with shots, side effects, "dates" with the ultrasound, blood draws, worries...and it's hard for women to compartmentalize, so I bet the more you are open to chatting through it and listening, the easier it will be on her. Plus constant reminders that it's not her problem, it's a problem the two of you are facing together.

7) You are absolutely welcome as a member on this board! Post away. IF is tough and confusing for both partners.

theholmanherd · December 2014

Welcome! PPs have already covered your questions, but I wanted to chime in.

****pregnancies, babies mentioned****

Sometimes, just a supportive hug or an "it's okay to be upset" can do wonders. Surprising her with chocolate or flowers is always nice also, especially if she just found out that yet another cousin/friend/coworker's SIL's stepdaughter is pregnant or just had a baby.

You definitely belong! But be prepared, we talk a lot about cycles, wine, chocolate, puppies, and throat punching annoying people or situations. If you can handle all that, you'll do fine. We don't bite, I promise

Again, welcome. Best of luck to you and your wife!

SND1231 · December 2014

PP have given great advice but I wanted to give you props for coming here and trying to find out more information about what it going on. Good luck!!

AndyMSchneider · December 2014

Thank you all. I think I know what I need to come away with from tomorrow's meeting with the doctor. One person asked, he is an RE, not an OBGYN.

Personally I think it's a matter of getting the dosage and timing down than anything else. I know the wife is more than willing to do whatever it takes, but since neither of us have insurance that covers fertility treatments we have to be a bit careful and can't jump to IVF.

THank you again to everything.

redandblue · December 2014

I don't have much else to offer, as PP covered everything, but I also wanted to welcome you here and also give you kudos for reaching out and asking the questions. Men tend to be 'fixers' and I'm not surprised with the questions you are wanting answers to. Continue to support her, love her, open up to her about how you are feeling, as well as listen to her. Remind her that you are a family and that you will make it through this. GL to you both tomorrow. I hope you get some answers to your questions and come away with some plans. Please feel free to join this community. It is always great to get lots of perspectives and support from people who understand this challenging process.

dancerspose · December 2014

I have nothing productive to add, but definitely wanted to stop by and add my kudos to you for stepping up here to get more informed and learn how to best support you're wife. To be honest, I'm still in the same place as your wife in terms of feeling "broken." DH does the only things he can do, all mentioned by other posters. He holds me when I cry, tells me he loves me and we're in this together, makes me dinner, etc. I can't imagine how helpless all this makes our partners feel, but just knowing we have each other is the best any of us can do. Best of luck at your appointment. I hope you get some answers and a good plan!

katers79 · December 2014

Nothing to add that the PP's haven't already covered, but welcome and GL!!

deelopi9 · December 2014

Hi and Welcome! I echo what the other ladies have suggested. My RE has me go in at cd3 for u/s, start injections - 75Iu's - they monitor me every other day w/ ultrasounds also checking my E2 levels (bloodwork) and forcing ovulation w/trigger shot. RE will either increase or decrease your dosage depending on follicle growth. Good luck!

PeonyPop · December 2014

GL at your appointment today and welcome! I agree with PP that it sounds like a dosing issue. I accidentally ran out of follistim during my first injectible cycle, and it really messed up my cycle (ended up having to cancel it). Really not sure why he thought 'coasting' was a good idea or injectibles every other day honestly. I've never heard of that... I'm not a doctor though, so it could be legit but just seems odd based on my experience. My RE explained that it was important to take the injectibles (follistim) every day cause it takes over your body's hormones, and will stop growth if you stop before you ovulate. So, expecting the body to 'take over' when you stop taking them seems like poor logic. It might be too late, but I'd like to hear his response on that.

tweetyknicks · December 2014

notadadyet said:

[S}ince neither of us have insurance that covers fertility treatments we have to be a bit careful and can't jump to IVF.

Ditto on this. We have no explicit coverage for fertility treatments, but our insurance has still been covering monitoring labs and ultrasounds. It might be the way the doctor office codes it when they send it to the insurance company.

Before you read the rest of this, please note that I am not trying to push you to do something you are not comfortable with or able to do right now. I want to let you know what it took me and my husband several months to figure out in case you find it relevant.

After two failed IUIs, a chemical pregnancy during a timed intercourse cycle, and a canceled IUI, my husband and I did some figuring and decided that IVF was actually more cost effective given the per-dollar likelihood of taking home a baby. Our diagnosis is male-factor infertility (post vasectomy reversal) and slight PCOS, though, so our chance of success with IUI is probably lower than yours would be (assuming you did a semen analysis that checked out normal).

If it becomes relevant, our chance of success with IUI was around 5% or less per cycle and with IVF it is around 70% per cycle. It would take us 23 cycles of IUI ($23,000) to have the same cumulative success rate as one cycle of IVF. I decided after two failed IUIs and one canceled cycle (which was devastating at the time), the wear and tear on me physically and both of us emotionally made the financial choice easier to see.

For the full run-down of why we decided to move on to IVF, see the link in my signature below.

Best of luck to you and your wife.

TTCBabyJ · December 2014

PPs gave some really great advice, but it really sounds there may be a dosing issue. It is really great to get a male perspective. You are definitely leaps and bounds ahead Mr. J.

You really seem very attentive and I think your knowing that she is not in this alone will go along way. I like when my DH helps around the house when I am cycling and doesn't even think of complaining when it's time to produce the sperm sample for the IUI. After injections and vag cam exams I just need him to do his part with no problem or complaints. Chocolate and wine also really do go along way as well. Good luck!

Sewfie · December 2014

First, I just want to echo what PPs have said- it's really awesome that you're so involved. My husband goes to most of my appointments (except for basic monitoring ones if they're scheduled when he's teaching; he's arranged TAs to handle classes for more important appts as necessary). He's also really good at asking our RE questions. Both of those things mean so much to me- I know that if I forget something, he'll remember it (and vice versa). So, keep on keeping on!

Personally, I don't have experience with menopur yet, but I'll be starting it in about 8 days. Our nurse gave us the same recommendation as @lemonliz- she said to take it out of the fridge about 30 minutes before inject time and to use the q cap for mixing. Side note: those things are awesome! I want some for work, for sure!

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