I have some questions about IVF

suzycupcake · April 2018

Thank you ladies

1. If during IUI cycles, small doses of Clomid causes a woman to over respond and higher doses of Femara were required to get more than two mature follicles, would you consider a mini IVF over regular since injections will also generally be a part of IVF protocol anyway?
2. What do they put you out with during egg retrieval? Do you feel any pain? Is it scary?
3. Does IVF find out what the problem was that IUI couldn't discover? My thinking....I have PCOS, but maybe there is something IVF will find that IUI couldn't.
4. Is there any advice that you can give me since we are now thinking of going with IVF? Like things you wished you would have known starting out, etc.

dragonette505 · April 2018

suzycupcake I cant answer the first question since I never did an IUI and went straight to IVF. Do you know your AMH, FSH and antral follicle count? Those data points are how they go about deciding what protocols and doses might be best for you. So if you have lots of eggs that are likely high quality, mini IVF is a great option, if not, then it might make more sense to go for a standard protocol (since that way, even if you do get a bunch of eggs that become embies, you can have multiple pregnancies and siblings. I think clomid probably works differently than the kind of stimulation you do for ivf (but I'm not sure).
2. Usually they use propofol. Its scary the first time, but usually the biggest fears people have is hoping they get as many eggs as they think they will. One thing you learn in IVF is Follicles don't always equal eggs (sometimes growing follicles are empty). You wont feel anything during the procedure. Afterwards, it really will depend on how many are retrieved. Ive found the higher number of eggs retrieved, the more uncomfortable I am. But that's really relative... ive always gone back to work the next day with no problem and ive never needed pain meds after the procedure.
3. Not really, what ivf does is take the guesswork out of whether or not you are fertilizing eggs. In IUI, they are spinning down the sperm and have stimulated you so you have some good sized eggs, but theres still no telling after insemination if any of the sperm are reaching the eggs. With IVF you will have a lot more info about that aspect. I think as well, your docs will be able to see your egg quality (which they cant really see in IUI) and they will get to see your fertilization rate and embryo development. That's actually a lot of good info. But if you've been following any IVF boards, you can see it doesn't work 100% of the time and docs don't always know why... it can happen right away, or it can take years and sometimes not at all. I definitely think if IUI's are not working, I wouldn't waste time... id hop into an IVF cycle for sure.
4. laaaaaawd.... I think you are already ahead of the curve being on here... I did my first couple of cycles just on my own and didn't have any of the girls on here as resources. I think having that IVF consult, getting preliminary testing done, getting those details about your hormone levels and then coming back here and running it past the crew is a great start. While IVF can work on the first cycle (hoping it will for you), sometimes that first cycle tells the docs more than any amount of blood work.

suzycupcake · April 2018

Thank you @dragonette505

An fsh test was done on cd7 February of last year. That result was 2.3 miu I just realized though they should've done that test on cd3 or does that matter? cd7 estradiol was 119. I read that if the e is elevated on cd3, which they didn't check, it can suppress fsh and make it look like it's normal. But we've already discovered I respond really well to stimulation so maybe that doesn't matter.

I haven't had amh checked since 2014. I cannot remember the exact result but it was over 4 and in the 4s range. I'm wondering if I shouldn't have that redone.

As far as antral follicle count. My right ovary is 15. The left is 4. I remember you telling me before that follicle doesn't always equal egg. I had forgotten about that. We should've just went straight to ivf....ugh

dragonette505 · April 2018

suzycupcake That FSH sounds good. Some clinics prefer day 3 because all the levels will be down to baseline (with nothing lingering from effects of your past cycle) but you are probably fine with those day 2 values. AMH needs to be done yearly as it can change pretty radically year to year (though it doesn't always). If its in the 4 range then you are great. With your AFC it seems to me they wouldn't have to be too aggressive with you... I think the main advantage of IVF is like I said that they are making sure your eggs are being fertilized. with IUI you just have to hope something happens. Also the other advantage is seeing the egg quality... I know with pcos that can sometimes be a bit compromised so it is a good way to know how that's looking too. The other good thing is most places do icsi automatically nowadays, so you are more likely to get fertilization if your eggs shells are a bit thickened and resistant (usually an issue for us older gals so might not be a problem for you).

Alyeena · April 2018

1. I never took Clomid so I cannot answer your first question.

2. I can't remember what they used to put me under now... But there was no pain and it was not scary at all, my husband stayed in the room with me the whole time (even though I was asleep) so it reassured me. I felt some cramping for about two days after but nothing bad. Plus I enjoyed just staying on the couch watching movies!

3. I have PCOS as well, we never tried IUI because we were given less than 5% chance so we went directly with IVF. The answer to that question depends so much on your situation though.

4. The best advice I can give is to take it one day at a time and try to be patient, the wait was the hardest for me but I enjoyed having my countdown to IVF calendar where I would put a big red X on each day, it was satisfying to visualize that we were getting closer. Also don't be afraid to ask questions, it does matter, really no question is silly.

Make sure you double check your medications and the doses. Personal anecdote: At my clinic they would email me the trigger dose I would need on the day of, and the nurse (not my regular one who was off) emailed me and it was not what my regular nurse told me before so I texted her and double checked and she was very happy I did because it would of completely ruined my cycle.

J1006 · May 2018

1. I never took Clomid but was on Femara for all four of my IUIs. I only produced one follicle each time. I questioned the use of this since I should have been producing one on my own anyway. My doctor at the time did say that Clomid would result in more follicles therefore a higher chance of multiples. Also women tend to have fewer side effects with Femara.

2. Yes you are out for retrieval. I was given a small dose of propofol and I don’t remember a thing. Apparently I’m a lightweight when it comes to anesthesia. Recovery was fine. I was back to my somewhat normal self the next day. I went out to dinner and a movie with friends the following evening and was fine.

3. My 4 IUIs failed. We were diagnosed with MFI and used a donor for all four. According to my doctor “it should have worked.” Switched doctors and current RE said we were excellent candidates for IVF even though we still had the same diagnosis. Her guess was an egg quality issue or a fertilization issue. We went from 15 eggs to 5 making it to frozen blasts. We elected to do PGS testing and while we had three embryos come back as abnormal we still had two healthy ones. So I guess it could have been a egg quality issue.

4. Ask questions. Even if you think they are stupid questions ask them. This is a hard one but I feel like it helped personally. Try and stay off of google as much as you can. I know it’s hard. I was just on this morning googling proper levels of progesterone needed. It can become an addiction haha. And the fact that you are already on here is a huge help. The ladies on these boards are awesome! I would also try and find one or two people you fully trust to be your support. I have a friend at work whose sister went through IVF and she was a huge support for me.

kristimh80 · May 2018

@suzycupcake Looks like your questions have been answered

So just chiming in! I did Femara and Follsitim for IUI's last year. I also have PCO - ovaries (not the syndrome part) with a ton of follicles and high AMH. I wish I had skipped IUI's and went straight to IVF. With IUI's, they only give you like a 20% chance as in normal life w/o doctors, etc. With IVF I was given 75% with PGS tested embryos. There's just a lot of benefits with IVF. I had a lot of eggs retrieved, but even so, I thought the actual egg retrieval was a breeze! Just a great sleep! I took it easy for a few days and by Day 5 I was feeling normal again. Just have patience and remember, esp if you decide to do a frozen transfer...the time between retrieval and transfer can see like an eternity, but worth it

Also, with IVF, you'll have a lot more doctor visits...so make sure to plan ahead for those. It's unpredictable but I would do it over in a heart beat

roisis · May 2018

@suzycupcake Hiya, it looks like you've got some good technical advice - so I'm just chiming in too

I also haven't done IUI and know little about mini-Ivf so I won't advise there. Don't stress about the retrieval - you shouldn't remember a thing! As many people have said, most women would be fine to go into work the next day, but personally I'd say give yourself a couple of days off if you can spare them - just to be good to yourself

Have you given yourself an injection yet? Honestly - the first time can be daunting - it's the thoughts of it! But you'll be surprised how quickly you get good at them (and they really don't hurt - and I say that having an extremely low pain threshold!).
I echo the 'ask questions' advice. Plus, I'd particularly say - don't be afraid to ask 'Why?'. I wish I'd ask that more in the beginning. If they say they're going to do 'X' protocol - you don't have to know anything about a different protocol to ask Why they're recommending that one. Plus, as @kristimh80 says - note that IVF can have delays and there can be loooooong periods of waiting. I naively thought "it'll be a month - one month and I'll know what's what". I wish I'd known earlier that due to frozen transfers and cysts and personal circumstance - this process can be quite long. I don't mean to startle you - you could have a very straight-forward one month cycle, but just to be aware that it doesn't necessarily go that way. Best of luck

suzycupcake · May 2018

Thank you ladies. I really appreciate all of you taking the time to respond in support. My husband and I have been sitting here the last couple of days feeling really downtrodden. We really thought IUI would be the ticket for us and

***tw in spoiler

having one loss in the process just made it even worse because it gave us the false hope of “if it happened once...”

my current RE is gonna call Thursday afternoon to discuss. I’ve straight up asked her what her protocol would be for IVF, why she thinks I have PCOS borderline or whatever and what she thinks happened. I experienced some heart palps yesterday after almost 42 days on Levothyroixine so I wanna ask her to draw labs to make sure I’m not going hyper now. Subclinical hypo was found after what I mention in the spoiler which I absolutely believe is related to the meds and that...but I’m not a doctor.

Im honestly not sure if we will stick with her as much as I adore her because there are other clinics that over mini IVF at a less expensive price. Their mini IVF and regular IVF packages are the same price which doesn’t make a lick of sense. I also found out about this new technology called invocell where they do less meds but they place a device into the vagina to natural incubate embryos for 3-5 days which makes the cost of IVF $6500 instead of $11K because apparently those incubation machines cost a lot.

There is a clinic I found 40 mins here who offers it, one of few within a few hours of me, and ...I don’t know. I guess I just want someone to sit down with us and explain our options, chances, etc. if we are gonna be forking over that much, I want personalized care. I know that some places offer deals where if you pay for 2 IVF, they let you go 6 times for free and give your money back if you don’t get pregnant. Maybe this invocell place offers that. I’m gonna check.

The clinic im at now has a really long wait when you go in there on IUI day. It was the same when I was at Kaiser previously. They have one collection room. You have to show up at 7am and wait in line for the collection room. First come first serve. Is that the norm I wonder?

Why did you choose the clinic you are at, what do you love most about it and why do you love your doctor?

kristimh80 · May 2018

@suzycupcake Check out clinic SART ratings online. I chose mine because of high reviews I saw online for doctors. Everyone loves and swears by mine, so made the decision easy. We also thought IUI's were going to be the answser being there were not real issues that could be seen. After 3 attempts I was over it and felt was throwing away $$ that could go to IVF. Best of luck with your RE search!

megmac2010 · May 2018

I'm jealous of all of you ladies who don't remember your retrievals. I remember mine. It hurt, but it's manageable.

wishiwaspreggo · May 2018

@suzycupcake I had my INVOcell counseling appointment today

I probably won't start my cycle until later this summer but I'm in the process now and gearing up for it. Gonna start my supplements up again and work on my diet/exercise. Anyway, I'm happy to chat with you about it! BTW, YGPM!

littlebeastshaya · May 2018

Hey there! How are you doing? Hope you are doing fine. If you have PCOS you can go for IVF. IVF has good success rates for women with PCOS who TTC by themselves. IVF success rate is hugely depended upon:

Age.
Age is a big factor. Women above age 33 do have a hard time with IVF.

Quality of Clinic/facility.
Higher quality clinic/facilities with a good reputation will have higher success rates with IVF.

Type of infertility.
Some women because of their infertility conditions can't conceive with IVF.

Hope my advice helps you. Take care. God bless.

fertilizemeplease · June 2018

Late to this party but soaking in what everyone wrote!!

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