Cuddlepie - I can understand why your brain is going to mush! On a bright note, it sounds like Dr S is willing to try things a little differently - certainly at least raise your FSH dose. If your existing FS wants to use the same ol' dose, would you consider moving over to Dr S for one or two cycles?? Also, have you tried switching between Puregon and Gonal-F? My FS said some women respond better to one than the other (though I can't see the logic behind this).
Baby Dreamtime - very interesting! From the research I did, the Clexane and aspirin were the standard everywhere. I have taken this up with my OB a few times, and he just won't budge He just looks at my homocysteine result and says it's not necessary. That's why I started taking the garlic tabs and drinking tomato juice daily - natural blood thinners. TBH, this has been lingering in the back of my mind, particularly more now as you've read that with normal homocysteine levels there is still a link with clotting. Is there any chance you could PM me the link of the article mentioning this point about normal levels and clotting? I am meeting with my OB next week and would like to talk to him further about it. Do you think this is a real threat throughout all three trimesters of PG?
BDT, I had a similar assumption about the dosage on Antagonist cycle vs down-reg. That's why I was a bit worried to over stim initially with the same dose as down-reg, obviously that didn't happen but the contrarory. To me, this doesn't make logical sense really. Maybe because I am not a poor responder on down-reg, so the opposite result? It also made me wondering if I should give Flare cycle a try, seems all these protocols really gives different result on each individual. Even when we look at stats/research, we are not exactly comparing apple to apple, you won't know until you try it?! It sucks thought, no short cut just have to go through it. Your friends' case made perfect sense, if you find any other examples, I'd also like to hear it, its so helpful.
I've sent an email to Dr. Lok last night asking to increase dose, Im sure he will take on board. I am thinking it should be around 200iu. (half a doctor am I? )
Sara, I would do a down-reg cycle if I could this month, but given now my strategy for this year is 'to accumulated more snow-bubs in the frozen bank with my 38-year-old eggs', I am trying to fit in more cycles as I could. I am now on my D20 and going to do NK cell b/t next week, so can't start a down-reg. Timing wise, a short cycle fit in better so I won't waste a month in between. Although my mind is still battling between Antagonist or Flare atm. On the other hand, I don't feel super healthy this month, my temp chart is all over the place and hardly take a hike after O, so this morning I am also doubting if I should go into a cycle straight away. It might not be the best thing to do anyway. So again, I am confused.
Fibriod issue has now been put on the back burner, I sensed that Dr. S is thinking checking other issues more important than this although he didn't make it very clear. He just said its a tricky issue but many women got pregnant when having much larger fibroid than 5mm. So my plan is to do a Uterus biopsy and checking inside of it at one go, this also need to be done at D23-26 of the cycle, which means down-reg is out again. Once I eliminate all other possibilities, maybe I will have to consider this. I hate the sound of key-hole surgery and that will put me out of action for at least 3 months, so I want to get most use of my 'young' eggs before I have to IYKWIM.
Sorry for the long post, but just need to get this out because I know your guys would understand.
Cpie: Sorry now may confuse you even more - my FS is deadset against Flare without pill. She says if you do that one hormone (and I again can't remember which one I think it's progesterone) can get too high which has a negative effect on implantation - so if you wanted to do a truly frozen only cycle you should be fine. In case you go for antagonist, she said the smaller dosage Pregnyl will soon be no longer be available, I'll be going in to pick some up from SIVF, hopefully enough for two cycles as the alternative is another medication which seems to be $140 per shot !
Otherwise:
DHEA - she said to stay on 50mg as otherwise the side effects will get worse, she thinks 75mg is a really high dosage but didn't really have a real reason for it, admitting that all studies available have been done with 75mg, she also said it's very important for me - I have now decided for myself to go up to 75mg for now, if I can't got next cycle I may go down to 50mg again as I don't want to take a large dosage for a long period.
Supplements, she said to go down to 110mg CoQ10 altogether (Blackmores plus one extra) and put DP on 100mg as well.
Egg donor: to my great relief she thinks I should go with my own eggs for now.
Colorado protocol: She said it's more one you do after recurrent miscarriages or real implantation problems and does not think it is of benefit for me at this stage.
Empty follicles: She is 100% sure I haven't ovulated, she doesn't really have an answer but would give me a much larger dosage of the trigger shot hoping to mature the eggs.
Orgalutran: that was interesting, she starts this on Day 5 of the cycle day for everyone - I asked if it wouldn't be better to look at people individually she said that in my case she started it last cycle on Day 4 as I already was at 1100 E2 and that especially with women with lower egg numbers she is really conservative with it as she does not want to lose any eggs, which kind of makes sense.
FSH: She thinks I will have a cylce with a 12 or lower FSH number at some point and thinks I should probably wait for it but is happy to go with higher number if i want that.
Dr Lok: that also was very interesting, she said she is happy for me to get a second opinion and he can have access to all my files. I asked her if she thinks he may say something different and I think I got her thinking, she suggested to possibly start Orgalutran later than last time and said that would mean I need to get even closer monitored - I guess that may mean daily BT which I don't have a problem with if it gives me a better outcoesm. She also now wants DP to go to another SDSA test, if that turns out his DNA damage has not imporved she wants to do the sperm extraction operation - so far I have only told DP about the other test, don't think I need to worry him with the operation until we have the numbers.....
Sara, thanks for posting the response, that's very helpful and interesting. Glad you FS is able to do phone consult, I am in the middle of getting frustrated as I haven't heard anything from FS re the email I sent and my b/t result.
After all the information I've got so far (especially after read what your FS said), I am now leaning toward another Antagonist cycle, at least I know what can happen. I am hopeful that with an increased dosage, the result can be improved somehow. My strategy will still be aiming to freeze the best ones and transfer the viable ones to take my chances, with Dr. Lok fully agree and on my side.
Great that she thinks you can keep going with your own eggs, what a relief! Hope with some adjustment of the drugs and experience from the past two cycles, she will have better control over your cycle. (did you get my email? let me know)
I am considered a poor responder (even though my FSH levels have always been under 10). My 2 Flare and 1 Antagonist cycles were all done on 450 of GonalF - I think that's the highest dose they will do. I'm kind of in the opposite boat - I wish they could give me less. There is a theory that all this stimulation reduces quality of the eggs - but when you aren't getting any eggs with less, there's no real choice. It also makes sense that a body may respond differently to the same levels of gonalF (or equivalent stimulating hormone) depending on what other hormones/drugs are being given at the same time. As the antagonist doesn't involve surpressing anything, it does make sense that a lower dose of gonalF is used than when doing the flare.
WTH - It will be very interesting to hear what my next cycle will require as it is with a new FS/new clinic and very, very different. And it does involve aspirin along with some other drugs which together make up something called the Colorado method although so far I haven't shown a positive test for a clotting disorder (still waiting for some of my test results to come back - I just can't keep track of them all - other than the fact that from what has come back, everything is normal...except for low vitamin D which I'm now taking)
As for the folic acid - I too was told 1000 is the max - but that's if you don't have other issues that may impact your folate levels. I can certainly see where if you know you have poor absorption, higher dosages make total sense. I think the dr's are all aware of this 1000 figure thus, they wouldn't be telling you this unless there is a reason and a good thing for you to do.
Sara - I would LOVE the email address of my FS - but I think she would put me in her banned senders list - I would have such a hard time restraining myself from sending over a question every time it popped into my mind. I've had to put the DHEA on hold until I get the tests result back from tissue from my m/c - given the possibility it may have been a molar pregnancy, I cannot take anything that stimulates growth. I am that all will be fine and I can re-start the DHEA. I am really petrified at the moment about my test results.
CPie - if the timing of my cycles allows, my new FS has agreed to do the NK testing on me. But we agreed not to delay my cycle it the timing of the NK test would interfere. I think you need to do the uterine test on day 21 of cycle and odds are I will be overseas - and when I return, I want to start my next IVF cycle. But given that I had a D&C today, who knows when my first AF will arrive - it may work out that I can have the test without delaying the start of next ivf cycle. Given that you have blastie(s?) waiting for you, I can see why you want to do all this testing first - I'd do the same. I also think it is brilliant that you are stockpiling embryos made with 38 year old eggs instead of waiting. My biggest regret is not doing the same - we were not ready then as we were still making sure we were right for each other (didn't marry until I was almost 40) - and I just didn't know all that I know now. However, based on my experience I would consider taking a break. I had my worst cycle when it was back-to-back - a complete waste of money and hard on the body.
Isn't it interesting how different all these FS are - they are all experts and yet they all differ but are so sure that their way is the right way! Just a reminder I guess that this is far from an exact science. Although, I do think that the fact that some of these cycles require more involvement by the FS and more monitoring/testing do impact their choices. Glad you pushed your FS Sara as it seems you may have made her realize this is about you and not her (although I have to say, your FS sounds really great - a phone consult after an established relationship when there's no real need for a visit is something I've thought about, but it has never been offered - did you ask for this?).
Silly me, before I started TTC & AC, I thought it was like baking a cake - take these drugs, mix egg & sperm...voila...baby. How really, really silly of me...the good old days of naivete.
Ladies I have removed some posts that are not appropriate for this forum. Please refrain from discussions about pregnancies, complications in pregnancies and birth in this forum. It is provided as a TTC support thread for those undergoing or considering IVF with PGD.
There are plenty of other areas in BB for such discussions to take place including PALTTTC, PAMC&L, and PMs.
If this happens again we will infract without warning.
Thanks for your understanding and continued support of those undergoing IVF with PGD.
Wrote a long response to you yesterday but lost it - basically I'd talk to Dr Lok about dosage and ask him if SIVF has statistics on flare vs antagonist. I've googled it and found a number on studies which were done on "poor responders" in down regulated cycles, sometimes they found antagonist was better but other studies found flare was better, so not sure.
The thing is that you aren't a "poor responder" so if you ahve doubt about going flare you could always consider a normal down regulated cycle instead.
Otherwise I thought Dr S suggestions soudned good especially to check on scarring - could you do the fibroid at the same time?
BellyBelly Member
He just looks at my homocysteine result and says it's not necessary. That's why I started taking the garlic tabs and drinking tomato juice daily - natural blood thinners. TBH, this has been lingering in the back of my mind, particularly more now as you've read that with normal homocysteine levels there is still a link with clotting. Is there any chance you could PM me the link of the article mentioning this point about normal levels and clotting? I am meeting with my OB next week and would like to talk to him further about it. Do you think this is a real threat throughout all three trimesters of PG?
)
that all will be fine and I can re-start the DHEA. I am really petrified at the moment about my test results.
WTH & BDT
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