Introducing Myself (SMBC/1st IVF cycle)

crystal_light · September 2021

I'm 36, I'm fat (BMI 47), I'm single (aromantic), and I'm in my first round of IVF. Everything has been going remarkably average for my age. I had to go out of pocket on my treatment because the facility my insurance likes won't take me at my weight.

Yesterday I got to see my growing follicles for the first time and there were a decent number I think (19 over 5mm and a few at the 10-12 range). I am in my 8th day of stimming (300 Follistim/75 Menopur). My nurse guesses I might trigger on Saturday for a Monday retrieval but we'll see. Today is the first day I've felt really bad with nausea and all, so that's lucky I guess.

I am really interested to see other peoples' TTC journeys and to try to spread the love and support. I also think it will be helpful to see other peoples' perspectives because I am a travel client at CNY Fertility, which is less expensive but there is not a lot of hand-holding.

Thanks for reading!

crystal_light · September 2021

Update: I had my second monitoring appointment during stims today. Today was after 8 nights of stims. My follicles did not grow a lot (an average of less than 1mm), but I do have 19 total that they counted. The biggest ones are still 12mm, although there are 3 now at 12mm instead of just one. The nurse I spoke to said this is within normal range, but I think it's so odd to be on so much FSH and see so little growth. My other thought is that I had a different ultrasound tech. She was lovely, but maybe her measuring technique is different from the previous? I've seen at least one study that shows that different ultrasound techs will count and measure differently.

My E2 levels also seem to lag behind normal for how long I've been stimming but are rising (I was 964 pg/ml today and 346 two days ago). I go back on Friday but the nurse said it's possible I'll be stimming until Sunday (13 days of stims) and trigger on Monday to retrieve on Wednesday.

So if I'm overall just slow and my follicles are evening out in size, should I worry? Do your follicles start growing more quickly the longer you stim? Everything was going great up until now . . .

walkawaynee · September 2021

Just wanted to say hello! I am getting ready to start IVF next month and wish you great luck this cycle!

isabelherna · September 2021

Hi there ladies! Good luck with your cycles! OP, I'm single as well and starting IVF, though older than you -turned 40 a few days ago-.

crystal_light · September 2021

Thanks for the hello. And best of luck next month! Looking forward to seeing how you fare.

crystal_light · September 2021

It's exciting and scary to do this single! I just turned 37 so we're closer in age now. I am excited for you! I hope for the best for you.

crystal_light · September 2021

Update: IVF cycle day 14/after 13 days of stims, I have 9 follicles 17+ and I'm triggering tonight (just Lupron, see below about OHSS risk) to retrieve on Wednesday. The nurse told me to take my leftover Follistim (about 300, the same dose I've been taking) this afternoon to give them a last "kick" (I have 4 more that are 15-16 that could be okay and a few in the 12-13 range that could theoretically make it, maybe). I am so grateful and lucky to have so many follicles and so relieved after they didn't grow at all between my second and third monitoring appointments!

My estrogen is about 2700 pg/ml, which I didn't think was very high. But they are calling me at risk for OHSS anyway, so no fresh transfer for me. The good news is all my blastocysts (if I have any) will be PGS tested so I will have a better chance at a sticky baby when they do the frozen transfer. I feel very lucky and very happy today, and also very nervous and pretty bloated.

walkawaynee · September 2021

@crystal_light very good news! Please keep us updated on how the retrieval goes. I won't have a retrieval until probably December and feel like I am going to do nothing but stress from now to then!

crystal_light · September 2021

I'm sorry the waiting is so hard. You can research (depending on your personality this is a good or bad idea), or I guess get a hobby but I *totally* get it. I have been working toward this for a long time and the waiting is horrible.

crystal_light · September 2021

Update: So now I am reading about the Lupron trigger and it's got me worried. Is it less likely to be effective? Are the eggs worse quality? I feel like I am reading pretty much equal (from doctors and studies) that "either Hcg or lupron is fine" or "Lupron might reduce OHSS but also might not develop your eggs properly." Yikes! I think one of the worries is that it won't be enough to surge you after suppression. I did a urine LH test today and it is showing maybe 20 or 25. So there is definitely a surge happening but maybe not a super-high one? Kind of impressive because my blood LH yesterday was below 2.

I guess I will know after tomorrow. No going back now; I've already done both doses.

I feel hit by a truck from the Lupron trigger, btw. I feel achey and bloated around my ovaries and also nauseated and just extremely blah. I am hoping this doesn't last for too long. And that it's worthwhile. I will update on the other side. My retrieval is tomorrow morning! This time tomorrow I'll know things!

isabelherna · September 2021

@crystal_light That's very good news and thank you for keeping us updated! Let us know how things go today.

I read in another forum that the waiting is exhausting in the whole ttc journey. Everything we do, we have to wait and fingers crossed we go to the next step/level. In any case, you're not alone, that's for sure, so let us know how it goes

crystal_light · September 2021

Update: My egg retrieval was yesterday morning. They got 8 eggs total and I will know how many were mature/fertilized today sometime. I feel like that number is low considering how many follicles I had that were an OK size, but there are a lot of factors that could go into that (Lupron trigger possibly not working properly, maybe my "good" egg size is larger than average, etc.). I was pretty devastated because I was just expecting more total eggs, and I sort of felt like it was possible that if the numbers they collected were so low that they probably weren't mature at all.

I am also feeling guilty because they gave me the option of stimming for another day, but I didn't have all the medication I would need on-hand to do that because we were pretty sure I'd trigger on Monday and I'd already re-ordered medications twice. Would that one day have made a difference? We'll never know, and I can't ruminate on it because I did the best with the knowledge I had at the time.

But my nurse was kind of like, you had a lot of follicles but a lot of them were smaller (true), and this was kind of what she expected. So after the hysterical crying on the way back in the car, I am holding out hope, at least until I get my fertilization phone call today. Lots of people don't even get to start with 8; I am grateful. And it only takes one.

Post-surgery wise, I feel great. I mean, I am a little bloated and a tiny bit achey in my lower abdomen, but it's still way better than I felt in the days before the retrieval. I am lucky in that regard as well; I know a lot of people have significant pain/discomfort the first day or two.

All I can do now is root for my 8 little guys!

crystal_light · September 2021

Update: 6 were mature and only 2 fertilized. I am feeling a lot less hopeful; I know the numbers, and they aren't on my side at this point to have any blasts at day 5/6. But the number isn't zero yet, so I'm not allowed to mourn. I feel stuck, angry, and sad.

crystal_light · September 2021

Thanks. Waiting is rough; getting bad news is rougher. It's all hard until it's easy, I guess.

walkawaynee · September 2021

I am sorry you didn't get the results you were hoping for but it only takes one good egg as they say. I forget are you doing a fresh transfer or frozen and are you doing testing?

crystal_light · September 2021

I can't do a fresh transfer because of the OHSS risk. I am doing testing, although really they want to freeze day 3 if they survive because of the low number. However, I honestly think this policy is about the clinic being able to say they did a transfer; if they're not going to make it to day 5/6 in vitro they probably wouldn't have made it anyway. And I would rather have them not make it in the lab then to go through a transfer and be more devastated. Also, if my eggs suck so bad that only 1/3 are fertilizing maybe the quality is very bad so I'd like to see test results. Maybe I am being very defeatist, but like I said, I know the numbers. Maybe I triggered too early; maybe the Lupron trigger wasn't effective; maybe my eggs are just poor quality even though all my hormone stuff is fine. There are so many factors and I don't even know what to focus on or think.

skyee87 · September 2021

Hi @crystal_light, sorry to hear about the results, but echo others in that all you need is one! Was the fertilization done with ICSI?

Typically we anticipate an egg to be mature if the follicle is 16mm or greater. A follicle will usually grow on average 1-2mm a day (although smaller ones could grow on average 2-3mm/day if my memory is not failing me). The effectiveness of the trigger would be based on the number of eggs that you would expect being mature based on size. If a follicle was below 16mm on the day of trigger, there are good odds that the issue is not the trigger. As far as whether it was an egg quality issue, consider discussing with the embryologist (as they may be able to give you more information on the reason why it did not fertilize). ICSI typically increases the odds of fertilization so if they did not use ICSI, it could be one of the reasons for the low fertilization rate (and not necessarily the quality of your eggs). May be worth also asking if they used zymot when doing the fertilization (i.e., selecting the best looking sperm). If the embryologist ultimately tells you that it was an egg quality issue, there are supplements you could take for purposes of a second ER to address this (omnitrope, etc.) (but again, all of this should be discussed with your RE). All of this assumes that you've also done a semen study to determine it is not an issue with the semen (low motility, etc.). Hope this is helpful as far as questions you can ask your RE/embryologist and trying to pin down the cause for purposes of a second ER.

No matter the outcome, be kind to yourself.

crystal_light · September 2021

Thanks very much for the suggestions. The fertilization was done with ICSI, and I'm using donor sperm so almost certainly no issues there (previous births from this donor, young, testing, etc.). My thought about the trigger being the issue is that I had so many follicles, including 9 above 17mm at trigger, and the total number of eggs retrieved mature and immature was only 8. I would have expected some of the follicles that were at 14/15 to at least have an immature egg in them to retrieve. I also was only given .8mg of Lupron at 36 and 24 hours prior. Everything I read seems to say that this kind of drug needs to be given in higher doses to bigger people, not lower, and that it relies on my body's LH surging properly after suppression to work.

I'm just frustrated at not being given any choice or information from the doctor/nurse since frankly I feel I was a borderline risk for OHSS in the first place. Why not give me at least a higher dose of Lupron? Or test to see if my LH actually surged or not? I just don't understand this result. I've scheduled a follow-up with a doctor to see what they think.

crystal_light · October 2021

UPDATE: Both of my fertilized eggs became 6 day blastocysts. Both were biopsied for PGS and frozen yesterday. They have middling grades (4BB and 4BA) but they beat the odds to both make it this far. I am a little confused about the 4 grade because the pictures look pretty hatched, but maybe they graded them pre-biopsy and the biopsy kind of hatched them more? IDK.

In 7-12 days I should have the PGS results, which will matter far more than the grading. This is a real emotional rollercoaster. I am hopeful that at least one will be euploid, but as we know it’s a little less than 50% likely for each of them to be normal given my age. So it’s good news given the previous results but also kind of no news at all because everything counts on the PGS testing.

Also, anyone else have pretty distinctly 8-shaped embryos? Is that from the assisted hatching (thinning a little part of the coat before the rest got thin enough to hatch) or are some embryos just like that? Just wondering.

crystal_light · October 2021

UPDATE: The PGS results are in . . . and both embryos are euploid (normal). It's shocking. I've gone from sobbing because I had only 8 retrieved/2 fertilized, to being shocked that both made it to blast, to now being just unbelievably lucky that both are euploid potential babies.

I have read a lot of very disparate information about the chances that one of these little guys will become a live birth. Some studies say grading still matters, or the day that they became blasts matters. Some say both or neither matter (just the PGS result). But I am counting myself lucky to have 2 euploid, average to good embryos (4BB and 4CC) frozen in a tube. It's against all the odds when I only had 2 fertilized eggs.

Also, this really makes me think that my egg quality is okay, and that my trigger was not strong enough or mistimed. But, fingers crossed, I don't have to do another retrieval. I am so grateful.

Tulips29 · October 2021

@crystal_light I'm glad you have 2 good embryos to move forward with! Just curious, why do you think your trigger was not strong enough or was mistimed?

crystal_light · October 2021

@Tulips29 As for the trigger not being strong enough, I had 20 follicles, and 11 that were 16-21 mm in size (would expect to see an egg in those at least, if not a mature one), and only 8 were retrieved/6 looked mature and 2 fertilized. I was told I was an OHSS risk (from my subsequent research I feel like I was only a borderline risk, but okay, safety first), so I was only allowed to trigger with Lupron. Lupron is generally effective but does have a 1/20 or so failure rate. Most clinics have you go in for a blood test to make sure your LH surges after a Lupron trigger because of this risk. My clinic didn't, and I didn't know about the failure rate until afterward. I home-tested my LH the next morning, and it was only at about 20, which is an okay surge but not the 50 or so you'd want to see, especially with all those eggs to mature. Of course my home test may not be accurate, but I was suspicious, especially because I'm a larger person and they had me on the smallest dose. I have been kicking myself for 2 weeks that I didn't just take the HcG trigger that I have in my drawer. How would they know? But generally I'm a good patient and follow directions.

Possible mis-timing: On the Monday, the clinic did tell me they wanted me to stim 1 more day. However, on the Friday previous they were pretty positive that I was going to trigger on the Monday. So I didn't have the medication I needed to wait until Tuesday (I had already reordered twice from a pricey and irritating mail-order pharmacy they use). When I told the clinic about the medication shortage, they didn't give me an option for them to call in a script to another pharmacy locally or get the meds that I needed overnighted. They just immediately said, "Okay, trigger tonight then," so I went along with it in the panic state I was in. My consistent opinion of this clinic is that they don't really talk things out with you or give you time to decide, you just wait for their phone call and have to make a split-second decision every time. In hindsight, I am of course kicking myself for not having the meds I needed on-hand just in case, but I was already $6K deep in meds and it was daunting.

I thought the other serious possibility was just that I had crappy egg quality. But even bad-quality eggs of correct maturity will frequently fertilize, but then peter out or have poor genetic results. I used a tested donor with previous live births, so I don't think sperm quality is an issue here, which leaves me with my egg quality as the only possible culprit other than the IVF protocol. It's still absolutely possible my egg quality is the problem, I would just like to understand it better. I guess at this point there's no way to know for sure. And I should really just be grateful of the outcome.

Tulips29 · October 2021

@crystal_light wow! First, I'm so impressed with your knowledge of all of this. I wouldn't beat yourself up over anything. At this point what's done is done. You have 2 great embryos which is important. I was also curious because my first clinic had a very by the book protocol and didn't tailor it to me specifically, which I've questioned afterwards and was curious how you knew these could be possible issues. I don't know if this is truly comparable regarding egg quality, but I've had 3 retrievals altogether. My first and second produced 19 and 21 eggs but in the end I had only 1 good embryo after the first and I believe 2 after the second. Then I did the 3rd retrieval right after the second one and all of a sudden had 7 good embryos. Not sure what made the difference as protocol 2 and 3 were exactly the same.

Is your transfer planned yet? Are you going to transfer 1 or both at the same time?

crystal_light · October 2021

@Tulips29 I am so impressed by your ability to go through this process multiple times, and sorry that you had to. I sobbed on multiple occasions over the past 2 weeks thinking I would have to do it all again. It was complex and painful and so expensive. Now the odds are in my favor I won’t have to.

I have heard of other people with similar sort of “up and down” results from multiple cycles, but it has got to be miserable going through all that and getting the short end of the stick twice in a row, and then really nice but also confusing to have so many the third time. I can’t imagine.

I talked to a doctor since my last post and they were pretty dismissive that anything in particular went wrong or even weird during my cycle/retrieval (I was 3 days into being 37 and only 2/6 mature fertilizing was alarming to me, but ok), but that given we have data from that cycle they might tweak some things and find a way to let me have some Hcg for trigger along with the Lupron.

Transfer-wise, I will need to wait until my next cycle which probably means mid-November. Because they are PGS tested, I can only transfer one at a time. And I really would only want to do one regardless; the risk of multiples is too scary for me.

I really wish you the very best of luck! When do you plan to transfer?

crystal_light · December 2021

Update: in case anyone is interested I figured I would continue my saga now that things are happening again.

My FET was 11/24/2021, the day before Thanksgiving. I transferred my 4BA euploid embryo (my earlier post had the incorrect embryo grades for some reason; they are 4BA and 4BB).

Starting 5dp5dt, I tested negative each morning on 4 FRERs. On day 9 (December 3rd) I had my beta hcg test at 8am and waited until 2pm for the call I was sure would be bad news.

But it was equivocal news: my beta was 15. So that could mean a lot of things from nonviable pregnancy to late implanter to the fact that people with high BMIs like mine have significantly lower hcg levels in blood and urine — or any combination of those.

So I have another blood test Monday to look for rising levels. And for the weekend I am grateful not to be entirely “out” yet, and hopeful that it might be okay.

crystal_light · December 2021

Update 11dp5dt, good news spoiler.

Update: my second beta 11dp5dt was 102. The nurse says it looks good. I am shook. With all my ups and downs I am having a hard time accepting it but I am pregnant for real! Another beta Wednesday 13dp5dt but feeling confident.

mbradfo2 · December 2021

Great news! FX for smooth riding here on out.

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Introducing Myself (SMBC/1st IVF cycle)

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Update 11dp5dt, good news spoiler.

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