IF Testing & Treatment w/o 05.10

[Deleted User] · May 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.
<div><div><img alt="fertility-process Andrologist Sexologist in Chennai " src="https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fwww.andrologycorner.com%2Fwp-content%2Fuploads%2F2018%2F10%2Ffertility-process.gif%3Fx63741&f=1&nofb=1">
</div><div>Diagnosis (if you've been):

</div><div>Status (WTO/TWW/TTA):

</div><div>What are you doing this cycle? (Testing? Treatment?):

</div><div>How are things going?:

</div><div>Any questions?:

</div><div>GTKY: If you could take a vacation in any time or place, where / when would you go visit?</div></div>

acleverusername · May 2021

@BusinessWife nice GIF find! Lol. That looks like something from a video game. Like a fertility version of Pac-Man.

@kiki047 I didn't comment on your update yesterday, but I wanted to say CONGRATS on such great ER results, especially since you said you got about 50% more than last time; and hopefully your above-average (that how I read your "abnormal" fertilization / PGT-normalness) tendencies from last ER translate to this one as well! 🤞🏻🤞🏻🤞🏻

Diagnosis (if you've been): suspected sperm-related fertilization issues; AMA

Status (WTO/TWW/TTA): WFAF

What are you doing this cycle? (Testing? Treatment?): on the tail end of a natural cycle, and gearing up for IVF with probably mid-luteal stim start!

How are things going?: Had our intake appointment at the new clinic this morning and it went great! I really appreciated that the doctor didn't try and explain to me what infertility was. He basically said "you've done a lot, you know a lot, so let me open up to you to ask me any questions." At which point I pulled out a 2-pager of questions I had composed yesterday and we started going down them. It was a _REALLY_ great discussion; there were points where I was actually completing the doctor's sentences (i.e. Doc: what will Receptiva Dx give us? Me: tell us if I have silent endo. Doc: and how do we treat silent endo? Me: depo-lupron or Letrazole... and, right, we already talked about using Letrazole for semi-medicated transfer cycle. Got it.) I could write an essay but I won't since right now our plan is still hypothetical, depending on a couple of other appointments we have booked this week: ASA test for MH and a genetic cancer counseling appointment to discuss MH's SDHA diagnosis and if we'll need to be doing PGT-M screening (this would take some time to design, so we wouldn't be able to start next cycle). Anyways, the probably protocol now is: mid-luteal phase start, with HGH for egg-quality, and dosages of about 225IU Gonal-F & 150IU Menopur. Doctor suggested we don't do Zymot/PICSI/calcium ianophore activation this first cycle since we don't know if we have a fertilization issue and Zymot/PICSI is really only for DNA fragmentation elimination (and his is fine at 13%). I might push back on this since I feel like 0% DNA frag is better than 13%, plus 13% is average.

Any questions?: Nope!

GTKY: If you could take a vacation in any time or place, where / when would you go visit? I'd go back to Portugal or Aruba. Both of those trips have been the best ones in my life and I'd go back to both places in a heartbeat. I'm not one of those ppl that "there are so many places to see! I'm not going back to places I've already been!"

optimistgardener · May 2021

@acleverusername very exciting about the beginning of your new cycle and your great-sounding doc! I like the sound of your protocol. Very reassuring.

@kiki047 fingers crossed for yr next update!

Hey y'all. I feel like I'm going to have nothing to report for a while so I'll probably just be luuuuurking till something exciting happens but, never fear! I'm just hanging out in the corner over here. Also I'm kinda half-assedly keeping an eye on my temps and using up some old opks wondering whether my body will try to ovulate anyway in spite of the Giant Cyst. No signs yet.

kiki047 · May 2021

@acleverusername thanks friend! Yes, you're right about the above-average results last time (5 eggs, 4 mature, 4 fertilized, 3 blasts, 3 PGT-A normal), which we know is not the norm so it feels like a fluke and that I should be prepared for more attrition this time around. But we shall see. So far still no update.
@optimistgardener I'll be watching for your lurker status while you're in limbo - please do pop in whenever you're feeling up to it, benched or not I still think about you and how you're doing!

Diagnosis (if you've been): PCOS, RPL, MFI

Status (WTO/TWW/TTA): ... lol I don't actually know what you'd call this stage. I'm not WTO but I'm not in the TWW yet

WF fresh transfer

What are you doing this cycle? (Testing? Treatment?): IVF #2 with ER and fresh day 5 transfer

How are things going?: We just got our Day 3 update so our week has been good so far. I'm feeling pretty good, maybe a little tender and sleepier than normal but otherwise no ill effects from Saturday's ER. We did decide we're done with keto though, hah. I just couldn't wrap my head around the restrictive nature of the diet and MH did not feel good on it so we're going to stick with low carb, no added sugars, whole foods, no gluten (bread, pasta), but adding little things back in like some fruit, legumes, etc. I won't be in ketosis but it feels like a more nutritionally complete lifestyle than just allll the meat and cheese.

As of day 3, all 6 of our embryos are still growing. The embryologist said 5 are "excellent", picture perfect textbook 8 cell embryos, and the other one is rated as "good". He went on to say that they always like to show off their best embryos so everyone in the lab was gushing over ours today, which made us feel pretty freaking good. He mused that he doesn't think we have an embryo component to our RPL issues but that he can't prove that beyond just knowing that we have great fert/development rates and hopefully we'll also have good PGT results too (obviously we're not testing the one we're transferring this cycle, but we'll see what happens).

Any questions?: NATM

GTKY: If you could take a vacation in any time or place, where / when would you go visit? If you ask me on any given day, it would be either Hawaii or Japan. I've been to Hawaii over 2 dozen times and would still go back again and again. As for when... oh, you know, like when there's no Covid lol. I'd love to re-live our honeymoon all over again because it was perfect in every way.

bumblebee0210 · May 2021

@acleverusername That sounds great! I'm excited for you to get started.

@optimistgardener You're a welcome lurker anytime. IF treatment has a lot of downtime.

@kiki047 Fx for this week!

Diagnosis (if you've been): DOR, RPL

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

What are you doing this cycle? (Testing? Treatment?): ER #3

How are things going?: Ok-- bummed about last cycle, but this one is going fine. Had my second monitoring visit today, and has 3 in the 10-13 range, and then I think like 8 littles running around. I looked back at last cycle and it's pretty similar, so hopefully I'm again on track to get 7-10 eggs. The novelty of constant ER cycles has definitely worn off, and this one came with some vicious migraines. I might try to take next cycle off to get a hysteroscopy if the timing works out, then try to get one more ER cycle in before we go away in July.

Any questions?: Not really. Has anyone else dealt with IVF migraines?

GTKY: If you could take a vacation in any time or place, where / when would you go visit? I have been thinking about this a lot lately. I have been feeling Greek beaches.

bows22 · May 2021

@acleverusername I’m glad you clicked with the doctor! Sounds like you have great plans in place. Good luck with the rest of your appointments this week, will be excited to see your updates!

@optimistgardener stop by as often as you’d like! Even just to talk about random stuff/jump in on some of the non-TTC related threads. This board is a nice place to pass the time when you’re on hold.

@kiki047 i had chills while reading about your embryos being shown off at the lab. So glad that everything is moving along so well and I’m so so excited for you.

@bumblebee0210 glad your cycle is good so far! I’m sorry about the migraines, that’s awful and I hope you can find a way to fend them off.

Diagnosis (if you've been): unexplained,AMA,endometrial polyps/thickening

Status (WTO/TWW/TTA): WTO

What are you doing this cycle? (Testing? Treatment?) Endometrial biopsy last week

How are things going?: my biopsy confirmed that I do have an endometrial polyp so I have to have a hysteroscopy before IUI. They said I can go on BCP to stop my cycle so that I can get the earliest available time versus needing to be within day 7-14 of my cycle. I don’t really want to go on BC but I don’t want to wait longer than I have to so I’ll just see what they have available and go from there. I left a message for the scheduler and am waiting to hear back. Honestly, I’m a little bummed that I’m not jumping right to IUI but a little time off to lose some pandemic/tax season weight is probably not the worst thing so I’m not too sad.

Any questions? Not really but if anyone has thoughts on being on BCP screwing anything up I’m open to them.

GTKY: If you could take a vacation in any time or place, where / when would you go visit? I’m actually not sure. I do like to travel but it’s more about getting out there and seeing/doing different things than it is about the actual destination. But it would probably be somewhere in Europe and be a food-driven decision

kiki047 · May 2021

@acleverusername I got a little caught up in my update because the lab called while I was typing it out so I forgot to respond about your initial consult with your new RE. That made me a little giddy knowing that you seemed to really click right off the bat. I'm so excited for you to be moving forward with such a great team on your side.
@bumblebee0210 I'm sorry to hear about the headaches - you're such a champ to be doing these back to back ERs. I did one and I'm wiped, I can't imagine being on my 3rd in a row. Makes total sense to take a cycle off before you get back into it. In the meantime, yessss keep dreaming about those Greek beaches, siiigh.
@bows22 oh friend, I wish I could hug you right now. That sucks so much about the polyp, I'm sorry. I hope they're able to get you in ASAP.

I just got a call from the hospital, the referral my RE submitted for me to meet with the geneticist in ... May 2019 (?) finally came through lol. Maybe by the time my appt rolls around I might even have the results back from my bloodwork that we went ahead and ordered even without a consult. I mean, it's kinda late now but I'd be interested to hear what they have to say so I'm going to keep the appt. It's the same day as one of my virtual conferences but I've waited 2 years for this appt, I'm keeping it.

bumblebee0210 · May 2021

I just want to mark the day in which my follistim dose has reached the pen's maximum (450 IU). Feels like a real achievement.

(Estradiol is *really* creeping along this cycle-- it's at 171 on stim day 7. Last cycle was pretty similar and we got 10 eggs, so I'm not too worried, but it would be nice to see it shoot up a little)

bows22 · May 2021

Minor update - I’m scheduled for 7/27 but may switch to 8/3 if they don’t have a surgeon for the first day. But, they want me to go on birth control starting on my next cycle day 1 and take it continuously so that we won’t have the worry about where I am in my cycle if a cancellation would come up.

@kiki047 I would have totally thought after 2 years that I just fell off the list, so I kind of cracked up reading that. When is the appointment?? It will be interesting at least! And thank you, I had my hopes up about doing an IUI next cycle, but I’m oddly not too disappointed about this news. I think because the way the RE explained it was that even if the biopsy came back negative that didn’t mean for sure that I wouldn’t need a hysteroscopy eventually so now it feels like at least when I do get to do an IUI I’ll have a better chance of being successful.

kiki047 · May 2021

@bows22 right?? I just assumed when she called that she wanted to talk about the results of the genetic panel blood test I did last month. But no. lol slightly ridiculous. Like imagine we wanted to do the genetic testing for our first round of IVF? If that had worked I’d have a 6 month old by now.

I’m glad you’re feeling ok with your plan, as much as it wasn’t what you’d hoped. I’ve heard so many stories of women who had the polypectomy/hysteroscopy who went on to have success in the months that followed so I’m keeping everything crossed for you that although it feels like a roadblock, it’s still a huge step in the right direction.

@bumblebee0210 oh man, yeah that’s something worth noting that’s for sure. My doses were like ridiculously low, and my E2 was still 9,000 by CD13. It’s crazy how differently everyone reacts to stims.

bumblebee0210 · May 2021

@kiki047 9,000!!!! mother of god. I am wondering if my low estradiol is somehow indicative of low egg quality (and hence low fert rates). My peak in cycle 2 was only like 1100 with 10 eggs (7m), in cycle 1 was 1900 with 7 eggs (5m), but also a 40mm gigantic follicle/cyst that was pumping out estrogen.

At least I am not paying OOP for these mega-doses??

optimistgardener · May 2021

Thanks guys for encouraging my lurker status! You can bet I will often be kicking around here, seeing what's up.

@kiki047 That's great news that your embryos are looking so good thus far! I'm willing them all forward (onward and upward!) from afar. After all, I do believe @bumblebee0210 pointed out that you owe us all identical triplets now. Also I am laaaughing about that delayed referral coming through after all this time. For what it's worth, my gynecologist referred me to my current RE way back in... early October? And in the meantime, I went ahead and contacted the clinic's office and did the usual intake stuff and then 1.5 medicated cycles this year plus waiting for my (now benched) IVF cycle, and it was only in April that the referral letter finally arrived. Not that it has done me much good as I don't have insurance that covers fertility stuff, but it did let me go back to fight and win a battle with insurance over who pays for the hysteroscopy I did in Jan.

@bumblebee0210 I remain in awe of your steadfastness through these retrieval cycles and agree that you have more than earned some time off from it. That really sucks about the migraines. I know nothing about them and have no expertise at all, and I know coffee is frowned upon in some circles around here, but... have you tried/would you feel comfortable trying a small cup of coffee? Some friends with normal/non-IVF migraines swear it helps. Also dang about that slow estradiol rise. I'd probably be on the same thought train about egg quality if I were in your shoes (which I kind of feel like I might be at some future date). At least if that's the case there's not really a lot (beyond all that follistim you're doing 💪) that you can do about it? I wonder what your doc has to say about this.

@bows22 😒😒 about the BCPs. I'm hella suspicious about them right now especially after my experience last cycle but hopefully they'll not misbehave with you in the same way as they did me. My RE did mention that next cycle he wants to put me on the NuvaRing instead of oral pills because he thinks that a regional option is less likely to produce cysts? In my hazy recollection of the convo he mentioned something about how oral contraceptives have more effect on the brain, which may or may not have been related to my cyst outcome in his schema. Who knows, but maybe worth asking your doc about different kinds of BC?

acleverusername · May 2021

@kiki047 I love that the embryologists in the lab were showing off your stellar embryos! Hahaha. Nerds! 🤓Hopefully this will lead to many PGT-A normal embryos. A word of caution about your E2 levels though... Canada uses a different unit system to report hormonal levels: pmol/L; whereas in the US, it's pg/mL. I realized this as I was looking through / sharing my ER results from Canada with another fertility patient (who is also a scientist) and she confirmed that's the case. So, a E2 level of 9,000pmol/L is ~2,450 pg/mL (link to converter: http://www.endmemo.com/medical/unitconvert/Estradiol.php), which is consistent with how many follicles you had / eggs were retrieved. Also, I'm happy/sad about your genetic consult finally coming through?! Lol. I really used to appreciate the Canadian healthcare system, but with the mismanagement of the Covid crisis and then also cases like yours, I start to wonder if there's another/better way to deliver public healthcare. Now, I don't advocate for the US healthcare system because here, unless you have good insurance, you're effectively effed. Anywho, good luck on the transfer tomorrow! And also hopefully you get a great Day 5 report today! 🤞🏻🤞🏻🤞🏻

@bumblebee0210 agreed with @kiki047said; you're such a trooper for doing all of these ERs back to back! I'm sorry about the migraines; were you prone to migraines before? Or this is a new thing for you. As for taking a break after this ER, it may be wise, but obviously you reserve the right to change your mind. So, see how this ER goes and then make a call. Your body will likely thank you for the rest though. Also, 100% on being grateful for not having to worry about paying for the drugs OOO; that would be about $8-9K otherwise!

@bows22 girl, I'm sorry about Mr. Polyp! What a party pooper! Although, I hugely (cannot understate) admire your attitude and the fact that you're OK will waiting so long until they hysteroscopy. I think I would have died... (figuratively only). You're handling it WAAAAAAAAY better than I would have in your situation. How do you feel about going on BCP for an indefinitely amount of time? Do you think that having TTC off your mind will allow you to focus on other areas in your life you'd mentioned you'd like to improve before IUI? Also, I'm with you on any food-driven destination. That's the thing I love most about traveling.

@optimistgardener I, for one, welcome our new lurker (overlord.)

Quick update from me: still waiting from AF and frig, I'm super anxious for it to come! That said, I only stopped progesterone on Sunday (last dose) and it usually takes 3-4 days after stopping for it to come. In the meanwhile, I emailed with my doc's care team, and he did agree to do PICSI (same as Zymot; for sperm selection). I also asked about taking Letrazole this coming cycle to expedite ovulation (since in non-medicated cycles, I don't O until CD20-21; and in medicated cycles, it's usually CD10-12) so that we can get this show on the road sooner, and he agreed! And finally, I also discussed postponing the cycle if, when it comes to baseline u/s, I don't have a decent AFC. If that's the case, we'll do priming with Aygestin (this is a synthetic form of progesterone). This is the first I've heard about using progesterone to prime but it makes total sense as it will stop natural FSH production, until I start hitting my ovaries with synthetic FSH. Anyway, all in all, feeling super good about the next steps and just hurrying AF along!

Edited: to correct grammatical mistakes that were really bothering me.

bumblebee0210 · May 2021

@kiki047 @acleverusername @optimistgardener
It's funny you guys think I'm such a trooper for doing these things back-to-back-- I think if i had to wait two months in between each of them I would lose my mind. Doing them back-to-back is kind of the only thing saving me. Also knowing I was in for a lot-- so each new one is expected rather than feeling like a failure.

On migraines-- yes, I have always been prone and in the last year or so they have been really cycle-driven-- I get them when I ovulate and when I get my period. Luckily I am married to a neurologist so I get the best possible care, but they do suck. I think I am just having amped-up menstrual migraines from the amped-up hormones.

Also that makes SO much more sense on the E2-- I was like I have *never* heard of someone getting near 9,000. But I still think my E2, which is more like 150 per mature egg, is pretty low, and makes me wonder if some of these "mature" eggs are not. Or it's possible I just metabolize hormones differently. Who knows.

bows22 · May 2021

@acleverusername thank you! I don’t really know why I’m not more upset about the wait. I wish I didn’t have to wait so long, but I’m almost glad there was a polyp so that maybe removing it is something that can give us a better chance if that makes sense. My hesitation with the BCP is more about how I’m going to feel on it. Now that I know I have a polyp, I don’t have much hope that I would be able to get and stay pregnant, so not being able to try doesn’t bother me. I think they would recommend that we TTA anyway (they did last time I had one) so this takes the decision out of my hands.

inthewoods23 · May 2021

*popping my head in*

@optimistgardener you're not the only hardcore lurker lol. I mean yeah I'm IF, but I don't have anything to contribute but my past experiences while we're back to trying naturally. We did have for a brief period of time a TTA/benched/waiting weekly thread that might be good for the few that are waiting for extended periods of time for things to start up for them.

@kiki047 yay embryos! You're off to a good start. I can't believe your fresh transfer is tomorrow! Eek!

@bows22 I like your positive thinking! When discussing having my hysteroscopy/polypectomy surgery to "clean me out" after my SHG showed an irregular lining and possible small polyp, my RE mentioned that they like to do things so that everything is as perfect as can be. So I totally understand being glad a polyp was found since it turns it into a "let's make this place pristine while we're here" kind of situation.

acleverusername · May 2021

@kiki047 Happy Fresh Transfer Day!!! I can’t find my token gif 😭 so I hope this is sufficiently 🍀 ! 🙏🤞🏻

[Deleted User] · May 2021

GL today!!! @kiki047

keikilove · May 2021

Thinking of you @kiki047 and praying the little freshie snuggles in nicely in the coming weeks!💗🙏🏽💗🙏🏽💗

bumblebee0210 · May 2021

@kiki047. Thinking of you! Hoping things went well yesterday and you are resting and feeling good.

AFM: ER is likely Monday or Tuesday. Really Tuesday or Wednesday-- I am going a teensy bit slower than last time, so no reason to think they would trigger me before day 12.

I am thinking about trying an estrogen priming protocol with the next cycle, since I need to get a hysteroscopy anyway, I can use the "off" cycle to do the priming. My only worry is that if I take the next cycle off, and my natural cycle is super long for some reason (is this a real thing? Or did I make it up?), then the 2-month priming protocol could push the ER into our summer vacation. I had originally wanted to take this next cycle for the hysteroscopy so I didn't end up with an ER in my first week or teaching, but I am so impatient part of me just wants to do two more antagonist cycles before we go away (since I basically know we could fit those both in), and do the hysteroscopy afterward.

Also-- for the nerds (ahem @acleverusername @optimistgardener), my doctor just emailed me the full, detailed EPP and I found it interesting-- it definitely gives some insight into the dosing choices and how they adjust things. In spoiler because long.

q Cycle day 1 is the first full day of a full flow. Start checking for ovulation on cycle day 11 with an ovulation predictor kit (for patients with REGULAR cycles that are <25 days or >32days, take the average cycle length and subtract 17. This is the day that they should start LH kits). Patient to call the office with a positive surge. If no positive surge by cycle day 17, have them come in for a progesterone level

§ If day 17 P4 is >5, then consider the patient post ovulatory

§ If P4 is <5, then repeat progesterone level q 2-4 days until >5

§ If second P4 is 1.5-3, repeat in 2-4 additional days;

§ If second P4 is still <1.5 patient can start estrace

q One week after the LH surge or day of confirmed ovulation (Progesterone >5), the patient will start Estrace 4 mg (2 mg x 2 tablets) PO q hs. Estrace is usually taken 10-21 days and the patient will menstruate while on the Estrace. The patient should take their last Estrace on day one of menses

q Patient to call first day of full menstrual flow. Appointment for ultrasound, E2 and beta hCG on CD2. Expect estradiol level to be elevated

q On the evening of CD1 (evening before baseline appointment), the patient should start Clomid 100mg (50 mg x 2 tablets) each evening for 5 days AND Dexamethasone 1 mg (0.5 mg x 2 tablets). Dexamethasone is continued until the day of trigger

§ Tamoxifen 20mg po can be substituted for clomid 100mg at provider’s discretion

q On CD3, the patient should start gonadotropin medications which should be taken at the same time every day between 7-9 pm. This is stim day 1

q The first ultrasound appointment will be on stim day 4 (after three days of gonadotropin stimulation and five days of Clomid)

§ If E2 <100, increase FSH by 75 IU, and repeat monitoring in 2 days

§ If E2 100-150, increase FSH by 37.5-50 IU, and repeat monitoring in 2 days

§ If E2 150-200, increase FSH by 25-37.5 IU, and repeat monitoring in 2 days

§ If E2 200-400, no change in dose and repeat monitoring in 2-3 days based on follicular size

§ If E2 400-600, decrease FSH by 37.5-50 IU, and repeat monitoring in 2 days

§ If E2 600-750, decrease FSH by 50-75 IU, and repeat monitoring in 2 days

§ If E2 >750, consider cancelling cycle

q When E2 400 OR stim day 6 OR lead follicle >14, start antagonist that night and then q am

q After any needed adjustments to current gonadotropin dose are made, add Menopur75 IU q pm to the patient’s regimen when antagonist is started - if not already using an LH product

q Plan for hCG trigger when there are at least 3 follicles greater than 18mm and several 14-18mm.

optimistgardener · May 2021

@bumblebee0210 Woah, dexamethasone! It's a tiny dose compared with what a chemo patient takes, but it's so interesting how there are occasional overlaps in medication between infertility and oncology. FWIW my mom hated the stuff, but she was taking a big fat dose.

I have lots and lots of sympathy re: trying to figure out your summer calendar with the next retrieval. I can see why you'd be interested in seeing how your body does with the estrogen priming protocol, especially since you've been a bit frustrated with the standard antagonist results? When you have a natural cycle, how much longer is your "long" cycle vs. a more standard cycle? Can you go back to your old FF (or whatever program you've used) record to see how often those cycles happen? Are we talking a 1 in 6 chance? Also, could your doc talk you through your body's likely reaction to coming off all the big gun stims? Is it more likely to respond by, like, taking a holiday of its own and doing a long slow meander of a cycle? Or will there be leftover effects that will encourage a quick little cycle? If, on the other hand, you just squeezed in another couple of antagonist cycles, would the likely result of those cycles be a surer bet than experimenting with the EPP? [This is the thought train my brain takes when faced with this decision.]

@kiki047 I hope everything is going well! 🍀🐣

afm, I've been idly keeping an eye out for signs of ovulation this month with this huge cyst on board because I can't help but be my own personal science experiment. So far (cd16) it seems like I might have an anovulatory cycle (I always flip an OPK by day 13 in a "normal" month). My temps are bouncing around in the range of my usual follicular phase. If the trend continues, this would be the first anov cycle I've seen since I started tracking my cycle 3 years ago. I'm curious how long it would take to menstruate without the usual "priming" functions of ovulation --> corpus luteum/higher progesterone, etc. Or maybe I'll still ovulate but be very delayed? I wish I knew what that cyst was doing in there. I occasionally think I can still feel it (GO AWAY DUDE) but who knows.

bumblebee0210 · May 2021

@optimistgardener. Yeah-- I was pretty against moving to the EPP because unless it's going to get me more than 2x the number of blasts, why take up two months? But since I have to burn a month for a hysteroscopy at some point anyway, I thought it might be worth a shot.

The thing is-- of course I wish things were going better. But realistically, I have an AMH of 0.42 and a history of RPL, so two blasts per cycle, and a high-ish-but-maybe-not-terrible aneuploidy rate is kind of on the good end of what is reasonable to expect. I think that is my doctor's take anyway-- the antagonist is working. It's just that what "working" means for me is getting one normal blast per cycle. If I only wanted one more kid I would probably be KU by now. So I am tempted by the EPP because what if I do it and get 3 or 4 normal blasts and am done? But I don't think there is any real reason to think the antagonist "isn't working". I just have DOR.

Also-- on long cycles, I basically never get them, I think in 25 cycles I can count 1 or 2 that went longer than 30 days, and it would have to go >35 to actually mess with my vacation timing, but I had it in my head that people have long cycles after ERs? I have no idea if that is real or not.

optimistgardener · May 2021

@bumblebee0210 it seems like you might be on your way towards a decision in favor of continuing the antagonist protocol? Either way, it seems like you are making solid decisions with good bases behind them. As a fellow DOR person (amh .36, but as I like to tell/mislead myself... if I had 2 ovaries maybe I'd be a .72!🙃) I am so grateful for your level-headed example so I can keep my own expectations in the realm of reality.

acleverusername · May 2021

@optimistgardener the cyst is messing up your cycle big time. You often hear stories of ppl who are getting negative pregnancy tests, but still haven't gotten their period, and the reason for that is: CYST! So, what's likely happening is that cyst is keeping your estrogen levels too high for your body to do anything.

@bumblebee0210 thanks for sharing that protocol w/ us. I've seen it before and I think it's actually gonna work really well for you. A DOR friend of mine (met on another fertility forum) did 4 ERs last year (just oocyte freeze-all, no fertilization) and 3 of 4 of her protocols resulted in quite a gap between a crop of large follies, and a crop of additional smaller follies. Well, then she was put on that exact protocol (except the addition of HGH; she's 36) and it made A HUGE difference. Here are some charts for you (note: only sharing details of the final protocol; however the follicle scatterplot will give you an idea how it worked better than the other protocols. I have those details too and can DM them to you):

Image: https://us.v-cdn.net/5020794/uploads/editor/97/6kcvpk3w7k2w.png

Image: https://us.v-cdn.net/5020794/uploads/editor/ef/a8s9j22nhv5n.png

As for long cycles, I too heard that sometimes you get a longer cycle after an ER. In my situation, I _thought_ I had longer cycles after medicated cycles. (I.e. cycle in Feb, I didn't O until Day 21; that was right after a medicated + IUI cycle; this past cycle, same deal, O on Day 20/21; also after medicated + IUI cycle.) However, I've also had inconsistent O before starting Synthroid last July, at which point I've also had cycles where I O'ed on Day 20-21; and also had cycles where I O'ed on Days 16, 17, and 18. Anyways, context aside, what I've done this cycle is asked my RE to give me Letrazole to "expedite" O so that we can start stimming quicker. I *know* that in medicated cycles, I usually O Days 10-12 and I wanted / needed that control. Perhaps this is an option for you too? Worth discussing with your RE anyway.

OKAY! BIG updates from me. My period arrived yesterday (well, technically on Wed at 6pm, but my clinic counts yesterday as Day 1). So, this is IT! My clinic uses mid-luteal phase protocol for patients in my age range, so I'm actually starting stimming this cycle, after Ovulation. Also, because I'll be taking Letrazole (2.5mg) to get to O faster, my current projected baseline u/s date & start of stim date is Friday May 28. It _might_ happen earlier, because as I mentioned above, I usually O Day 10-12 during medicated cycles, but I've only ever taken 5mg or more of Letrazole; this time I'm only taking 2.5mg so it might take a few extra days. Anyways, the current starting protocol is: 225IU Gonal-F; 150IU Menopur and 25IU of Omnitrope (HGH). Projected retrieval date is week of June 7. Eeeeek! I'm so excited about it all! Also, yesterday MH had this ASA test (anti-sperm antibodies) so we'll see what the results of that is shortly. Finally, on Wednesday we had an appointment with a genetic counselor regarding MH's faulty SDHA gene results from a few weeks ago, and turns out they booked the wrong appointment type for us; we should have had a genetic doctor in there along with the counselor. So, we're having a re-do this coming Thursday. The most important fertility question arising out of this appointment would be whether or not to PGT-M test our embryos. So, I also need to take a cancer screening test to see if I'm a carrier for this faulty gene. That's gonna take about 3 weeks to get those results back, so – if we're getting close to retrieval when we get them back, and they're not favorable – we'll need to act quickly and do an oocyte freeze-all cycle because PGT-M testing requires special preparation.

optimistgardener · May 2021

@acleverusername oh yeah i have no doubts it's messing things up. i'm just curious how exactly it's messing it up.

Edit: oops. Hit save without finishing my thought.

Congrats on the hitting CD1 and all aboard for the action part of the journey! I'm looking forward to hearing how it all goes, and I have my fingers firmly crossed for you that it all goes even better than hoped.

Edit 2: update: I'm having an LH surge!

bows22 · May 2021

@acleverusername so glad all of your plans are falling into place! Could the results of the ASA test change things?

acleverusername · May 2021

@optimistgardener

Image: https://us.v-cdn.net/5020794/uploads/editor/s6/s25ca727bxjn.gif

@bows22 Nope! If anything, it would just explain why we haven't been able to conceive; the best treatment for ASA is IVF. 🤷‍♀️

optimistgardener · May 2021

@acleverusername I've never had someone direct a gif at me before! I feel honored. 💚

acleverusername · May 2021

Watched this documentary this morning; it's really good (also, TEW is in it). First of all, the variety of cases presented is excellent: a couple with azoospermia; a couple with RIF and having to use a surrogate; and even has a transgender male/couple. It also explains some complicated topics in ways that makes it easy to understand. Specifically PGT testing and how there's evidence that embryos themselves kick out the abnormal cells out of the inner mass of cells, into the trophectoderm. So, given that PGT testing is only sampling the cells of the trophectoderm, it can lead to mistakenly classifying normal embryos as abnormal. I watched it with MH cause I wanted him to understand what we're about to go through; it worked.

optimistgardener · May 2021

@acleverusername thanks for sharing this documentary. I cried 😭! But you're so right--it was excellent. I especially appreciated the woman who described her baby as not so much a miracle but rather "the spoils of war!" I totally feel what she's saying there. And I also was glad for the attention to non-traditional families and the fertility challenges experienced in the Black community. The discussion of mosaic embryos and the limitations of the classification system made me think about our conversation here a few weeks ago.

bumblebee0210 · May 2021

@acleverusername. Thx for sharing-- I'm interested to watch, especially since we have a low-level mosaic embryo on ice. And glad you're getting the show on the road! Also thanks for sharing the EPP results.

AFM: I'm not having a great cycle-- I have 5 big follicles ready to be triggered (almost surely tonight), but nothing else even within range (I have 10 more <10). My estradiol is around the same as last time (when I got 10 eggs), so I am interested in what happens this time, since my theory was that the low estradiol per egg was an indication of poor egg quality last cycle-- maybe having the same estradiol with half the number of follicles will mean better fert rates? Just trying to put a positive spin on a potentially disappointing cycle....

I think if this one is a bust, we will almost surely go to EPP. If not (I am laughing thinking maybe we will get *exactly* the same as the last two-- 3 fert, 2 blasts), then I'm not sure. I'm a little worried the EPP will make my migraines a lot worse, but who knows.

optimistgardener · May 2021

@bumblebee0210 I'm so sorry you feel like you're not having a great cycle. I am excited to hear that your estradiol levels are higher (on a per egg basis) this time, though! I hope your theory is correct and that you'll get a better ratio of viable embryos. Fingers crossed for your retrieval and for fertilization.

kiki047 · May 2021

Sorry for the late responses, I haven't been on a computer all weekend and I hate mobile bumping. Thank you everyone for your well-wishes. I had a major panic attack on my way over there for no good reason other than I think I was just triggered by everything, but despite being over an hour delayed, the transfer went smoothly. We transferred a 3AB Day 5 embryo that the embryologist was very happy with. I'm going to add a *TW* for this just out of respect and to be sensitive as I know there are others going through the process as well and I know how hard it is not to compare results. All 5 of our remaining embryos made it to blast (2 Day 5 and 3 Day 6) - of that, 4 were biopsied for PGT-A and the last 1 was frozen. Grading was a little all over the map but we're extremely pleased with the results as I know that we are the exception, not the norm, to IVF attrition rates. For that we are so, so grateful. Grading was 3AB, 3BA, 4BB, 5BB, and a 6BA. Hoping to have PGT results back in 2-3 weeks, and my beta is next Tuesday.

@acleverusername thank you for the tip on E2 levels - my clinic doesn't have any kind of patient portal so I don't get copies of any test results and nothing is written down for me. So when my RE quotes levels in passing, it's usually when I'm in the stirrups and he's looking at the US results saying "looks good, lining is at ___, and your estradiol is over 9,000 so we're ready to rock and roll on Saturday". None of my hormone levels ever seemed to line up with what I read online (almost 100% US-based) so now it makes more sense why that is. Like I don't know what it means that my AMH is 66.9? 66.9 what? I think it's usually stated in ng/ml but my RE read it, decided it was fine and we've never spoken about it since.
Hope your upcoming (proper) consult with the genetic Dr goes well, and that you're off to a great stim cycle!!

@bumblebee0210 I'm so sorry this cycle has not been kind to you. I hope your theory is right and you have 5 great follies in there. My RE insists on quality over quantity, so I'm keeping everything crossed for you that those are 5 of the best quality eggs you've produced thus far!

[Deleted User] · May 2021

That sounds like an amazing cycle @kiki047 Congratulations!!!! Fx for you <3

@bumblebee0210 (((hugs)))

[Deleted User] · May 2021

Morning monitoring happened today, just anxiously waiting over here for my results. And so tired. Glad I don't have to go anywhere or try to WFH today, either.

Maybe it's just the tiredness and coming down from the weekend, but I guess I'm just feeling kind of blah at the moment. My eating has been all over the place so far this cycle, but I'm choosing not to beat myself up over it, with everything that's been going on. I just cracked into a big ole bottle of beet juice, so that evens it all out, right? I don't really think anything I do or don't do is going to change the outcome at this point, apart from timing / following doctor's orders, so it just feels like I'm kinda going through the motions. Which is fine. I have learned from experience that being all into it and hyped is not a prerequisite for any particular cycle working or not working.

Also just still sort of grappling with the whole being done with treatment thing. There is a part of me that so wishes we still had sperm on ice to give it all another try, but at the same time, not necessarily having DH on board would technically become an impasse either way, so maybe it makes things a little easier to accept. I have been looking more at adoption resources as well, though I'm sure if this doesn't work, we would need to take a beat before starting down the next path... In my heart, I just want this to work so badly, I'm not really ready for it to be over yet. :/

optimistgardener · May 2021

More later but I'm sending you a great big internet hug @BusinessWife.

laura-kay · May 2021

Such a crazy week - just posting a quick update. I had my appt with my doctor about next steps. We are still thinking through the options. Also, today is CD1, so that’s that!

[Deleted User] · May 2021

(((hugs))) @laura-kay I have been thinking of you! Glad to see your face :)

laura-kay · May 2021

@BusinessWife (((hugs)))! thinking of you too!

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