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Cancelled IVF cycle ... low E2 level

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#1 Julia1977

Julia1977

    Julia

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Posted 24 November 2012 - 02:19 PM

Hi Dr. ....

I just had my first IVF cycle cancelled due to low Estrogen (136 on Day 8 of stimulation). My protocol was BCP for 23 days, Superfact 0.5 for 12 days, start stimulation by 2 menopur +1 bravelle per day & reduce superfact dose to 0.25. Bravelle was increased to 3 per day from Day 4, and to 4 per day on day 6).

Honestly it surprised me as I went through 2 complete (but failed) IUI cycles (with 3 good sized follicles in each cycle) whereby estrogen was never an issue ... instead ...there were some concerns regarding my FSH/LH levels.

Before those 2 IUI cycles, I had a cancelled IUI as it was then that the RE discovered a possibility of POR/DOR as a result of elevated FSH level after taking clomid for stimulation.

why would the Estrogen level pattern change that much from one cycle to the other? is it the hormonal blocking by superfact? or the quality of eggs? if I managed to grow the eggs in the IUI cycles, why is it that different in IVF?

Another question, what is the maximum time before I get my next period after cancelling IVF on Day 8?

Thanks in advance for the feedback.

Best regards

Age: 37
TTC: 3.5 years. Dx: Endometriosis stage IV in 2004 + Poor/Diminished Ovarian Reserve (relatively high FSH + low AMH)
ART Attempts: 1 cancelled IUI + 2 Failing IUIs + 1 IVF (Cancelled) + 1 IVF (BFN) + 1 IVF (BFP then miscarriage)

****************************************************************************************
IVF#1 (Nov 2012): (long protocol)
(Menopure, Bravelle)
Cycle cancelled due to poor response (Estrogen levels not increasing)

IVF#2 (Feb 2013): (microflare protocol): menopure (3 vials x 2 per day)
4 eggs retrieved (2 on each side) .... all mature, 2 eggs fertilized out of the 4 ICSI'd. Transferred 2 embryos of average quality (1 @ 5 cells & the other @ 7 cells) with AH -->
 BFN

 
April 2013: Laparoscopy: Removal of cysts from right and left ovary and some little endo spots and freeing right ovary from adhesion.
 
IVF#3 (June/July 2013): Microdose flare + Saizen+testosterone
5 eggs retrieved, 3 mature and fertilized by ICSIET of 2 6-cell embryos grade 2 and 3 --> BFP,

1st Beta= 57. US on 8th week: baby measures at 6 weeks and no heartbeat. Confirmed missed miscarriage, M/C at 9 weeks

 

Full panel of blood work analysis done for possible etiology of miscarriage. Everything was normal, except for a heterozygous MTHFR mutation (prescribed high dose folic acid)

 

IVF#4 (Dec2013/Jan 2014): Microdose flare+Saizen+testosterone 

4 eggs retrieved, all mature and fertilized by ICSI, ET of 1 6-cell embryo an 1 8-cell embryo graded 2 and 3. Non left to freeze --> BFN

 

IVF#5 (April/May 2014): Antagonist Estrogen Priming -Cornell Protocol (Clomid+ Menopur+Gonal F + Orgalutran)

6 eggs retreived, 4 mature and fertilized by ICSIMay 11: Day 3 ET on mother's day of 2 grade 2 8 cell embryos with less than 10% fragmentation. Non left to freeze

--> BFP : 1st Beta: 315.2, 2 (May 25th), 2n beta: 2715 (May 31st) smile.png --> June 19th, U/S shows one bean measuring right on track at 8w1d and heart beat above 150.

20w U/S confirms we are having a BOY ... Screening was negative and all measurements were normal. EDD: Jan 29th, 2015

 

Jan 30th 2015: My little baby boy was born ...can't be more grateful

 

Details in the "About me" section


#2 Lisa1981

Lisa1981
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  • Interests:Getting my sanity back
  • Dx:Endometriosis
  • My Clinic:N/A at the moment

Posted 24 November 2012 - 05:02 PM

Hi Julia, I posted this on the Nov/Dec IVF thread but though that maybe I could post it here Image postée. I'm not the RE nor do I think that I have enough knowledge but, I'd like to share my opinion :).

You had asked me what protocol I was on because of the similarities in our DX....Truth be told, I think your protocol was wrong for your DX, you mentioned that everything went well for your IUI's but not the IVF, my guess is, you didnt have the same protocol for either one of them.. I copied and pasted my answer from the other thread:

I 'm on a very simple short protocol. 225iu Gonal F, 75iu luveris and starting Monday, I'll add cetrotide to prevent early ovulation. Maybe a change in protocol would be best for you. It may be worth asking you RE. I was on Gonal F for my IUIs and on my second one, they even had to reduce my dose because to many follicles were growing for an IUI (5 of them were fighting for the lead). Sometimes, the simpless solution, is the best one. One thing I dont understand is, if you have DOR, why the he** would they suppress you with BCP, a short protocol would be best (thats my opinion and my RE's opinion).... This is an extract from my clinics website (long protocol is with BCP):

Hormonal suppression
During the IVF process it is essential for a patient not to ovulate prior to egg collection. To prevent this from happening we either suppress your natural cycle with a GnRH agonist before beginning ovarian stimulation ("long protocol"), or alternatively we use a GnRH antagonist after we have begun ovarian stimulation ("short protocol"). In general, we prefer to use the long protocol with a GnRH agonist in women who are young and are expected to have a large number of eggs. In contrast, we prefer to use the short protocol with a GnRH antagonist in women who may not have such a robust response to ovarian stimulation.



In plain english: Many follicles: BCP/long protocol.. DOR: short protocol....

Me: 33 - DH: 36

July 2012: referred to Ottawa fertility center
August 2012: Test results are back
High FSH, Low AFC (only 6)
Endo (duuuh) & DOR  (great....)

And may has well make it a trio...male factor (motility)

 

After 2 failed IUIs, 5 Failed IVF:

Trying on our own until spring come's along... 

 

Feb 09: A little Miracle, a natural BFP. Praying it sticks around for 9 months.

Feb 11: Beta 25 (yikes)- P4: 47 oh boy, put on progesterone

Feb 13: Beta 86 - P4: 144

Feb 18: Beta 544 - P4: 96

Feb 20: Beta 1128 - P4: 81... increased progesterone to 600mg

Feb 24: Beta 1608 - P4: 100... oh boy, not looking promissing

Feb 25: Beta: 1942 (no P4) at another hospital.. ok, looking better... U/S: sac and yolk. Nothing else.

March 04: HB 115. Problem: Sac is small... repeat u/s next week

March 14: U/S , HB (abdominal) 167bpm (internal) 158bpm. Problem: Sac still small, reapeat u/s in 10 days..

March 24: U/S confirmed no HB.. stop progesterone. M/C that same evening


#3 Julia1977

Julia1977

    Julia

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Posted 24 November 2012 - 10:32 PM

Thanks Lisa for the information, that was so enlightening ...
The reason my clinic provided for starting with the long protocol is that they try to avoid exposing the patient in a first IVF to the high doses for stimulation .. so they try the standard way first, based on which they adjust later if standard doesn't work.
In all cases, I will be looking forward to my next steps ...and certainly ... to your current cycle bringing you what you aim for :)
Thanks again for the support

Age: 37
TTC: 3.5 years. Dx: Endometriosis stage IV in 2004 + Poor/Diminished Ovarian Reserve (relatively high FSH + low AMH)
ART Attempts: 1 cancelled IUI + 2 Failing IUIs + 1 IVF (Cancelled) + 1 IVF (BFN) + 1 IVF (BFP then miscarriage)

****************************************************************************************
IVF#1 (Nov 2012): (long protocol)
(Menopure, Bravelle)
Cycle cancelled due to poor response (Estrogen levels not increasing)

IVF#2 (Feb 2013): (microflare protocol): menopure (3 vials x 2 per day)
4 eggs retrieved (2 on each side) .... all mature, 2 eggs fertilized out of the 4 ICSI'd. Transferred 2 embryos of average quality (1 @ 5 cells & the other @ 7 cells) with AH -->
 BFN

 
April 2013: Laparoscopy: Removal of cysts from right and left ovary and some little endo spots and freeing right ovary from adhesion.
 
IVF#3 (June/July 2013): Microdose flare + Saizen+testosterone
5 eggs retrieved, 3 mature and fertilized by ICSIET of 2 6-cell embryos grade 2 and 3 --> BFP,

1st Beta= 57. US on 8th week: baby measures at 6 weeks and no heartbeat. Confirmed missed miscarriage, M/C at 9 weeks

 

Full panel of blood work analysis done for possible etiology of miscarriage. Everything was normal, except for a heterozygous MTHFR mutation (prescribed high dose folic acid)

 

IVF#4 (Dec2013/Jan 2014): Microdose flare+Saizen+testosterone 

4 eggs retrieved, all mature and fertilized by ICSI, ET of 1 6-cell embryo an 1 8-cell embryo graded 2 and 3. Non left to freeze --> BFN

 

IVF#5 (April/May 2014): Antagonist Estrogen Priming -Cornell Protocol (Clomid+ Menopur+Gonal F + Orgalutran)

6 eggs retreived, 4 mature and fertilized by ICSIMay 11: Day 3 ET on mother's day of 2 grade 2 8 cell embryos with less than 10% fragmentation. Non left to freeze

--> BFP : 1st Beta: 315.2, 2 (May 25th), 2n beta: 2715 (May 31st) smile.png --> June 19th, U/S shows one bean measuring right on track at 8w1d and heart beat above 150.

20w U/S confirms we are having a BOY ... Screening was negative and all measurements were normal. EDD: Jan 29th, 2015

 

Jan 30th 2015: My little baby boy was born ...can't be more grateful

 

Details in the "About me" section


#4 SLJ

SLJ
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Posted 25 November 2012 - 11:01 AM

Hi Julia,
I know it's frustrating to have to cancel a cycle. It's all about finding the right protocol and dose that produces a decent response. Unfortunately, sometimes its just trial and error. I have a very low amh and my RE wouldn't even consider putting me on BCP. I'm on a short antagonist protocol with no suppression. At the end everyone responds differently and every cycle is different. I hope you have better luck in your next cycle.

Dx: Male Factor, DOR
TTC since Dec. 2010

IVF#1 - Oct '11 - converted to IUI - BFN

IVF#1 (take 2) - Dec '11 - BFP
Beta 1 (9dp3dt ) -58, Beta 2 (11dpt)-178, Beta 3 (13dpt)-435, Beta 4 (15dpt) - 935 -Born Still - May 18,2012

IVF #2-4 

FET #1 - Jan '13 - Chemical

Surprise Natural Pregnancy - April 2013


#5 Julia1977

Julia1977

    Julia

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  • Gender:Female
  • Dx:DOR

Posted 25 November 2012 - 01:48 PM

SLJ thanks a lot ... you know just reading your stories and seeing your successes ... bring me hope ...
Thanks a lot ...

Age: 37
TTC: 3.5 years. Dx: Endometriosis stage IV in 2004 + Poor/Diminished Ovarian Reserve (relatively high FSH + low AMH)
ART Attempts: 1 cancelled IUI + 2 Failing IUIs + 1 IVF (Cancelled) + 1 IVF (BFN) + 1 IVF (BFP then miscarriage)

****************************************************************************************
IVF#1 (Nov 2012): (long protocol)
(Menopure, Bravelle)
Cycle cancelled due to poor response (Estrogen levels not increasing)

IVF#2 (Feb 2013): (microflare protocol): menopure (3 vials x 2 per day)
4 eggs retrieved (2 on each side) .... all mature, 2 eggs fertilized out of the 4 ICSI'd. Transferred 2 embryos of average quality (1 @ 5 cells & the other @ 7 cells) with AH -->
 BFN

 
April 2013: Laparoscopy: Removal of cysts from right and left ovary and some little endo spots and freeing right ovary from adhesion.
 
IVF#3 (June/July 2013): Microdose flare + Saizen+testosterone
5 eggs retrieved, 3 mature and fertilized by ICSIET of 2 6-cell embryos grade 2 and 3 --> BFP,

1st Beta= 57. US on 8th week: baby measures at 6 weeks and no heartbeat. Confirmed missed miscarriage, M/C at 9 weeks

 

Full panel of blood work analysis done for possible etiology of miscarriage. Everything was normal, except for a heterozygous MTHFR mutation (prescribed high dose folic acid)

 

IVF#4 (Dec2013/Jan 2014): Microdose flare+Saizen+testosterone 

4 eggs retrieved, all mature and fertilized by ICSI, ET of 1 6-cell embryo an 1 8-cell embryo graded 2 and 3. Non left to freeze --> BFN

 

IVF#5 (April/May 2014): Antagonist Estrogen Priming -Cornell Protocol (Clomid+ Menopur+Gonal F + Orgalutran)

6 eggs retreived, 4 mature and fertilized by ICSIMay 11: Day 3 ET on mother's day of 2 grade 2 8 cell embryos with less than 10% fragmentation. Non left to freeze

--> BFP : 1st Beta: 315.2, 2 (May 25th), 2n beta: 2715 (May 31st) smile.png --> June 19th, U/S shows one bean measuring right on track at 8w1d and heart beat above 150.

20w U/S confirms we are having a BOY ... Screening was negative and all measurements were normal. EDD: Jan 29th, 2015

 

Jan 30th 2015: My little baby boy was born ...can't be more grateful

 

Details in the "About me" section


#6 Julia1977

Julia1977

    Julia

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  • 525 posts
  • Gender:Female
  • Dx:DOR

Posted 01 February 2013 - 09:59 AM

Hi Julia,
I know it's frustrating to have to cancel a cycle. It's all about finding the right protocol and dose that produces a decent response. Unfortunately, sometimes its just trial and error. I have a very low amh and my RE wouldn't even consider putting me on BCP. I'm on a short antagonist protocol with no suppression. At the end everyone responds differently and every cycle is different. I hope you have better luck in your next cycle.

Hi SLJ,

 

How's you little baby angel doing? 

 

I'm coming back to you after 2 months as I'm going through my flare protocol and having had my ER yesterday with 4 eggs, 2 of which fertilized by ICSI.

I just would like to ask you about your successful experience, and how many eggs you had retrieved and got fertilized?

 

Thanks again for the info


Age: 37
TTC: 3.5 years. Dx: Endometriosis stage IV in 2004 + Poor/Diminished Ovarian Reserve (relatively high FSH + low AMH)
ART Attempts: 1 cancelled IUI + 2 Failing IUIs + 1 IVF (Cancelled) + 1 IVF (BFN) + 1 IVF (BFP then miscarriage)

****************************************************************************************
IVF#1 (Nov 2012): (long protocol)
(Menopure, Bravelle)
Cycle cancelled due to poor response (Estrogen levels not increasing)

IVF#2 (Feb 2013): (microflare protocol): menopure (3 vials x 2 per day)
4 eggs retrieved (2 on each side) .... all mature, 2 eggs fertilized out of the 4 ICSI'd. Transferred 2 embryos of average quality (1 @ 5 cells & the other @ 7 cells) with AH -->
 BFN

 
April 2013: Laparoscopy: Removal of cysts from right and left ovary and some little endo spots and freeing right ovary from adhesion.
 
IVF#3 (June/July 2013): Microdose flare + Saizen+testosterone
5 eggs retrieved, 3 mature and fertilized by ICSIET of 2 6-cell embryos grade 2 and 3 --> BFP,

1st Beta= 57. US on 8th week: baby measures at 6 weeks and no heartbeat. Confirmed missed miscarriage, M/C at 9 weeks

 

Full panel of blood work analysis done for possible etiology of miscarriage. Everything was normal, except for a heterozygous MTHFR mutation (prescribed high dose folic acid)

 

IVF#4 (Dec2013/Jan 2014): Microdose flare+Saizen+testosterone 

4 eggs retrieved, all mature and fertilized by ICSI, ET of 1 6-cell embryo an 1 8-cell embryo graded 2 and 3. Non left to freeze --> BFN

 

IVF#5 (April/May 2014): Antagonist Estrogen Priming -Cornell Protocol (Clomid+ Menopur+Gonal F + Orgalutran)

6 eggs retreived, 4 mature and fertilized by ICSIMay 11: Day 3 ET on mother's day of 2 grade 2 8 cell embryos with less than 10% fragmentation. Non left to freeze

--> BFP : 1st Beta: 315.2, 2 (May 25th), 2n beta: 2715 (May 31st) smile.png --> June 19th, U/S shows one bean measuring right on track at 8w1d and heart beat above 150.

20w U/S confirms we are having a BOY ... Screening was negative and all measurements were normal. EDD: Jan 29th, 2015

 

Jan 30th 2015: My little baby boy was born ...can't be more grateful

 

Details in the "About me" section


#7 Julia1977

Julia1977

    Julia

  • Cyclebase
  • 525 posts
  • Gender:Female
  • Dx:DOR

Posted 18 February 2013 - 10:36 AM

Hi Julia,
I know it's frustrating to have to cancel a cycle. It's all about finding the right protocol and dose that produces a decent response. Unfortunately, sometimes its just trial and error. I have a very low amh and my RE wouldn't even consider putting me on BCP. I'm on a short antagonist protocol with no suppression. At the end everyone responds differently and every cycle is different. I hope you have better luck in your next cycle.

 

 

Hi Julia, I posted this on the Nov/Dec IVF thread but though that maybe I could post it here smile.png. I'm not the RE nor do I think that I have enough knowledge but, I'd like to share my opinion smile.png.

You had asked me what protocol I was on because of the similarities in our DX....Truth be told, I think your protocol was wrong for your DX, you mentioned that everything went well for your IUI's but not the IVF, my guess is, you didnt have the same protocol for either one of them.. I copied and pasted my answer from the other thread:

I 'm on a very simple short protocol. 225iu Gonal F, 75iu luveris and starting Monday, I'll add cetrotide to prevent early ovulation. Maybe a change in protocol would be best for you. It may be worth asking you RE. I was on Gonal F for my IUIs and on my second one, they even had to reduce my dose because to many follicles were growing for an IUI (5 of them were fighting for the lead). Sometimes, the simpless solution, is the best one. One thing I dont understand is, if you have DOR, why the he** would they suppress you with BCP, a short protocol would be best (thats my opinion and my RE's opinion).... This is an extract from my clinics website (long protocol is with BCP):

Hormonal suppression
During the IVF process it is essential for a patient not to ovulate prior to egg collection. To prevent this from happening we either suppress your natural cycle with a GnRH agonist before beginning ovarian stimulation ("long protocol"), or alternatively we use a GnRH antagonist after we have begun ovarian stimulation ("short protocol"). In general, we prefer to use the long protocol with a GnRH agonist in women who are young and are expected to have a large number of eggs. In contrast, we prefer to use the short protocol with a GnRH antagonist in women who may not have such a robust response to ovarian stimulation.



In plain english: Many follicles: BCP/long protocol.. DOR: short protocol....

 

 

 

Hi Ladies ...

 

It's been a long time. I have been following up on some of your posts, and I don't know if you have been updated about my cycle.

 

Yesterday was my beta day and I got my official BFN. I had some hopes, but anyway ... it's just not our time I guess.

 

So ... 

I just got a call from the clinic this morning saying that RE reviewed my file (I was surprised at the prompt feedback!! they are just amazing). As per the nurse, Re said that the only thing we can do differently next time is adding Saizen (Human Growth Hormone) during stimulation, as I had already been on the aggressive protocol (microdose flare). I've read some positive things about Saizen, I wonder if you did use that during your cycles, and if it is different from DHEA.

 

Now I need to wait for AF, and accordingly we can do the calculations for the possible dates. Most probably I will do a BCP-free cycle, then go for a BCP cycle after which I start the next IVF cycle (probably in April).

 

Wishing you all the best


Age: 37
TTC: 3.5 years. Dx: Endometriosis stage IV in 2004 + Poor/Diminished Ovarian Reserve (relatively high FSH + low AMH)
ART Attempts: 1 cancelled IUI + 2 Failing IUIs + 1 IVF (Cancelled) + 1 IVF (BFN) + 1 IVF (BFP then miscarriage)

****************************************************************************************
IVF#1 (Nov 2012): (long protocol)
(Menopure, Bravelle)
Cycle cancelled due to poor response (Estrogen levels not increasing)

IVF#2 (Feb 2013): (microflare protocol): menopure (3 vials x 2 per day)
4 eggs retrieved (2 on each side) .... all mature, 2 eggs fertilized out of the 4 ICSI'd. Transferred 2 embryos of average quality (1 @ 5 cells & the other @ 7 cells) with AH -->
 BFN

 
April 2013: Laparoscopy: Removal of cysts from right and left ovary and some little endo spots and freeing right ovary from adhesion.
 
IVF#3 (June/July 2013): Microdose flare + Saizen+testosterone
5 eggs retrieved, 3 mature and fertilized by ICSIET of 2 6-cell embryos grade 2 and 3 --> BFP,

1st Beta= 57. US on 8th week: baby measures at 6 weeks and no heartbeat. Confirmed missed miscarriage, M/C at 9 weeks

 

Full panel of blood work analysis done for possible etiology of miscarriage. Everything was normal, except for a heterozygous MTHFR mutation (prescribed high dose folic acid)

 

IVF#4 (Dec2013/Jan 2014): Microdose flare+Saizen+testosterone 

4 eggs retrieved, all mature and fertilized by ICSI, ET of 1 6-cell embryo an 1 8-cell embryo graded 2 and 3. Non left to freeze --> BFN

 

IVF#5 (April/May 2014): Antagonist Estrogen Priming -Cornell Protocol (Clomid+ Menopur+Gonal F + Orgalutran)

6 eggs retreived, 4 mature and fertilized by ICSIMay 11: Day 3 ET on mother's day of 2 grade 2 8 cell embryos with less than 10% fragmentation. Non left to freeze

--> BFP : 1st Beta: 315.2, 2 (May 25th), 2n beta: 2715 (May 31st) smile.png --> June 19th, U/S shows one bean measuring right on track at 8w1d and heart beat above 150.

20w U/S confirms we are having a BOY ... Screening was negative and all measurements were normal. EDD: Jan 29th, 2015

 

Jan 30th 2015: My little baby boy was born ...can't be more grateful

 

Details in the "About me" section


#8 Lisa1981

Lisa1981
  • Cyclebase
  • 1698 posts
  • Gender:Female
  • Location:Gatineau
  • Interests:Getting my sanity back
  • Dx:Endometriosis
  • My Clinic:N/A at the moment

Posted 18 February 2013 - 10:42 AM

Hi Ladies ...

 

It's been a long time. I have been following up on some of your posts, and I don't know if you have been updated about my cycle.

 

Yesterday was my beta day and I got my official BFN. I had some hopes, but anyway ... it's just not our time I guess.

 

So ... 

I just got a call from the clinic this morning saying that RE reviewed my file (I was surprised at the prompt feedback!! they are just amazing). As per the nurse, Re said that the only thing we can do differently next time is adding Saizen (Human Growth Hormone) during stimulation, as I had already been on the aggressive protocol (microdose flare). I've read some positive things about Saizen, I wonder if you did use that during your cycles, and if it is different from DHEA.

 

Now I need to wait for AF, and accordingly we can do the calculations for the possible dates. Most probably I will do a BCP-free cycle, then go for a BCP cycle after which I start the next IVF cycle (probably in April).

 

Wishing you all the best

Hi Julia,

 

I was actually following your cycle in the Jan/Feb thread and just read, a few minutes ago, about your BFN... my heart sanked.. I'm so sorry. I have nver heard about Saizen, I sure hope it works for you.

 

Wishing you the best of luck in your next cycle (I'll probably be stalking you then too, lol),

Lisa


  • Julia1977 likes this

Me: 33 - DH: 36

July 2012: referred to Ottawa fertility center
August 2012: Test results are back
High FSH, Low AFC (only 6)
Endo (duuuh) & DOR  (great....)

And may has well make it a trio...male factor (motility)

 

After 2 failed IUIs, 5 Failed IVF:

Trying on our own until spring come's along... 

 

Feb 09: A little Miracle, a natural BFP. Praying it sticks around for 9 months.

Feb 11: Beta 25 (yikes)- P4: 47 oh boy, put on progesterone

Feb 13: Beta 86 - P4: 144

Feb 18: Beta 544 - P4: 96

Feb 20: Beta 1128 - P4: 81... increased progesterone to 600mg

Feb 24: Beta 1608 - P4: 100... oh boy, not looking promissing

Feb 25: Beta: 1942 (no P4) at another hospital.. ok, looking better... U/S: sac and yolk. Nothing else.

March 04: HB 115. Problem: Sac is small... repeat u/s next week

March 14: U/S , HB (abdominal) 167bpm (internal) 158bpm. Problem: Sac still small, reapeat u/s in 10 days..

March 24: U/S confirmed no HB.. stop progesterone. M/C that same evening






Also tagged with one or more of these keywords: Estrogen, IVF