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Thread: IVF with PGD #4

  1. #73

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    Sara - I am probably a bit late posting this, but I generally have a light to medium AF. But after my cancelled and failed IVF cycles, my AF was very heavy. I made sure I remembered to take my iron but I still felt incredibly drained. Glad it has eased a little and hope you enjoyed your bushwalk

    Cuddlepie - WOW - you certainly have your plan underway. I did the same 15 darned viles of blood so I know how you feel Good luck with your appointment with Dr Sacks (I met with him, too - great for NK cell issue investigation) and hope you get some answers when your BT results come through.

    Julie - you are such a rock of support. Hope you are holding up OK



    to Kel, WLAB, Saph, Meredith and Lisa

  2. #74

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    Hi Girls,

    WTH: Thanks for letting me know, it's good to hear that it's just normal. Hope everything is okay with you.

    CP: Hope your appointment with Dr S was productive.

    Julie: have posted to you in the other thread, thinking of you.

    Meredith: always lurking to see how you and WTH are goign in the pregnancy thread - hope things are still okay.

    Kel: hun, how are you going? You are in my thoughts.

    WLAB: have posted to you in the other thread, keeping fingers crossed.

    Saph, BDT, Lisa, BW, Kate

    AFM: Cramping again this morning although AF is nearly over, hope everything will get back to normal, finally got my list of questions together for my FS and have emailed them to her, will post them below, any suggestions appreciated.

    Antagonist vs Flare cycle: I am wondering what your opinion is on whether my next cycle should be a a flare or an antagonist cycle. I don't want to take the pill before a cycle as I am worried of getting understimulated again but have heard from a number of women who did a flare cycle without the pill - you mentioned a problem that can ocur in this case, can you please explain it to me again.

    DHEA: I am back on taking 50mg since day day of the BT - should I increase it to 75mg? I have the side effect of very greasy skin.

    Colorado protocol
    : I'd like to hear your thoughts on the Colorado protocol. One friend told me her protocal which includes: AUGMENTIN, Estraderm MX patch, Prednisolone, Astrix 100mg - do you think I could benefit from this?

    Day 6 transfer: In both cycles the Blastocyst was only tested on Day 6, I am worried that this lowers the chances of implantation - do you have statistics from SIVF which show implantation rates of Day 6 vs Day 5 transfers?

    Elevated FSH: Is there anything I can do about this? From the result of the last cycle at what level of FSH would you adise me to do a cycle (personally I would prefer to wait until the FSH is 13 or lower but I obviously dont know if that ever again is going to be the case)

    Egg donation: Do you think I should already think about egg donation or is it worthwhile to keep trying with my own eggs for another one or two cycles?

    DP' s supplements: Is there anything else DP should be taking - I've heard som men also take Fish Oil, Vitamin D, Bio Zinc, CoQ10 - 150mg - DP at the moment takes Menevit plus Blackmores Men Multi.

    My supplements: I am taking Blackmores preconception, CoQ10 - 100mg, Iron tablets (They also contain B complex and Vitamin C) Folate 500mg. I have heard that too much Folate is not good I am currently taking 1g on advise from SIVF - can youplease confirm I should continue with this. Some women also take: Bio Zinc, Vitamin D Ostelin - should I include this?

    Empty follicles syndrom: Please let me know your thoughts on how this could be avoided.
    Orgalutran: I am wondering if there is the possibility that I might have ovulated as I took the last Orgalutran about 26 hours BEFORE the trigger on advice from the nurse - would it be better to take Orgalutran on the night of the trigger as well - that is what I was told to do during my cycle in January.
    Trigger: You were saying something about perhaps using a larger dosage of the trigger and I have also heard that using Pregnyl as the trigger could be of benefit.
    I have also read a scientific article by Dr Lok and am wondering if you would advise to consult him for a second opinion on this issue (I am not thinking about changing FS)?

    Sara

  3. #75

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    Hi Sara

    That is a fantastic list of questions. I think it is great you have forwarded them on to your FS in advance to that you get optimal mileage from your appointment.

    Just wanted to talk to you about "too much folate". My understanding is that as a B vitamin (B9), your body will excrete any it does not need. I take the 5mg (10X normal dose) of folate. I originally started taking the larger dose after my first chromosonal loss that in a Dutch study, women who had lower folate intake had a great chance of Trisomy 21. I went on to read it helps with red blood cell division, and that some women believe taking extra helped them conceive (I cannot explain this one, not sure about it). After my third loss (a Trisomy 15), I did the MC investigation program and they discovered I have a double gene for MTHFR. In some women this raises their homocysteine levels, resulting in blood clotting disorders. My level was fine, but they still recommend the 5mg dose, regardless, along with extra B12 and B6 to absorb it.

    But.... It is dangerous to take high levels of B6 (pyrodixine). I have read up to 100mg a day is fine - and it assists with extending luteal phase length. But higher doses over a long period can cause nerve damage. Was just wondering if perhaps this is the B-vitamin you were reading about that can be harmful in high doses. Basically my understanding is that you can't have too much folate. My OB said if he had his way, every one would be on the 5mg - man or woman, regardless of age. It has many other qualities (but can't remember what they are as I have a one-track TTC mind)

    Hope you don't mind the ramble!!

    Luv WTH xx

  4. #76

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    WTH:

    Thanks for the advice on B6. I'll check on it, I am a bit worried as my iron supplement has B vitamins and the Blackmores as well, took a higher dosage of iron over the last few days and was worried I might overdose on the B vitamins.

    About the folate I am aware that you were taking a higher dosage and don't really know anything about it, but just saw a few media articles recently, obviously they may not be reliable at all, have posted below.

    Sara

    Pregnant women overdosing on folic acid
    Danielle Teutsch
    SMH March 15, 2009

    Pregnant women may be taking excessive levels of folic acid in the misguided belief more is better for their babies' health.
    Professor Julie Owens, head of the school of pediatrics and reproductive health at the University of Adelaide, is calling for more research into the effects of large doses of the B-group vitamin, which is recommended to pregnant women because of its important role in preventing neural tube defects.
    Professor Owens said it was very important that expectant mothers take folic acid at the levels recommended by the National Health and Medical Research Council - 600 micrograms a day. But she was concerned women who took daily supplements and consumed folate-fortified foods could be consuming more than the 1000mcg recommended upper-level intake.

    In September, mandatory fortification of bread with folic acid will start in Australia. Mandatory folic acid fortification programs in the US and Canada have been successful in reducing the rate of neural tube defects in the population.
    Professor Owens said: "It's important to follow the current guidelines, which are effective in reducing the occurrence of neural tube defects, but there's now emerging evidence that we need to do studies on long-term health consequences, such as the risk of asthma and insulin resistance in offspring.
    "The guidelines should be adhered to but not exceeded. It's probably well-educated women who are concerned about doing the right thing in pregnancy who think more is better."

    Dr Mark Lawrence, associate professor in the school of exercise and nutrition sciences at Deakin University, said women taking folic acid supplements as well as fortified cereal and juice may exceed the recommended daily intake.
    There was an even greater risk of women taking more folate than necessary once mandatory fortification of wheat flour started in September.
    "The whole issue of quality control is really difficult," he said. "The US experience is that manufacturers have erred on the side of over-fortification."

    Food Standards Australia New Zealand spokeswoman Lydia Buchtmann said less than 1 per cent of the female population would be likely to exceed the 1000mcg a day maximum intake. Ms Buchtmann said the introduction of the mandatory folate fortification program would add only another 100mcg of folate a day on average.

    Hollie-Berri Sleeman, who is 33 weeks' pregnant with her second child, has been swimming, doing yoga and taking supplements throughout her pregnancy. In the first trimester, Ms Sleeman, 36, of Woolooware, took a folic acid supplement as well as a pregnancy multivitamin - a total of 1000mcg of folic acid a day. For the second and third trimesters she continued taking the multivitamin, containing 500mcg of folic acid, as well as fish oil for foetal brain development and magnesium to prevent leg cramps. She follows a healthy diet, which includes some cereal fortified with folic acid.
    She said "it would be good to get independent research" into the effects of vitamin supplements and safe upper intake levels.

  5. #77

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    Sara - thanks for sharing this information with me - I really appreciate it. I had not seen it as I was a more than two months into this PG when it was released and I had stopped my obsessive research. I guess because of my MTHFR situation I will need to continue the 5mg, though I don't feel so good about it now

  6. #78

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    Sorry WTH really didn't want to worry you, pretty sure your OB knows a lot more about it than a newspaper article.

    Sara

  7. #79

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    Hi everyone,

    Sara, that is a great list of questions, all the best with getting your answers.

    WTH, I also tested + for two mutations of MTHFR, my FS has also recommended 5mg folate, in all of my Googling those with +MTHFR are recommended to take 5mg of folate, B6 and B12 to help absorption and low dose aspirin for life, regardless of TTC. I believe being +MTHFR means that you are not processing/absorbing the folate properly, hence the need for the larger dose which would ideally give you the right amount once your body processes it.

    CP, hi, thinking of you and hope you get some answers also after your extensive BTs, will be watching to see your news.

    Hi to Saph, Julie and everyone else. xx

  8. #80

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    Hi Baby Dreamtime - yes, I was planning to take 5mg of folate for life, plus B12 (I am vegetarian and need the extra anyway) and B6. However, I am am a bit unusual as my homocysteine and folate levels are normal, so I do not need the aspirin. In fact - my OB, who specialises in recurrent MC, won't let me near aspirin as he says it raises the risk of MC (unless you have an identified clotting disorder, eg elevated homocysteine levels)...

    BTW - we aren't oddbods - the double gene is present in 10% of the population and thankfully is not always connected to MC, just increases the risk when the homocysteine level is off the scale due to clotting

    Sara - have printed off the article and am taking it to OB appointment on Monday. Thanks for sharing the info

  9. #81

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    Hello ladies, sorry haven't been posting much lately because all the options seriously doing my head in...

    Had two FS appt in the last week or so, first with my own FS and the other with Dr. S. The result with my own FS, we have decided to do a Flare cycle, just for a change because of my poor response from the last Antagonist cycle. However, FS did pointed out that each cycle is different, the poor response might not because of the protocle itself which I tend to agree. He ordered me the intensive b/t as you knew and still waiting for result atm.

    Then went onto to see Dr. S, he sent me to do a NK cell b/t which is his specialty and suggested a uterus biopsy if result came back positive or on border line. He has also brought up a good point - wanting to check the womb after my last D&C, because there is basically no success after that, he just wants to make sure there is no scaring inside etc. This can be done together with the biopsy. So I will have to schedule that in the next month or so.

    One thing he said about Flare cycle is IVF Aust has done some research and this protocle has the lowest success rate, hence the clinic now tend to use either down-reg or Antagonist cycle. So that kind of giving me doubt of my decision with FS of doing a Flare cycle next month. Have been research onlin but can't really see much of the concrete result. Any opinions girls?

    Dr. S also concerned about my current FSH dose (150iu), he said it is really low for my age. Now I am thinking of it, I was on it since 2007 when I was 36. My last Antagonist cycle was a poor response could possiblly because of the lower dose? My E2 was a bit low to start with, so even the increased dose on Day 9 to 175iu probably is too late.

    All these are doing my head and I am a bit lost at the moment just thinking of it....I thought I'd put it out here so any suggestion would be grateful.

    Sara, your list seems really comprehensive and hope you will get some solid answers to move forward. Seems we are both in the process of deciding Antagonist or Flare cycle atm.

    to BDT, WTH and anyone who is lurking...

  10. #82

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    Hi everyone

    WTH, I have done tones of research on MTHFR and read a lot of the forums, particularly in the UK there are extensive threads just on this topic. From what I have read there is an indication that even though homocysteine levels don't register as elevated, there is still a link to increased clotting. A lot are saying that even though they did not have high levels, they still benefited from aspirin. My FS has recommended low dose aspirin, and Clexane from ET, though I am in a different situation from you in never having conceived.

    CP, it is great you are trying to get answers. I am really interested in the FSH dose for down reg, versus antagonist, versus flare, and agree with Dr S re revisiting your FSH dose. I will need to do some more research, but from what I have always heard, antagonist and flare cycles are better for poor responders, but the contradictory idea is that antagonist cycles will give less follies but better quality, so not quite sure what is going on. Last cycle my FS put me on a lower dose FSH for the antagonist cycle compared to down reg, assuming because I wasn't down regulated I would respond better, but it was the opposite. I spoke with a friend yesterday who is having EPU today on her first antagonist cycle. She had done down reg in the past, hyperstimed on FSH 150, but reponded perfectly on FSH 150 for this antagonist cycle. So by that rational you should up your dose slightly on antagonist to get slightly less follies and ensure no hyperstim.

    Does this makes sense? I can't find any info on FSH dose for down reg versus antagonist cycle. Any ideas?

    Hi to everyone else.

  11. #83

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    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).

  12. #84

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    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?

    THANX

  13. #85

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    Hi Cpie,

    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?

    WTH & BDT

    Sara

  14. #86

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    WTH, will have a look and find the links and PM, I guess just something to consider. xx

  15. #87

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    Baby Dreamtime - I really appreciate it. (Don't feel bad - you are helping) but I am now quite worried...

  16. #88

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    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.

    Ah, desicion time is tough girls....sigh...

  17. #89

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    Hi Girls,

    Buliej: You are in my thoughts today

    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.....

    Anyway lots of food for thought for me I think.

    Have a great weekend

    Sara

  18. #90

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    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)

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