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6 weeks of stims for IVF?
8 replies to this topic
Posted 18 February 2013 - 12:34 PM
I'm new here and just looking for some IVF advice and support because I don't feel like I'm getting any from my doctor or fertility clinic. I'm starting to feel extremely overwhelmed and my hubby doesn't know how best to help me.
I am 26 years old with stage 4 endo (which was removed 18 months ago and again on January 8th this year), PCOS (which was treated on January 8th as well), high prolactin (currently under control on bromocriptine) and blocked fallopian tubes. My hubby is 27 and has some minor sperm motility issues. We are currently undergoing our first cycle of IVF (ICSI) antagonist protocol.
I have been stimming for 10 days now. I was on 100mg of Gonal F. I've also been taking orgalutran since day 4 to stop ovulation. I had my first scan last Friday and the doctor didn't even tell me what was happening, just that my follicles were too small at this stage so he increased my Gonal F injections to 125.
I went for my second scan this morning at my doctor's clinic and although I have lots of follicles in both ovaries (he didn't tell me how many, just said "lots" and I could see maybe 10 follicles in each ovary) he said the largest is measuring 6mm and they need to be at least 18mm before we trigger and go for EPU.
From scouring the forum here and other similar forums I haven't heard of anyone with follicles measuring only 6mm or less after 10 days on stims. Is this normal??
The doctor wants me to keep stimming until this Friday and increase to 150 Gonal F. He will then scan again and see how I'm doing. By this stage I will have been stimming for 14 days.
He said he strongly believes it will take another couple of weeks for me because my PCOS and endo are effecting my ovaries and it will take a lot longer for my follicles to grow. He said not to be concerned because he will keep stimming me for up to 6 weeks before they cancel my cycle.
Now I am SUPER confused because I've never heard of anyone stimming for 42 days straight!!! I am super tired, bloated and sore already and don't think I can stand stimming for another 4+ weeks. Has anyone else stimmed this long???
I've heard stimming for too long over-matures the eggs and they're less likely to fertilise later. I don't want to go through all this trauma (both physical and emotional!) for up to 6 weeks just to have to cancel the cycle at the end. I would rather rest for a month and then start again.
The only thing my doctor has recommended is that I drink as much powerade as possible. I've read mixed reviews about powerade/gatorade stopping hyperstimulation. Has anyone had success with this? Is there anything else I can do to help my follicles grow?
Posted 18 February 2013 - 02:22 PM
I don't have much IVF experience. About to start my 3rd stim but I would have thought stunning for that long wouldn't normally be done. I would have thought they would cancel the cycle but I could be wrong as I really have no idea other then what my clinic have told me. First stim I didn't trigger until day 14, pick up on day 16 so fingers crossed this is what happens for you.
Posted 18 February 2013 - 02:39 PM
I would assume they would only be doing small increases because of the PCOS and worried you will over stimulate (first IVF's are all 'trial' to see how you respond)
With my first IVF, I started off at 300 Puregon, but I had done 3 IUI's with injectables before this and they knew how I would respond.
Posted 18 February 2013 - 02:58 PM
I'd be quite concerned too - I did three full stim cycles (with PCO, I don't have the fullblown syndrome) and never stimmed longer than 12-14 days. My understanding is that it is mirroring a normal cycle, where ovulation would be around day 14, but the injections ensure that more than the standard one follicle are being matured to increase the numbers of eggs for IVF. My FS was also concerned about hyperstimulation and started me on around 100 Gonal F, increasing to around 150 by the end of the second week. However, I was monitored almost every day, and the drug was altered with minimal increments - sometimes from 125 to 137.5, then back again. I was monitored VERY closely because of PCO, follicles are more likely to respond too well rather than not at all.
My antagonist cycle chart that I filled in each drug amount only goes to Day 20 - it doesn't make sense to me that your clinic can say you'll stim for 6 weeks! If you're already feeling sore and bloated I would be VERY concerned and getting in contact with them again.
And you are correct, even though you are artificially stimulating the eggs, they reach maturity within 2 to 3 weeks. Even if your follicles got to 18mm over the space of a few more weeks I can't imagine the quality of the eggs would be any good.
I am not an expert, but having been through this process three times I am very, very worried for you. Are you with one of the big fertility clinics? This is from my clinic's website - it even says that stimulation of ovaries is only 2 weeks:
I would be calling them now to find out what is going on.
Posted 19 February 2013 - 02:15 PM
Thanks for your responses. It basically confirmed my feeling that something isn't right here!
I spoke to one of the clinic nurses this morning and she said my doctor is the only one at the clinic that likes to take his patients past the recommended cut-off for stimming. She said it doesn't usually end with viable eggs and I might like to look at canceling this cycle. I can't believe we weren't warned about this before we started!
We are going to stay on the 150 of Gonal F and see what happens at my scan on Friday (which will be day 14 of stims) and if my follicles are growing really well then we might stick it out and see what happens (but definitely not go past day 20 of stims). If my follicles still aren't growing then we will be canceling on Friday even if the doctor doesn't recommend it.
After this cycle has ended we are going to transfer to a different doctor at the clinic but unfortunately can't get in to see them until April. I feel like I've been taken for a ride by this doctor, spent a lot of money on this and invested all my emotions in it and now I'm just back at square one again purely because I have a doctor who didn't offer me the care I deserved or monitor me as he shoul have. He didn't pick up until it was way too late that I wasn't responding to the stims. I feel very deflated.
Posted 19 February 2013 - 08:17 PM
So sorry to hear you,re having a bad time with your first ivf. If you,re looking for a recommendation for a good understanding dr in Sydney pm me. Am really happy with mine and would recommend them wholeheartedly.
Posted 20 February 2013 - 05:29 AM
Hi, I'm no expert on IVF but I have PCOS so I can relate to your story as I stimmed for 3 weeks (not as long as 6, but still felt like a lifetime!!!). The thing with PCOS/PCO is that if they increase you too much at the start, you can end up with LOTS of small follies and high E2....they need to do it slow. I am glad you are waiting til your next scan to make a call as my response changed over 3 days (ie went from nothing to the cycle having to be cancelled due to too many follies -I'm doing times intercourse so that's a problem!!). If it doesn't cost you too much extra, I would ask them to monitor you as regularly as possible. Good luck!!
Posted 20 February 2013 - 06:04 AM
I only did one antagonist cycle and my natural cycles were very short to begin with anyway. I think I was put on 200 and they monitored my bloods and dropped me back a bit so that I didn't over stimulate. When I had the ultrasound the lady soon the ultrasound got me involved and had me wrote on a piece of paper how many were on my left and right ovaries and the sizes of the bigger ones on each. It isn't nice being kept in the dark and if I was you I would be frustrated too as I loved knowing what was going on. I think I was told to trigger the day after my ultrasound showed an 18mm follicle.
Good luck with it all! I went through Genea (in Sydney) and could not fault them. I was kept informed every step of the way.
Posted 21 February 2013 - 10:04 AM
Thought I might give an update! I moved my scan to this morning (Thursday) because I was fully confident we were going to cancel the cycle and I'd even booked in to see a new FS next week. I figured canceling today meant one less day of nasty injections (I'm getting a lot of side effects ) and would allow me to start the recovery process and begin planning for our second cycle.
But guess what? The doctor saw at least 10 follicles on each ovary, all measuring around 16mm or bigger now so we're going to give them a couple more days to grow, triggering on Saturday and going for EPU on Monday morning. This will be day 18 of my cycle. Hopefully the eggs aren't over mature by that stage.
I'm still not happy with my doctor and plan to move to a new FS if this cycle doesn't result in a BFP but I'm pleased that my body has finally started responding. I'm unsure how my biggest follicle could go from 6mm on Monday to more than 16mm on Thursday. I'm thinking perhaps the doctor didn't measure me correctly on Monday....
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