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Please help me make a decision

Posted by Sapphire , 04 December 2009 · 1227 views

It's been a long time between blogs, but I really need help with the latest dilemma IVF has faced us with. Every time I think I've dealt with every setback and frustration IVF can throw at you, it throws me a new one. Long story short, I've had two unsuccessful cycles this year and three cancelled due to (variously) high FSH and high E2 on day one.

Today's day one test is another high FSH, but not bad enough for the clinic to cancel me. Just bad enough for the nurse to say, 'it's not good, but it's really up to you if you want to go ahead'. FSH is 25. The last cycle we did it was 20 and my Dr's note on the file is we go ahead if it's under 23. So basically, it's so close to the cut-off that they've thrown it back to us.

So far, so sucky, but I was ready to say 'damn the torpedoes, we're going for it'. Whatever my hormones are doing, I feel good (well, I did until I got this call) - calm, hopeful and excited about getting another shot. How big can the difference between FSH 20 and 25 be? Last cycle, starting off with 20 we got two good embies and one to freeze - I was hoping for better this time (of course) but I could live with a result like that again (as long as it resulted in a BFP!). Maybe I need to face up to the inexorable rise of the FSH and this is just as good as conditions are going to get for me. So we go for it, right?

The problem was that I went on talking to the nurse (who is lovely), telling her I would need to talk to DH but thought we would probably go for it. 'That's fine', she said ' just as long as you understand that we might have to abandon you'. I know what she meant was abandon the cycle if there aren't enough follicles, but I think the word "abandon" struck a chord with how I felt about them leaving the decision to me. It left me feeling discouraged, sending me off into making the case for delaying until next year (I've decided I don't want to do the FET at this point - I've built it up in my mind as my 'very last chance' and want to keep it in reserve until I've run out of alternative). It's crazy to blow all the time, emotional energy and money on a cycle when we don't have the best possible conditions to start with. We could try again in the New Year with a full course of BCP , which resulted in lower FSH last time (it was shortened this time so as to mke sure ET happened before the clinic closes for Christmas). We could avoid all the IVF/renovation/Christmas travel complications and I could chill out and have a wine or two to see me through the silly season.

But, despite all that, I still want to go for it. The bit I'm struggling with the most is that going for it will put me into another holding pattern until Thursday, when I have my first U/S. After the nurse's reference to the risk of cancellation, I know I'll still be up in the air until I see follicles with my own eyes. I was psychologically prepared for cycling or not, but either way, I would be out of the holding pattern and able to see my way through the rest of the year. I'm not sure if I've got it in me to line up for another week of uncertainty and waiting to find out if we're going to make it to the finish line. On the other hand, what have I got to lose but $1,000 worth of drugs and a week's sanity?

I'm away from home tonight, but have talked to DH. He's inclined to go for it ('it's all a gamble and you've got to be in to win') and I'm still going backwards and forwards. We've put of the decision for now - I can take the first couple of shots while I'm on the road and decide once I get home on Sunday.

So, here's your chance, ladies, I'm conducting a referendum on whether we should go for it now or wait until the New Year. Register your vote below. Votes from anyone who's been pg after an FSH in the 20s will be counted twice. ;)


((Saff)) Fingers crossed you catch a break soonest!It's easy to say, because I'm not in your situation, but I think if it were me I'd start the drugs and see what the u/s revealed before giving my final decision. If there was a good follicle count/response then, I'd likely through caution to the wind and give it a go. In my "abandoned before it started" cycle (in between the failed IVF and the successful one) I had a reasonable AFC, but a number of follies were already over 11mm, that combined with the high FSH, led us all to think it wasn't worth going forward and I'm glad I didn't. Just in case you do decide to hold off - has your RE considered a cetrotide shot to supress your system - it worked really well for resetting my system and lowering my FSH. Although my high FSH was a one-off aberation, and 15.5 so no bonus vote, I know my clinic has had great success using Cetrotide (and no BCP) for supression and to lower FSH. One of the ladies I did my orientation with had chronically high FSH (highest was 34) and after Cetrotide treatment is now waiting on her viability u/s (I believe she had more than one shot because she had three months before she was able to cycle).Sending you and DH good wishes as you figure out the best way to move forward!
Oh sweetheart I don't know what to say but I do know that Miracles happen every day :)

I'm sorry for your tough decision. I will be watching for your updates and wish you so much happiness!

Dec 04 2009 08:25 AM
Saffy - This is a tough one to advise anyone on because it really depends on what your heart is telling you. It sounds like you are leaning toward going for it so I think it is very reasonable to give it a go at least until next week's u/s. Let that be the deciding factor. None of this is ideal and I'm sorry you are being faced with all these uphill battles. Abandoned was a terrible choice of words for that nurse to use. Follow your heart.
Sorry for this tough spot you are in ..Hugs!!

Have you looked at your nutrition or seen any alternative health care? This maybe the missing link for you. You may want to consider this avenue before going ahead with any other cycles. Good Luck withh everything:)
First, Saffy, I do think the nurses and some REs need communication lessons. And, by saying "abandon", they're probably trying to tell you that if things go wrong it's because of your body, not what they do Second, I agree with Mouse and Molly that you could see what the ultrasound reveals or try cetrocide (don't know about it though) to see if it will helpThird, after many delays and obstacles, maybe waiting until next month or the new year may not be a bad idea. As Tina suggested, have you explored all your nutritional outlets to see if anything (else) could help? Last, your chances may be lower, but you could be the one in a thousand who succeedsI'd say go for the ultrasound and make your decision based on what you see or wait until next year
I can only offer lots of love and hugs for this tough decision.
I agree you should wait for the u/s. The other question to ask is: will you forgive yourself if you don't give it a chance?
Thanks so much for your comments. After I took the first shot last night, it suddenly seemed to make perfect sense to keep going until Thursday and let the U/S decide instead of trying to guess.

I have been taking millions of nutricional supplments and doing acupuncture, but haven't had acupuncture for about a month and wonder if that contributed to the FSH sneaking back up. I'm scheduled to start cetrotide on Wednesday but will PM Mouse to find out how she used it to combat the dreaded FSH.

Thanks again
I don't think there is a big difference between an FSH of 20 and 25, and there definitely isn't a difference between 23 and 25. All lab tests have a margin of error...

Given that you FSH isn't likely to really improve with time, you should go for it if you want to do this... of course only you and DH can make that decision. You can't win if you aren't in is right!! Good luck with your decision.
If it were me, I would do the FET, only because I would not want to leave it frozen for longer than necessary. If you still don't want to do that, then I would do a cycle in the new year after you do the BCP for longer which you indicated would lower your FSH. I would relax and enjoy the holidays with a glass or two of wine or whatever drink you choose.
I don't have any personal experience with high FSH, but I know the feeling that time is running out. I still waited six months before I did my FET because of the holidays, I wanted everything to go smoothly and did not want any unnecessary stress. Good luck to you, I wish you the best.
I agree with hoping for #2 - does freezing for longer affect embryo quality? Maybe think about doing the FET

is it rare that your FSH hovers around your FSH usually much higher.....if it is rare that you have an FSH as low as 25 then go for it....if you have seen lower values, wait for a couple of months

Wow I FEEL your pain, my second cycle was almost cancelled again.

I know you probably dont want to consider this right now but it made me feel abit more hopeful of having a family when I told myself that there are other options if IVF doesnt work, for example, egg donor or adoption.....

Good luck with your decision. I will be thinking of you.
Dec 04 2009 07:12 PM
Saffy - my vote is with Mouse and Molly - I would start the meds and reevaluate at the first u/s.

Wishing you your Christmas miracle!
Tough call. There are other factors to consider besides FSH. Are they doing the same protocal because different protocals can result in better outcomes. Estrogen priming seems to be helpful for those who don't respond well. Some people have success with DHEA but you should take it for 2-3 months before. I have done three IVF cycles and each one had a different approach. For me the flare protocal was successful. Wishing you the best and much success now and in the future.

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