Lilypie - Pregnancy

Thursday, October 22, 2009

I can't begin to tell you about what a disappointment today has been. I'm sad and angry and frustrated and pissed off. And I need advice.

I have five follicles. The RE said it was borderline on whether we should continue with IVF or convert to IUI. She doesn't know why, at my age and with no known issues, I only have five follicles.

So here are my questions:

1. I have been taking L.upro.n for 16 days and f.olli.st.im for 8 (today will be 9). Until today there has been no monitoring, no bloodwork, no ultrasounds. Now it is too late to affect the number of eggs by adjusting the dose of my medication. Is this normal? Shouldn't there have been some sort of monitoring before now? This is an awful lot of money to throw at a problem without checking to see if the proposed solution is working until it's too late.

2. What do you think I should do? I've done 4 cl.omid cycles and always had 1-2 follices, and always got a BFN. Will having 5 follices really make an IUI that much more likely to succeed for me? On the other hand, continuing with IVF will realistically get me at most 1-2 embryos to transfer and nothing to freeze, and will involve a surgical procedure and weeks more of injections. And it will use up one of the IVF attempts we paid for.

3. Should I switch clinics? This clinic is no longer really inspiring much confidence in us. Today, when I checked in, the receptionist told me that our ICSI fee would be due at retrieval - this is the first time anyone has mentioned that we should even do ICSI. Neither the doctor nor our IVF coordinator nor the embryologist had mentioned this to us at all. Shouldn't someone talk about whether it is appropriate with us earlier than now?

I have to run to a work meeting. But I would love to hear your thoughts. Thanks.

14 comments:

  1. Knowing little-to-nothing about IVF--having not gone there myself--I can't offer you advice about your situation.

    But I wanted to comment and say that I'm sorry that you're going through this and that I hope it is a resolved in a way that will give you some peace and hope for this cycle. I will be keeping you in my thoughts.

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  2. That is so frustrating. There is nothing worse then getting your hopes all set, and then potentially not moving forward. I honestly don't know what I would do in your situation. Part of me things I would cancel, do the IUI and try again next time (possibly at another clinic...), and then the other part of me knows how antsy I was just to get started and go through with it. I am in the 2ww after our first IVF (unexplained infertility). We had 16 mature eggs, 11 fertilized, transfered 2 5-day blasts, but none made it to freeze. So, I don't know if have 5 good eggs, that fertilize, and you are able to transfer...maybe that is a great situation.
    I hope that you are able to find some peace. Did they give you options for how they would start you off differently next time? Make sure they offer you a good plan if you do decide to cancel. Praying for you!

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  3. I'm so sorry about the frustrations. For what it's worth, here's my two cents:

    I find it problematic that you've had no checkups on folicles since you started meds. I had only five eggs after retrieval with 10-12 follicles showing beforehand, and two to transfer - and I did get pregnant, with the very rare complication of ectopic. But, either way, I think it's a huge oversight that your clinic doesn't do regular ultrasounds and bloodwork. I was in the freaking clinic all the time during the meds part of the cycle; otherwise, there's no way to know if your meds should be adjusted mid-stream.

    Yes, I think someone should have talked with you about ICSI before now. Maybe your clinic simply uses ICSI for everyone, but even in that case, that should have been explained to you. If your husband has no known issues, ICSI should not be necessary - unless they want to give you an higher chance with few follicles, which is fine, but again, should have been discussed beforehand.

    Honestly, regardless of what you do this time around, I would find another clinic. This one sounds sloppy. Doing an IUI with 5 follicles is a little risky, too; your chances for multiples are definitely increased. Is there another clinic in town you could call for a second opinion?

    I really am so sorry. You've gotten so far, and it's so hard to be disappointed now. Thinking of you.

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  4. I wish I knew what to advise...but I'm really at a loss when it comes to IVF. Sorry :(
    When do you have to decide whether to switch to IUI or stick with IVF?

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  5. So sorry for this situation! I definitely think you should have been monitored more. My RE up/down'ed my dosage depending upon how I was responding right from the begining. During my (close to final) scans, I had close to 60 follicles measuring between 15 to 22'ish mm. However, they could only retrieve 27, of which 17 were mature, 13 fertilized... of which at the end 2 were transferred and we could freeze 5. I have seen BFP's with just 5 retrieved and then I have seen BFN's (with no transfer and none to freeze) with 30'ish retrieved. It really varies from case to case. If you can stop the IVF and save some money and change your clinics... that might give you some value for money, but then you would always wonder what would have happened had you gone all the way through! This can still work out!

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  6. I also find it problematic that you had no monitoring during the time you were stimming. You should have been having an ultrasound plus blood draws at least twice a week, but probably more like every other day. Not only would that help with monitoring the number of follicles, but also your E2 levels, which can indicate if you're in danger of being overstimmed/at risk for OHSS (or understimmed). Also on the E2 front, in my case there were more follicles lurking that they couldn't see on the ultrasound, and that level indicated to the doctor that that was a real possibility (and kept us on the IVF track, rather than the IUI track).

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  7. Well...that stinks, and I agree..how frustrating! I just looked back at my last IVF cycle - I stimmed for 6 days before my first check and there were 6 follicles; 2 days later I had 10 follicles and 2 days after that there were 13. At retrieval there were 12, 8 mature, and 5 fertilized. We transferred 3 on day 3 and the other two did not make it to freeze. I know everyone's body is different and each doctor does different protocols so it's hard to tell you what to do. I, too, think doing IUI with 5 follicles is risky. When is your next u/s? Are they doing bloodwork with them?

    I completely agree with you about ICSI! Not everyone is comfortable with it and wants it, so it should definitely be discussed before you pay for it. I think your thoughts about switching clinics/doctors depends on you and how you feel. I completely trusted my doctor and his nurses even after we didn't get pregnant with 3 IUIs and 1 IVF, but if you don't trust him/her it might be worth switching.

    Good luck with your decisions!!

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  8. I am sad for you because I know how disappointing it can be to get to this point and be faced with this decision. I have a few points:

    1) We thought about canceling IVF#1 because my estrogen and follicle number (10) did not correspond. We decided to risk it and only had three eggs, one fert, BFN. In retrospect, I think I went through with it because I was so into the cycle and certainly could not imagine canceling it. For me, I regret doing it because it used up one our attempts when we should have just taken it and learned about how I stim.

    2) My doctor flat out told me that the reason he monitors at day 3 is because it is still early enough to change the medication. He explained that most clinics wait until day 6. However, waiting until day 8 or 9 is far too long to wait to adjust the meds if you need more stimulation or you could hyperstimulate so easily. I would seriously have a discussion with your clinic and if you can get the majority of your money back, I would move to a new clinic. If you stay with them, I would definitely demand frequent monitoring starting at day 3 of stims.

    I don't know if this helps, but this is the kind of information I wish I would have known. Of course, I support you in whatever you decide. :) I hope you get some answers from them.

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  9. I agree with the others that the clinic should have been monitoring before now. I think I stimmed for 4 days before being checked and then I was in about every other day and my dose was increased part way through.

    As far as the number of follies, it's tough to say. I only had 5 and was really worried, but they were all mature, and all fertilized. We transfered 2 on day 3, got our BFP and 2 made it to freeze.

    And unless you have male-factor issues, I'd be worried about doing IUI with 5. The fact that your clinic is considering that tells me they might not be the best one around. This is a lot of money to invest and you deserve a quality, thought-out procedure that isn't putting you at such a risk.

    Are they doing more monitoring? How soon do you have to decide?

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  10. Ok, I am so pissed off and frustrated for you after reading this. I had monitoring and blood draws 3 days after starting stims, then every other day after that...they are supposed to adjust your meds based on your response.

    What would I do? And I can imagine it would be the hardest thing ever after waiting all this time and planning for this cycle....I'd check out another clinic. Something just isn't adding up with this picture.

    As for proceeding with this as an IUI vs IVF, it's a tough one. It just seems they could have done much better by you. I'm sorry you're even having to think about this right now.

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  11. I am so sorry that this cycle is not going according to plan. While I have never done IVF or IUI, I think I have read enough blogs and message boards about it to think that something is kind of hinky with your clinic. Most IVF blogs I have read talk about multiple check ins with the clinic and adjusted meds, and I can't recall how many IUI blogs I've read where the doc cancels because there are too many follies. And then to throw ICSI into the mix without having even discussed it?

    I don't know what it would take to change clinics and how much it would cost you financially, but I think the emotional payoff of being in the care of doctors that you trust might be worth it.

    (((hugs)))

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  12. I am so sorry to hear this. I went through this as well and had nothing to transfer. In hindsight, I should have cancelled. If you have already paid for a certain number of cycles - is that transferrable to another clinic? If so, I'd take my money and run.

    Did they explain why they didn't monitor before now? I had monitoring on day 3 of stims and then almost everyday after that until retrieval.

    If an IUI doesn't cost much, or is covered by insurance, I'd do it. What's the harm?

    If you no longer feel confident in your RE, it's time to move on. My first RE left me in tears every time I visited and I just always felt like it was a bad news situation. My 2nd RE was incredible and so compassionate. I would have never gotten pregnant without the change.

    Many prayers for you, sweetie. I have been there and I know how devastating this is. I am so sorry that you are having to experience this.

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  13. I think any place that inspires that little confidence is a red flag. I think that your clinic should be monitoring the whole way through and be very clear about all possibilities. That they didn't tell you about ICSI before letting you know that the fee was due - bad news. After the first BFN (IVF #1), we felt like we weren't getting the attention we wanted. A heart to heart with our doctor and one of the nurses helped and IVF #2 we got a lot more personal attention. That, and a good acupuncture clinic where I am NOT a number have made this cycle much more bearable - no idea if it has been successful though.

    I'm so sorry - that's a rough situation.

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  14. Well that just sucks. It must be so incredibly frustrating and confusing right now, and made worse by the lack of confidence you have with you clinic.

    My two cents? I wouldn't convert to IUI because the risk of multiples is so great (unless you have MFI, but even then it could be an issue).

    Before deciding whether to abandon the cycle completely or push ahead, I would have a long talk with the RE about why they didn't do any monitoring before 24 days into your injections. My clinic, which has it's own quirks, does monitoring 2x during suppression and then at days 5, 7, 9 etc of stimming. I kind of think that they should cut you a financial break and use this cycle to learn how you respond to the meds.

    And wrt the ICSI -- yeah -- bring that up too -- billing shouldn't be telling you about RE decisions.

    Good luck with whatever route you choose!

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Thanks for sharing your thoughts!