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

[lemon_tree]

Thanks for sharing that link, I'll definitely check it out.

I think the thank you letters sound nice and reassuring.

How are you feeling about all of this? You've been through so much! It's so exciting to see you approaching retrieval.

 

[BronteForever]

Hiker, I've heard mixed opinions about sacrificing the bigger follicle, but yes I believe that's what they were trying to do. However, my top 9 were all over 21 mm by the time I triggered. I think there were only 6 in the 17-21 mm range and most of those were over 20 mm as well.

However, I consulted an embryologist to get a second opinion, since they answer questions on facebook and they said it's commonly believed the largest follicle or your lead one is your best chance at success. Because it's the one that likely would have ovulated naturally. There's different opinions on that. That's another one of my questions. I think what they did might have worked if they'd checked me properly in between, but they didn't. But there's really no way of knowing if that caused it. The embryologist also told me to ask specific questions about the look of the embryos because that can tell me if they were too mature. So I have that question too.

Anyway, good luck to you. Sounds like you are getting close. Yay!! I'm so hopeful this round will work for you!

 

[star_e]

Hi ladies,

Some of you might remember me from a while ago. If not, I will recap very concisely.

I have been ttc since January. My infertility issue is ovulation dysfunction due to PCOS. So even though I have been trying since January, I only had my first real chance this past month, when they finally got me to O. It was a several month build up stage to realize that I was clomid resistant (tried one month at 50mg and no O and then at 150mg and nothing, so that same month we added follistim and then i overstimmed with 7 days of dose level 75). I think I overstimmed partially b/c the the clomid at 150mg worked a little and that with the 7 days of follistim put me over the edge.

The iui this past cycle led to a BFN. We managed to get one follie after a 31 day extremely low dose of FSH stimulation. The doctor was ultra conservative b/c she only wanted one follie as she said if we were more aggressive i might overstim again due to my sensitivity to the FSH drugs.

We decided to take the plunge and go for IVF this cycle. I have just begun to start to learn about IVF and woke up at 6am today and read someone's entire journal, went through all the emotional ups and downs of the story and was so deeply touched. I also realized through that process that I have so much homework to do with regards to learning about IVF.

I have heard the term pgs used and will research it soon. but is pgs something that is greatly recommended to do?

We did not get a shared risk package, we just paid upfront for this ivf and i am not even sure what tests it includes. it was an extremely stressful decision to make b/c of the money and i was so overwhelmmed with starting AF, etc. I'm feeling lost.

ive read so much about people doing tests with the embryos, is that something i'm supposed to be doing? i don't even know what the tests are.

is there something i am supposed to be looking out for? i have read that i need to really keep track of my e2 levels and that there is a certain window for transfer that's supposed to be ideal?

how many eggs should i ideally want? we have decided to freeze any leftover eggs, but then i have read about fresh and frozen transfers, is one better than the other?

i have to start somewhere with learning about all this, but i am overwhelmmed. we just decided to do it and i already started my stims and am realizing i don't know enough about this process.

i read one journal today and am so appreciative that she shared her journey. my heart sunk so many times and got lifted and the story still continues. i am going to read up from where i left off on this thread to learn about the stories posted here and educate myself more.

i have to start somewhere and will appreciate any information you wonderful ladies have to share.

 

[BronteForever]

Star_e - welcome to the world of IVF. I was super stressed out when I started as well because there really is a lot to learn. But you will get through it and it wasn't nearly as bad as I built up in my head. You just have to take it day by day.

Anyway I'm happy to answer some of your questions from my experiences. But I want to give it a bit of time. I'm on my way to the lake and a day with family but I promise to get to it later today.

Just wanted to pop in and wish you luck in the meantime. When do you start your stims? And are you in the US or elsewhere?

 

[Hiker1]

Hi star e and welcome back! I was wondering about you and how you have been doing. We've all been through alot, obviously you included, in the past months! It sounds like IVF is the way to go for you. After a while I felt like I was wasting my time with IUI's and it sounds like it was very hard to regulate for you so hopefully IVF will do the trick!! Fingers crossed!

Like Bronte said, yes there is a lot to learn, but one day at a time is best for sure. To be honest, you could be totally ignorant and trust the doctors and be just fine that way, but sounds like you, like the rest of us want to be informed and know whats going on with the process and your body. Question - did you doctor provide you with informational material about IVF? If not, you may want to ask for that. At both clinics I've gotten treatment for, I've been given lots of info that helped me to understand what I am going through, including pgs testing, etc. But I'll try to answer your questions the best way I understand things...(I'm copying and pasting your questions below...

I have heard the term pgs used and will research it soon. but is pgs something that is greatly recommended to do?
-From what I understand, unless there is a good reason to genetically test your embryos (ex: both you and your hubby are carriers for something or there is a family link to some disease) they generally don't do it. It is an extra expense for sure and even when they test embryos the results aren't always 100% accurate and I've heard that doing the testing may damage embryos. Then there is the freezing process which is debatable whether embryos could be damaged from that and not survive the thaw process...but other folks just want the assurance that everything is healthy from the get-go, so very personal decision. I believe that in order to do it the embryos need to make it to day 5 blasts, so depending if yours make it to that point, it might not even be feasable. I also think they have to make special catheters for each couple so if you are planning to do pgs, you'd have had to plan for it several months prior to the cycle.

ive read so much about people doing tests with the embryos, is that something i'm supposed to be doing? i don't even know what the tests are...
-as far as I know the only tests they can do on an embryo is PGS but I could be wrong. We aren't doing any embryo testing.

is there something i am supposed to be looking out for? i have read that i need to really keep track of my e2 levels and that there is a certain window for transfer that's supposed to be ideal?
-the docs will be keeping tabs on all your levels and will tell you when you are ready for retrieval. Since you just started stimming, you'll probably start going in shortly for testing (bloodwork and ultrasounds) every other day or so to see how things are progressing. You should see a rise in E2 as well as multiple follicles starting to develop and grow. I'm not 100% sure on what E2 levels are "good" or indicators of success - I've heard that for every 150 means a mature follicle? As for size, once they are in the 16-20mm range, those are supposed to be the ones that are ideal for retrieval and fertilization.

how many eggs should i ideally want? we have decided to freeze any leftover eggs, but then i have read about fresh and frozen transfers, is one better than the other? I've read you want 8-15 follicles ideally. Too many (20+) sometimes can have quality issues - same for too few. My round of IVF in May/June I had only 2 fertilize and they did not progress well after day 3. As for fresh vs. frozen, my doc said that fresh is very slightly more successful than frozen. I think the thinking though behind frozen success is that if they make it to day 5 and look good, then can be frozen and thawed and still be good, then they are resilient and strong and of good quality. I would love to be able to freeze some for the future, but due to my low response due to DOR, I am accepting that we may be lucky to ever get one day 5 blastocyst, so if we are able to have 1 child of our own DNA then I would be over the moon about that. The possibility of freezing would be amazing but I'm thinking unlikely in my case.

Hope that helps!! Good luck to you and please keep us in the loop!

As for me, today's scan showed my E2 is now 1477! (Last round on this day it was 613, and at retrieval it was 950 I think). My follicles are: 19, 19, 14, 13, 13, 11 (Last round this day I had 3 14's). I am continuing on my meds and go back Monday for another check - we are hoping those 14's and 13's catch up a bit. They said likely my retrieval will be Wednesday. Off to go meditate!

 

[BronteForever]

Well I had a bit of a break

** I have heard the term pgs used and will research it soon. but is pgs something that is greatly recommended to do?

It depends. PGD and PGS are the two primary tests they do on the embryos. It is very personal choice. It's about $4,500 extra at my clinic to do PGS on up to 8 embryos. It includes the biopsy fee and then fees at the seperate genetics lab.

My doctor strongly recommends PGS for women over 35 because about 50 percent of eggs we produce will be chromosomal abnormal. It's also recommended for those with recurrent miscarriages or occasional those with multiple IVF failures. There's no way of knowing if the embryos will be chromosomally abnormal unless you test them. PGD tests for specific genetic disorders like cystic fibrosis so that's only recommended for people with medical history in their families or recurrent miscarriages with known genetic issues.

I think it is kind of pointless if you get few eggs that survive. Because you might as well just transfer more than one and let nature take its course. But it is a really personal decision of what you can handle.

We did not get a shared risk package, we just paid upfront for this ivf and i am not even sure what tests it includes. it was an extremely stressful decision to make b/c of the money and i was so overwhelmmed with starting AF, etc. I'm feeling lost.

I was so stressed about this too. We did a shared risk because we got a discount for being "teachers" and new we might do PGS which would require a FET (or frozen transfer) at our clinic. It worked out price wise to be not that much more and provided some reassurance if the first cycle failed which mine ended up doing. It's so tough though and you have to do what you can afford and what's comfortable for you. We got an entire work up of paperwork of what was included with the price. If they haven't given you that definetly ask for it.

ive read so much about people doing tests with the embryos, is that something i'm supposed to be doing? i don't even know what the tests are.

See above for PGS and PGD. Those are the most common.

is there something i am supposed to be looking out for? i have read that i need to really keep track of my e2 levels and that there is a certain window for transfer that's supposed to be ideal?

E2 is a bit confusing to me as well. But it's supposed to show how much your eggs are being stimulated. It needs to be in a certain range. If it's too low you are being stimulated too little and if it's too high you are being stimulated too much. It needs to grow as you go in the process. Mine doubled about every 2 days. They will track it at all your ultrasound appointments to make sure you are in the correct range for the day of stims you are on. I also recently found out if it's higher but your follicles aren't in range it can still indicate you are about to ovulate or your eggs are ready. Don't know much about that.

how many eggs should i ideally want? we have decided to freeze any leftover eggs, but then i have read about fresh and frozen transfers, is one better than the other?

Totally depends on you. I've read studies says 13 is ideal because its highest rate of success. Some with low reserves will never reach that. It's hard not to focus on numbers. But quality truly is more important than numbers. I had 14 and none made it to ideal blastocyst stage of embryo development.

i have to start somewhere with learning about all this, but i am overwhelmmed. we just decided to do it and i already started my stims and am realizing i don't know enough about this process.

Don't worry. You learn a ton as you go. And hiker is right if you trust your doctors they should know what they are doing.

Feel free to ask any other questions. I'm an open book now and was so appreciative of the women that helped answer all my questions before my first cycle.

Good luck.

 

[BronteForever]

Oh and in terms of fresh vs frozen it's hard to say. Heard so much variety.

If they do genetic testing like PGS they really have improved the process so much they rarely if ever damage the embryo now. They pull a small amount of cells from the area that will become the placenta I believe so it doesn't even have potential for damaging the cells that form the child. It used to but not anymore.

Same thing with frozen transfer. They have improved cryofreezing techniques even in the last few years that embryos are preserved much better to survive freezing and being thawed. You can still lose some in that process for sure. But it's so much better.

Some doctors recommend FETs for certain women now with trouble during fresh cycle. It is true frozen embryos are usually of higher quality to have gotten to that stage. However it's also true that frozen cycles can work better for women who overstimulated during the IVF process. Your body has calmed down more and you might be more receptive to a transfer when you aren't as hyped up on meds. If you paid for a fresh transfer though it would be hard to justify bypassing that and then doing a frozen. Since you are paying by cycle you'd likely need to pay for both. You usually don't get refunded for an unused fresh transfer.

 

[star_e]

Bronte, it was your journal i read this morning! Thank you so much for sharing your story. i could really feel the experience from your writing and will continue to follow the journey.

i am in the US. I started my stims yesterday. im on dose 75 of the gonal drug. my next appointment is on tuesday and i will continue this dose until then.

when i read your journal, i formed piles of questions, almost wanted to take notes b/c i did not know what pgs was or some of the other terms you were using and today i was not able to do the research b/c life got in the way and the time i thought i had i didn't. but tomorrow i will have more time to research my questions, which will help me to feel more secure. i feel overwhelmed with all the information.

i think i just paid for the regular ivf, not for endo scratch or pgs or any testing and i want to know if i need to ask for testing of some sort. what are the things i am supposed to be doing? im basically a beginner and just looking for some guidance and tips. any info will help, even directing me to other info that any of you have found useful.

 

[star_e]

oh hiker thank you so much for your response!

i am already starting to feel better from the responses to my questions from all of you! thank you!

your e2 levels seem high! that's good from what i'm learning. i hope you have many juicy follies come wed. i need to catch up on this thread to hear the backstory. i remember rooting for you from when i was last on and i am still rooting for you know. fx.

question - is it super difficult for the follies to make it through the blast stage? and is that determined on egg quality. how do i know if my eggs are good quality? i have pcos and i think that might affect them. i guess the process of going through IVF will teach me these things?

 

[star_e]

bronte thank you too for your response!

the pgs sounds like a very useful test from your description, but also very costly. i am 34, so almost 35. does having an abnormal chromosome mean miscarriage likely? or does it mean it will harm the child?

would you say most people if they can transfer more than one?

i cannot afford the pgs right now, but, it is something to think about for the future. thank you for explaining all of this to me!!!!

 

[BronteForever]

Glad the journal helped some. That's one of the reasons I started it. Plus this process is super emotional so it's helpful to get it down. All the terms are so confusing. I had a three month wait before knowing I was doing IVF and starting so I had time to do lots of research but I still learned an awful lot going through the process.

To answer some more of your questions:

Since you have already started stims already it's pretty much too late for an endo scratch. It's supposed to work best to be done the cycle before your IVF stims. It's not even usually done on a first time but it can be. Normally they do it after a failed cycle where a good embryo fails to implant.

And the testing thing is such a personal choice but if you don't think you can afford it, honestly I wouldn't be worried.

One of the reasons we decided we were going to do PGS is because we'd suffered an early loss before and I didn't know if I could face it again after going through IVF. Plus we were looking like I was responding really well so they'd estimated I'd have more embryos at day 5. However it was always in our minds that if we had only 1 or 2 embryos make it to that stage we'd just transfer and let nature take its course. PGS was only ideal situation if we needed to weed out unviable embryos to get the good ones early on. We are borderline age so we should hopefully have some good eggs left but I was of course still worried. I also had possible scar tissue that could have been damaging my eggs. If your issue is PCOS you honestly have a good shot with IVF. A lot of the PCOS women on here do really well with IVF. The only thing you have to worry about is that it's easier to get overstimulated with PCOS. Looks like you are on low doses to help with that though. I hope you progress nicely!!

Also, if embryos have chromosome issues it's most likely they won't implant or you could have a early miscarriage. They of course could also have a genetic condition such as Down syndrome but the implantation issue and miscarriage is more likely. My one embryo that made it to day 5 had they transferred and somehow it implanted would have shown up as an empty sac later on ultrasound because it didn't have the cell portions that make up a child.

But looking back now and even knowing that I think I'd still have preferred to try transferring. Not even doing a transfer sucked. It's so tough either way.

Oh and it is rare for most of your eggs to make it to blastocyst stage. A lot depends on quality of the eggs. However with PCOS you actually might be in great shape because those ladies always seem to respond really well and have lots of eggs to choose from.

Also transferring 1 or 2 embryos is also a hard choice. I think two only increases the odds of success slightly. But again it depends on age. They usually recommend transferring more for older women just in case one is bad. You aren't really to that age yet. I'm closer to 36 than 35. So I'm creeping up. But I was still probably only going to transfer 1 embryo unless we only had two that made it I would have tried two.

Good luck.

.

 

[Smille24]

Hiker- I just wanted to pop in and say I'm still following you and wishing you the best of luck this cycle. It sounds like you're responding really well this cycle and may have a lovely number of eggs. I'll keep you in my prayers .

 

[star_e]

Hi ladies!

I wanted to read up from where I left off last time and so much has happened!

Hiker
-I left off around page 40, and instantly remembered Hiker’s experience with getting one follie on the bcp cycle b/c of the clinic trying to force everyone to the same schedule. So glad you found another clinic Hiker!

-how did the new doc (when you switched to the new clinic) know that your eggs did not let sperm in easily? you mentioned she suggested ICSI.

-I also like that you think of every next thing as a milestone, even AF. i’m going to try to implement that headspace as much as i can into my journey b/c its true, the time seems like endless space otherwise.

- glad you have some insurance coverage for IVF! that's awesome. i only have it for IUI, but no coverage for IVF. which is why it was so hard to take the leap.

- its good that your doctor is honest. but, i don't understand why your chances for mc would be higher. how does she know that?

- if this IVF does not work, i will look into th it starts with the egg book you mentioned.

- is this thread your personal journey thread ? i actually don’t know the protocols, can i be posting my own questions on this thread? and good luck this cycle! fx for you!!!!

tullip - sorry you had a cancelled cycle in june b/c of womb lining. everything is new to me so I had not heard of that. i'm learning as i go along. don't know what i would do without these forums.

lemon - there were not too many follow ups post your surgery. i hope it went alright and that everything is in order for your ttc journey.

smile - congrats on finding out your little bean is a girl! so cute, wonderful news.

Bronte - so sorry O pains hurt you so much. I have never had any O pains, I don't think. I was able to iui just once and i had some pains post O, but they were not that bad. are the O pains still as bad as before? also Bronte, why were the 2 extra days of the stim bad? why would it have been better if it were faster? also didn't know having oversized follies could mess up the cycle? cause when i had my iui, i had a follie at 22 and they still made me do another dose of FSH to try to get it at 25 and then i triggered. due to my temps though i think i actually Oed before my IUI, so the timing was messed up and i remember thinking why am i doing another FSH dose if the follie was so big already. very much hoping this next cycle works for you!

 

[BronteForever]

Star_e - I'm not terribly familiar with IUIs to answer your questions. But one of the biggest differences between IUI and IVF is that during IVF in addition to FSH you are also given meds that essentially prevent you from ovulating. So if you stim too long you are essentially maturing the eggs past the time when they naturally ovulate and make them worse quality. Stimming faster isn't necessarily good either. It's a fine balance. But the normal total days for stimming is 10 and I went 12 days on my first cycle. The biggest problem with mine is I was not checked on day 11 which likely would have revealed they had a huge growth spurt in a super short amount of time. Then going one extra day likely overcooked them so to speak. If my meds would have been slightly adjusted more the thinking would be they would have been in the appropriate range at the appropriate time close to when a natural ovulation would have taken place. All that leads generally to better quality eggs then you'd get without those conditions lining up. It's the doctors job to do the best job they can at predicting how you will respond and keeping track of everything to try to get the timing perfect.

Frankly I agree that you might have ovulated too early on that IUI cycle but certainly ask the doctor for the reasoning behind it. Don't be afraid to ask questions. That's one of the big things I'm constantly having to relearn.

Oh and I've only had O pains since my ectopic in 2009. It honestly varies greatly by month. It depends which ovary I ovulate from and a whole ton of other things. It's just life now. If I'm no longer TTC I can probably help it greatly with BCP.

 

[Hiker1]

Smille, thanks for checking in on me! I think of you often and I just love your preggo profile pic. You look fantastic! I appreciate your and everyone else's support!!

Star e, Bronte did a great job, much better than I, in answering a lot of your questions! There really is a lot to learn, but try to relax during this stim phase right now!!

Since you did direct a few questions my way, let me try to answer them the best I can:
-how did the new doc (when you switched to the new clinic) know that your eggs did not let sperm in easily? you mentioned she suggested ICSI.
-She said that is typical of DOR eggs. The thinking is they are likely poor quality and thus can use all the help they can get! (That was my hunch all along)


-I also like that you think of every next thing as a milestone, even AF. i’m going to try to implement that headspace as much as i can into my journey b/c its true, the time seems like endless space otherwise.
-Glad that is helpful for you!! It's the only thing that keeps me sane I think. Even after a failed cycle, to have a plan, next appointment or something else waiting makes me feel like there is all is not lost - there is something else to come and to try next!


- glad you have some insurance coverage for IVF! that's awesome. i only have it for IUI, but no coverage for IVF. which is why it was so hard to take the leap.
-I can imagine. We really are so lucky. Although even after having insurance the first round, there was nearly $3,000 not covered (the ICSI and assisted hatching I believe). I said to my husband after our failed cycle, "for us right now this is sad and horrible. I can't imagine adding a $15,000 price tag to that sadness." I feel very lucky. With our new insurance I'm keeping my fingers crossed it covers most things but every time I call in for clarification, I get different answers. Seems like you don't know what will be covered until the procedure has happened.

- its good that your doctor is honest. but, i don't understand why your chances for mc would be higher. how does she know that?
-I think she said that was true of DOR patients. But I question that because I'm assuming that most DOR patients have DOR because they are older., and older patients statistically also miscarry...which may or may not be related to DOR. At 35, I don't think I'm super old in the realm of infertility...so I'm trying to stay positive about the miscarry statistic and tell myself that is more true for older women

- if this IVF does not work, i will look into th it starts with the egg book you mentioned.
-Great! I think you will find it very informative!!


- is this thread your personal journey thread ? i actually don’t know the protocols, can i be posting my own questions on this thread? and good luck this cycle! fx for you!!!!
-Haha, no technically not my personal journey thread but it seems to have kind of morphed into that. In retrospect I totally should have started a journal, but I figure I'm too far into my journey, and this thread has logged everything I've gone through since the very beginning, so why start over now? Also I love that there are others on this thread and my intention was/is to share this experience with others, so please do continue to post and join in!! The more the merrier! Thank you so much for your support! xo

 

[lemon_tree]

Hey, Star_e! You're super sweet for checking in on all of us, thanks!

Post-surgery, my biopsy results all came back benign, which was a relief. My doctor found a bunch of endometriosis, which I hadn't known I had. It was all over the place, in particular my bladder and left ovary, and ahe excised everything she saw. My AMH numbers were pretty low, so my endo was affecting my egg supply and that would explain it.

I've been told no TTC for 6 months post-surgery, and so I'm on BCP until late September. After that, I start a long IVF cycle! My very first!

I hope my eggs are viable and that a few come out to play. My doctor called me "a little bit DOR" so we'll see what happens. We have 2 IVFs covered, and if they don't work we'll have some big decisions to make about what to do next - paying for more IVF with or without donor eggs, adoption, fostering, or living child free. We'll see.

Looks like you're a couple days into an IVF cycle? And you're stimming now? Good luck and keep us posted! I want to hear everything that's been going on. PCOS sucks and I'm sorry you're dealing with it - but I'm new to IVF too and am learning a ton from your questions and the answers you're getting. Thank you for that.

Hiker, thanks for sharing your thread with us all. You've got a great group, here.

 

[star_e]

Bronte - thank you so much for your response. it makes sense what you say about how the size shouldn't be too mature b/c its past the size it would have naturally ovulated. i really hope for your next cycle that they scan you more frequently and that your follies are at a better size. my fx for you!

I have to learn how to ask questions too. I don't ask nearly enough. But, I always feel like the nurses and staff at my clinic are annoyed anytime I ask questions. During this IVF process, id really like to know things, like the exact e2 level, etc. i'm thinking i'll start taking a notebook in with me and ask for the info so i can write it down. im sure they will be annoyed with me, but its my right to know.

HIker - im 34 and i agree with you, i don't think 35 is old. i am so hopeful everyone here gets a BFP soon. ttc can be a long long process. i mean, it took me 6 cycles just to figure out how to ovulate. i'm trying to keep a positive mind. and have hope for the future. thank you so much for sharing the thread!

lemon - so glad everything came out benign. and september is not too far away. gives you enough time to enjoy the summer and get in the right space for the IVF. will be rooting for you! glad you are leaning too from the questions. and PCOS is so frustrating. hopefully IVF works. my fx. i'm on cd 4 and started stims on cd 2. my next appointment is tuesday. i'll keep you all posted.

 

[Hiker1]

Hi guys! Just a quick update - I'm triggering tonight for Wednesday morning retrieval! Looks like I'll have 6 follicles! My E2 is 1951, follicles are: 22,19,18,16,14 and 14.

Bronte do you think that 22 will be "overcooked" as you said? Now comes the stress and waiting after all the buildup. I'm cautiously optimistic...

 

[BronteForever]

No I don't, that's in great range and your E2 isn't too high. So you should be good girl. Mine was 26.6 on the day I triggered. That's 4 extra mm and all my others ones were much higher. Plus, my e2 was almost double yours, which suggests they were going to grow more in a short time. Yours sound like perfect range!

You got this girl. I have a really good feeling about this cycle for you! Keeping my fingers crossed.

 

[lemon_tree]

Yessssss that all sounds great!!!! Good luck, Hiker!!!