IF Testing/Treatment w/o 1.18

keikilove · January 2021

This is a place for those of us who have already started TTC, but have started infertility testing and/or treatments. You can express your thoughts, feelings, and frustrations on infertility. TTC can be a long journey naturally, then add in the difficulties associated with infertility, and it becomes a whole new ball game. The road to infertility can be lonely, frustrating, and complicated, so let's make this a place where we can vent, ask questions, and support one another. Feel free to resurrect this thread at any point in the week if you have something to say. Treat this as an ongoing conversation.

Diagnosis (if you've been):

Status (WTO/TWW/TTA):

What are you doing this cycle? (Testing? Treatment?):

How are things going?:

Any questions?:

GTKY: Favorite movie of all time, and why?

acleverusername · January 2021

This is place is like a ghost town now! (That's a good thing!)

Diagnosis (if you've been): hypoandrogenic PCOS, AMA

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?): Doing a Letrazole + Menopur IUI cycle, hoping for 2 mature follicles! I also have a saline sonogram tomorrow to take an in-depth look at my uterus (I've only had the HSG so far; I insisted we do this one). Finally, I have my first "second opinion" consult at the AZ clinic tomorrow (cheaper IVF than Bay Area). I already sent ahead all of our test results/records, our fertility narrative, and a 1.5 page worth of questions for the doctor there. I'm pretty excited about it!

How are things going?: Doing great! Honestly, I'm currently at my optimal dose of anti-anxiety medication and I'm really feeling so good. It's such a difference from where my head was in September/October. I also feel that I have a really great support network: The Bump has been great and the group of girls I met in my fertility group therapy in Nov/Dec have continued meeting on a bi-weekly basis. I finally also feel like I don't have to rush to get treatment (i.e. to move to IVF). I know doctors recommend trying a maximum of 4 IUIs before moving to IVF, and on the surface, it feels like we're due to move on. However, I dug into that over the weekend and realized that the 4 IUI max recommendation is when all of the "inputs" are good. I.e. sperm is good, follicles are good. However, we've only really had 1 such IUI. So, on those basis, we should be OK to try at least a couple more before moving on to IVF.

Any questions?: Yeah, actually I have a question for folks that have done/are doing gonadotropin IUIs (@laura-kay and I think @ramzlau did that as well?) What is/was your AFC versus how many follicles got stimulated b/c of gonadotropins? What was your FSH dosage?

GTKY: Favorite movie of all time, and why? Oooph; that's a hard one. I haven't watched it in a while, but it used to be Boondock Saints. I should re-watch to see if it still holds true.

laura-kay · January 2021

@acleverusername will write soon! Busy day

keikilove · January 2021

@acleverusername It has definitely been super quiet around here lately! Good luck with the saline sono and second opinion tomorrow. Dumb question, but is it in person? (I’m assuming these 2 things are happening at the same place?) Besides the HSG & now saline sono, have you already done a hysteroscopy? I can’t remember. Anyway, hope it all goes great. And great to hear that you’re feeling confident about doing another IUI.

Diagnosis (if you've been): RPL, HLA/DQ Alpha & Beta match, blood-clotting disorders,AMA,DOR

Status (WTO/TWW/TTA): WTO/WFFET

What are you doing this cycle? (Testing? Treatment?): Natural FET!!! Finally!

How are things going?: Today things are excellent! I had a check-in with my local RE whom I love. I’d sent her all my questions ahead and caught her up to speed on our very busy months of OCT-DEC, telling her that we went to Mexico for LIT & DuoStim. I wanted her opinion on whether it’s a terrible idea to go back to MX for this natural FET, considering how bad COVID has gotten since we last travelled. I also wanted to know what our next steps might be with her if this FET doesn’t work. She said our blood, sweat, tears, and hard work are in MX and that we should go for the FET. No point in thinking about our next steps with her right now—we need to focus on making this FET a success! She also likes all the out-of-the-box things they’re doing in MX and wants to go study at my Mexican RE’s clinic when COVID isn’t an issue and makes that doable. She talked me through how to prep for this FET and gave me questions to ask my doctors about additional things to try, such as Human Growth Hormone (aka Omnitrope, aka Saizen). While we were talking she sent me some of the articles about why she anted me to look into this. I just love her, she’s so amazing.

Any questions?: What did your natural FET prep look like? What kind of timing should I expect? @mvt2003 Now that we are at this step of natural FET, I’m finally mentally able to absorb all your wisdom on this whenever you have the time! 😘 ETA: Specifically, what day does the transfer happen? You mentioned that you were ready to trigger on Day 10 and that the transfer happened 7 days later. Was that with a Day 3 or Day 5 embryo? Can you try naturally (HIO) while also doing the FET?

GTKY: Favorite movie of all time, and why? The epic Bollywood movie called “Asoka”❤️ It’s based on a historic emperor (I love history) who raged war all over India before denouncing violence and ultimately spreading Buddhism across the continent. The movie isn’t exactly historically accurate—it’s part family betrayal, part love story, all with gorgeous cinematography, beautiful dancing (of course!), and catchy songs. I love this movie so much that I pasted the trailer for y’all to enjoy.😄 The movie is old but it's even better than this trailer hints at.

https://m.imdb.com/video/vi3527981081?playlistId=tt0249371&ref_=m_tt_ov_vi

mvt2003 · January 2021

@keikilove Wheeee!!!! So excited!!! IMO, if you can do one, a natural FET is a great way to go! So, referring to my notes, I went for my first monitoring of the cycle on 7/5, CD10, and had an 18mm follie ready to go. I did my trigger shot that evening, and transferred at 2pm on 7/12. I transferred my last 2 Day 5 embryos, I have 1 Day 6 left in the freezer. Technically, you're not supposed to HIO during a FET because of risk of multiples, so depending on what you're transferring you may want to abstain (I've seen stories of embryos splitting!) I was on no meds except my trigger shot and my endometrin, and the major difference for me this cycle was that I took it very easy and did not do intense workouts or a lot of activity. Hopefully that helps, but let me know if there's anything I've missed!!

shoogapoff · January 2021

Lurking

@acleverusername I did gonadotropins with my last 2 IUIs. My AFC was 14. I can't remember how many follicles we got with the first round with injectables, but with the 2nd, we had 3 really good follicles and 2 maybes. My dosage was 150, 150, 100, then scan. They added 3 days of 75 iu on at the end to try to make sure things were good. I was also taking letrozole.

acleverusername · January 2021

@keikilove Yay! FET month is here! Your local RE sounds amazing! I wish that every doctor was as selfless. And the fact that she wants to go study the techniques in MX... double wow! Hopefully you won't need to seek her out for further care, but I feel like she's a lifelong friend for you. All that said, when are you heading to MX next?

On my end, the 2nd opinion consult is virtual, whilst my saline sono is at my local clinic in SF. I have not had a hysteroscopy and it's actually one of the questions I have for both the doctor today and TEW when we consult with her on Feb 3: do I need one? My current RE said "either saline sono or hysteroscopy" is needed, but that's not what I've read/heard on the forums. Hopefully I'll get all of my outstanding q's answered over the next couple of weeks.

acleverusername · January 2021

Ah @shoogapoff thanks so much for that insight! I keep worrying that an injectable round would yield too many follicles, result in cycle cancellation so this is exactly the kind of perspective I've been looking for! 🙏🏻

laura-kay · January 2021

@acleverusername Mine was 150 each day Gonal F. My cancellation wasn’t due to too many follicles - it was due to them maturing too late. I’ve had about 2 mature follicles with the good cycle. The others (about 2 more) were too small to be viable.

acleverusername · January 2021

Thanks for sharing @laura-kay. What does "maturing too late" mean?

Update: had my saline sono and it all looked good: no polyps, or fibroid, or other nefarious things that would prevent pregnancy. My RE did do a monitoring u/s at the same time (she wanted to make sure I wasn't ready to trigger yet... it's only CD7!) and the initial results are positive! I had 1 follicle at 15mm; another at 12; and a 3rd at 8mm. I'll be going back on Friday for another monitoring visit, and I'm hoping the 2 larger follicles will have matured by then. I doubt the 3rd will catch up enough to be a contender. But yay! 2-3 follicles is what I was hoping for! My lining also looked promising at just under 6mm already. I also made my RE laugh: when she inserted Wanda into my vajayjay, I said "I see my lining! It looks to be trilaminar!" She burst out laughing and I replied "if you're looking for an understudy, I'm available!"

laura-kay · January 2021

@acleverusername I mean that my follicles weren’t at the size large enough for a mature egg in time. When everything looked perfect, my blood level showed that I already was ovulating.

acleverusername · January 2021

@laura-kay continuing this convo via a PM!

laura-kay · January 2021

@acleverusername Just responded. Thanks for telling me here! On the mobile site it isn’t readily apparent that there is a message waiting in the inbox.

keikilove · January 2021

Sorry I fell off this week. Been super sick, just lurked a little. Anyway, @kiki047 my RE at home sent me this article to encourage me to use human growth hormone (HGH/Omnitrope/Saizen) to prepare the uterine lining for receptivity. It took me back to you asking what else can be done to thicken your lining. This might be helpful to you. (And others here so sharing publicly.)

https://www.frontiersin.org/articles/10.3389/fendo.2019.00502/full

ETA: Graphic

laura-kay · January 2021

Diagnosis (if you've been): unexplained

Status (WTO/TWW/TTA): TWW

What are you doing this cycle? (Testing? Treatment?): natural cycle (a break from injectable IUIs)

How are things going?: I’m recuperating this month emotionally and physically. We’ve actually enjoyed some time together without treatment. I’m still torn up about some things but I’m better than I was.

Any questions? I read that anti inflammatory meds are a no no during treatments (for implantation). Do you know if they have a negative impact during natural cycles? I hurt my knee and anti-inflammatory meds help so much more than Tylenol

Favorite movie: Return of the King is one of my favorites.

acleverusername · January 2021

@keikilove I hope you're feeling better! Is your being sick impacting your cycle?
@laura-kay so nice that the natural cycle has been good for your mental health and couple health. 👍🏻to your choice of Return of the King; it's definitely my favorite of the LOTR trilogy.

acleverusername · January 2021

Okay, big update incoming. But first, an IVF related Bernie meme for ya'll:

Image: https://us.v-cdn.net/5020794/uploads/editor/wi/k9y1brnu2vvo.jpg

Now, my updates. All in section because I realized I was gonna write a novel shortly after I started.

Saline Sonogram & Cycle Monitoring visits thus far:

That was scheduled on Wednesday at 11:30. It was CD7. The doctor first wanted to do a monitoring visit to make sure my follicles aren't ready for a trigger yet. Normally they're rearing to go by Day 9, so I don't blame her wanting to check. Well, the follicles looked OK: L-14.3mm & 8.6mm; R-12.7 & 9.44mm. HOWEVER, my E2 was CRAZY low at 41. Anyway, I did the saline sono and everything looked good: no polyps, no fibroids, and tubes were open (I knew that from my HSG in August). However, I found it really weird that the doctor couldn't tell me about scarring; she said she'd need to do a hysteroscopy to see that. In the meanwhile, a lady in my fertility support group had hers done a week ago, and the doctor was able to tell her that she had some uterine scarring. Weird. Anyway, I scheduled another monitoring appointment on Friday.

Friday I go in, and now my follicles are: L-13.4mm, 9.2mm, & 9.1mm; R-14.8mm & 9.8mm. That's right, the left one "shrunk". The theory there is that it's actually the non-functioning cyst I had at the beginning of the cycle. And the kicker is... E2 is only at 66! I mean WTF is going on this cycle? For the last 5 medicated cycles, we triggered either on Day 9, 10 or 11. And here I am on Day 9, no where close to ready to trigger. Anyway, I was told to take Menopur right through Sunday, and go back for another cycle visit on Monday. So so so strange. Depending on the size of my follicles on Monday, I might ask the doctor to put me on Cetrotide so that the 2 9mm follicles on my left can "catch up". I REALLY want to have superovulation this cycle.

2nd opinion consult with AZ doc - summary & questions for others:

The other "highlight" of my week was my 2nd opinion consult with Dr. Lipskind at the Arizona Center for Fertility Studies. I booked it all the way back in November and Jan 20 was their first available date. Anyway, we had a REALLY good call with him. For those just joining, we're considering AZ because it's about 30% cheaper than doing IVF in the Bay Area.

One of the great things about Dr. L is that MH really liked him. Some information that I've been telling him (MH) for the past few months really "clicked" coming from this doctor. For example, that we'll most likely have to do 2-3 cycles. Another "fun" thing about the visit is Dr. L is also going for quarantine hair and I made a joke at the start of the call that his hair was longer than MHs (MH last cut his hair on 1/4/2020). But most importantly, Dr. L was able to answer questions that my current RE hasn't been able to answer!

For example, I mentioned that my Vitamin D levels were 30.3, below the normal range. When that test results came back to my doctor, I asked her about it, and she said "endocrine society recommendation is 25-35 so you're fine"; never mind that my levels in summer were 33, just above the cut-off, after which I started taking 5000IU of Vit D. Only to have my levels go down? I've also heard The Egg Whisperer (TEW) say in her podcasts that she wants to see levels over 40 in patients she treats. So, Dr. L said immediately that there's an absorption problem. Now, I've recently changed to a different brand of Vit D and also started taking it with supper - my fattiest meal - plus also with Fish Oil, so hopefully that will resolve it. However, I find it so weird that my RE didn't think it was an issue that required addressing.

Another thing I asked Dr. L is whether or not anything we learned during my IUI cycles would influence my IVF protocol. He said that because I have evidence of a lead follicle developing very fast, he would definitely have me prime. His recommendation of protocol was also very aggressive... highest doses of FSH and Menopur, and possibly even the micro-dose lupron protocol. That's totally the opposite of what my RE has recommended (a very conservative cycle, using 225IU of FSH and 150IU of Menopur).

He also said that he would have gone ahead with an IUI cycle that ended up being cancelled in November because of "risk of post-mature egg". He said that post-mature egg is relevant in IVF, but not so much in IUI cycles. I also asked him about the mechanistic reason for why I develop a lead follicle so quickly and he said that I may be very sensitive to the meds... that my FSH probably spikes right after I start the medication. He said that if I were doing an IUI at his clinic, he's have me starting my medications on Day 4-5, not Day 2 or 3.

Most importantly though, is that this doctor really demonstrated that he wanted to examine me personally – not just go off the exams from my current clinic – before creating a bespoke protocol for me. When my RE recommended the IVF protocol to me, she said she was going with the antagonist protocol because it "works for 90% of people". There's really nothing bespoke in that statement.

Anyway, at this point, all other things being equal, if we do IVF, it'll be in AZ. However, we still have the 2nd opinion consult with TEW on Feb 3, and I'm really looking forward to chatting with her. My fertility acupuncturist mentioned that after consulting with her, even if we don't go with her, she still would answer questions if we have any.

Question I have: has anyone else had vastly different suggestions of protocols from different doctors? Has anyone else had a really high-dose protocol? How did it work out for you? Thanks!

quiltandknit · January 2021

@acleverusername SO glad to see your update! Sounds like you're getting some great information to help you move forward! And dying to hear what TEW tells you!

laura-kay · January 2021

@acleverusername That’s so frustrating when estradiol is low compared to follicles!

My last medicated cycle had some strange “shrinking” as well. It was so weird. I had a new doctor who just works on weekends who said early that I already had a 15mm follicle on day 6! My estradiol was at 128 though. Strange thing is that on day 8, my follicle was smaller! It then took forever for my follicles to get to the right size and my estradiol to get to the right level. I trust my primary RE most, so I’m glad he was there for the second half of the treatment cycle.

Good luck with moving into injectables! It sounds like a good step forward especially since you are reviewing IVF at the same time. It’s great that both you have a good feeling about the RE. That helps so much!

acleverusername · January 2021

@quiltandknit Thanks! Is your appointment coming up this week?

@laura-kay if things aren't ready to go tomorrow, I'm going to ask for Cetrotide to prevent early ovulation so that my follicles can catch up. At this point, I've spent enough on medication so I might as well... I'm not doing a 1 follicle cycle anymore.

laura-kay · January 2021

@acleverusername Maybe that’s what my doctor will be recommending for this next cycle. He said that he wanted to add something to prevent me from ovulating too early.

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