Entering the world of Assisted Conception...like it or not...

[robinsonmom]

No bfp. I had af and on day 4 tomorrow of second round of clomid 100mg I can this going to be my bfp month I just know it! That clomid has very little side affects with me and extreme ovulation.

 

[Hiker1]

Good luck Robinson! It's just a matree of time!

Bee, there is always a risk of multiples with multiple follicles, but for the 2 months I did IUIs it was helpful to know the statistics for 1) a reality check and 2) how likely is the risk. For example, at our clinic I've been told repeatedly that on any given IUI whether with pills or injectables, the likelihood of getting pregnant at any given cycle is 20% and no more. Then, of those that get pregnant, depending on the number of follicles, there is a percentage of chance per follicle. Last iui when I had 5 follicles (not all mature ) they told me 20% chance of conceiving, 10% chance of twins if I conceive, and 3-5% chance of triplets or more. We went ahead with it because when you added all those factors in, it was still quite low. This last time, with 7, the chances for triplets or more was much higher. They didn't give us percentages that time but it was clear that both doctors were uncomfortable with it, as was my hubby. And while it was hard to voluntarily skip last month, I can't imagine having to ever decide selective reduction. Ever. We were going to go with another round of injectables but they couldn't give us any assurance that they could get the follicle numbers under control, so that's why we are onto ivf. Hopefully you won't get to that point, but it is crazy the number of judgement calls, decisions, and ethical questions that cam so quickly come into play when you start down the road of AF. Did the doctor give you any kind if game plan in terms of how many rounds she'd try of oral meds before considering injectables? Or just one month at a time? At our first appointment, our doc was quite cLear about the plan for us and how quickly we should move given my crap ovary status.

 

[beemeck]

Thanks Hiker. It's so crazy because when it was other people, it was easy for me to see that the risk is low but with myself, I feel panicked! lol. I guess that's life. I'm just worried that if my doc is right, and my cervix is my problem, well then we know that DH and I are super fertile otherwise since we got pregnant the first month we stopped using condoms! I guess that's what makes me extra nervous. She said she will only do IUI with up to 3 follies for me because of this - will cancel if there are 4. So injectables will probably never be an option for me - I'm on the lowest dose of femara right now and could have even done an unmedicated cycle since for me, the eggs aren't what the issue is. She did say that after 3 failed IUIs, the plan would then be a hysteroscopy to take a camera into my uterus to see if that's the problem and that's why the first one bypassed the uterus and implanted in my cervix. So that will be our next step.

I believe that she told me that there is a 30% of pregnancy for the IUI. I wonder if it's because we have different doctors? She said 10% chance for twins and 3% for triplets. But I actually don't give a lot of meaning to those numbers because so many women are getting IUIs with different conditions and situations that it can't be across the board stats. So I'm just trying to think about my situation specifically and then there is just too much unknown to come to any real sort of conclusion. DH and I would love twins and I would be okay with triplets but sheesh - scary! So since they won't even do an IUI on me with more than 3 follies, I just need to take deep breaths and know that it will be okay. I can't be scared of a bfp after a years worth of fear for bfns.

my ultrasound is next friday morning. would love to run into you there! what is going on with the IVF process right now?! I'm so excited for you!

 

[Hiker1]

I wonder if they give different statistics based on our situation? I've heard 20-30%kicked around at that office. I seem to remember my doc saying that wasn't specific to me, just that in general people going to that doctor already have various issues, and overall that's what they see as a success rate. He told me 30% chance of ivf success, which I was a little discouraged to hear...

The multiples thing is such a conundrum. I mean the idea of raising 2 or 3 infants may sound great but in practice would be so challenging. Then when you look into the realities of the dangers to the mother and children, it gets less than ideal pretty quickly. I was on board with twins too, but now back on the one at a time plan. I think once it's time to decide, I'll start with one embryo and only consider 2 if 1 didn't work. But in the end it's all such a personal decision and sometimes it works out that the decisions are out of our hands (ie what if an embro splits??)

For me, now I'm just on birth control every day. My big box o' ivf meds should be arriving today. (I've heard it's insane...I'll post a photo) next Wednesday I'm taking a day off and having a Sonohyst to prep the ivf retrieval route. That's all for now!

 

[beemeck]

yeah the percentage thing could just be the docs too. I guess I kind of got the impression with dr homa that you had kind of implied with your "let's do IVF right now, oops we can't make that kind of decision so quickly". She was a little flighty, it seemed. oh well, she is helping me so I'll take it! perhaps I'll meet dr heicht one of these days.

post a pic of the box! are they all injectables? my trigger is being delivered to my work today lol. I had a package stolen from my mailbox/doorstep a few weeks ago so I'm having it delivered here. I was pretty shocked that it was $60 since everything else has been covered...

 

[BronteForever]

Good luck everyone. Lots of exciting things are happening.

Multiples are such a personal choice and I've found that with many things in this journey you won't really know what your decision is until the time you are faced to make it you. You can prepare yourself for all the possibilities it could go based on others, stats, and more, but until the doctor reveals your specific case and your results, you won't know what you will do.

It's great to have a game plan and a firm deciding line you don't want to cross, but it's also good to remain somewhat flexible at the same time. Because yes triplets are scary, selective reduction would be incredibly hard, and multiples can be dangerous to both babies and the mother. It's also possible everything could go fine. Only you know what is right for you, and what you could handle. And there's no wrong decision, because it's YOUR decision.

When we first started this we thought if it would come to assisted conception, we'd do everything we could and then stop before IVF, but now that IVF is really the only assisted conception option available to us and we have done much more research on it, now we are moving forward with it.

 

[lemon_tree]

It's interesting to hear the different stats doctors quote.

My doc said 10% chance with IUI, 40% with IVF. But I've got no idea where these numbers come from!

Good luck to you all. It's so exciting to see things moving forward for everyone!

 

[Hiker1]

Can you see my box of goodies I got today? Holy moly!

 

[Smille24]

Hiker- that is so overwhelming . I really hope this all works out for you hun.

Robinson- I'm so sorry for af. I'm so happy you're optimistic about this cycle. I was too up until after the IUI (but that is a whole other story).

As far as the percentages, I think it varies depending on the couples issue(s). My dr never gave percentages as far as the IUI due to dh's sperm issue. We were told IVF was 50/50.

 

[robinsonmom]

5 days until the Big O!

 

[star_e]

hi all. i recognize some of you from other threads. i want to give you a bit of my backstory and if you have any advice/comments, please let me know.

im 34, have pcos, do not ovd on my own. first cycle did 50 mg clomid, no response. 2nd cycle (the cycle that i am on right now at cd22), i was given 150 mg of clomid and was told i did not respond by one doctor, but then another doctor told me that maybe i did respond but perhaps it was slowly. there are two docs at this clinic and one of them was out this friday and so i had to see the other one and thats why i got conflicting info. b/c one doc felt clomid was not working for me, she added, some follistim injections mid cycle.

i did four 75 uis and still only had the same one 12mm follicle. so the doc added 4 more, by the time i had done 3 of them, i was in a lot of pain, was experiencing symptoms i had never ever experienced: ewcm, tender breasts, discomfort in my ovaries, lots of pins and pokes. apparently i over-stimmed.

the doc tried to convert me to IVF, but i told him no b/c my insurance does not cover IVFs. he still strongly tried to push it, telling me that b/c of my pcos, i will always over stim and he doubts that doing iui will be possible for me (b/c he says its unlikely that we will get me to only have 1-3 follies develop; on friday i had one at 15mm, one at 13mm, and like five at 12mm). his lack of enthusiasm for trying iui, which is covered by my insurance, made me feel very anxious. i dont want my only option to be ivf.

does anyone here have pcos? have you been able to use injectables? what protocol has worked for you? oh and DH's sperm has not problems (forgot to mention that above).

many women on other threads i am a part of have suggested femara, which i will absolutely bring up at tomorrows appointment. i just want to know if those of you who have switched to IVF, did you do IUIS first? im not in a position to do IVF right now; i am just hopeful that the doc is wrong and that i will have at least a shot at doing iui.

tomorrow they will check my follies to see if the bigger follie continued to grow even after i stopped doing the injections.

i dont know what to make of all of this and am troubled b/c the docs seem to really want ivf. this makes me feel like they wont really try for iui. im considering looking into other clinics, but i am going to wait until tomorrow to see if the doc is a bit more receptive to working with what my insurance covers.

 

[BronteForever]

Hey star_e. I really hope the meds start working for you so you don't have to try much further. I can't comment since IVF was really my only option since I have tubal issues. However, you have to feel comfortable with your RE and if you feel like they aren't listening to you then certainly be open to trying someone else. Money is a big concern for all this and if they aren't listening to your concerns then they aren't doing their job. They can tell you all the stats and give you their opinion on what will and won't work. But you need to be comfortable (within reason) at every stage. Good luck!

Hiker - do you mind sharing what pharmacy you used? My goal within the next few weeks is to look into different pharmacy prices. This process is so expensive and my insurance doesn't cover anything. I'm hoping at least some of the meds are covered. But I want to get that cost down as much as possible.

Good luck with everything. So exciting you get to start soon. Good luck!

 

[star_e]

Hey star_e. I really hope the meds start working for you so you don't have to try much further. I can't comment since IVF was really my only option since I have tubal issues. However, you have to feel comfortable with your RE and if you feel like they aren't listening to you then certainly be open to trying someone else. Money is a big concern for all this and if they aren't listening to your concerns then they aren't doing their job. They can tell you all the stats and give you their opinion on what will and won't work. But you need to be comfortable (within reason) at every stage. Good luck!

Hiker - do you mind sharing what pharmacy you used? My goal within the next few weeks is to look into different pharmacy prices. This process is so expensive and my insurance doesn't cover anything. I'm hoping at least some of the meds are covered. But I want to get that cost down as much as possible.

Good luck with everything. So exciting you get to start soon. Good luck!

How many IVF's have you done? I agree, if I still don't feel comfortable after tomorrows appointment, I will seriously consider looking at other clinics. I hope tomorrows appointment goes better than Fridays.

 

[Smille24]

I was diagnosed with pcos by my RE. I have a high ovarian reserve, but they were not maturing properly. I was ovulating on my own but they were poor quality. If clomid is not working, try Femara. IUI is definitely an option for you with either pills or injections to help your follicles mature. They can also prescribe a trigger shot to force ovulation when your follicles are mature enough. It sounds like your dr is not listening and working for YOU. Pcos is very easy to treat. If they aren't willing to listen, I hope you have to option to find another dr.

 

[BronteForever]

Star_e - I should start my first IVF cycle in summer. So I'm a complete newbie at this point to assisted conception. Though I've been TTC for awhile. It sounds like you have some other clinic options near you which is good. Hopefully you'll have a better appointment. But yeah I agree if they haven't even tried the other med yet or even attempted an IUI to see how you'd respond, than there's still more for you to try before moving onto IVF, especially since you have insurance coverage for some of it.

 

[star_e]

I was diagnosed with pcos by my RE. I have a high ovarian reserve, but they were not maturing properly. I was ovulating on my own but they were poor quality. If clomid is not working, try Femara. IUI is definitely an option for you with either pills or injections to help your follicles mature. They can also prescribe a trigger shot to force ovulation when your follicles are mature enough. It sounds like your dr is not listening and working for YOU. Pcos is very easy to treat. If they aren't willing to listen, I hope you have to option to find another dr.

yea I'm going to talk w them tomorrow and if they are not receptive I'll start shopping around. they seem to think pcos is very delicate and thus difficult to treat bc of the problem of too many follicles growing. but I've read many stories of people with pcos being treated w meds or injections and IUI who have gotten BFPs. ill see how tomorrow goes. thanks so much for your input.

 

[Smille24]

I was diagnosed with pcos by my RE. I have a high ovarian reserve, but they were not maturing properly. I was ovulating on my own but they were poor quality. If clomid is not working, try Femara. IUI is definitely an option for you with either pills or injections to help your follicles mature. They can also prescribe a trigger shot to force ovulation when your follicles are mature enough. It sounds like your dr is not listening and working for YOU. Pcos is very easy to treat. If they aren't willing to listen, I hope you have to option to find another dr.

yea I'm going to talk w them tomorrow and if they are not receptive I'll start shopping around. they seem to think pcos is very delicate and thus difficult to treat bc of the problem of too many follicles growing. but I've read many stories of people with pcos being treated w meds or injections and IUI who have gotten BFPs. ill see how tomorrow goes. thanks so much for your input.

I had over 30 follicles and with 100mg of clomid I had 1 mature follicle and a couple others that weren't ready (about 13mm). The dr was completely satisfied with that and gave us the go ahead with the procedure. My re said pcos is very easy to treat, so your dr is no educated. I hope they listen to you and stop treating this as a bigger issue than it really is. Good luck!

 

[star_e]

went in for my appointment today. all of the follicles continued to grow. I now have 7 mature follicles. cycle is officially cancelled. DH and I have been instructed not to BD for one to two weeks until these follicles have shrunk. after that I'll have to take the meds for ten days to induce AF. so basically I'm out for another month. unless the follicles shrink in one week but doc said it could take two weeks. even more than wanting to get back to trying to ttc, I want these follies to shrink soon bc I am so uncomfortable! I'm also scared about how much potential pain I'll feel if I ovd on my own given the number of mature follicles. I have an appointment next week for a consultation on what's next for us. if at that appointment they seem negative as to the prospects of a protocol that works with our insurance coverage, I'll look for another clinic.

also I had forgot to tell the doc that DH and I BDed on Saturday. so I went back and told the nurse and she said it's okay as long as we don't anymore. she said sperm does not really last beyond two days. i hope this is okay and we didn't make a mistake BDing on Saturday.

also if these eggs shrink, does anyone know what happens to them? are they still potentially good follicles for another cycle or were they harmed in some way by growing and then shrinking?

im starting to really see that this journey could be very long.

 

[BronteForever]

So sorry it got cancelled star_e. Hopefully they can figure out a better medicine plan for you or you can find a new doctor to work with.

 

[Hiker1]

Hi guys! Sounds like I missed a lot.

First, Bronte, I wasn't given a choice with pharmacy - my RE just told me I'd be dealing with Walgreen's mail order pharmacy. Maybe they looked into my insurance or something? I didn't really look into it any more since my Rx's seem to be costing what my insurance typically charges for meds. Generics are $8, specialty meds are $30, and I forget what they are considered, but things like the Ovidrel trigger shot are $60 (that's the max any meds of mine cost under my plan). This first box of joyful IVF goodies cost me a total of $220, which isn't bad considering I found out that the Follistim injections out of pocket are like $900 PER VIAL. For 3 vials, I was charged $30! You might want to look into places like Sam's and Costco. I've had luck there in the past for affordable meds that weren't covered. It's absolutely insane how much this stuff costs, and my heart breaks for folks who don't have good insurance. I thank my lucky stars that I have such good insurance and that with all the stress that comes with this, that money isn't a huge concern. Now, once we go ahead with IVF, there are things that aren't covered. For sure I know we will have to shell out $1,200 for cryopreservation of our embryos. If they have to do "assisted hatching", I believe that is extra too. My insurance caps out at $5,000, which they said will hopefully cover most, if not all, of just 1 IVF round. So, if my husband didn't have the insurance option he does, then in theory, we'd do 1 round, have 1 baby, and then if we wanted a second, that would be completely out of pocket - so upwards of $10,000 per round! I hope your insurance will help you in some way. Our financial lady at our clinic says that sadly some folks are taking out loans or borrowing from family in order to go ahead with the procedure. And to think, there are people out there getting pregnant by accident or having babies they don't want. Bronte, curious, why do you have to wait until the summer to start the IVF process?

Star e, I'm so sorry you had to cancel. I had the exact scenario a few weeks ago. I was on my second month of injectables and had 7 follicles (not all mature, but several very, very close), so we chose to cancel. It was heartbreaking and frustrating to essentially "waste" another month, but we couldn't bear the thought of having to selectively reduce should we conceive with high multiples. We also came to the conclusion that, for us, we can't go through this roller coaster every month. Just 2 months of injectables (not to mention the exhausting early morning trips to the docs for bloodwork, ultrasounds) only to be told I had so many eggs that it was too risky. I asked the doctor if we might be able to do lower doses of injections to try to make the number of follicles more reasonable, but he said, unfortunately with injectables and IUIs, there just is no way to know on a month to month basis what you'll wind up with. I guess if I was younger and more patient, I might be willing to roll the dice every month and hope I get a reasonable number of follicles, but 2 months of this and I just don't want to waste any more time trying to experiment with getting the dosage right, only to have to cancel yet again...but it's such a personal decision, and your doc might be more confident than mine with getting the dosage under control. Sounds to me though you are responding well to the meds, so what does your doctor think for next month? They really need to respect your decision to continue on with meds with IUI's, especially for financial reasons. But just understand it might take some patience and experimenting since it's much harder to control what your body does when on meds. Which might be why they are recommending IVF...you're unlikely to get crazy multiples because it's very controlled. But that's why it's so expensive.

As for your questions about the 7 follicles you have now, this is how I understand it...so basically the eggs that mature will release, will go unfertilized, then get absorbed into your body. The follicles, those mature and not, will also collapse and essentially wither away as well. There is a chance that you could have a residual cyst (a follicle that didn't shrink and collapse). Depending on the size of the cyst, they may need to have you on a rest cycle. They aren't harmed at all. Ever since you started your period as a young teen, you've been developing follicles and eggs, and every month they collapse and are absorbed. Next month, you will grow new ones! Don't worry about running out of eggs or follicles, at least not for a long while. You still have thousands and thousands of eggs left. These 7 you lost this month won't make a difference. Hope that helped!