5 Mature Follies: WWYD?

BunnyBerry · December 2014

First of all, Happy Boxing Day to our Canadian friends!

3T, I am in need of advice (and perhaps sanity?). 3 days ago, I had at least 8 follies in the running, and was told to do 3 more days of Bravelle (but one vial instead of 2). I felt funny about that and wanted to come in after just 2 days (on Christmas), but just listened to them. Had I known that it was a different RE who checked my chart and made the decision, I would have insisted on coming in earlier, but whatever.

So this morning, DH and I got to see the 23.5mm, 21mm, 19mm, 16.5mm, and 16.5mm follies on the screen (plus a few in the low teens). The RE on duty (not my own RE) stopped in briefly to tell me IUI is cancelled, and not to BD (but didn't even let me know how long to avoid). He'll wait for E2 levels to determine if it's safe for me to take a 2/3 Ovidrel shot so the follies hopefully O and I don't get cysts, but also don't get OHSS.

Here's the thing. When others here were in the same situation, I advised against TI. But since we have MFI and so many failed cycles...it just seems so silly to think we need to avoid. Also, we were given a 15% chance tops if we had 3 follies. So doing the math, we should have no more than a couple % chance of twins, and a negligible chance of triplets or more.

I think the RE tried to scare us away from BD by telling me that the cysts are vascular and I have to take it easy physically, no exercise, etc., they will get bigger still quickly, and that intercourse is the biggest cause of them rupturing. Believe me, it's quite uncomfortable already and there won't be any headboard-banging tonight...but is it crazy that we are (tentatively) planning a stick-and-shoot tonight and then continue timing it depending on OPKs and/or trigger?

I believe in life at the one-cell stage (fertilized egg) and would have overwhelming guilt if I was facing selective reduction based on my own decisions. But it's hard to believe that TI with 5 follies is actually any riskier for us than IUI with 3 follies.

I can't believe that I'm even considering this, but the thought of having to move to OOP IVF after throwing away a cycle like this...and with so many failures and DH's terrible morph and low motility even post-wash, it really seems like we have no more risk of SR in this TI cycle than doing IUI with 3 follies (with the chance of identical twinning). I guess I'm just thinking that the doctor is telling us to avoid to cover their butts. Is this crazy, obsessive, desperate infertile woman thinking? Thank you so much for your honest input!!

SND1231 · December 2014

I am just speaking from my own opinion, but I agree with you about everything you said. Since you'd DH has MFI and you have a lower success rate I agree that you should be ok. I'm not saying go against your doctor but maybe call and talk with him about how you are feeling. If I personally was in your shoes I would go for it!

mshandlebar · December 2014

That is a really hard one, and I'm not sure how much advice I have to give (but I have all of the moral support in the world). I do agree that MFI is a whole 'nother thing, and honestly as a desperate infertile lady myself, I would probably keep on doing it. Just in case. Especially if OOP IVF is looming in the future. I would also make sure you and YH are on the same page about multiples and SR. Just in case. I might also talk to your RE and check in with the cyst rupture thing. I wouldn't go through with the cycle of it meant risking your health. Good luck with whatever you decide to do.

BunnyBerry · December 2014

@snd1231 You and my sister both suggest talking to the doctor, and I guess it's a bad sign that I don't want to ask him because I know what the answer would be.

@lemonliz Yes, that's exactly how I'm feeling. It just seems so obvious, I've never had a BFP after all this, how could I get more than 2 or 3?

@mshandlebar Thanks, for once in his life DH is being really calm, rational, and understanding as we discuss this, and listening to my concerns. He is fine with SR in his own mind, but does not want me to have to be in that position.

@rumbera28 Thank you for that big dose of reality. I guess it feels so impossible to get pregnant, I can't even wrap my head around the possibility that we'd get pregnant with more than 3! But your sentence "life is crazy like that" has really stopped my emotional thinking in its tracks. I think it's time to go do some research on SR and the risks of HOM and face the reality of this choice before we make it.

BandM14 · December 2014

Hey Bunny, I'm so sorry for the tough decision you are facing

. I know you were hoping for more of a response (and wow did you get one!) but having to cancel the IUI totally blows. I get what you mean about "pregnancy feeling so impossible", but I guess there is still that small chance of HOM. If it were me, and given YH's MFI, I would probably go for it. But, I do think it's worthwhile to talk to Dr. G (since he wasn't the one to actually speak with you about it) and get his input. He knows your case inside and out, and the other REs at the practice do not, so maybe he will surprise you and be ok with TI. He also would probably be able to give you some clearer stats on your chances of HOM.

Good luck, I'll be thinking of you!

cateyes543 · December 2014

I don't have any experience but wanted to offer you all the support. I think if it were me and with the poor sperm factor of the past, I would go for it. You have to decide for yourself, but that is what I would probably be doing.

katers79 · December 2014

***SIGGY WARNING***

I'd be pushing to speak to MY RE, not one who doesn't know my story. I'd be leaning towards continuing too, with OOP IVF looming. No personal experience, but thinking of you. GL!

redandblue · December 2014

Hey @BunnyBerry‌ , I don't have much of an 'educated' opinion on this due to your own situation and MFI, but I would probably say go for it! But that's just my heart talking. I wanted to just chime in and give you support in whatever decision you decide on. Everything happens for a reason, and so will your decision. GL

BunnyBerry · December 2014

@bandm14 @bluefairy5 and @katers79 Thanks, you guys are so right - I need to hear from my own RE on this. I like the idea that he will be able to say what kind of a risk it is with DH's numbers. And it makes so much sense what you said about E2 - I don't know what it's been this cycle, but it must have been on the lower side or they wouldn't have had me keep stimming, and on a double dose for a week. Of course, I also never had amazing EWCM like this...didn't even think of that as a contributing factor.

I just spent about 30 seconds looking into HOM risk factors to the babies and was *this close* to vomiting and had to stop...it's so scary and upsetting, I told DH, "No! Forget it! I don't want to deal with this, let's just forget it, no chance of a 2014 conception for us." But then I saw the last few replies here and realized it's not that simple. Clearly if I went from feeling "of course!" to "no way!" in a few seconds, it's not such a simple answer, and now I am just going to let it go until the E2 results are in and I can talk to the doctor.

@booklover811 @redandblue Thank you! The kind words from you both are so good to hear.

@lemonliz Yes, going on the record here that we would love the chance for twins.

Another thought is that our years of failures were before my surgery to open up the cervix and treat endo...so in reality, I should just be thinking that we had 4 failed IUIs with 1 follie each. Not such a hopeless picture in the face of possible HOM. This Bunny does not want to breed like one.

juneroses · December 2014

I have no advice - in the same situation I would probably do something completely irrational , like do it once at a bad time.

I think the ladies here had some great advice about thinking through both scenarios & making peace with the one you choose. Good luck with your decision. I hope you can come to an agreement that feels right for you.

TTCBabyJ · December 2014

Bunny, first off let me say I really hate that IF forces you to make a decision like this...I'm so sorry. I would definitely ask more questions (directed at your regular RE, not Mr. Scare tactics). I would just be honest with your RE about considering TI. But on a personal level I would really consider it given our MFI. I know I would totally rationalize my decision. I'm also really glad that it seems like DH is fully involved in the decision making process. Good luck!

southernyankeegirl · December 2014

*** Grad / Siggy Warning, BFP mentioned ***

Hey there my friend... Sorry you're stuck making such a tricky decision! I just wanted to throw it out there that I would def want to know the E2 numbers before deciding. Personally, I would go ahead in your shoes, but I am okay (at least conceptually) with selective reduction. Especially given a number of failed cycles, I wouldn't have a problem taking that risk.

I did want to say that our IUI cycle had similar follicle sizes when we triggered. We had 3 definitely mature and 4 more
potentially mature. My E2 was around 650-700 so we felt like all of them probably wouldn't be mature, but we could have had 4-5 mature, or the smaller ones could have contributed to the E2. Regardless, we only ever saw one egg sack on ultrasound so it seems like only one ever fertilized and implanted (and certainly only one has stuck around!).

I know IntuitiveBlue did an IUI with 7 mature follies and ended with twins. Same concept - failed IUIs in the past, took the risk. Especially as you'd be TI with MFI, I would personally take the risk.

emmuffy · December 2014

sorry you're facing such a hard decision. Trust your gut.

FWIW, I would go for it (because of the MFI + possibility of OOP IVF).

BunnyBerry · December 2014

@iputketchuponketchup Exactly, I know that I am the person saying, It's not worth it! when anyone else asks this same question! Especially for anyone not okay with SR. It feels so different now, unfortunately.

I have to say, this whole process has definitely reminded me - no decisions are easy when it comes to IF.

@emmuffy I would love to trust my gut, but it is pushing me in different directions! What a crazy feeling. I've never felt so torn before. I typically have an easy (well, at least, not too emotional) time thinking through decisions and then moving forward without regrets. Just when I thought deciding whether to do IVF would be our big choice with plenty of time to make it, this hits! It's even more annoying because I bet those 16.5's weren't in the running one or two days ago and we could have triggered with 3.

@southernyankeegirl Thank you for joining this discussion! It's so helpful to hear from someone who was in a similar situation and it turned out so beautifully...even if we choose to abstain, at least I'm not crazy for considering it, you know?

@rainbowbridge14 Thanks. I am already getting nervous about ovulation, especially with a trigger - there's a lot of discomfort going on already. Luckily it's a break from school so I can stay home and not move and just soak up pity from DH! If we talk to the RE and then agree to use TI, we're planning more on Timed Poking-it-in-at-the-last-minute rather than intercourse.

BunnyBerry · December 2014

I was so afraid to bother the nurse or sound like a crazy person - but we talked and she said that I have a very valid question since the E2 might show fewer mature (RE's message said to use Ovidrel, so it can't be super high), and also because the RE might not have realized we have MFI. The office closed at 12pm with no warning (boo), but she will check my E2 in the office tomorrow and speak with the doctor and call me, and try to speak with my doctor (yay!). So I trigger tonight and just wait for their advice on whether to BD at O time (which is what DH wanted anyway, he hates ejaculating 36 hours before IUI because he thinks it messes up his counts). She said no way to IUI, which partially overcomes MFI, but maybe BD was in the realm of possibility.

Thank you so much for all the input. I know after we get the doctor's recommendations, I will be reading back through this discussion a few times and thinking through all the points brought up before making a final decision. I can't imagine what I would have done if I didn't have you guys to run to...I am so thankful for this community of friends! I would have been uninformed and helpless, but you guys have helped me feel comfortable advocating for myself and seeking real answers individualized to our situation.

LindseyM2012 · December 2014

Hey Bunny! I know you're waiting to talk with the doc tomorrow, but I just wanted to chime in by sharing my experience from last cycle. I had 5 mature follicles (>18mm). Taking Letrozole does suppress E2 levels so they can only go by size to determine maturity. I'm sure your E2 levels will give you more information Since you're on injects. We went ahead because we decided multiples would be ok but we're told our odds were <10% for twins and <1% for triplets. I triggered with Ovidrel and only 3 of the 5 ovulated (confirmed by tv u/s). Just because you trigger doesn't guarantee all follicles will ovulate. So there could be a couple possibilities for you: you trigger and ovulate all 5, and do TI but the MFI will likely put you at lower risk for higher order multiples; you trigger, not all 5 ovulate and do TI, putting you at even lower risk for multiples; or you trigger and avoid.

Personally, I would go for it. That opinion is based on the facts that you're dealing with MFI and you've previously stated you're ok with multiples. The chances that all 5 follicles will ovulate, get fertilized and implant are likely low. Life is weird and crazy things do happen, but the statistical probability is low.

BunnyBerry · December 2014

Thanks, @lindseym2012! I am so excited to hear the results of your cycle...sounds like good chances. Can't wait to hear how it went.

I didn't even think about whether or not they would O...perhaps with the reduced Ovidrel shot there's a chance of them not O'ing? I also just went back and re-read your discussion from a couple weeks ago. Funny how the answer is not so clear-cut to me now...I am reaching for all the info possible in case there is a chance we could use TI responsibly. I mean, if we have less than 1% chance of triplets, I'm not going to worry about it.

A silly thing - I did the Ovidrel shot on the right side where the most mature follie was, thinking maybe the ones on the left will not get as much meds to make them all mature or O. Now I swear I feel twice as much O pains on that side.

Also, I'm pissed at the RE who just randomly mentioned, "take 2/3 of the Ovidrel shot, just eyeball it" because I did just that including the front part of the syringe with a lot of meds, but when I injected it turns out that part doesn't get pushed in by the plunger, so now I'm pissed that I used more like 1/2 of an Ovidrel shot and now I'll get stuck with cysts or something after all this.

I really hope I get the call tomorrow morning that E2 was at 600 or something reasonable like that and we can just enjoy the "natural" try this cycle.

deelopi9 · December 2014

If i were in your shoes, I would BD and not waste the cycle. That way I would have had no regrets later on.

LindseyM2012 · December 2014

@BunnyBerry - Yes, the theoretical decision can be easier than the real life decision. The answer is definitely not as clear cut when you're the one making the decision to potentially waste a month. And a lot of factors play a part in the odds. I'm sorry you even have to wrestle with this but I'm sure you're going to make a decision that you and your husband are comfortable with.

tweetyknicks · December 2014

The Ketchup is wise. Lots of good ideas from PPs that I won't repeat.

My two cents: MH's SA was low even for IUI (5% chance at most). Given that, I'd go for it anyhow in your situation. I'm very curious to see what your RE suggests.

BunnyBerry · December 2014

Thank you for all the support.

@murrt We are still deciding. This is like a little mini hell for us this weekend but I'm trying to stay calm about positive about it all. Thanks for asking.

The other RE called me back this morning and was extremely gruff. The call woke me at 8am and I was so nervous I couldn't ask all my questions.

RE: I thought we had a great conversation about this yesterday [right, less than a minute of you talking at me!] What is your question?

I told him the message he left after checking my E2 results said IUI was cancelled, but said nothing about the E2 level or TI.

RE: Will you reduce?

Me: "No..." but didn't know how to explain to some random doctor in a big rush that I am willing to consider it for safety reasons.

RE: Then no, no, no.

Me: What is the estradiol level?

RE: Under 2000. 1700.

Me: That's high! [as in, represents many mature follies]

RE: No it's not. [as in, not too high for an Ovidrel trigger?] Your ovaries will get large in 4-5 days. It will hurt so go ahead and take Motrin, we don't care about that because you won't be pregnant. [Gee, thanks! And btw, I'm not allowed to take Motrin due to my Crohn's, but then you probably never checked my chart once in all of this.] Call the office when your period comes.

Me: Okay...thanks.

RE: Bye.

I should have called the nurse back and insisted on talking to my own doctor. I just couldn't bring myself to do it, I thought, he must be on vacation and if the answer is "no way, Bunny, obviously you shouldn't do TI!" then I would still be in the same confusing position I am now (as evidenced by how many friends here would go for it anyway) and I would feel like an idiot for being so pushy. It's a problem, I have a fear of doctors and other authority figures.

I did the math and found that we (should) have a 4/1000 chance of quads or more if we do IUI with 3 follies (the cutoff our RE recommended and something we were comfortable agreeing with). We (should) have a 6.5/1000 chance of quads or more if we do IUI with 5 follies...and of course TI should reduce that significantly due to our MFI. So it's really hard to imagine that it's an irresponsible choice to use TI right now...it's not really different from the normal risk of IUI taken every day by women who would not use SR. I feel like it's more of how it looks - no one blames an RE who uses IUI with 3 follies if the woman gets pregnant with quads or quints, but if they have a patient with HOM and they allowed TI with 5 follies, of course it sounds like they did something horribly irresponsible.

(And yes, I am not focusing on the chance of triplets because both of us decided 100% that we would not reduce from triplets, unless there was a threat of imminent death to mother or babies. And anyways, there is a higher chance of triplets for us with 3 follies and IUI than with 5 follies and TI.)

DH and I had a good long chat this evening. Turns out he did not realize that there is a possibility of identical twinning (or an extra surprise mature egg) even if we had just three mature follies. He started thinking that maybe IUI was not okay for us even with fewer follies, and was mad that maybe we'd have to go to IVF just because of my moral position. So he got pretty flustered with the thought that I would not just abort if we got HOM. He wanted me to tell him exactly whether and when I would abort, and I just cannot answer that question! We had a real heart to heart. He is frustrated that I would not abort a clearly disabled fetus. But at the end he was able to accept TI and IUI with the fact that I would definitely agree to SR if there was an immediate threat to the life of the other babies or myself.

So now the choice is with me. We are considering intercourse (the kind that wouldn't harm my ovaries, Lol) at the 24 hours past trigger mark because it reduces chances, but still gives some kind of a chance. And maybe repeat at the 36 hour mark, since his numbers would be way down by then, or maybe not if I'm feeling scared or regretful. This is all so ridiculous though. I know that if we end up with quads, I'll never forgive myself. But if there's literally no chance for sperm to get anywhere near an egg this month, that's also pretty hard to live with!

Sorry to write books on this topic, and also sorry that my thinking probably isn't very consistent yet.

southernyankeegirl · December 2014

I am so sorry you and your DH aren't seeing quite eye to eye on this. That's one of the hardest parts of this - you both have to make decisions you both can live with, fully understanding that someone else has to deal with your decisions also.

As far as the disabled fetus, that could be cultural (as I'm sure you know) but the comparison I gave DH about why I didn't even bother with testing was because we can only predict so much. If I could do something different, like with a heart defect having a surgeon on stand by for delivery, then I'd want to know. But if it won't change medical treatment, I didn't care to know. We could rule out all physical and genetic abnormalities and still end up with a severely autistic child or have the child develop juvenile cancer. Stuff happens, you can't predict it. All you can do is deal with the hand you're dealt.

Whatever you decide, just trust your faith and try to let what happens happen. I send you all my good wishes.

***** Grad / Ticker Warning *****

tweetyknicks · December 2014

What @bluefairy5 said... TP the other RE! Jerkface. *mutter, mutter, mutter*

Also agree with @rainbowbridge14 that OHSS sucks. E2 of 1700 is rather high for 5 follies, I think. Mine was ~4300 the morning before trigger when I ended up with 30-something mature eggs from IVF. (I think my E2 was kind of low for the number of follies. My E2 seems to always be low.) Maybe consider the E2 relative to prior measurements? I'd be more afraid of hiding follies with that E2 if you don't normally have high E2.

BunnyBerry · December 2014

@rainbowbridge14 Thanks! No, idiot doctor didn't say a word about OHSS. I think by saying "under 2000" first for the estradiol, he was trying to point out that I shouldn't be at risk for OHSS? Well, waking up this morning there is a ton of discomfort now, and it doesn't feel pinchy like O...it feels pressurey and sore. Luckily [unbeknownst to him] I have learned from you guys and ate protein-and-salt-rich Chinese hot pot yesterday!

@tweetyknicks Thanks, that is good advice! The only E2 number I know from the other Bravelle cycle was 200 about 5 days before O, with one lead follicle (because I saw it on the chart - they don't tell us details unless we ask, and I'm usually to shy to ask). So I think my extra little follies must be producing a lot?

@southernyankeegirl Thank you, I think that point might really work on him! He is really good about respecting my position, and repeats that he would only want us to do what we can to have a baby that doesn't go against my principles (yes, he learned this word - I was super impressed). But he was nervous that we'd end up in a position where my principles would create serious division in our marriage.

@bluefairy5 Thank you, it was a helpful conversation for sure!

BandM14 · December 2014

BunnyBerry said:
@rainbowbridge14 Thanks! No, idiot doctor didn't say a word about OHSS. I think by saying "under 2000" first for the estradiol, he was trying to point out that I shouldn't be at risk for OHSS? Well, waking up this morning there is a ton of discomfort now, and it doesn't feel pinchy like O...it feels pressurey and sore. Luckily [unbeknownst to him] I have learned from you guys and ate protein-and-salt-rich Chinese hot pot yesterday!

@tweetyknicks Thanks, that is good advice! The only E2 number I know from the other Bravelle cycle was 200 about 5 days before O, with one lead follicle (because I saw it on the chart - they don't tell us details unless we ask, and I'm usually to shy to ask). So I think my extra little follies must be producing a lot?

@southernyankeegirl Thank you, I think that point might really work on him! He is really good about respecting my position, and repeats that he would only want us to do what we can to have a baby that doesn't go against my principles (yes, he learned this word - I was super impressed). But he was nervous that we'd end up in a position where my principles would create serious division in our marriage.

@bluefairy5 Thank you, it was a helpful conversation for sure!

Wow Bunny, I'm so sorry that you are still struggling with this, and I hope you don't have to go through OHSS. I wish Dr. G would call you, I still think it would help to talk to him! Is "idiot doctor" possibly my current-soon-to-be-former RE? Cause that convo sounds a lot like his style.

BunnyBerry · December 2014

@bandm14 Lol, no it is a different one, really highlights how different Dr G is!

Well, we made our decision...used un-TI, as in BD at a less-than-ideal time. I am truly not worried, the chance is so low for us with the MFI. I'm sure this will be another BFN anyway, and we can just move on instead of regretting it!

ronniesgirl1981 · December 2014

Just wanted to add that your biggest follicle (and perhaps two largest) are likely over mature by the time you triggered. There is controversy on this, but-when it comes to IVF-many REs are triggering at closer to 18/19 and then the follicle is in the low twenties when it ovulates. In any event, you are a rockstar for any kind of BD with that many mature follicles. Ouch!

BunnyBerry · December 2014

@ronniesgirl1981 So true, very good point! The lead follie grew from 13.5 to 23.5 or 24 (I forget) in 3 days, which is crazy fast, and I was thinking it might be overmature. Lol, I am super proud of DH for his performance under very strict conditions.

tweetyknicks · December 2014

Glad you made a decision that makes both of you comfortable. Well, not necessarily physically, but that can't be helped to a certain degree :-P

BunnyBerry · December 2014

@tweetyknicks Thanks. Actually, we found a way that really worked for us...I may ask for "ovarian over-stim" sex again!

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