25 replies to this topic

[tryingforever]

Hi there,

I posted this in a different forum and then I found this one. Thought I might get a different perspective from other who are over 35 and might have experienced similar cycles.

I am doing my 5th medicated cycle at the moment and am on day 7 of a really high dose of gonal-f (450 units). The reason for this is my poor response to ovarian stimulation in the past.

I had an ultrasound on Friday and was told that I had only 1 large follicle (12) and the others would likely not grow (3.5, 4, 5, and 6). They said to come back on Saturday. I did go yesterday and at that time the follicles were now at 13mm, 9, 5.5, 5.5, can see the 5th one). Here's where my question comes in...

Would you stop and switch to an IUI? I have done IUI's in the past with no luck and have 1 blocked tube so my odds are pretty bad. I need to get to 3 follicles for an ER.

The doctor also said that my lining was thin at only 3 and my Estrodial level is only about 520.

Hard to summarize everything in an post, but the doctor also said based on my history and she thinks that I could be premenopausal...and that no amount of drugs is going to help my body create enough estrogen to create multiple follicles.

I have another u/s & bloodwork on Tuesday, but need to question...am I throwing my money away on false hopes?

Any thoughts you have I would be very greatful.

Thank you
kdl

[Sandibeach]

Age aside, your stats don't sound very good. Not that I'm any expert by any means, but what concerns me the most is your lining... even if they only get 1-2 good eggs and they fertilize... if your lining is too thin, implemenation is almost impossible (from what I understand). I'm assuming your paying for this out of your pocket, so it sounds like this would be expensive experiment. I agree IUI probably wouldn't work, but wouldn't you want to try again and not waste this IVF attempt? Do the doctor's know why your lining is so thin, do they think it will correct itself in time for the transfer? It sounds like this maybe your last attempt, a tough decision. All the best and hope it works out!

[sweetredpepper]

Hey tryingforever,
I have no particular opinion on your current situation, but I wondered if you've thought of trying DHEA? I was a poor responder too when we tried our first IVF cycle, and since then I've read about DHEA helping poor responders make more follicles. It's only available in the U.S., but I got someone to pick some up for me at a pharmacy when they were in the States.
My clinic has suggested the Flare protocol as our next step. I wondered if your clinc has had you try a different protocol?
By the way, a friend of mine had only 5 follicles when she did IVF the first and only time and she ended up having healthy twins, so you never know (although I think clinics hesitate to even try with a small number unless you insist; they don't want to mess up their stats)- just sayin'...
Good luck!

Such a hard choice. I'd be tempted to save the IVF funds for a later cycle if RE thought I could improve chances. It sounds like that unless you get to 3 of an acceptable size, they will not go ahead anyways. Are they certain the other follicles won't grow? Is there time to wait it out a bit to see if they catch up? It sounds like they said they wouldn't grow and then, they did. In my first IVF, I had 1 lead follicle that was lost and then a bunch of slower ones that were more similar. I wasn't ready to go until Day 12 of stims, so is there a chance of this for you?

I had to face a similar choice and chose IUI in the hopes I'd get more eggs next cycle. This is because I only had 4 mature follicles and then 2 tiny ones. It's a personal choice, though, and I found it a very hard decision. I hope your RE has more promising news at your next ultrasound. Good luck with your decision and cycle.

[Nitzerette]

I am just wondering about how exact the u/s actually is for knowing how many there are. Because when mine was done, she could see and measured about 7, but when I had my egg retrieval, they got 14 or 15. Also, if this is your 5th cycle, do you have the option of trying a different fertility centre or getting a second opinion/cycle schedule?

[tryingforever]

Thank you all for your thoughts - the support you get from these boards is so comforting!

Sandibeach - you're right, my lining is thin - they didn't mention anything as far as it correcting itself. Hopeful by tomorrow it will have thickened.

Sweetredpepper - I haven't heard of DHEA - I am definitely going to do some research. I have always done a flare protocol - I wonder if a long protocol with BCP would work for me. I never thought of the stats...perhaps that is the reason they were pushing me to cancel - I don't think that was the only reason, but maybe some of it.

Stillhoping - You're right the follicles that they said would not grow did grow. I am thinking that I will probably lose the lead follicle, but I would rather that than losing all of them.

Nitzerette - I agree with you about the accuracy of u/s. The RE even said that part of my bowel was covering the ovary. On Friday they say 6 -7 and on Saturday it was only 5. When I asked what happened to the other ones, she said "did you see them". She was kind of short with me. Prior to this cycle I did one other canceled IVF with this clinic and then I did 3 medicated IUI's with a different clinic. I don't know if changing clinics is the answer.

Thanks again everyone - I'll post tomorrow and let you know what the outcome is.

[maybebaby]

Good luck, tryingforever! Hope you don't have to try much longer...

Hey tryingforever,
I have no particular opinion on your current situation, but I wondered if you've thought of trying DHEA? I was a poor responder too when we tried our first IVF cycle, and since then I've read about DHEA helping poor responders make more follicles. It's only available in the U.S., but I got someone to pick some up for me at a pharmacy when they were in the States.
My clinic has suggested the Flare protocol as our next step. I wondered if your clinc has had you try a different protocol?
By the way, a friend of mine had only 5 follicles when she did IVF the first and only time and she ended up having healthy twins, so you never know (although I think clinics hesitate to even try with a small number unless you insist; they don't want to mess up their stats)- just sayin'...
Good luck!

Hi,

What is DHEA? It is so frustrating that I have been through two IVF procedures and my clinic doesn't seem to share a lot of information with me. I have had to be very demanding in order to get information. I also agree that they discourage patients if they have 5 or less follicles b/c they don't want their stats. to drop, but I think that their long wait lists are also affecting their stats!! It took me 12 months from the time I saw my GP to the time I was offered 1 cycle in Calgary!!!! This definitely affected my ovarian reserve!!

My first protocol produced 5 follicles, and we were advised to cancel the procedure. Now, looking back, I think that we should have proceeded b/c all follicles were close in size, which is what matters. The next protocol-the "flare" is the most aggressive protocol they have, but the drugs are very expensive! ($6,000). It is also very long b/c you have to go on birth control for 1-2 months before they start you on 450 IU gonal-f and usually 150 IU menopur-depending on your chemical analysis. This protocol produced more follicles, but the follicles were more separated, so they didn't mature together. The leading two follicles were much larger than the others. Much research on medline has shown that some older patients respond better to natural IVF procedures rather than more aggressive stimulated IVF procedure. However, in Canada, not many clinics do the natural IVF procedure-too time consuming. Wait lists toooooo long already.

If you doctors recommend the "flare" protocol, I hope that this has helped give you some info. about it.

Take care,
Winsett

[sweetredpepper]

Hi Winsett,

I'm at Foothills as well. I didn't realize that the drugs were that much more for the Flare. Oddly enough, I produced the same number of follicles on Clomid as I did on the IVF stims.

Anyway, DHEA is dehydroepiandrosterone (are you impressed that I remembered that? ) It's only available over the counter in the U.S., but it can apparently help with poor responders. Do a google search with the terms poor responder and DHEA. If you don't find anything, send me a message and I can probably scan some of the articles I found last year. Here is a link that Dr. Peter posted about it last year: http://www.ncbi.nlm....l=pubmed_docsum

SRP

Good luck trying forever!

SweetRedPepper - I have thought about DHEA as well but am nervous about effects. If you have an RE you feel comfortable with, you could try asking them about it to make sure it is a good idea for you. Then again, many RE's won't recommend things that aren't along the norm.... Here's what Dr. Tom Hannam on this forum said...

DHEA for example, if taken too long or at too high a dose, can be associated with androgenic side effects like acne or hair loss. (Such changes are generally reversible, but nonetheless, supplements are not to be taken lightly and you should ask your clinical team if they are right for you).

So I guess it can be helpful but you have to be careful about dosage... I'm still wondering about it but scared to try something else new after last messed-up cycle.

Good luck everyone, wherever you are at.

[sweetredpepper]

Good luck trying forever!

SweetRedPepper - I have thought about DHEA as well but am nervous about effects. If you have an RE you feel comfortable with, you could try asking them about it to make sure it is a good idea for you. Then again, many RE's won't recommend things that aren't along the norm.... Here's what Dr. Tom Hannam on this forum said...

DHEA for example, if taken too long or at too high a dose, can be associated with androgenic side effects like acne or hair loss. (Such changes are generally reversible, but nonetheless, supplements are not to be taken lightly and you should ask your clinical team if they are right for you).

So I guess it can be helpful but you have to be careful about dosage... I'm still wondering about it but scared to try something else new after last messed-up cycle.

Good luck everyone, wherever you are at.

Stillhoping, You're too right- DHEA does have some scary side effects. However, I do think it's worth exploring; some women in the U.S. and Europe seem to take it regularly at a low enough dose that they don't suffer from side effects. My acupuncturist recommends during the folicular phase of the cycle only, which I imagine would giv you the support needed and would mitigate the negative effects at the same time. Like so many of the other decisions we're called on to make in this journey, it's not easy. I will still plan to talk to my clinic about it if they ever call...

[Irishrose]

Just to add my two cents worth. For what it's worth, my doc said that IUIs had an extremely low implantation rate for over 35s and he doesn't recommend it. I would save my funds for a later IVF date if there is a possibility that you may get more to transfer and up your chances - how many were you hoping to transfer?

The flare protocol (450IU Gonal F), 150 Luveris worked well on me though I was a slow responder and they had to up my meds to 600 Gonal F for a few extra days to mature as much as possible. It did work out between $5500-$6000 just for the drugs so super expensive though, amazingly, I did produce 12 follies and 9 eggs. But, I agree with winsett, two of my leading follies were much, much bigger than the others and overmatured. But, from my ovarian count, we had only expected about 5-6 follies so I was delighted with the response.

Good luck and hope you soon get more info on which to base your decision!

Hi there,

I posted this in a different forum and then I found this one. Thought I might get a different perspective from other who are over 35 and might have experienced similar cycles.

I am doing my 5th medicated cycle at the moment and am on day 7 of a really high dose of gonal-f (450 units). The reason for this is my poor response to ovarian stimulation in the past.

I had an ultrasound on Friday and was told that I had only 1 large follicle (12) and the others would likely not grow (3.5, 4, 5, and 6). They said to come back on Saturday. I did go yesterday and at that time the follicles were now at 13mm, 9, 5.5, 5.5, can see the 5th one). Here's where my question comes in...

Would you stop and switch to an IUI? I have done IUI's in the past with no luck and have 1 blocked tube so my odds are pretty bad. I need to get to 3 follicles for an ER.

The doctor also said that my lining was thin at only 3 and my Estrodial level is only about 520.

Hard to summarize everything in an post, but the doctor also said based on my history and she thinks that I could be premenopausal...and that no amount of drugs is going to help my body create enough estrogen to create multiple follicles.

I have another u/s & bloodwork on Tuesday, but need to question...am I throwing my money away on false hopes?

Hi, I just completed two IVF cycles. I was told that I was a poor responder to stimulated IVF. I only produced 5 follicles both times. Remember only 70% of the follicles will have eggs, which is what happened to me. My first cycle was cancelled prematurely I feel. The second cycle, the two leading follicles didn't have eggs, so I was left with three eggs. I just found out today that they didn't mature, so we are looking into egg donation. We have spent 15,000 already and just can't afford to spend more on attempts with my eggs. I personally wouldn't do IUI. I didn't have that option b/c I have tubal issues. The chances of having successful IUI transfers with tubal issues are just not good. I would try the IVF. At least then you gave it your best try. That is what I did. In my case, IVF didn't work, so now we are doing egg donor.

Good luck,
Winsett

Any thoughts you have I would be very greatful.

Thank you
kdl

[tryingforever]

Well they officially canceled my IVF cycle. I only have 1 lead follicle so they are suggesting I convert to IUI...what do I have to lose - so I take my HCG tomorrow and then IUI on Thursday followed by the dreaded 2WW.

Egg donor was also mention at my appointment, but I don't feel that I can get into that head space at the moment.

Sooooooooooo disappointed!

kdl

[maybebaby]

So sorry! HUGS!

[Sandibeach]

So sorry to hear that!

[Rosa]

I'm sorry to hear that.

[hopeful_flyer]

Im really sorry.

So sorry to hear. I'm going through the same thing (Cancelled last Sunday but it's our first IVF cycle) We're in our 2WW for IUI. It is better than nothing but I know how disappointing it is. My thoughts are with you and LOTS of baby dust is being sent your way!

[Nitzerette]

Trying,
Sorry to hear about your news. I know how hard it is to hear that you can't do something. I end up in tears when they tell me I have to take a month off in between! Best of luck with the IUI - still hope.

[sweetredpepper]

Baby dust to you for the IUI!

[tryingforever]

You guys are great!

Thank you for all your kind thoughts. I feel a little better today.

beauty66 - looks like we can be in the 2ww together.

Lots of baby dust to you all!

dkl

kdl and beauty 66 -- So sorry about your situations. I just went through the same thing. It is really disappointing and disheartening. I hope your IUIs work out and you get those beautiful BFP's! Thinking good thoughts for you.

Sweet Red Pepper - I'll read up more on DHEA. I am just so scared to try anything new after my failed expensive experiement last time (changed diet, acupuncture). I am much too chicken. I hope your clinic calls you back soon -- that's rotten when you have to wait. I am figuring it must be a really good and a really busy clinic!

My heart is sinking a little as I hear about med costs... I just don't know where we will get an additional $2500-$4500... maybe I'll have to see if they'll try "cheaper" (hahaha -- still nearly $3000!) protocol again, or just have to accept, no more IVF. Clinic only gave me a prescription for around $3000 worth of meds but now I'm thinking this is just a starting point... maybe they don't want to scare you right off the bat with the big-ticket med prices.... Where there's a will, there's a way, maybe. On 225 IU Puregon and 75 Repronex, I produced 4 mature eggs and two "teenagers" so maybe I won't need that much?? I'm hoping I respond well to higher dosage and it doesn't run that high in cost, but of course you have to have the funds in place if it does. It is all worth it if it works but for us, it is really a case of having no additional resources. We spent it all on acupuncture. Feeling down... maybe will grab some of that disallowed caffeine to perk me up. (Always healthy to rely on stimulants....) (not!)

[maybebaby]

Stillhoping: check out your options. For instance, at the Mt. Sinai clinic changing room, ladies have posted their phone numbers with vials for sale (Puregon, Repronex, you name it), properly refrigerated and not past expiry. Much better prices than getting it filled at the pharmacy. If that option doesn't work for you, then shop around -- Pharmacies all have different prices for the same product, it's worth it to make some phone calls ahead of time to see who can get it in stock at a better price. Finally, if you share with your RE that you are having difficulty affording the meds, she/he may know someone who is in a position to 'donate' unused medication. Insurance companies have different rules for coverage, i.e. life time cap, whether the meds must be purchased monthly or all at once, etc. This means that some women buy in bulk, and then don't need the remainder if they are successful their first time. I wish you luck. It's not fair that some people are unable to have a chance at having a child because of the high costs of ART.

Make sure they have run the full gambit of tests on you -- some women have posted that they went through several IUIs or IVFs before the doctors realized that there was something else going on (i.e. male factor, or polyps / cysts or whatever). You want all your money to go to what has the highest chance of working.
Good luck!

[tryingforever]

Stillhoping,

I agree with getting as many tests done prior to forking out the "dough". Have you by chance had an antral follicle count done. It is where they do an ultrasound (they same as when you are cycling) on a non stimulated cycle and then are able to look at your ovaries to see just how many follicles are waiting to be stimulated. In my case there were only 8 and for the most part not all of them will be stimulated - hence my situation.

The other test I did is the chlomid challenge test. You have blood work done on day 3 to see what your FSH and estrogen is at. They you take Clomid or 5 day. After the 5 days you get another blood test done to see where your FSH and Estrogen is at. I believe this along with your antral follicle count can be very helpful in predicting what the meds will do for you. And to boot, they are not expense tests and fairly quick to get done.

Best Wishes!
kdl