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Special treatment for plus size women


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#1 Sweetheart

Sweetheart
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  • 287 posts
  • Gender:Female
  • Location:Toronto
  • Dx:Unexplained

Posted 12 April 2008 - 11:32 AM

Dear Dr. Hannam
I've read online of a few changes that might be necessary if you are overweight. I wonder if I should be using longer than the normal needle for my IM shot? I'm using 1.5" but so are the thin women around me. Should I get a longer needle? I just started the Lupron flare on 0.1 cc and this will be my first IVF attempt. Should this dosage be increased for the overweight? The tiny needle for lupron (tuberculin needle) is definitely only getting into fat. Finally, I've read that egg retrieval might be difficult in the overweight but my doctor has not mentionned anything. Should I be concerned? Thank you very much for considering my questions.
SH
TTC #1 since 04/06
Age: 45, DH: 51. TTC#1 since 04/06
2/07 First Clomid natural cycle = BFN
3/07 Second Clomid natural cycle = BFP, MC 5/07 at 8 weeks, D & C 5/07
07/07 Third clomid natural cycle= no sign of follicle but ovulation assumed by bloodwork = BFN
8/07 First Clomid + IUI cycle = BFN + complications
9/07-11/07 Unable to TTC due to recovering from injury
12/07 First Injectibles cycle (SC) (Puregon) + IUI = 1 mature follicle and a BFN
01/08 2nd Injectibles cycle (IM)(Puregon & Repronex), 2 follicles but not quite mature, IUI any way = BFN
02/08 3rd injectibles (IM) (Bravelle & Repronex), 2 follicles 21 and 14, IUI = BFN
03/08 4th injectibles (IM) (Clomid + Gonal F), 1 follicle, IUI x 4 days in a row = BFN
04/08 IVF#1 Lupron flare w/o BCP, Lupron+Bravelle+Repronex, 7 follies but only 1 matures +IUI=BFN
05/08 Break from injectibles: Femara + IUI = BFN
06/08 Break from injectibles: Femara + 1 follicle + IUI = BFN
07/08 6th injectibles: high dose gonal F: 1 follicle +IUI =BFN
08/08 IVF#2 with low dose repronex only: Surprise 3 follies, 15, 19, 21. 1 egg retrieved fertilized and Grade 1 8 cell transfered aug 19=BFN
BREAK of 6 months turned to 8: took accupuncture, lost 30 pounds, added exercise, turned 41, Day 3 FSH down from average 7 to 4, worked on marriage relationship strained from dealing with IF
05/09 IVF #3 Gonal F and menopur. 5 Follicles but none mature. Cycle canceled.
07/09 IVF #4 Known DE cycle, 10 follicles, 1 sad egg, no fertilization. WT*?
08/09 Started taking DHEA (why didn't I know of this before?)
01/10 IVF #5: Convert monitoring cycle to natural cycle IVF due to 2 mature follicles being observed on ultrasound
01/10 1 grade 1, 8 cell embryo transferred. BFN
04/10 Estrogen Priming Cycle was cancelled for some reason I forget. known DE planned
08/10 IVF #6 Estrogen Priming Cycle with massive doses of FSH = nothing = cycle canceled and told to go away.
09/10 Waiting for Known DE cycle with younger donor
12/10 Known DE backs out
02/11 IVF #7. 2 embryos, both transferred. HPT+ 8dp3dt!!!, Beta #1 14dp3dt 278, Beta #2 16dp3dt 604, Beta #3 18dp3dt 1158 (not quite doubled...), first ultrasound--> TWINS!! March 25 only one slow heartbeat. April 2 no growth, slow heartbeat, April 6 no heartbeats--miscarriage at 9 weeks. D&C.
7/11 FET #1 BFN
9/11 IVF #8 Sad looking embryos. 4 transferred on day 3. BFN. Advised to move onto surrogacy. d e v a s t a t e d and b r o k e
04/13 Adopted 2 blastocycsts: BFN. Sperm banked before DH treated for cancer..
11/13 Very last attempt. New clinic. DE. Add intralipids and viagra. 9 eggs, 5 mature, 3 fertilized, 1 made it to day 3. no surprise, BFN..
04/14 Second "very last attempt" with 4th DE IVF.
04/05/14 13 eggs eggs retrieved, 7 mature, 7 make it to blast, 2 transferred, 2 frosties, BFP!! First Beta 4/21/14 = 92; Second Beta 4/23/14 = 265; 3rd Beta 4/25 613. May 9 ultrasound, right on track 6 weeks 5 days and hb 113 bpm. .
05/13/14 bleeding. May 14 no heartbeat. May 16 D & C. Are we allowed to say F words on here?

#2

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Posted 12 April 2008 - 12:42 PM

Dear SH,

It is true that weight, often defined as BMI, can make a difference to treatment. (if you want to calculate your BMI you could go here http://www.cdc.gov/n..._calculator.htm sorry not sure how to hyperlink text yet)

There are 3 ways weight could make a difference. I'll list the issues, and then what you might do about them

1. Absorption might be compromised (though usually it isn't)

This one is controversial, to some degree, as we aren't too clear on exactly how weight might affect the dose of hormones that your ovaries (or uterus) actually see. You mention that you are worried that injections might not get past the fat layer for example. But the good news is that you can always check how well aborption is happening: you just have to check how well your body is responding.

In a flare protocol, for example, as you are on, after 4 days of Lupron at 0.1 (which should be a sufficient dose) you should see your body responding with an estrogen >400, and if your clinic measures it, an elevated LH level too (often >8). So you will know shortly if the "flare" had its effect. I would think it will: Lupron is meant to be taken subcutaneously, and in my experience, it is well absorbed by everyone.

Similarly, when taking the progesterone in oil, you can have your serum progesterone levels checked. There is no perfect number here, just any value >30 to let you know that the progesterone is getting into your system. If you are worried about it, ask your clinical team to show you once again how to take the injections. If there are any worries you can supplement with progesterone suppositories too.

2. Retrieval or transfer could be a bit more difficult

Your reading is correct here, though the good news in your case is that, after all the IUIs you've done, your team knows that they can certainly provide treatment for you.

3. Pregnancy might be more complicated

Obesity can contribute to pregnancy related complications, to the degree that the British Fertility Society suggests that women with BMI >30 consider losing 10-15% of their weight. You can visit http://www.britishfe...maleHealth.html for more information

But SH, don't try to lose weight at this particular moment. It seems that you are in the midst of a cycle, you've had a protocol based on all the prior experience of the IUIs, and its time now to just follow the schedule.

Hope that helps.

TGH

PS Clinics don't usually distribute longer needles, for safety reasons (you really wouldn't want a needle to go TOO far)

#3 Sweetheart

Sweetheart
  • Global 100+
  • 287 posts
  • Gender:Female
  • Location:Toronto
  • Dx:Unexplained

Posted 12 April 2008 - 11:22 PM

Thank you very much for your comprehensive reply. You have really given me some thoughtful answers and also eased my mind about the Lupron. I will keep you posted. Thanks again.


Dear SH,

It is true that weight, often defined as BMI, can make a difference to treatment. (if you want to calculate your BMI you could go here http://www.cdc.gov/n..._calculator.htm sorry not sure how to hyperlink text yet)

There are 3 ways weight could make a difference. I'll list the issues, and then what you might do about them

1. Absorption might be compromised (though usually it isn't)

This one is controversial, to some degree, as we aren't too clear on exactly how weight might affect the dose of hormones that your ovaries (or uterus) actually see. You mention that you are worried that injections might not get past the fat layer for example. But the good news is that you can always check how well aborption is happening: you just have to check how well your body is responding.

In a flare protocol, for example, as you are on, after 4 days of Lupron at 0.1 (which should be a sufficient dose) you should see your body responding with an estrogen >400, and if your clinic measures it, an elevated LH level too (often >8). So you will know shortly if the "flare" had its effect. I would think it will: Lupron is meant to be taken subcutaneously, and in my experience, it is well absorbed by everyone.

Similarly, when taking the progesterone in oil, you can have your serum progesterone levels checked. There is no perfect number here, just any value >30 to let you know that the progesterone is getting into your system. If you are worried about it, ask your clinical team to show you once again how to take the injections. If there are any worries you can supplement with progesterone suppositories too.

2. Retrieval or transfer could be a bit more difficult

Your reading is correct here, though the good news in your case is that, after all the IUIs you've done, your team knows that they can certainly provide treatment for you.

3. Pregnancy might be more complicated

Obesity can contribute to pregnancy related complications, to the degree that the British Fertility Society suggests that women with BMI >30 consider losing 10-15% of their weight. You can visit http://www.britishfe...maleHealth.html for more information

But SH, don't try to lose weight at this particular moment. It seems that you are in the midst of a cycle, you've had a protocol based on all the prior experience of the IUIs, and its time now to just follow the schedule.

Hope that helps.

TGH

PS Clinics don't usually distribute longer needles, for safety reasons (you really wouldn't want a needle to go TOO far)


TTC #1 since 04/06
Age: 45, DH: 51. TTC#1 since 04/06
2/07 First Clomid natural cycle = BFN
3/07 Second Clomid natural cycle = BFP, MC 5/07 at 8 weeks, D & C 5/07
07/07 Third clomid natural cycle= no sign of follicle but ovulation assumed by bloodwork = BFN
8/07 First Clomid + IUI cycle = BFN + complications
9/07-11/07 Unable to TTC due to recovering from injury
12/07 First Injectibles cycle (SC) (Puregon) + IUI = 1 mature follicle and a BFN
01/08 2nd Injectibles cycle (IM)(Puregon & Repronex), 2 follicles but not quite mature, IUI any way = BFN
02/08 3rd injectibles (IM) (Bravelle & Repronex), 2 follicles 21 and 14, IUI = BFN
03/08 4th injectibles (IM) (Clomid + Gonal F), 1 follicle, IUI x 4 days in a row = BFN
04/08 IVF#1 Lupron flare w/o BCP, Lupron+Bravelle+Repronex, 7 follies but only 1 matures +IUI=BFN
05/08 Break from injectibles: Femara + IUI = BFN
06/08 Break from injectibles: Femara + 1 follicle + IUI = BFN
07/08 6th injectibles: high dose gonal F: 1 follicle +IUI =BFN
08/08 IVF#2 with low dose repronex only: Surprise 3 follies, 15, 19, 21. 1 egg retrieved fertilized and Grade 1 8 cell transfered aug 19=BFN
BREAK of 6 months turned to 8: took accupuncture, lost 30 pounds, added exercise, turned 41, Day 3 FSH down from average 7 to 4, worked on marriage relationship strained from dealing with IF
05/09 IVF #3 Gonal F and menopur. 5 Follicles but none mature. Cycle canceled.
07/09 IVF #4 Known DE cycle, 10 follicles, 1 sad egg, no fertilization. WT*?
08/09 Started taking DHEA (why didn't I know of this before?)
01/10 IVF #5: Convert monitoring cycle to natural cycle IVF due to 2 mature follicles being observed on ultrasound
01/10 1 grade 1, 8 cell embryo transferred. BFN
04/10 Estrogen Priming Cycle was cancelled for some reason I forget. known DE planned
08/10 IVF #6 Estrogen Priming Cycle with massive doses of FSH = nothing = cycle canceled and told to go away.
09/10 Waiting for Known DE cycle with younger donor
12/10 Known DE backs out
02/11 IVF #7. 2 embryos, both transferred. HPT+ 8dp3dt!!!, Beta #1 14dp3dt 278, Beta #2 16dp3dt 604, Beta #3 18dp3dt 1158 (not quite doubled...), first ultrasound--> TWINS!! March 25 only one slow heartbeat. April 2 no growth, slow heartbeat, April 6 no heartbeats--miscarriage at 9 weeks. D&C.
7/11 FET #1 BFN
9/11 IVF #8 Sad looking embryos. 4 transferred on day 3. BFN. Advised to move onto surrogacy. d e v a s t a t e d and b r o k e
04/13 Adopted 2 blastocycsts: BFN. Sperm banked before DH treated for cancer..
11/13 Very last attempt. New clinic. DE. Add intralipids and viagra. 9 eggs, 5 mature, 3 fertilized, 1 made it to day 3. no surprise, BFN..
04/14 Second "very last attempt" with 4th DE IVF.
04/05/14 13 eggs eggs retrieved, 7 mature, 7 make it to blast, 2 transferred, 2 frosties, BFP!! First Beta 4/21/14 = 92; Second Beta 4/23/14 = 265; 3rd Beta 4/25 613. May 9 ultrasound, right on track 6 weeks 5 days and hb 113 bpm. .
05/13/14 bleeding. May 14 no heartbeat. May 16 D & C. Are we allowed to say F words on here?