In need of advice ASAP

MagicMikki · February 2015

Hi all,

I am currently on my 3rd IUI and have run into a road block. At the beginning of this cycle, I ended up with a cyst that we took care of using the pill. After 10 days of BCP, the cyst was gone. I started my Bravelle injections last Wednesday, Feb. 4, and after 5 days of injections, went back in for monitoring on Monday, and had 4 follicles with potential. I was instructed to do two more days of injections, and went back this morning for another u/s. I have 1 follicle that is of good size (19mm), and one that is "getting there" (13-14). The nurse instructed me to take my trigger tonight and to come back Friday morning for the IUI. HOWEVER, I'm a little concerned. I had 1 follicle with my first IUI and 2 follicles with my second IUI, both of which failed, obviously.

I spoke with the nurse this morning about our options, who said we will want to trigger the one follicle tonight and come back on Friday for the IUI, but I don't know that I agree with that. I asked if we could do one or two more days of injections and come back on Monday for the IUI, but the nurse said no because we risk my body ovulating the bigger follicle on its own, and also risk too many follicles and having to cancel.

I really do understand the fine line between too few and too many follicles and I know it only takes one; I also do understand that the more follicles, the higher the risk of multiples, or having to cancel. I truly do understand that. But we are ready to be more aggressive with this.

I would prefer to do one or two more days of injections in an attempt to have 3-4 follicles, or at least two guaranteed instead of just the one. I can make one on my own-- follicles and ovulation are not our issue, it's DH's numbers. (Note: At our initial appointment with our doctor last summer, she said she is comfortable triggering with up to 4 follicles.)

I'm wondering if I should call my RE back to discuss doing two more days of injections, taking the Ganirelix to avoid ovulating the bigger one, monitoring on Friday (instead of IUI), and if all was well, triggering on Saturday and going in on Monday for the IUI. I know there is a fine line before over-stimming...

Would I be completely insane to want to stim for two more days?? While every cycle can be different, I only stimmed for 7 days, whereas in the past I've stimmed for 12 days and 11 days. Do I have a right to do this? Any advice is welcome, even if you're going to virtually slap me alongside the head and say stop being irrational and just do what my clinic says!

Edited because I'm trying to discretely post while at work without getting caught and apparently can't spell while watching over my shoulder...

MagicMikki · February 2015

So, I have an update... I ended up calling my clinic just to talk to the nurse about at least understanding the situation better. I started to think that maybe it was that I wasn't understanding the situation and that's why I was feeling uncomfortable with it. Anyway, I specifically asked that either my RE or the nurse I saw this morning (who is typically the nurse I deal with) call me back, and I received a call from some random person that I have never spoken to before. She was so rude to me, I am seriously on the verge of tears.

I described my situation from this morning and her tone with me was outrageous. She was rude and condescending. She said, "Well, you have two follicles..." I explained that it was my understanding that I had one big follicle with one smaller follicle that was "getting there" but might not make it (the 13-14 one). She said, "Well, I don't know why you think that. I can see here in the notes that it was a 14." I told her I was told that it was between 13 and 14, which in mm, that can make all the difference! She didn't have much to respond to that, except that she was "rounding up" to 14. She was clearly not thrilled to speak with me about this.

I also asked about taking the Ganirelix and stimming for another day or two and she said that that won't help because people ovulate right through it. I said what is the point of Ganirelix if people ovulate right through it?? She said there isn't one. (WTF??) She said that if I stim for another day or two I risk having too many follicles (I have 4 potential... up to 4 is what my doctor said she's comfortable with...) She said that I also had several smaller ones that were 9-9.5 that could get bigger and we would risk having to cancel. IN TWO DAYS? I know that that *might* be possible, but it isn't likely. I said we would be willing to take that risk. She then started in again about me ovulating on my own. I asked about monitoring to make sure that I'm not ovulating on my own and she said, "No, none of this is going to happen. You can come in on Friday for your IUI or you can skip it... your choice."

I expressed my concern again with spending hundreds on meds to get just 1 (at best 2) follicles each month, when I can make 1 follicle on my own. She said (in extremely condescending tone), "Again... like I said before....you have TWO. TWO follicles. That's twice as many as ONE. Do you make TWO on your own? I don't think so!" What the hell, seriously. I have a huge issue with her saying that the second one is a viable follicle when I'm triggering tonight and it's only 13.5 and the nurse this morning (who was great, always has been) didn't feel the need to even count that one.

I felt even more uncomfortable after talking with her than I did earlier. I told her that I was calling to perhaps discuss my options, and if I have no other options, that I wanted to at least feel comfortable with the only option I have at this point, but I feel more uncomfortable about it. I asked if I could speak with my doctor. She said NO! Didn't offer an alternative time, didn't offer a reason why. She just said NO. I asked if the doctor could call me back at a later time that's more convenient to her and the lady told me that the doctor "probably won't do that". ARE YOU FREAKIN KIDDING ME!!?? I told her that I expect a call back from my doctor TODAY and said this is my cell phone number and she can reach me AT ANY TIME TODAY on this number. She said she would pass the information on to my doctor. So I guess that means I likely WILL NOT receive a phone call from my very own doctor, who I haven't actually spoken with since September!

Maybe I'm not in the right to request to stim for one or two more days, and maybe I am crazy or just not well-informed for wanting to allow for the other two follicles to grow. But I still just cannot believe the service I received from my clinic today. DH and I agreed that we will just go in for the IUI on Friday and after the beta, never, ever return. Ever.

przemosbabe · February 2015

Wow how rude is that! And no point of ganirelix? That's a straight up lie. I have he follices bigger than your largest one in an IVF 1 and I did not ovulate through the ganirelix. I have ovulated on.a long lupron protocol, but you are more at risk for that with lupron. I would tell that RE that because of the way she spoke to you, you will not be coming back - but wait until you to the IUI lol. And it is very possible to make two eggs on your own. I know I have done it!

MagicMikki · February 2015

@przemosbabe , I also think it was very rude. It just seemed like the nurse was going in circles between two or three different "points", but each point contradicted the other. I also now feel like the clinic has their own agenda and is not in my best interest.

Another nurse called me back later in the day (NOT my doctor, surprise, surprise) and this was the nurse I had originally wanted to speak with. She was very kind and understanding, but mentioned that she spoke with the doctor about my concerns and the doctor was only willing to budge "a little". I ended up taking two more vials of Bravelle on Wednesday night between 7-9pm along with a dose of Ganirelix (hm. I guess there IS a point??), then I was instructed to take my trigger shot Thursday night between 7-9pm and to still come in on Friday morning at 10am for the IUI.

I wanted to do two more days of Bravelle to try to grow the third follicle, but the dr. said that just wasn't an option. But, by doing the one more night of Bravelle, at least I was able to guarantee that the one follicle that was 14mm would get big enough to be of value.

I expressed my concern with taking the Ganirelix on Wednesday night w/ the extra Bravelle, then taking the trigger on Thursday night and coming in Friday morning for the IUI. That wouldn't leave much time between the trigger and the IUI... the nurse said that the clinic does "24 hour IUIs all the time". I mentioned that this is only 12 hours, not 24 hours! She was like, "huh??" like she didn't get it. When I explained that it is only 12 hours, not 24 hours, between trigger and IUI, she was like, "Oh, I guess by 24 hour IUI I meant next-day IUI." I explained that in this case, there is a huge difference between 12 hours and 24 hours. Well, she called me back later and said that she talked to the doctor about this and the doctor instructed me to trigger instead between 7-9AM instead of 7-9PM on Thursday. So thennn.... I expressed my concern that now it's only 12 hours between taking the last dose of Bravelle and the dose of Ganirelix and the trigger shot! Ugh, I felt like I couldn't win. The nurse told me that the Bravelle would have done it's job in 12 hours, and that completely, completely contradicted what they told me during my January cycle and everything I had read, but whatever. I gave up. I did (sort of) what I was told.

I took 2 vials of Bravelle with the Ganirelix dose on Wednesday night, about 8:30pm or so. I ended up forgetting to grab the hcg when I was at the pharmacy on Wednesday night so ran on my lunch break on Thursday and picked it up and took it, which was around 1pm on Thursday, so that was my fault. We still went in for the IUI on Friday morning, 10am, about 21 hours after having taken the trigger.

When we went on yesterday morning for the IUI, the nurse that walked in was none other but the famous nasty-nurse that I spoke with a couple days before (from my original post). UGH. She wasn't wearing a name tag, but I recognized her voice. I had never seen her before, I've always dealt with the same couple of nurses, so this was unexpected. I asked her name just to confirm that she was the same person, and I used this time to apologize for the phone call the other day (Minnesota nice, I don't know... I just needed to clear the air...), even though I really felt like I was NOT in the wrong to attempt to advocate for myself! But, this woman held a lot of power in our life at that moment, so I felt like I needed to do that. Plus, it doesn't matter how mad/anxious/frustrated I was, I said some things that I should probably have held back.

During the IUI, the nurse also told us that if this 3rd attempt fails, THEN we would have the opportunity to talk to our doctor and ask questions. The doctor will then speak with us about converting to IVF. So. frustrating. Why do we have to wait for yet another failed attempt just to speak with our own doctor?? And we're not switching to IVF at this clinic. We'll try 3 more IUIs (insurance coverage) at another clinic, first.

Anyway, these are the longest posts ever. Thanks to those who've read! If others have ended up in a similar position in the past, I would love to hear your stories. I know these boards are completely dead lately, but I feel better getting all this out there in hopes that maybe SOMEONE reading this cares to share their experience! Sorry for the incredibly long, dragged on story!

Rtamom · February 2015

Sorry i have no valuable advice! Just lurking and wanted to wish u the best of luck with creepy internet hugs

Knottie4978096 · February 2015

I agree with you, I'd be uncomfortable with the communication issues at your clinic. I would definitely find a new staff that you're comfortable with. Some of these clinics seem to operate a very 1 size fits all cattle herding for profit business and don't spend enough time with their patients. I ran into one of these earlier this year and although my new RE is more expensive, I'm monitored nearly every day and my questions are answered immediately. This makes a huge difference. Hugs to you and I'm sorry you're going through this. You deserve better.

MagicMikki · February 2015

Thanks, Knottie. We're currently in the TWW with IUI #3, and if this one fails, we will take a couple months off and move on to a new clinic.

In need of advice ASAP

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