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Thread: Protocols at different IVF clinics - sorry it's long

  1. #19

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    Sheree,

    I bow to your expertise, hunny Sue was saying earlier that her clinic only does EPU once day a week. Doesn't that sound too easy to miss the right time for EPU?



    love
    sushee

  2. #20

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    Sue
    Synarel 1 sniff morning and night
    then I was on puregon 300iu
    I had 29 follicles with 15 of large size on Monday before Thursday OPU -they were going to cancel me because of risk of OHSS.
    I ended up with 17 eggs -13 fertilised
    11 still on day 1
    8 on day 2 - 2 transferred and 6 snowbubs

    Trigger was 500iu on Pregnyl and 1500iu daily of transfer
    I had crinone gel morning and night
    On my FET I was on nothing as supposed to be natural because I 'O' regularly - I asked for Pregnyl for luteal phase support and they finally agreed
    on 1st FET they thawed 5 to get 2
    Doing this again this cycle with my last little snowbub if it makes it through the thaw...
    I always thought 300 was too high but now I am not so sure - not sure what they will put me on if go back for stim cycle in Oct

  3. #21

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    Trish, it's so good to see you back here (I think - you know what I mean).
    Are you ok?
    It's all a bit confusing with different dosages etc. I really do think they gave me too much stim, but not enough luteal support.
    I have lots and lots of questions for Thursday though.
    Have everything crossed for your little icypole to stick!!! Would love to cycle with you again but I don't want to (again - you know what I mean).
    Take very good care of yourself and take it easy.
    Love
    Sue

  4. #22

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    Default Today's appointment - it's long

    Hi everyone.
    Well I saw Dr Quinn today. He was very good I have to say. Didn't mind all my questions and had no hestitation showing me the entries on my file. I won't be changing clinics. Leisa, you're right, better the devil you know and he really took a lot of time and didn't mind any of my questions.
    So, here is the upshot.
    My down-reg cycle
    7/7 Day 22 P4 - 31.1 Synarel started 8/7.
    19/7 Base E2 - 100, LH - 1, P4 - 1.4. Day 12 of Synarel.
    28/7 E2 130. Day 6 of FSH.
    2/8 E2 945. Day 11 "
    4/8 E2 2200. Day 13 "
    8/8 E2 3455. Day 17 " Day 32 of Synarel.
    11/8 EPU.
    Follicles
    I ended up with 7 - 20mm, 21mm, 15mm, 15mm and the other 3 too small.
    Eggs
    Only 2, 1 didn't fertilize.
    Embryo
    B Grade, 2 cells at transfer (Day 2 past EPU).
    My drugs
    Gonal-F - he felt 300 was fairly high, wouldn't want to go any higher.
    Crinone - again, he felt 1 pessary was sufficient didn't want to overstimulate.
    Verdict
    My ovaries took a long time to respond and kicked in a bit later than they would have liked. He felt this could have been because it was a down-reg cycle. Could have been the Synarel. I'd been taking it for 26 days before my E2 started to rise. He also said he was surprised and disappointed I only ended up with 2 eggs. I mentioned my age (of course) and while it's obviously a factor, he didn't think that was the sole reason. He seems to be leaning toward the fact it was down-reg. His comments regarding the 1 EPU day were that it worked out well because of my late response to the E2 - it sounded feasible I guess. We discussed ovarian reserve checking. He said doing an IVF cycle is the best way to check that. He didn't seem concerned about that but was honest and said that obviously, my little store is rapidly declining!!
    Where to?
    He wants me to do a short protocol (flare Sushee?) cycle. Double the dose of Synarel (which doesn't seem to make sense given the above...) :-s and start injections Day 2/3. I asked if Puregon was any different/more successful than Gonal- F - he said no. He said I can try Puregon this time if I want. Any comments on that would be appreciated.
    He also suggested injections post transfer (I forget the drug name) instead of Crinone if I want, again any comments on that welcome!. We talked about when I may possibly need to consider egg donation. He thought if the next cycle doesn't yield better results re # follicles/eggs, that in all honesty it would probably be the best option. Think about that if I get to it. He said that most of the hormones should be out of my system so could not explain my still bloated tummy and swollen bbs now at CD14.
    So, there it is. I'll probably wait until the cycle after next to jump on the merry-go-round again. That will be mid October. Hopefully, it will be nice and short and not 49 days like the last one!
    The best bit I went to Medicare and got $1905 back - a nice surprise. That will help pay for the next one! :smt038
    I know this is long and reads a bit like a science paper, but, if any of you have any comments, I'd really appreciate them.
    I'm feeling a lot better with regard to my age and it's effect on this little journey now.
    Love
    Sue :luck:

  5. #23

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    You sound really calm in this post, like you have direction and are confident with it, thats such a good thing (and not always easy to come by!)
    I can't help answer your queries, but it was so good to read how you went, and to hear you feeling positive and determined.

  6. #24

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    Sue,

    There is no difference between Puregon and GonalF, I far as I know. None whatsoever. Just who manufactures it, and what the doctor prefers. I believe Sheree has been on both, and it didn't make a difference.

    The short protocol is the flare protocol, which I believe is what is usally used in more mature women (like you and me #-o ). I was surprised to be put on down reg after a couple of flare cycles, but have since found out that my Dr is Mr Conservative himself and generally never does flares. Having said that, of the three down regs I did, the first I didn't even respond, the second, AF was 1 weeks late, and my third, it was nearly 2 weeks late. The flares were infinitely easier on my body.

    The Luteal Support your Dr seems to be suggesting is pregnyl, which are HCG shots. It'll mean no HPTs, I'm warning you first, coz they can give false +ves, but in general easier than pessaries and probably more convenient. I've never had them myself but *Tam* has for all her cycles. I reckon I would have preferred them myself.

    Your E2 levels are on the lowish end of the scale, where you'd generally be looking at about 1000iu per follicle just prior to surge. Still, I would have expected more than 2 eggs by your levels, but unfortunately the E2 levels are an approximate only.

    On the other hand, it is believed that often doctors don't necessarily go for the higher dose of FSH to get more eggs because they want quality not quantity. Where quality may be an issue, there is a belief that trying for fewer eggs will mean better quality.

    On the whole, it looks like you're on the right track (and definitely asking the right questions) Are you going for a 2 day transfer again this time? Or will you try for an older embryo if you end up with more to choose from?

    Ah decisions decisions! Lol! I hope I haven't confused you even more, but you know my email if I have, matey!

    love
    sushee

  7. #25

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    Hi Sushee
    Thanks, no, I'm not confused.
    Your comments previously about down-reg being used so they have pretty much total control of cycles was right. He told me that.
    I mentioned a lower dose of Gonal-f (thinking quality not quantity as you mention) but he wanted to stay at 300.
    Pregnyl, that's right. He said I can have it if I want but he did seem to think I'd be better with Crinone. Concerned about overstim.
    Thanks for the Puregon comments. Don't really want to go changing everything!!!
    We're aiming for Blast (we did last time too). Unfortunately, because I only had the 1 emby, they decided it was best to transfer it. He explained their reason is they go to blast so they can pick the best to transfer. No choice when there's only 1!!!
    Thanks for your help.
    Are you feeling better? How's the ms??
    Love
    Sue :luck:

  8. #26
    confusedegg Guest

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    Hi sue

    I have replied to you by email.

  9. #27

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    Sue, so glad your appointment went well and you are all infoed up & in control

    I can't help too much on the technical side of things, I consider myself to be a newbie, just do what they tell me.

    I used Puregon for my stims & then Pregnyl for trigger & also support shots every 3 days afterwards.

    On a couple of my cycles I had to use Progynova (oestrogen) & Progesterone pessaries during my LP as well.
    I am using both of these now on my HRT FET. Also had to have a couple of Primogyn (oestrogen) shots to boost up my levels (600 at day 10, should be 800 & at day 13 was over 3000).

    Sometimes I go between thinking I should know what they are doing & should pay more attention, but then I think/hope that I will get pg & won't have to/don't want to know anymore.

    Hope all goes well

  10. #28

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    sue,

    it sounds like your Dr is balancing the quality/quantity issue quite reasonably by keeping you on the same dose. 4 follies in a good number to aim for, I reckon.

    I have had empty follies as well, but it does seem to chop and change between cycles, so am hoping for a better collection this time round for you. I completely understand not going to blast with 1 embryo - I would have wanted to transfer it as well!

    I'm fine too, thanks for asking. No ms for two days and then bam! last night it was back with a vengeance. I gather that some foods (like Chinese) seem to bring it on! Lol! Have taken my own MHD today to get over neurosis of vanishing/returning symptoms, and also coz I'm still a little green in the gills.

    So, it all start again for you In Oct? So exciting!

    love
    sushee

  11. #29
    Teagan Guest

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    Hi Sue,

    Yay!

    Sounds like your appointment went pretty well. What is a down-reg cycle? It does sound like a bit of science paper But it is really exciting that you will be trying again. Hopefully we will be cycling around the same time.

    It's great that you money back from medicare. How much out of pocket expenses did you have?

    ttys.

  12. #30

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    Hi girls
    *Tam* Thanks for the info. I remember now I had Pregnyl for my first GIFT 10 years ago. They had to reduce the dose after the 2nd injection post procedure though as they were worried about overstim. I'm still not sure what to do about the post EPU support. Plenty of time to think. When I was on IVF before, I questioned and researched everything. Drove myself around the bend and worried about everything. I was determined not to do that this time. It meant I remained relaxed throughout the cycle, however, when I was unsuccessful I started to question everything. I guess it depends on how much of a worrier you are. I still believe sometimes ignorance can be bliss. 8-[
    Hi Chris, still getting to my emails!!! Thanks for responding though, will have more time tomorrow to get stuck into them. :smt024
    Hey Sushee. Glad you're feeling better. Good on you for having a MHD. Pamper yourself while your pg, no point pushing yourself for your job (especially a govt one!!) - bub comes first. I'm pretty happy with my dr, he was very patient and didn't treat me like I was trying to be an amateur doctor. I'm hoping it was just a flukey off cycle - it's been 8 years since my body has been through this. Everything is still sore in my internal girly bits though. He said it's probably bruising from the EPU. Funny that I didn't feel it as much before as I am now. I actually believe I know exactly where my ovaries are now. I've just ovulated so they're probably a bit sensitive. Yep, probably start around 6 weeks from now. Definitely want a cycle's break considering the bloating and pain I still have from this one. How long did your flare cycles go for? The only other suggestion he had for me was a good multivitamin. Any suggestions? I'm taking folic acid and calcium supplements.
    Hi Teagan, I ended up being $1910 OOP for a long-protocol ICSI cycle. That included all drugs and monitoring.
    My first day payment was $4025 (not much if you type it fast and don't reread it). :-$
    That included $3270 for ICSI, $650 for blast - that didn't happen so they refunded that. It also included $105 for donor sperm. My appointment yesterday was $90.
    Medicare gave me back $1905. So, the clinic got $1560.
    My counsellor's appointment was $100 - not claimable. I forget how much my initital appointment with Dr Quinn was or whether I could claim it.
    I had to pay $250 excess for the hospital (haven't looked into that with my fund yet).
    I don't think a flare cycle is any cheaper, however, ICSI is $200 cheaper for subsequent cycles.

    Sorry it's long again ladies. I'm a bit of a jabber-jaws :-#
    Love
    Sue :luck:

  13. #31

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    Teagan, I hope I didn't scare you with all that info. Sushee and a few of the other ladies have been helping me with lingo and dosages so I put it all in - they're experts.
    I didn't know what down-reg meant either until Sushee explained it. My clinic calls it 'long protocol'. A 'flare' cycle is what my clinic calls a 'short protocol'. Down-reg they start you on Day 22. You take hormones for longer so they can have almost total control of your cycle. Mine went for 7 weeks, I think 6 weeks is probably closer to the average.
    As Sushee said, they usually use 'flare' cycles on we "mature" women.... They start you on the drugs on Day 1 and it should be a bit shorter and easier on the body.
    That's not an explanation - I know. But, again, don't get ahead of yourself, you're young and healthy so am sure you won't need a proper explanation! [-o<
    Love
    Sue :luck:

  14. #32

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    Actually Sue, I forgot to add in that my IVF cycle was a flare cycle. Seemed to go pretty quickly. Don't know if I could handle sniffing the Syneral any longer than I did!

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