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2 Follicles - Day 4 of stims

dor day 4 stims 2 follicles

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#1 TS1906

TS1906
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Posted 01 October 2018 - 03:58 PM

Hello, I'm new to IVF and to this forum and i'm desperate for some help and guidance.

 

I'm 39 y.o., AMH is 5.9, DOR, and cycling at Mt. Sinai Hospital. It's my first IVF attempt and i'm so lost and overwhelmed with all the lingo and information i'm finding on the internet, while getting very little information that makes any sense from my clinic - basically i only get to speak to nurses (not doctors) which are not really answering my questions - or maybe i just don't understand their answers.

 

Here is my concern. I had a round baseline tests (day 3 blookwork + ultrasound) in June 2018 prior to starting IVF earlier this month. On that day 3 ultrasound (in June 2018) my antral follical count was 10 - 6 in one ovary and 4 in the other.

 

Fast forward to September: From day 21 of last cycle until the day I started stims, i was on Estrace 4MG per day. My period came and they "assigned a day 3" (which was my ACTUAL cycle day 7) - first scary part. On my "assigned day 3" (actual cycle day 7) i went in for bloodwork and ultrasound and started taking stims: Puragon 300IU and 75IU. Did that for 4 days and today i went for my "day 7" (actual cycle day 11) bloodwork and ultrasound -  They only saw 2 follicles on the right ovary (i overhead them say 0.8 - i'm assuming size?) while my left ovary is "resting" - so nothing.

 

I'm so confused how can the original antral follical count of 10 become just 2 follicles with all the stims that i've been taking? Does one at all relate to the other - my nurses says it doesn't have anything to do with one another but reading from all the other forums, it looks like it does relate?

 

I am not sure what i was expecting as my clinic really gave me nothing to go by, but after reading so many forums, i was expecting a much higher number. They're now saying that they may cancel this cycle if nothing happens on the next round of tests, which is in 3 days from now, but for now to just continue taking what i've been taking and come back in 3 days.

 

Any insight would be very helpful and appreciated!



#2 schlepp

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Posted 02 October 2018 - 07:30 AM

If there are no additional follicles recruited at your next ultrasound, that you want to cancel and try another protocol. It sounds like they did estrogen priming. Have they talked to you about DHEA or androgel/testosterone priming? I would say you can do better if your resting follicle count is 10. Do you know what your day 3 FSH (blood work) is? .8 would be the size of the follicle. .8cm or 8mm. 

 

This process is definitely overwhelming and all the lingo makes it even harder. 

 

When you say actual day 7, do you mean that you got your period day 1? My RE likes to say he ignores my period with IVF. It isn't as relevant as the blood work. 


(age 38) June 2016 IVF #1 antagonist, 13 mature eggs, 4 fertilized, 1 blast frozen

October 2016 FET #1 cancelled, thin lining

Changed clinics

(age 39) April 2017 FET #1.1 BFN

July 2017 partner has vasectomy reversal

Feb & March 2018 - Medicated IUI x2 - BFN (even with 7 mature follicles on the 2nd IUI)

(age 40) May 2018 IVF#2, lupron flare, 7 mature eggs, 5 fertilized, 1 blast & 1 morula fresh transfer, BFN. 1 low quality blast frozen

June 2018 IVF#3 mini stim, 1 egg, immature

Sept/Oct 2018 IVF#4 antagonist with HGH - CANCELLED due to high estrogen/29mm cyst

Oct 2018 IVF#4.1 antagonist with HGH - 7 eggs, all mature, 6 fertilized, 2 blasts on day 6, PGS tested/euploid

November 2018 FET #2 w/immune protocol and 1 PGS tested -  BFN

Locus Medicus testing for virus, bacteria and immune issues. Husband treated.

(age 41) April 2019 IVF#5 converted to IUI#3 due to follicle growth. BFP 12 day post IUI. Di/Di twins.

Dec 17 2019 - Baby boy and girl born at 36 weeks + 2 days. Everyone very healthy. 

 

See my 'about me' page for more detail on my treatment history.


#3 returnable

returnable
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Posted 02 October 2018 - 07:42 AM

Hello, I'm new to IVF and to this forum and i'm desperate for some help and guidance.

 

I'm 39 y.o., AMH is 5.9, DOR, and cycling at Mt. Sinai Hospital. It's my first IVF attempt and i'm so lost and overwhelmed with all the lingo and information i'm finding on the internet, while getting very little information that makes any sense from my clinic - basically i only get to speak to nurses (not doctors) which are not really answering my questions - or maybe i just don't understand their answers.

 

Here is my concern. I had a round baseline tests (day 3 blookwork + ultrasound) in June 2018 prior to starting IVF earlier this month. On that day 3 ultrasound (in June 2018) my antral follical count was 10 - 6 in one ovary and 4 in the other.

 

Fast forward to September: From day 21 of last cycle until the day I started stims, i was on Estrace 4MG per day. My period came and they "assigned a day 3" (which was my ACTUAL cycle day 7) - first scary part. On my "assigned day 3" (actual cycle day 7) i went in for bloodwork and ultrasound and started taking stims: Puragon 300IU and 75IU. Did that for 4 days and today i went for my "day 7" (actual cycle day 11) bloodwork and ultrasound -  They only saw 2 follicles on the right ovary (i overhead them say 0.8 - i'm assuming size?) while my left ovary is "resting" - so nothing.

 

I'm so confused how can the original antral follical count of 10 become just 2 follicles with all the stims that i've been taking? Does one at all relate to the other - my nurses says it doesn't have anything to do with one another but reading from all the other forums, it looks like it does relate?

 

I am not sure what i was expecting as my clinic really gave me nothing to go by, but after reading so many forums, i was expecting a much higher number. They're now saying that they may cancel this cycle if nothing happens on the next round of tests, which is in 3 days from now, but for now to just continue taking what i've been taking and come back in 3 days.

 

Any insight would be very helpful and appreciated!

 

TS1906 - please take a look at my profile. I was 40 when I did my first estrogen priming IVF protocol. My AFC was also 10. You are still VERY early on in the stimulation phase. Based on your numbers you are also, like me, most likely a poor responder. Also, at this advanced age, or for any age for that matter, there is no expectation that you will stimulate all follicles. In my first IVF with an AFC of 10, I only stimulated three follicles. You cannot compare yourself to women that have much higher AMH and AFC numbers that are younger and will stimulate much better.

 

Take it from me, because I stressed out about the process more than I should have, to take a deep breath, educate yourself on the terminology and rather than discussing the results with the nurses in a panic, understand what they are saying. Really the nurses generally have a lot of experience. I never directly discussed the results with my RE during stimulation, but knew that he was looking over the results through the entire process and making the decisions that needed to be made.

 

Like Schlepp said, the day # is not very relevant during IVF as there is a window that they just have to meet. Your body is being controlled by the hormones you are injecting rather than your natural hormones. Also, you are not yet at the highest dose of stimulants, so that is also an option. Give it some more time, at least until day 10 of stimulation to see how many follicles you are stimulating.

 

I know this process is overwhelming and very emotional because of what we are all trying to achieve, so try to rely on the people on these forums to help you take things in stride. I know it sucks when you're never going to stimulate 20 follicles, but you just have to work with what you have.



#4 TS1906

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Posted 02 October 2018 - 08:16 AM

Dear Schlepp and Returnable, thank you soooo much for your responses. 

 

Schlepp: My doctor (or nurses) never discussed any protocols or strategies with me. I'm not doubting that they're very experienced or knowledgeable, I'm just feeling very overwhelmed because I have no idea what to expect. I didn't even know anything about "protocols" until I got on forums and finally asked yesterday "what protocol am I on?". So, to answer your question, no there was no discussion of DHEA or androgel/testosterone priming or anything of the sorts for that matter. I did so much research but I was so overwhelming that I don't know what questions to ask, and I take on full responsibility for that.

 

So are you saying that if I only have 2 or 3 follicles by Thursday to allow them to cancel this cycle? What are the realistic numbers I should be expecting at my age and situation? Not even this was discussed with me so that's probably why I was so shocked by 2 follicles! Had they told me what their expectations are, I think I would have been a lot more prepared instead of going into a full on panic yesterday. 

 

Now, if they do cancel, what should I be doing to make sure I understand next step/cycle? I know research - but can this be narrowed down a bit? What's to say that my next cycle won't be the same? And if it is, is there a point proceeding with a small number of follicles to see if anything "sticks"? I keep reading that it's not the qty is the quality, but not sure if that's the right mantra in this situation. 

 

I'm also very paranoid and am leaning towards being ok with cancelling this cycle as I feel like I didn't take the best care of myself that I should have - again probably due to being uninformed and unprepared. First, I got a bad cold for 5 days last week. Then, I was not feeling too well so I barely ate. I had such insomnia so I didn't sleep well. I stressed too much, but not too sure how to avoid this. Would all this affect my egg quality? 

 

Returnable, thank you also for your reply! I did check out your profile, but it looks like with your numbers being so similar to mine, your developed more follicles than me? It's funny - our stories (at least in short form) look very similar. My husband also had a vasectomy reversal so combine that with my age and numbers, ICSI seems to be the best route for us.

 

Thank you again ladies! Much love your way!



#5 returnable

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Posted 02 October 2018 - 08:50 AM

I believe it is too early to cancel the cycle. After your number of days of stimulation, I was also only at two follicles stimulated. You really have to see until days 10-13. Unfortunately there is no guarantee that a next cycle would yield significantly different results. Not eating well or stressing out would not have an effect on how you stimulate. Unfortunately there is not A LOT that you can do, and as I have come to accept through our struggles, you have to come to terms with that. DHEA taken for at least three months prior to a cycle may improve egg quality, but it won't impact how you stimulate.

 

I do get frustrated that the process does not educate the patient to understand what the potential outcomes should be. If anything I would say this is the biggest issue I see.

 

One option is to also get a second opinion somewhere once you see how this cycle evolves to see whether they would have a different perspective on  your case. Unfortunately you are looking at a complex situation with your fertility medical histories. BTW it was Schlepp's husband who had the vasectomy reversal. My DH just had issues with high fragmentation, but his numbers have always been great.



#6 TS1906

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Posted 02 October 2018 - 10:58 AM

Oops sorry about the "husbands mix up" lol - only been on this forum for not even a day now, so still learning how to navigate this...

 

Question - has anyone on this forum recommend a doctor(s) who specializes or has a lot of experience with women such as me? Poor AMH, DOR, on the older side (wow I can't believe I'm referring myself as older :(), "poor responder" (is being a poor responder tied to being DOR or we just double "lucky"?)...

 

I'm definitely up to getting a second opinion; the reason why I'm at Mt. Sinai right now is because I'm on the "funded cycle" and my GP said they're great and also had the fastest turn around for funded cycles - I was in IVF process within 2 months of completing all my testing.

 

I also read that some people switched to IUI at some point during their cycle due to low follicles - do you know anything about that? Would that be an option for us?

 

Lastly, what number of follicles would you say I should be hoping for in order to have a decent chance?

 

Thanks so much for all your help and feedback returnable!!! Really really appreciate it!



#7 schlepp

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Posted 02 October 2018 - 01:18 PM

TS1906 - I believe you get to cancel once on the funded cycle but it could be specific to a clinic. You could convert it to an IUI but check with your nurse/RE to see what their policy is. IUI is definitely an option if your partner's numbers are good enough for it. My partner had a reversal last summer and his numbers are great but he has antibodies now. We did try two medicated IUIs after the reversal and before returning to IVF. 

 

Returnable has a lot of experience with this and has offered some great advice. Wait and see how much further you get. If you do cancel, don't rush to the next cycle. Maybe pause and do some research, talk to your RE about different protocols including priming. It takes 3-4 months to impact the eggs that will be used in an IVF cycle. So if you haven't started supplements for egg quality you will want to get on those right away. There are a lot of threads on here with supplement recommendations but you could also see a naturopath that specialises in infertility. Just run any supplements by your RE once you start a cycle to make sure they are comfortable with them. 

 

It seems like follicle count is not indicative of the number of eggs recruited for some women. Especially as we age. I have a really good follicle count (22) but only seem to recruit and grow about 1/3 of them. I see younger women recruiting a much higher percentage and sometimes more than they started with on day 3.  It is very frustrating. 

 

I'm sorry you're not having a great experience. No one prepares you for how overwhelming this is and how much you have to learn. I think a lucky few get pregnant their first round and don't really have to research or advocate for themselves. 


(age 38) June 2016 IVF #1 antagonist, 13 mature eggs, 4 fertilized, 1 blast frozen

October 2016 FET #1 cancelled, thin lining

Changed clinics

(age 39) April 2017 FET #1.1 BFN

July 2017 partner has vasectomy reversal

Feb & March 2018 - Medicated IUI x2 - BFN (even with 7 mature follicles on the 2nd IUI)

(age 40) May 2018 IVF#2, lupron flare, 7 mature eggs, 5 fertilized, 1 blast & 1 morula fresh transfer, BFN. 1 low quality blast frozen

June 2018 IVF#3 mini stim, 1 egg, immature

Sept/Oct 2018 IVF#4 antagonist with HGH - CANCELLED due to high estrogen/29mm cyst

Oct 2018 IVF#4.1 antagonist with HGH - 7 eggs, all mature, 6 fertilized, 2 blasts on day 6, PGS tested/euploid

November 2018 FET #2 w/immune protocol and 1 PGS tested -  BFN

Locus Medicus testing for virus, bacteria and immune issues. Husband treated.

(age 41) April 2019 IVF#5 converted to IUI#3 due to follicle growth. BFP 12 day post IUI. Di/Di twins.

Dec 17 2019 - Baby boy and girl born at 36 weeks + 2 days. Everyone very healthy. 

 

See my 'about me' page for more detail on my treatment history.


#8 returnable

returnable
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  • Location:Whitby, ON
  • Interests:travelling,gardening,cooking
  • Dx:DOR
  • My Clinic:Trio, cycle monitoring at Lakeridge

Posted 02 October 2018 - 03:28 PM

I don't know whether with a funded cycle you can convert to an IUI or you have to cancel in order to keep your funded cycle for next time. It was never offered to us, so I assume my RE did not give it much hope.

 

I think for the most tailored approach, Hannam seems to be a good place to go, however you cannot take your funded cycle with you. My RE at Trio has experience with DOR and tried what he could, but I wouldn't say he was too out of the box. Perhaps if we had more money and we'd tried more cycles he would have been more open, but with two cycles we tried two different protocols and basically got the same results in the end.

 

It is hard to say what number of follicles are worth it for retrieval. For us the decision was whether we thought we could do better next time, and we didn't think so, so we went ahead with retrieval. Although we ended up with one five day blast out of each of our IVF cycles, unfortunately neither ended up being PGS normal.

 

I don't think you can set your sights on the number of follicles you need for a decent chance. You may not get any better, and it truly does take just one. Unfortunately with the number you will get and your advanced age, the odds are not in your favour. I know that is hard to hear, but unfortunately that is the truth. We went through our process to accept that as our funds were limited.







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