1 Follie ... again !!

Hi girls,
Am hoping I might get some insight into puregon and low response experiences. Last month I started a stim cycle and was put on Puregon (200 daily) and got 1 follie. On Day 9 the follie was 13mm, by EPU day it was 18mm. All indications were that it looked like a goodie as it had matured … but unfortunately it did not fertilise (via ICSI). Not sure how that happens given ICSI was used, Melb IVF does not offer any explanations either, other than there are many factors involved and it could be any number of them. Have gone back again this month and am on the same cycle, 200 daily dose of Puregon. Just had my Day 9 scan (am having scans on Day 9 as Day 8 fell on a Sunday on both occasions). Anyway, sure enough there is only 1 follie again, this time it is 10mm. Have been told to come back on Thurs for another scan and in the meantime still take the Puregon (200 daily) as well as Orgalutron daily for the next 4 days (which as some of you may know is $98 a pop with no form of rebate). So as you can see I truly am a low / poor responder to ovarian stim cycles (have tried gonal-f on higher doses last year … same sort of result). I’m turning 40 later in the year so don’t have time to waste and am getting a bit disillusioned with it all. Have been reading that some of you have had your cycles cancelled when you’ve only had 3 follies as this was seen as a poor result, so I’m not sure why they are still happy to proceed with my cycle when all I’m getting is 1 follie. Have also been thinking I may as well just do a natural cycle with ICSI as the medications don’t seem to be producing anything more than I normally would get. All up I have had 3 failed ICSI cycles so far and am now hoping this 4th one will produce better results … for no other reason but pure optimism. Would be interested in hearing from those of you that have had similar experiences … were you advised to proceed with a cycle with just 1 follie, was it successful? I know they say it takes just 1 egg … but realise that it also lowers my chances.

Hi lulu, as for proceeding with only 1 follicle I agree with you thinking about a natural cycle. My cycle was cancelled on day 6 with 550 puregon shots due to low E2 (no follies growing or very little) the clinic told me that when you dont respond the highest dose is usually around the 450 mark...I wish I had the answer for you, and am glad in a way I was cancelled and didnt keep on jabbing away only to grow 1 or nothing. I know some cycles naturally are good and bad, but if your consistently getting low or no follicle growth its time to re think the protocol. Lots of best wishes to you with whatever you decide...

Hi lulu70,
We are going through our 2nd orgalutran cycle now and are having a completely different response to my 1st cycle where i had 24 follicles and my E2 skyrocketed so i had to trigger early and only got 8 eggs as i didn't have time to let the smaller ones catch up.
This month i have around 20ish follicles but they have grown really slow due to a lead follicle and all on the right side are to small so we were given the choice to cancel with 6 follicles on the left side or give it another few days to see if those 6 increase in size i did have my dose increased to 225 and we will have to wait until wednesday to make the decision i would go to EPU with 5 or more but i would not with less as we need them to get to day 5 and not many do make it to day 5 but people say you only need one so it is a hard choice to make whay havn't they increased your dose?

Hi Lulu, sorry to hear that your stim meds aren't working like you would hope. While I don't have any experience with low response (I responded really well on fairly low doses of Gonal-F), I can comment about the ICSI failure. My first cycle didn't use ICSI and of my 10 eggs, 7 fertilised when they just let DH's little swimmers race for my eggies. Unfortunately our PGD results showed all embies to have chromosomal abnormalities. Our second cycle we used ICSI as we found out that it didn't cost us any extra, and we were told it would increase the rate of fertilisation. That time we got 21 eggs (slightly increased dose of Gonal-F) and after the ICSI only 10 fertilised. I was really shocked. Our first cycle was 70% fertilisation rate "naturally" so I thought the ICSI would increase that, so getting a less than 50% rate was surprising to me. Of our 10 embies all but one had chromosomal abnormalities again, so we've been extremely lucky that our one healthy embryo has implanted and is growing strong.

As for doing a natural cycle, do you know if you definitely ovulate when you are not on the stim meds? If you do, then I guess there would be no difference for you between doing a natural cycle and a stim cycle.

I really hope you have some luck soon and wish you all the best!

hi girls, thanks for the responses. i'm pretty sure i ovulate as they've never told me i have a problem with this. my cycle is bang on 28 days all the time. our problem is related to DH's low sperm count and poor motility.

i don't know why they haven't suggested i up the dose, maybe they are going off my lack of response to higher doses last year ?? i just wish they provided more info on why the most recent failed cycle did not go so well ... given i only had 1 follicle. When i was told it had matured to 18mm (which is supposed to be ideal for fertilising) i was pretty hopeful as most of my past follicles have only reached 14 to 16mm. They did not mention abnormalities, so i'm at a loss.

i guess i'm a little suprised that no one has mentioned the possibility of cancelling this cycle, seeing as it's produced only 1. i didn't think to ask until i started doing google searches on the topic today and noticed how many cycles get cancelled when there are 3 follies. and now that i've forked out almost $400 on orgalutron and will possibly need to buy more if my scan does not go so well on thurs, it's a bit too late to just say that's it i'm calling off the cycle ....

maybe i'll be pleasantly suprised after all of this and go wow .... all you need IS 1 follie ... it just would've been nice to get a few more so that i could at least freeze some. how annoying !!!

Lulu70-I forgot to mention we pay $62 for each orgalutran and claim half back through our private health fund and i was informed that orgalutran will be on the PBS list in august so will cost next to nothing.
And DH and i made a decision if i have a few follies that have reached the right size on the left ovary we will go ahead because we have waited so long and i don't want to miss a singel chance there just might be one good healthy embryo that makes it but if not i will do things differently next time i will never do another cycle if i have a lead follicel as it has made a huge difference by stopping all my follicles from growing on the right ovary and to be honest to have 20+ follicles and they are going to be wasted because of that lead follie is a real disapointment.

Good luck with your cycle i have my last u/s tomorrow so i am on eggshells waiting to see if the follies are big enough.

My orgalutran was costing me $75 each, but when I took the receipts to my health fund (HBA) I was told that because I got them from the IVF clinic that I couldn't claim them. The girl telling me was actually angry at HBA because she said that if the doctor had prescribed them and I picked them up from a chemist, then I could have claimed them!

I cant believe the difference in price and the way health funds refund i got mine last year at $90 dollars a needle from SIVF and my health fund rebated half the cost until i reached my limit and this cycle they are through WIVF clinic at $62 and my health fund still refunds half until i reach my limit.
Why such a difference? but next month it all changes because of the PBS list so it will be more affordable.

Hi have you thought about trying a steroid called DHEA? I am a poor responder and my last cycle we got 4 eggs but only 2 fertilized i had a m/c at 6 weeks and now back on the ivf train again for the next cycle.
This cycle i have been taking DHEA which is apparently to improve the egg quality and the no of eggs produced? Will see how it goes i have done some research works for some not all and so far i have had no side effects from it only a little oily skin and hair so not complaining there.
I am also on prednisone 5mg x 2 daily and lucrin injections. I then start on FSH Puregon 750 the highest dose i think that you can get and cetratide so will hopefully see some different types of results.
Anyway just thought id let you know about DHEA and you can do some research and see if it something that may work for you?
Good luck

Lulu, sorry you are going through this...it certainly worthwhile checking with your FS to up the dose, Im surprised they didn't suggest this after the very first cycle. My FS said for women over 36, 250iu is the minimum dose to get the response, in America, they use a lot higher dose. I hope you won't need another cycle because this one will be a success. All the best!

Hi Lulu,
I had my first try with IVF and had only 1 follicle, they advised i could go ahead if i wanted to, i decided not to as they said next time i would probably get a better result. The next time i still only got 1 but decided to go thru with the operation and everything anyway...just hoping. It didnt make it to the 5 day blast. Then the doctor said to me that they were going to try IVM..i hadnt heard of it, they said it is where they take the small eggs out and mature them in the lab, they said they would have a better chance cos i had a few follicles but none big enough to use for IVF. I went ahead, they got 3 immature eggs, all matured, all fertilised, but only 1 made it to blast and i had it transferred. (i am pregnant now) . But if they had not done the IVM, then i would never have known and i would have kept on going thru the cycles getting only the 1 egg...
I am in WA and i went to the Fertility specialists of WA, they scientist there said that they are the only ones that do it. But maybe that has changed now. It is worth asking about it i reckon cos if you are just getting the 1 that is big enough to use (like i was)..then you have nothing to lose!
GOOD LUCK!!!!!!
Please let us know how you go :) :) :) :) :) :)

hi girls, here's my update ... went in for my 2nd scan today. the 1 follie is still there - has grown from
10mm to 14mm, not great considering my last cycle I was 17mm by this stage ... so it means i will need to
keep taking the Orgalutran for a few more days ... 4 or 5 :( On a positive note I contacted my health insurance fund and found out that MBF provide $50 per script upto a limit of $300. So at least my last few doses will be
covered ... however this additional amount won't be ... Given i've already spent quite a bit extra on meds I just
have to keep going with this cycle in the hope that I get pregnant. Have started ringing round to see whether
I can get Orgalutran cheaper thru other pharmacies ... but of course not all pharmacies stock it or won't get it
in time for my next injection (tomorrow morning). Its costing me $90 a pop now. If anyone knows of a place on
Melb that sells it for less please let me know.

blossom73 yes I have read up about DHEA and am starting to think about trying it out ...

i feel so helpless when i put my trust in the hands of experts ... and all they are really doing is just experimenting.

Thanks for your words of support girls !!!

ok - so i finally had my ovum pick up today. the 1 follie made it thus far. Crossing my fingers it fertilises and that we will be able to transfer it in a couple of days time. the ivf process is so nerve wracking!

Good luck my fingers are crossed for you that this one egg is a strong one.

Thanks ferrals4. Have waited patiently all day in the hope that i wouldn't get the call to advise that it hasn't made it ... so far, so good ... my transfer time has been booked for tomorrow and am crossing my fingers, legs, everything, that it makes it to that stage and then turns into a BFP!

At least it has helped me to be able to vent about my lack of response to the fertility drugs. The worst part about it is that if i chose not to take the drugs and try a natural cycle ... considering i'm just going to get the same result anyway - it would actually cost me more money, as the Gov subsides less if you have a natural cycle. Which seems unfair because it doesn’t account for the fact that some women don’t respond as well to the drugs, yet they have to pay for them as part of the cycle, in order to get a bigger subsidy .. making the treatment more expensive than it needs to be. And what if the problem is purely male infertility and all you would like is a natural cycle with ICSI … again you would have to do a full stim cycle unnecessarily. It’s just crazy !!!

Anyway, for now all I’m going to focus on is the egg growing and multiplying over night and making it to the next stage ….. grow egg !!!!!

Good luck i have everything crossed for you.
Just in regards to the DHEA (which you wont need coz this one is going to be the BFP) i have just had a scan done on monday and i had the most follicles that i have ever had before and i have only been on it for maybe 4 weeks.
Sending you lots of baby dust

thanks blossom :D

where did u order ur dhea from? i wanna make sure i get onto it asap if things don't go my way ... but remaining hesitantly positive ... i was overly positive last month and think it might be better to err on the side of 'just in case it doesn't work' this time round ... if u know what i mean ....

Lulu70-how did your TF go? did you get a good quality embie?

hi my fs gave me a script and i got it at a compounding chemist. If you google them you should find some in your area.
Good luck

embie survived the transfer process ... yay !!! grew to 4 cells by the time of transfer. is hopefully now doing its job multiplying and will stick. the 2ww has begun. hopefully this month will bring a BFP. how stressful and exciting at the same time !!

Sending you all the growing vibes Lulu and i hope this month will bring you a BFP!

Oh Lulu! Good luck sweet!!! Finger's crossed that this little embie is strong little fighter and you'll get your much wanted BFP :hug:

Went in 1 day early for my blood test as I was starting to suspect AF was coming and sure enough result came back as negative :( Am now looking down the barrel of another stim cycle ... worst part about it is my FS wants me to do the same thing as the last 2 ... which means I'll probably only get 1 follie again (if i'm lucky). My FS does not think I will have much success due to my age and poor egg quality and I guess they figure I'm lucky to even be getting 1 follie. I asked whether I would be able to try DHEA and my FS flatly refused to even consider it. So now I'm stuck. Do I blindly go ahead and try another cycle - and be happy with 1 follie? Or do I get the hell out of there and try another FS who is more open minded to trying alternative approaches? And if so, who in Melbourne?

Blossom can I ask who is your FS as they sound willing to try supporting patients on DHEA?

Thanks for all the support girls - I know you can all sympathise with me and the horrible roller coaster road ivf can be.

Hi Lulu, so sorry to hear that your blood test was negative :( I'm not sure where in Melbourne you are, but I was seeing Dr Weston in Sunshine (he also work in Clayton and somewhere else I think) and he was wonderful. He's with Monash IVF. I also originally saw Dr Toledo with Melbourne IVF (at Freemason's in East Melbourne) and she was great too. The only reason we swapped to Monash was because we didn't feel confident with the particular geneticist we saw at Melbourne IVF.

Do you mind if I ask you what meds you were taking for your cycles?

Hi Mylitta,
Not at all ...

Cycle 1 : 200 Puregon daily for 10 days, Orgalutran (2 times), Ovidrel as the trigger, Crinone cream as luetal support for 14 days following transfer
Result : 1 Follice (18mm), didn't make it to transfer

Cycle 2 : 200 Puregon daily for 13 days, Orgalutran (8 times), Ovidrel, Crinone for 14 days
Result : 1 Follicle (17mm), transfered at day 3 (divided into 4 cells), did not stick

Cycle 3 : Which I'm supposed to start in 2 days time ... 200 Puregon daily ... and then wait and see what the scan will reveal ....

hi lulu sorry to hear about your bfn!
My FS is Dr DeAmbrosis from QFG in Brisbane.. I travel to see him from sydney.
I have just had egg collection and i had 12 eggs. My last cycle i only had 5.
Out of the 12 only 5 have fertilised last time only 2 fertilised.
I have ET tomorrow so fingers crossed.
Good luck and personally i would change clinics as time is of the essense and all FS have their own way, i find my FS now fantastic and i know that he is trying everything he can for us to fall pg.
We have been to 4 clinics in total, havent done cycles with each, and they are all so different and if we had stuck with the first lcinic we would have given up years ago.
Good luck with your decision.

That is a fantastic result blossom73 !!!! That's more than doubled :dance: All the very best with your transfer tomorrow and I hope the next 2 weeks go quickly and stress-free for you and most importantly you get a BFP !!!!!!! Sounds like you have some great eggs there ready to turn into healthy little bubs :D