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Estrace priming for IVF

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#1 magnum

magnum

    magnumopus

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Posted 21 January 2012 - 07:04 PM

Hi - this is my 1st time posting. I posted this in the "ask an RE" forum but would like to benefit from anyone else's experience.
I'd also like to hear from anyone who has had similar information provided to them from the Mount Sinai fertility clinic about deferring a cycle because they don't want your egg retrieval to fall on a weekend.. I am very upset that they just shared this with me on my body's day 2 when I fully expected to be starting Puregon day 3.. I have taken a leave of absence from work for this cycle after having a miscarriage with IVF #1 and it's incredibly stressful already.. let alone have me on some "protocol" I can't even find referred to on the internet - I am very concerned that fighting my body's cycle even more is going to lead to suboptimal results - I'm really losing my mind over this and would be incredibly grateful if anyone can help or give me any recommendations, advice. Thank you!

Here's what I posted :

My query is regarding Estrace priming. With my 1st IVF (with ICSI) in August I took 4mg of Estrace orally daily for 7 days (starting 1 week after ovulation), then stopped, my period arrived the following day - I then commenced Puregon on day 3 (with ganirelix added day 8), This was considered a successful cycle with 10 eggs retrieved on day 14, 3 embryos were transferred on day 3 - I was pregnant but miscarried after the diagnosis of a blighted ovum at 8 weeks.

I was intending to commence my 2nd IVF (ICSI) & understood that my RE (Dr. Heather Shapiro) intended to follow the same protocol as it was successful in producing a reasonable number of eggs. I again was told to start 4mg Estrace orally 7 days after ovulation & continue until my period arrived.

I notified the clinic my day 1 (period) arrived on Friday Jan.20th and was anticipating going in for day 3 bloodwork & ultrasound & commencing Puregon again as before... Instead I was told by a nurse to continue the 4mg Estrace daily until Friday Jan.27 (my day 8) at which point they would book bloodwork/ultrasound and have me commence the Puregon and "pretend" it was day 3 (??) I was then told that the doctors no longer worked weekends at the Mount Sinai clinic and manipulated patient cycles such that the egg retrieval would fall upon a weekday for their convenience. Apparently this policy was put into practice in late August after my 1st IVF - I was not informed of this change.

My concern is that overriding my body's cycle to such an extent will result in a poor outcome in terms of the quantity of mature eggs retrieved, hence decreasing my overall success rate. Is there any clinical support or evidence behind extending the Estrace priming thusly? Is there any way this could compromise the efficacy of my IVF? I would greatly appreciate any information.

#2 CatL

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Posted 21 January 2012 - 09:56 PM

Magnum - welcome to this forum! I don't know if it common for clinics to do this but I was asked to continue the Estrace for 3 more days with my last cycle to avoid having an ER on Christmas day (my clinic did not close during the holidays). I ended up with a good outcome (ET of two grade 1 embryos and 2 frosties) and am presently 5 weeks pregnant. With the cycle before that, I was on a short protocol which did not require me to start the Estrace after ovulation in preceding cycle, but my RE still got me to take some Estrace from day 2 to day 6 to avoid a weekend u/s (this was a different clinic that has only 2 REs and they do not do u/s on weekends). I was a little shocked at this as I thought I would be starting my stimming drugs on day 2-3 and worried that it would compromise my cycle. That cycle did not turn out so good, but I don't know if it's due to the extra Estrace...Sorry I'm not of any more help, but just thought I would share my experience...Good luck with your cycle!! FX that you get a great outcome!
<p>Me: 36 (homozygous MTHFR + heterozygous Factor V Leiden) DH: 40 (slightly low morphology (7%))
May 2006 Natural pg - 1st M/C at 11 wks
Aug 2006 Natural pg - 2nd M/C at 8 wks
Dec 2006 Natural pg - DD born Sept 2007!!!

TTC #2 since Feb. 2009
IUI #1 May 2010 - BFN
IUI #2 June 2010 - BFN
IUI #3 Sept 2010 - BFN
IUI #4 Oct 2010 - BFN

IVF #1 - Long Protocol
Puregon 225iu, ER Feb. 23rd (8 total, 5 fert)
ET Feb. 26th (2x8cell grade 3), no frosties :-(
1st Beta Mar. 11th - 243!!!!
2nd Beta Mar. 14th - 667 :-)
1st u/s Mar. 28th - singleton measuring 6w5d and HB 118...Yippi!
2nd u/s Apr. 12th - no HB...3rd M/C at 9w2d :-(((

IVF #2 - Antagonist protocol
Day 3 u/s showed 14-15 follies
CD 3-6 2x2mg Estrogen daily, CD 6 start 100iu Puregon/75iu Repronex
ER - Aug. 31st, 2011 (12 eggs/10 mature, 9 fert)
ET - Sept. 4th, 2011 (sET grade 2 blast), no frosties :-(
Sept. 10 6dp5dt +HPT :-)))!
Sept. 15 beta = 9 :-(( Chemical Pg

IVF #3 - Estrogen Priming Antagonist Protocol - Dec. 2011
Estrace, 225 ui Gonal-F/75 ui Repronex
ER - Dec. 29th, 2011 (12 eggs/11 mature, 6 fert)
ET - Jan. 1st, 2012 (two 8 cells, grade 1), 2 frosties :-))
Jan. 8th 7dp3dt +HPT...Please let this be the one!!!
Jan. 13th 12dp3dt Beta 642, 15dp3dt Beta 3112
Feb. 3rd 7w1d u/s - Twins!! HBs 143 + 144
Mar. 9th NT scan (12w1d) - still 2 babies developing perfectly :-))

Our girls were born Sept.7th, 2012 (38 wks 1 day) weighing in at 6 lbs and 6 lbs 12 ounces!!<a href="http://lilypie.com/"><img src="http://lbdf.lilypie....com/z9eqm4.png" width="400" height="80" border="0" alt="Lilypie Pregnancy tickers" /></a>

#3 magnum

magnum

    magnumopus

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Posted 23 January 2012 - 09:26 PM

Hi CatL,

Thank you so much for your reply - and congratulations! It turns out there was a miscommunication from the nurse - I received a call back from the clinic and went in Sunday for day 3 ultrasound and started Puregon, just as I had previously discussed with my RE. Dr. Liu who is on this site in the "ask your RE" forum was at the clinic Sunday and was very kind, clear and reassuring about how things would proceed, as was Madeline - one of the wonderful nurses. I am very grateful to be at the Mount Sinai clinic which has provided me with an exceptional level of care.. errors can happen anywhere and it's vital to question anything you don't feel is right or matches what was previously discussed, as in my case. All's well that ends well ...
That being said - I wish you all the best - that you have a joyful pregnancy free of complications and a happy & healthy baby! Posted Image





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