Jun 14, 2011

day 9 of stims=disappointment

When I went in on Sunday, we were told we were on-target for a Thursday egg retrieval. Unfortunately, due to disappointing progress since then, we've been postponed until next Sunday since they don't do ERs on Friday or Saturday. Of course I am incredibly anxious about postponing ER until Sunday because it essentially means sacrificing the current leaders with the hope that the larger cohort of smaller guys will play catch-up. The problem is that I just don't have such a large number of follicles to begin with and the ones I do have are still a wide range of sizes. On my right I have 19mm, 18.5mm, 16mm, 14mm, 13mm, and 12mm (2x) and on my left I have 21mm, 13mm, 12mm, and 11mm (2x).

Frankly, I would have felt comfortable with Plan A, which was to get in another shot of Gonal-F this afternoon and then trigger tonight for a Thursday ER, knowing that I probably won't get a very high yield of mature eggs but also that the current leaders will be in prime shape. My E2 was in the high 3000s today (equivalent to around 1000 pg/ml), so really not that much has happened for me since 48 hours ago.

I guess the logic now is to just keep pushing me out longer with the hope that everything currently in the 11-14mm range will be ready come next Sunday. I have some misgivings since the little guys have actually moved hardly at all since Sunday. It's a leap of faith for me that they won't just fizzle out the same way all those 10s and 11s did during injectable IUI cycles and I am sad for the current leaders who have been growing so nice and strong that we are essentially sacrificing them! I've also read that in general, pregnancy rates are lowered when you postpone trigger more than 24 hours past when the lead follicle reaches 20mm. I know as this process unfolds, I will always find something new to worry about! The irony is not lost on me that the doctors were initially preparing me for a hyperstim situation. Is it sad that I've already started thinking how we can improve our next fresh IVF cycle when I haven't even reached ER yet with this one?

ETA: I believe that this is the most often cited paper on the topic:

Prolongation of the follicular phase in in vitro fertilization results in a lower ongoing pregnancy rate in cycles stimulated with recombinant follicle-stimulating hormone and gonadotropin-releasing hormone antagonists. Fertil Steril. 2004 Jul;82(1):102-7.

The gist is this: they took two groups of patients with similar diagnoses, all on the antagonist protocol. Half of the patients were triggered when at least 3 follicles were at least 17mm and half of the patients were triggered 48 hours after this criteria was met (in my case, I will trigger over 72 hours after this criteria was met). On the whole, the patients in the late trigger group had higher E2 levels at the time of trigger and more mature eggs retrieved than the early trigger group. However, despite the larger numbers of mature eggs, the ongoing pregnancy rate in the late trigger group was 25% compared to 35.6% in the early trigger group. The theory is that prolonged stimming leads to decreased endometrial receptivity and lower implantation rates, perhaps as a result of the increased progesterone level at the time of trigger that comes with pushing the mature follicles past their prime. I can't help but feel doomed already knowing that my trigger will be over 72 hours past the time 3 follicles reached 17mm.


10 comments:

  1. A, I'm sorry today's monitoring was disappointing. I guess you just have to trust your doctors that they know how to direct this IVF so that you will get optimal results. I'm sure your doctors know their stuff, odds, etc. The sizes of my follicles were similar to yours on the same day, but my E2 was around 8400, which as you know comes with it's own problems. Good luck! Have faith in your follicles (and doctors).

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  2. Oh this stuff is so hard to decide on what is right. I hope that delaying the ER is what is best for you in the end!!!
    Thinking of you!

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  3. How disappointing. I hope you get a good result from your retrieval, no matter when it is.

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  4. That's upsetting, I'm sorry to hear this. I really hope it works out for you and you are pleasantly surprised with the results.

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  5. Gah, so difficult! I wish I stimmed a day longer but I had to have faith in my doctor. It is too bad they don't do Fri-Sat ER. They must know what they are doing, try to let it go and KNOW that you are going to have healthy mature eggs on Sunday!!!

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  6. How disappointing. I hope you get great results on Sunday. ((hugs)) I'm thinking of you.

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  7. I have a hard time trusting my docs to do the right thing, too. I guess we just have to let them make the decision that they think is right for us...knowing that they want you to be successful, too. I wish you good luck and hope everything goes well!

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  8. You must be very frustrated. I hope the doctors have made the right choice for you. Good luck on Sunday.

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  9. Sending your follies good vibes for lots of wonderfully mature eggs on Sunday!!!

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  10. Thanks guys! I still don't know whether it was the right decision to hold off until Sunday - I really, really wish we could an ER on Friday...it seems like that would probably have been the optimal day. Oh well, at this point all we can do is hope for the best!

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