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Cloudy: thanks!

ross: that's a great result! Are they still developing in the lab? What is the next step?

Briss: yes, I had you in mind when I was looking for experts on Asherman's--I totally remember you saying you also suspected something had gone wrong in my miscarriage... Thank you! And thanks for the filmy thoughts and wishes, too! My ERPC was at CRGH but I don't blame them... Dr Trew said some women are just prone to scarring, and will scar even with very careful ERPCs, while others will escape unscathed from real hatchet jobs. Hmm, that's odd about your blood pressure... I have no idea, really, why it would go up... Do you undergo sedation when you have EC? If so, this is definitely something to bring up with the anaesthesiologist next time... I understand re. LH--I get that you seem really to have been surging... Your oestrogen, though, is not great, to be honest... 180 pg/mL is only equivalent to 661 pmol/L, which would be enough for one mature follicle but only just... And you had two... I seem to remember you saying your E2 was, like, 1800 at some point, no?! If so, this may be one of those "follicles fizzling" stories, where for some reason the follicles run out of steam before they're mature... I've had a couple of cycles like that and it's utterly heartbreaking... But maybe I'm misremembering your numbers... Still, the rule of thumb is, if your oestrogen ever goes down appreciably (and there's no cyst to explain that), that's a bad sign for the health of any of the eggs that are growing... I hope for a better cycle next time around, whenever that might be... I'm so sorry--it did look promising for a while...

Sunshine: do you have news on the two that were still growing? Unfortunately protocols that work for DOR women are really trial and error... Here's one I did that had Letrozole:
previous cycle: estrogen patches starting one week post-trigger.
meds:
CD2 onwards: Letrozole 5mg (= 2x2.5mg tablets, evening); partner starts taking doxycycline 2x/day
CD4 onwards: 150 iu Gonal-F, 75iu Menopur (evening)
CD?? onwards: add 250mcg cetrotide

and here's the protocol that I responded to best, personally:
previous cycle: estrogen patches one week post-trigger.
meds:
CD 3-7: 2x50mg Clomid (evening)
CD 3 onwards: 225iu Merional alternate days
CD10 onwards: indometacin 3x/day

I'm sorry this protocol doesn't seem to have worked so well for you, but the truth is, your baby may be among these embryos!

AnnaKay: this is one of the most exhausting things about this process--we can't really relax and put ourselves in our doctors' hands. I mean, many women can, and they're really lucky, but LTTTC women really cannot, in general. I don't think any clinic or doctor can hold the full complexity of our case in their minds. We have to do that, and we have to know what it means. It sucks, but... you did catch it. You deserve massive kudos for that!

katkat: my thinking on the 2ww is that, though it is torture, we've put in so much work obtaining each and every embryo that we owe it to ourselves and the embryo to give it every chance... I've read that implantation happens on average at 9 DPO, but can happen as late as 12 DPO. So, testing on 11dp3dt is just about ok, as long as it's a blood test... An FRER wouldn't pick up the tiny amount of hcg an embryo would produce if it had implanted just, like, 36 hours before (bearing in mind we should use the first urine of the day for an early FRER). From that perspective, the clinic's diktat of 14dp3dt is actually quite sensible, and not too cruelly long, if you're going to POAS (CRGH demands 16dpt!)... Good luck, whichever way you go!

LXP: what's on your horizon?!

Blue: I totally use Pregnacare conception. I supplement with 6 other things (uhm, let's see: turmeric, Vitamin D, Vitamin E, Vitamin C, Omega 3, Folic Acid). And I'm on Thyroxine. And back when I was still collecting eggs I was also on Ubiquinol. Can't wait til I don't need any of this stuff anymore!

AFM: looks like Dr Trew's secretary at Hammersmith Hospital has quit/been fired/something, so I haven't been able to schedule my operation yet... He only does them on Mondays and I was kinda hoping it would be this Monday but obviously it won't be... Pretty annoying when this whole important part of your life is hanging on something so chaotic, but I'm just trying to remind myself that, in practice, next Monday is part of the same cycle so I wouldn't be losing any cycles by waiting another week...
 

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LXP: amazing that you have even growth! That's lovely!!! As for Vitamin D, most of us are deficient, especially in this not-very-sunny country! From memory, I think I use 25mcg... And Vitamin C was Dr Ozturk's recommendation to prep for transfers, rather than egg collections... Plus he said to stop taking vitamin C once the embryo has been transferred (it's been found that lots of antioxidants are great for egg development but not so good for embryo development...) As for your scan, what cycle day are you? This won't surprise you but you're looking for growth (on average 1mm per day for each follicle) and your lining thickening... I actually write all this data down, so if the sonographer doesn't tell you feel free to ask for follicle sizes and lining thickness!

Mac: sorry ovulation tracking is driving you loopy--it has the same effect on me! FWIW, my impression is that you've ovulated--don't worry if LH stayed high for 3 days--that's not so strange... If it's more than 3 days, though, then there's probably a different reason why your LH is high. One thing that, for me, is surprisingly accurate is tracking my basal body temperature: when I wake up each morning, before getting out of bed, I take my temperature and record it along with the time of day. After ovulation, my temperature always goes up; right before AF, it always goes back down. It doesn't help you predict when to BD (temperature only goes up after ovulation), but for cases like yours where the OPK is making you confused and anxious, it helps to confirm whether or not ovulation has happened...

Helen: If your lining continues puzzling you, I think it's worth seeing Dr Geoffrey Trew, at 92 Harley Street: https://www.92harleystreet.com/contact/ -- each consultation is £250, and if he sends you for a HSG with Prof Hemingway, that would be another £465 (so you might be looking at £965 just for the purposes of diagnosis (counting one consultation before and one after the HSG)--I haven't even found out how much the lap will cost yet, as I can't get through to someone who can give me any info on it...) Expensive, but so far I'd say it's worth every penny, to either set your mind at ease or to address a really egregious problem... Still, I hope your lining looks perfect this cycle and gives you reason to stop worrying about it altogether!

Anna: thanks! Hope your weekend has been good!

Babyhopeful: hang in there! When is OTD?!

Sunshine: Ugh, I'm so sorry you have some reason to expect bad news... I hope the news are better than you expect, though... Good luck tomorrow...

ross: Congrats on being PUPO!!! Wow, so much PUPOness going on on this thread! I'm hoping we're starting the year on an excellent note!
 

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Sunshine: An 8-cell plus two blasts! Amazing!!!! Well done!!! I really don't know if Create often use letrozole--perhaps another RE there does, and your RE just doesn't know about it? Is there a reason why you prefer letrozole over Clomid? If Clomid give you bad side-effects, it's best to avoid, but if it doesn't it tends to be marginally better at recruiting more follicles... Maybe they tend to work with Clomid instead of letrozole? No idea, really...

ross: congratulations on being PUPO!!! The 2ww is difficult. It's hard to know where to pitch your hope... in my experience I'm either 100% hopeful or 100% hopeless. Anyway, hang in there, and good luck!!!!

Helen: in my limited experience, sore boobs has meant high progesterone, but if your AF has started that should mean your progesterone has dropped... I hope you get some relief soon!

Briss: did you take your bloods before or after EC? I feel like E2 shouldn't drop before ovulation has actually occurred, but in point of fact I don't know that to be true. My last E2 numbers are always from trigger day, so I really really don't know... Have you ever measured E2 on collection day before?

Blue: Dr Ozturk prescribes 1g Vitamin C+ 2x400mcg Vitamin E for lining, but stopping on transfer day. As for other remedies, I've found Floradix 2x/day to be seemingly effective... Also, I've heard Brazil nuts (selenium) rather than walnuts, and pomegranate juice, and red meat and lentils.... Some women also swear by acupuncture, but it's really not my thing!

LXP: those are some great results! I hope things continue to move well!!!

katkat: low oestrogen or high progesterone could cause you to be very hot, I guess... Your oestrogen ideally should not be that low in your 2ww... As for progesterone, I can't explain it... Are you taking it orally, whereas normally you have pessaries?! Maybe that makes a difference? Not sure--I just hope that, despite your doubts, it's a great sign...

Anna: FWIW, from what I've seen, the worst microdose flare does is limit you to just one egg... It's not like you get nothing, or like you have to wait a month before your ovaries recover... So, it's not too terrible and it's true, some DOR women respond well to it. You just don't know if you're one of them until you try it...

Babyhopeful: really hoping you're not disappointed on the weekend!

Mac: I'm sorry--it's really upsetting not to know where your body is. I hate it with a passion... Echoing Briss and Anna, if you want to take matters into your own hands, you can try to measure at least progesterone, tomorrow if you like--if it's low, then you're at the beginning of a cycle; if it's high, then either you have a cyst or you're at the end of the cycle; if it's in between, you're ovulating now (I don't expect that to be the case, though). Hopefully it will be low and then you will be free to use these amazing antral follicles!!! (Personally I'd measure oestrogen as well, because it's good to get a baseline, but it's expensive and not totally necessary so you can skip that...)

Shady: yes, I do feel very lucky that CRGH by total coincidence would only do mild stims with banking, and refused fresh transfers outright. I wasted 4 cycles at Cornell, trying to do fresh transfers, but then my CRGH cycles gave me these precious embryos that are just waiting for a good home... I know what you mean, not being able to bear the alternatives for m/c... My cousin and a friend both had horrible experiences naturally passing miscarriages at roughly the same stage... I really didn't want to do that, either... And anyway, Asherman's has pretty identifiable symptoms: thinner lining and/or less flow during AF and/or extra pain during AF. So if you had it, you'd have reason to suspect it. And, most likely, you won't. It's enough suffering, already. Really. I hope the rest of your journey to having a baby is unbelievably easy!

AFM: Dr Trew's team's chaos continues... Hammersmith hospital couldn't help me, in the end, so I called 92 Harley Street and they said they were trying to book it for Feb 19th. That would be next cycle. One more wasted cycle. I asked if it could be sooner and they said, "that's the date we're trying to book." I mean, if it's the NHS then I'd feel bad trying to get customised service, but I'm paying up the wazoo here! You'd think they'd at least explain why they have to be so inflexible! Grrrr... And to make it worse, my best friend, who lives in LA, is going to be in France for just 4 days, leaving on the 19th--I'll have to cut short my trip to see her so I can be back in time. Ugh!
 

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katkat and babyhopeful: I'm so sorry... It hurts so much every time... I send you both big hugs...

katkat: that lining sounds cushy enough... it likely was the embryo... Still, if you want to give the lining a bit of an extra boost, it wouldn't hurt... I'm sorry you're so tired of it. I totally get it, and send you hugs... Looking forward to seeing you soon, hopefully...

babyhopeful: re. DHEA, have you tested your testosterone levels to see if you needed? Both of my REs have dismissed it outright, so I don't even know what tests are needed, but I've observed that for some women the response is indeed better on DHEA while for others it's worse... As for immunes, I'm sorry, I forget--have you ever had implantation? If not, I might test. Or just go straight for taking prednisolone... in the US they give you four days of prednisolone around transfer time as a matter of course... And CRGH prescribes Clexane to pretty much everyone. I'm feeling a bit cynical about testing for immune issues, and feel more like throwing the kitchen sink at every transfer makes more sense unless you have a reason not to... I'm planning prednisolone, intralipids, and Clexane for my next transfer, whenever that might be...

Shady: it will be excellent to (hopefully) see you! I'm really looking forward... Some day I hope it will be in celebration rather than commiseration, but for now we will have to settle for comforting and encouraging each other...

ross: keeping my fingers crossed for you... re. supplements, I believe in the 2ww you should still take a multivitamin like Pregnacare Conception, extra folic acid if you take it, Vitamin D most likely, and Omega 3.

Briss: thank you! Ok, I understand re. bloods--I guess when the follicles start detaching from the ovaries they stop producing as much oestrogen... I hadn't thought about that... I'm hoping for a better cycle for you next time. You so deserve a break...

LXP: how did it go? I hope your ovaries both made an appearance and you got a nice haul!

Mac: how did the progesterone test go? I agree--it's funny how minds work, but if you know non-IVF-related relaxation helps you more, go for that!

tily: thank you, that's very sweet! I hope I get to see you... Happy to go to "my restaurant" or anywhere else in London, really... Is the timing for your London trip working ok? You're going to visit Lister, right?! Incidentally, I've thought with apprehension of your hysteroscopy too--but I think you said your periods have, if anything, normalised a bit, so your signs so far are good. I'm so hoping you get that lasting BFP before you make that switch to DE...

AFM: it's confirmed, the hysteroscopy is on the 19th, and I have to be in hospital at 7:30am, so I'm cutting my France trip a little short and taking the Eurostar back from France on the night of the 18th. Apparently that's the only day Mr Trew is operating at Hammersmith in February. I'm so tired of waiting... so tired of bending over backwards... It's so odd--I'm not even a little interested in collecting any more eggs while I wait for this surgery. I'm just done with that. I guess on the plus side, after all this if we don't get our bio-baby, the adoption process will seem like a complete walk in the park!

One somewhat awkward question: I have a friend visiting from Norway next weekend--and so far it's sort of looking like Saturday Feb 10th is the most likely date we will meet (the doodle poll is here, for whoever else wants to join: https://doodle.com/poll/ycrq4b982t6756ir )... By some coincidence, she is also DOR, and she's TTC her second child... She's had a number of miscarriages so far... She's married to another woman, and now they've switched to doing reciprocal IVF (so, my friend's wife, who is not DOR, donates the egg and my friend carries...) She can absolutely entertain herself while I go see you, but if you gals think it's ok I think she'd find it interesting to meet you... She'd be a total stranger to all of you, though, so I'm on the fence about how good an idea it would be... Thoughts?
 

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LXP: wow, 8 is a great haul! FX'ed for your fertilisation report today!

Briss: thanks! I send you hugs. I hope you're holding up ok...

Babyhopeful: I didn't know CRGH has a sister clinic... Different CRGH consultants have different attitudes, but hopefully yours will be willing to offer you at least some immune support. Technically I have had immunes testing but I feel like the conclusion would have been the same even if I hadn't... As for these strange bleeds, they might all be implantation bleed followed by chemical pregnancy, but they might also be hormonal. The pill sometimes hides hormonal changes as they occur... Did you test your progesterone around one of these strange bleeds?

MA66: oestrogen priming would help both with even follicle growth and to suppress cysts, but in your case it's contra-indicated as oestrogen exacerbates endo. Norethisterone would be an option, and again it should help with both, but if it's not working for you then perhaps you should change tack. Have you tried long protocol? If you have 15 follicles, it might be worth trying. It's risky as sometimes it oversuppresses women and then takes 2 months or so to recover from, but I wouldn't expect that with someone who has a confirmed AFC of 10+... Did CRGH or ARGC never suggest that? In your place, I'd be tempted to try it... Otherwise you might want to look into whether the pill is ok to take for endo women, and you could perhaps take that for a week or so starting a week after ovulation. As for IVM, it's really intended for PCOS women, who produce loads of eggs, all immature. One doctor explained to me that the fertilisation rate for IVM eggs is the same as for in-utero matured eggs, but the pregnancy rate is much, much lower. Most clinics avoid the longer IVM for non-PCOS women (though most clinics are ok to do IVM overnight, just to help the egg along its very last step of maturation). And as for utrogestan, I've never seen any reason to lie down after taking it, and I certainly didn't back when I used to take it. What has been said recently about it is that Briss and katkat have both had unpleasant physical sensations while on it.

Sunshine: thanks! I can vouch for back-to-back cycles personally, and one consultant said that sometimes the second cycle in a back-to-back yields more eggs (but not to count on it). My own personal experience is that 2 stim cycles in a row is a good idea, but with hindsight I'd have given myself a break on the 3rd cycle. I'd have done 2 on, 1 off. But each person is different, of course. As for natural cycle IVF, no reason not to do them back-to-back-to-back... Hope your appointment goes well!

tily: I owe you an apology... I'm so paranoid about Asherman's now that I may have alarmed you without reason. Dr Trew was clear that only interventions on a pregnant uterus cause Asherman's, and of course that wasn't your case... So, phew, I can relax on your behalf, and I'll try to think before I type next time--I'm really sorry...
 

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Briss: I'm very sorry about your BFN... There is always hope, even for the longest of longshots... and it hurts when it's dashed. It does seem like you are bouncing back, at least to some extent--you got maturity and fertilisation, which is better than you've had in a while... I really hope that between your diligence and your body just bouncing back, you will get a good embryo soon... I have no idea what to think re. sperm vs egg--as you know the egg is a lot more complex and therefore more things can go wrong with it, but who ever really knows?!

ross: I'm so sorry about your BFN... It really just bites... How much of what kind of progesterone are you on again? For me, with Crinone AF shows up 2 days after I stop, but with intramusculars it takes more like 5 days... Also, it's different for every woman...

Mac: it's certainly not your obligation to carry another woman's genetic material, so you should not feel guilty about depriving your husband of anything. What I can say is, I know one woman who's gone down the DE path, and I have to say, her pregnancy was a joy to behold. She was sooooo happy... and now her twins have been born, and she couldn't be happier. Pregnancy and birth are intense, life-altering experiences... For some women, they are more important than the genetic material. For other women, looking at the baby and seeing little bits of yourself is way more important. Some women absolutely hate pregnancy, though they love their babies once they're born. So you just have to give yourself time to think through all the possibilities, in detail... Like, how does it feel to know that eating your favourite food would be feeding the DE foetus, and that you would experience it moving around in response? Weird? Wonderful? Offputting? Downright unpleasant? Whatever your reaction is, it's not wrong. You have 100% of a right to feel that way. It's not your fault that you have DOR, and it doesn't mean you owe anything to anybody. If anything, the world owes you a chance to get pregnant and have a baby as a result of simply having sex. Don't feel guilty! Just do what's right for you...

Babyhopeful: I'm sorry AF is so uncomfortable... Oh, I HATE the scrutiny--I try not to tell anybody anything (apart from my therapist), as nobody bloody gets it except for other DOR women who've also been trying for a long time. Odd indeed re. your mid-luteal phase bleeding... I absolutely think you should have some progesterone support prescribed for your natural attempts... Good luck!

LXP: you've probably heard by now, and I hope it's good news! Looking forward to cheering your own in your hopefully soon-to-be PUPOness!

Laura: ubiquinol is the main thing I, too, would add to your regimen. I was taking 200/day, but I know some women here take 300 or more! The other thing I wonder is how high your stims are. If you produced three embryos, you might benefit from mild IVF if you're not doing that already--loads of stims sometimes (not always!) seem to fry eggs... Are you doing back-to-back?

Helen: I'm sorry--I don't know where to get a scan on demand--I've never done that, myself... That said, given your history I might have my lining checked on CD 11. Katkat's plan is good for controlling your ovulation... if you wanted to do a fully natural transfer, though, and avoid the trigger, you'd have to do OPKs til you get your surge and then do one or two more scans after that to confirm ovulation has occurred. I would not use those post-ovulation scans as a lining check, though, as progesterone tends to compress the lining and you might get an unnecessary scare out of it.

Sunshine: enjoy your break and good luck on your natural attempt! Yeah, if you're not happy with your AFC you probably shouldn't go on the pill. I think you don't have endo, right? Why don't you do oestrogen priming to avoid a new cyst forming? It totally doesn't prevent you from trying naturally. As for cyclogest, it's recommended that you start it the day after ovulation, or max 2dpo. Ask your clinic to prescribe more--they really should support natural attempts with progesterone!

katkat: thanks for welcoming my friend! Re. oestrogen after transfer, some women (especially DOR women) don't make enough oestrogen for proper embryo development, so it sometimes helps to supplement with oestrogen as well as progesterone. I'd say just do it, really, but most clinics don't prescribe it as it's either a rare problem or an underestimated one... Re. endometrial receptivity, as I understand it, the point is that the embryo and the endometrium are in tune with each other in terms of timing... So, a 2-day embryo is not ready to implant and a 2-day lining is not ready for implantation. Same with a 3-day embryo... The lining on average matures around day 6, I believe, and stays mature/ready for implantation until day 12 or so. Similarly, the embryo starts to be ready to implant around day 6 and remains ready for implantation for a week or so. A day 5 transfer isn't really better, as I understand... It's true that the embryo would only arrive in the uterus around day 5, so its natural environment before then is the fallopian tube rather than the uterus. Still, embryologists I've spoken to have been adamant that the uterus is a better environment for a day 2, 3, or 4 embryo than the lab. So, according to them, it goes: best environment for days 2-3-4 is fallopian tubes, then uterus, then lab. The embryo doesn't hurt anything by hanging out in the uterus a bit early--it just can't implant. That's how I understand it, anyway!

Anna: FWIW, oestrogen priming has always helped eliminate my functional (oestrogen-producing, specifically) cysts and to avoid the formation of new ones. However, I'm not sure the scan picture you described is consistent with you having ovulated... if you can, I'd take a progesterone test to figure out where in your cycle you actually are (specifically: are you really in your luteal phase, as you believe?)... My cycles are generally very regular, but sometimes they're weirdly slow, usually because they start with a cyst... Ovulation does happen--it's just delayed. As for your conversation with your husband, I'm really, really sorry... This process takes it out of everybody. It really does. It's good to start talking about the future, but the fact is, you've got some OE chances still ahead of you... Hopefully--hopefully! the DE decision will simply be irrelevant in future... and surely if there is a OE baby, you'll both fall in love with it. That's the scenario I'm envisaging for you...

tily: I'm glad I didn't freak you out--I'll go find something else to feel guilty about, then ;-). Please add one to the reservation number, then--my friend is less technically savvy than many of us here, but she has certainly been through a whole lot... I'm really looking forward to seeing you! If it is on the 10th, the only thing I regret is that Cramer seems not to be able to make it...

AFM: this is a moan, so if you don't feel like reading one, look away! My partner's best friend and his girlfriend are visiting for 3 days... He has 3 kids with his estranged wife, who decided to move with the kids to the other side of the world--a place where he wouldn't be able to get a job in his field. His middle child is 4--she's been in this world for as long as DP and I have been TTC. His youngest is 2. He and his girlfriend have been together for about 18 months. They announced that they are 5 months pregnant, and I congratulated them warmly despite my deep surprise and--let's face it--wild envy. She's in her late 30s, so I totally understand her hurry. So far, so just-about-bearable. When I congratulated them, he said, "We're very happy. We've been trying for a long time, and it's been difficult." Now, he's my partner's best friend. He's not unaware of our difficulties. In this context, he has no flipping idea what "trying for a long time" or "difficult" means. Even if they started trying from the moment they met (which is hopefully unlikely), that would still mean it only took them just over a year to get pregnant. FFS. Bloody insensitive jerk. And poor DP has been feeling guilty about feeling envious. I mean, come on. Ok, moan over! xx
 

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Helen: awesome that you've found a cheaper place!!!

Sunshine: my oestrogen priming has always been: put on 100mcg patch one week before AF (on average, you start one week after ovulation, or 9 days after your first LH surge, but that assumes a 14-day luteal phase. Mine is 12 days so I start one week after my LH surge.) You wear the patch for two days, then swap it for a new one; repeat until AF arrives, but don't take it off--leave it on until you start stimming (if you're stimming) so you can get a little flare effect from the sudden drop in oestrogen. Your clinic just has to be aware that you're using the patch, as they might measure oestrogen at baseline to make sure you don't have a cyst (so they'd have to account for the noise introduced by the patch). I don't know what sorts of cysts you normally have--if they are oestrogen-producing, in my case, the patch has suppressed them every time. Doesn't work for all women but it does for many. As for using it alongside cyclogest, the problem is that oestrogen + progesterone is pretty much the pill, and so can be oversuppressive. However, you'd only be taking that combination for a week. One of my best cycles ever, personally, was a cycle right after I was on the oestrogen patch and doing intramuscular progesterone injections (which should be stronger than cyclogest). So, if you're terrified of oversuppressing you might want to think twice... Otherwise, I think it's worth a try... Good luck!
 

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tily: Oh, yes, I'd have loved to have shamed him into a little bit of empathy. But yeah, people are often just self-absorbed idiots. Another friend I like much better told me I looked very happy holding his newborn baby (in point of fact, it was bittersweet). He's a sweetheart, but he was just assuming that if he's happy, everyone must be happy. Re. consent forms, yes, somewhere in the UK a woman who had separated (or divorced?) from her husband forged his signature and had some frozen embryos transferred. She ended up with a daughter and the man unsuccessfully sued the clinic for the costs of educating his daughter privately. Something like that. Anyway, I'm sorry your natural attempt did not bear fruit, but best of luck with baseline and onwards! I'm looking forward to seeing you!

Laura: if there's one thing I hate, it is clinics that only try one thing and then blame the patient if it doesn't work. I'm half-minded to ask you to consider moving clinics. Echoing Pickle, you've tried long protocol--now perhaps it is time to try short protocol, perhaps with oestrogen priming or norethisterone or the pill for a week or two to quieten your ovaries a bit. I honestly find it idiotic that a clinic would put you on long protocol and then complain about your response, rather than switch the protocol around. Long protocol often oversuppresses (though sometimes it's brilliant for) DOR women, so I find it not even a little surprising that it had that effect on you. Sorry, I'm in a bad mood! So yeah, I think short protocol, and then maybe use Clomid or letrozole to try to recruit more follicles once you've made your ovaries sleepy with oestrogen or norethisterone or whatever, and then go on to use the 125 Gonal-F or whatever. As Shady has hinted, it's kind of equivalent to upping your stims dosage, except you use your own naturally-made FSH, which apparently is more effective. That's what I'd try for you, personally... So yeah, I'd encourage you to ask about short antagonist protocol, ideally with Clomid or letrozole to start... Good luck...

Shady: wow, your friend's husband sounds like a real jewel of a man. So enraging that he gets to drink and take drugs and yet only take 6 months to conceive! Please don't worry about your AF being light this first time... They aspirated pretty much everything that was in there, after all... I forget, are you able to try naturally?! If so, good luck! If not, best of luck next cycle--there is a sense, which even doctors seem to share, that one is far more fertile in the couple of months after a m/c... Not sure whether it's follicles or lining or both, but hopefully at least the lining and, if natural is an option, the follicles too!

LXP: For some people, everything is always about them. It's exasperating, because they are entirely clueless, but at least it's possible to get one thing out of it: you can get really angry at them and not feel guilty about that at all! Also (and this is really naughty of me) you can comfort yourself with the fact that when you finally have a baby, it's going to have a mother who is not clueless. (Actually that makes me sad for her kids.) Re. your embryos, that sounds great! Were they 10 cells at the same time of day as they were fertilised? If so, yeah, a little fast, but quite good. "Not far behind" is an odd thing to say--9 cells, then?! Best of luck for your day 5 call!

Helen: re. my partner's friend, I cut him no slack for being a man. I reckon we as a society expect less of men than of women, and that's why they get promoted ahead of us and earn more than we do. Anyway, as LXP noted, insensitivity comes from both genders! As for progesterone, I find it depends on the type and amount, and when I start it, and even then it's somewhat random. But yes, it's not at all unusual that follicles develop even while AF is being suppressed via artificial progesterone. Still, some REs believe (and I with them!) that a common problem for DOR women is, we don't produce enough progesterone for long enough in our luteal phase. Apparently good embryos can implant as late as 12 DPO, so you need to figure out if you're going to give those late implanters a chance... That might mean a shorter follicular phase next cycle, but, at least in my personal experience, that doesn't affect the quality of the eggs... But yes, each person is different. I think Briss has found that it does mess with her egg quality, though, so yeah, you just have to figure out what works for you, personally... Anyway, to your current concern, I'd do my scan (and possibly trigger) only once it looks like LH has shown its face--I'd keep on the cheapo OPKs!

Pickle: looking forward to meeting you in person, finally!

Briss: you must be on AF watch... Again, I'm so sorry... I hope you get a good cycle again, soon... xx

AFM: getting information about this hysteroscopy is like pulling teeth! Last week the hospital sent me all sorts of useless information (like, what time is lunch?) but nothing like, "nil by mouth from x o'clock." That is coming from the clinic instead. They presumably sent me that info a week ago by post, but it hasn't arrived here yet, so there's probably a neighbour of mine who's got my hysteroscopy instructions. There is no privacy in this world!

btw, doodle poll is here: https://doodle.com/poll/ycrq4b982t6756ir
 

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Briss: yes, bring it on!

tily: Ah, nothing like oestrogen to get FSH to a decent level! I'm hoping these beautiful follicles do you proud and get you that baby in the end! Embarrassing--I didn't even realise The Blue Legume was closed for 3 weeks, and I live, like, a block away! I'm into Mexican, personally, but I'm generally quite easy-going re. food. Pera is almost right next door and has a kind of similar-ish menu to what The Blue Legume used to have (maybe more explicitly Mediterranean), just in case people don't like Mexican. But anyway, good luck with this cycle!!!

Laura: I think we DOR women need to start sending feedback to the NHS so they can update the NICE guidelines. LP works wonderfully for some women, but not for all!

LXP: congratulations on being PUPO!!! Hopefully at least one will stick!!!

MA66: sure, the pill also quietens the ovaries--problem is, with DOR women, sometimes it oversuppresses when taken for 21 days. Hopefully not in your case, though... Was your oestrogen ok, in the end? Incidentally, you're far more likely to get migraines from low oestrogen than you are from high. Also, oestrogen suppresses follicle growth, so if your cyst is oestrogen-producing, that definitely doesn't explain why your other follicles are relatively large--if anything, it would make it even more puzzling! I personally wouldn't be worried about early growth, though some other women have found it to be negatively correlated with egg quality... It's really personal, and you just have to learn what your body does... I hope you got good news about the cyst and will get to use this cycle!
 

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queenie: welcome back! FX'ed for some beautiful follicles next cycle!

Helen: your follicle size and E2 and LH are all beautiful for the stage right before ovulation. I wonder whether you don't want to try to grab that egg, actually, though with LH surging you'd have to have some luck with the timing in order not to miss the egg... As for a transfer, I wouldn't do it on a 5.8 lining. Did your lining used to be thicker before your D&C? If so, yeah, I would suspect Asherman's... But if this is the first time you've seen it be thin, it may just be that it was a dud cycle--you can try giving it another chance to see what happens... Ugh, I really hope you don't have it. I mean, thank goodness there's a(n expensive) way to address it, but I wouldn't wish it on anyone...

Babyhopeful: I wish you a speedy recovery...

Mac78: I'm sorry about your best friend's mum, and I'm really sorry you had to cancel your appointment and are probably stuck waiting another month. I have to say, I've become quite single-minded about TTC. I will not do anything that will get in the way of my cycling. Though I've done things like having phone consultations before when I had to be travelling at a time when I needed a consultation... Sorry, I'm not at all saying you shouldn't have been there for your friend--I think it's wonderful of you that you were. But personally, I've just become selfish when it comes to this. Everything else can go on the back burner. I'm sorry, too, about the job interview... DP and I have also been having a really rough couple of years--I totally know what it's like when it feels like everything is going wrong at the same time... I send you big hugs...

Shady: as I understand it, for a natural-cycle FET (maybe with a bit of oestrogen help), it's not a good idea to start the oestrogen early. This is because oestrogen suppresses your follicles' growth, which means you won't be getting your naturally-produced oestrogen, which is really what one is going for in a natural-cycle FET. The FET protocol that has you taking oestrogen from the beginning of the cycle (Katkat is familiar with that one) is one where your follicles don't develop and you don't ovulate--virtually all your hormones are supplied artificially. But that's not the protocol you're on, so it's better to wait until your lead is really secure in its role, and only then adding some artificial oestrogen is not going to stop your lead from doing its job.

LXP: my consultant said that the studies on aspirin are inconclusive--that, if anything, there's a tiny negative correlation between taking aspirin and success. That said, they prescribe Clexane to pretty much everybody, to thin the blood...

Pickle: thanks! Lol, your description of DP's friend rocking up was spot on! I'm sorry about your tonsillitis and cough/cold... As for your DP "having" to BD, that really is one of the saddest things about this process--how sex becomes, so often, an obligation... If I'm lucky, I get to have a transfer in March, too--though I'd love it if all this obligatory BD'ing paid off for you ahead of time!

Anna: personally I've cycled with haemorrhagic cysts and non-functional cysts that didn't really get in the way of anything. That said, my ovaries are spacious enough for the few follicles I have, so the space-taking aspect of cysts has never been a problem for me as I know it is for some women. For me, ageing has taken precedence--I'd rather try and fail than wait and wonder... No baby for me yet, though, so take what I say with a bucket of salt... As for your struggles with your DH, that's one of the most heartbreaking aspects of LTTTC--it puts an enormous strain on relationships. I'm in permanent wonder that DP and I are still together after all this. And we do see eye-to-eye on most important aspects, but when you don't--like, when you disagree on DE--wow, that's tough. I just really hope you don't have to get to that decision at all. I understand that you feel a need to know that you have a plan B, I understand that you need to plan your life, but you do have a chance to try with OE, and hopefully--hopefully! that will be all you need!
 

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Hopeful: what wonderful news, congratulations! Thanks for letting us know--we need all the hope we can get!

Pickle: I'm so sorry we couldn't meet you in person... I hope your little one is ok... Hopefully we will meet next time--with everyone pregnant, ideally!

Cramer: sorry you couldn't make it this time... it's good to hear from you, though! Re. vitamins, Dr Ozturk told me to stop ubiquinol, Vitamin E, and Vitamin C (if you're taking those above and beyond your pre-natals) at transfer time, and start again only if a BFN has been clearly established... Honestly, though, I just kept going with the ubiquinol because I never really believed that any one transfer would work. I've stopped ubiquinol now that I'm not collecting anymore. I'm sorry work's been so busy but really glad you're feeling good about yourself. I think that positions you much better for success! FX'ed!!!

Briss: so sorry we didn't get to meet in person... How's your little one dealing with her chicken pox? Yeah, your follicular phase seems to have really shortened--your FSH is probably relatively high... I'd consider either luteal phase stimming, to boost the follicles a little, or (my preference) oestrogen priming, to slow them down until AF actually starts... Of course, you'd have to see what actually works for you... This process is exhausting!

Shady: it was lovely to see you again! You look really well... I'm hoping for that post m/c boost for you!

tily: thank you so much for organising--it was lovely to see you again! I'm sending your follicles "grow strong" vibes--good luck!!!

Blue: thank you very much! Yes, being a "rescuer" works against us--we need to spend our energy on ourselves, too!

Helen: it was great to meet you in person! How did the scan go?

Laura: thanks for all the wishes! Where are you in your cycle--sorry, I forget... have you started the meds yet?

katkat: it was lovely to see you again! I'm sorry it's been such a frustrating journey... I can also totally relate with becoming the whining partner... Ugh! I just hope you get to say, when you finally have your baby, that it was all worth it in the end!

Sunshine: BCP for a week in the luteal phase should at least suppress oestrogen-producing cysts... Good luck with that natural attempt!

AFM: AF arrived Saturday night and it was quite heavy, so I started getting paranoid that this upcoming hysteroscopy is entirely unnecessary. It's horrible to be paranoid all the time--that's really not who I want to be! Anyway, it was only heavy for one day, and now it's practically gone, so I've calmed down again. Can't wait for next week so I can get this thing behind me!
 

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quick one for tily: I'm really really sorry your E2 is not corresponding to your follicles... I would not trigger today. Frankly, I probably wouldn't even trigger tomorrow. Did your LH start to rise? Lister should know this, but on letrozole protocols follicles have to be bigger before they're sure to be mature (Cornell likes them > 21--if possible, they like 23!). So unless your LH already had an appreciable rise, I would not trigger tonight. My 2 cents... Good luck--I still have high hopes for these follicles! xx

Will try to write more later!
 

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Helen: I'd say if your lining was 6.8 after ovulation, it was likely over 7 before. I am really sorry about your PGD results... This is going to sound really messed up, but if you want to (you have to think about relationship issues...), you could transfer that PGD-abnormal, as monosomies are not survivable. PGD throws up false positives sometimes, and CHR in the US has transferred non-survivable PGD-abnormal embryos and gotten healthy births out of it. If it was survivable (say, trisomy 21) then I wouldn't transfer, but as it's not survivable the worse that happens is a BFN or maybe a chemical (you'd have to ask if implantation is even possible). See here, for instance: https://www.centerforhumanreprod.com/video-gallery/video/why-abnormal-embryos-can-result-in-healthy-pregnancies/ . So you could transfer it this very cycle, if you wanted. Something to think about. But you might not want to spend your money on a longshot such as this, especially given the relationship issues... I'm so sorry you're having to deal with those... I send you hugs...

tily: yeah, it's sounding kind of borderline but I wouldn't give up on it, that's for sure. Just keep an eye on those follicle sizes, the oestrogen, and the LH, and frankly I'd just keep going until either the lead is >23 or the LH is starting to think about surging... I'm really sorry you got the "this is not looking good" disclaimer. That sucks. We so want to feel like our clinic is on our side--and a lot of the time, it is, but sometimes it's all just too enraging...

Mac: I'm sorry you're on day 35 with no sign of AF. That's scary... You'll be talking to someone about HRT, right? I think you need something like that... Lower your FSH with oestrogen, grow a follicle with your natural FSH, get it collected, ...

Babyhopeful: I'd say you were appropriately stroppy. What was the consultant thinking? I mean, I think mentioning DE is actually ok if you're at the start of your journey and might not be aware of the possibility, but lecturing you on your age is not exactly helpful.

Briss, Cramer, Shady: hugs!

katkat: sorry, don't know anything about vaccines and follicle development. I don't think I would skip the cycle, personally, if that was the only factor (unless you learn otherwise). But maybe you need a break, for sanity?! If so, I'd take it!

Sunshine: sounds like your ovulation is delayed... What happened last cycle, again? Stimming or priming or the pill can delay ovulation in the next cycle... I mean, by all means DTD as much as you like! But if there's not even a hint of LH, you probably won't be ovulating anytime soon...

xx!
 

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super quickly (so sorry!) as should pack for early flight tomorrow:

Briss: can be morning or evening--I've done either, actually. At Cornell I sometimes did both, when they were afraid I'd surge early.

tily: I'm so glad your E2 finally shot up! I'm not sure why they originally thought of triggering you at 19... Whether you get one or two tomorrow, I hope one is excellent--excellent enough to fertilise and grow inside you for 9 months!

Laura: March feels like forever away... hang in there...

katkat: bummer about the lining... if you decide to collect, I hope you get the one you really need!

queenie: shame about the cancellation... hoping for a really good cycle for you next month, and the flexibility to actually use it!

blue: hi!

susie: I trust everything continues to proceed well!

Mac: some types of HRT let you ovulate, some don't. If you want to use your own eggs, you'd use either the pill or just oestrogen for a couple weeks, to decrease your FSH, then have a scan to see if any follicles are starting to grow. Once they are, you get off the HRT and let your natural FSH grow the follicle. The follicle's oestrogen then suppresses your FSH somewhat and you can have a normal cycle with ovulation. Hopefully a gynaecologist and Serum can help you with something like this!

Blue: hi!

Babyhopeful: good luck on your AMH results, but whatever they are, don't fret too much. There are stories of a number of babies delivered to women of undetectable-range AMH! And, as for your friend, she's lost perspective... she was with you while you were both struggling, but now she's been successful suddenly she can't stay with your pain. It does happen. But it sucks... I'm sorry...

Helen: you might have a corpus luteum cyst--hopefully it will clear up and stop hurting, though... Well done on keeping sane under the circumstances. I don't know how anyone treating a miscarriage can be anything but super-sympathetic, but... we've seen it all by now...

AFM: France tomorrow, back Sunday night, hysteroscopy (finally!) Monday morning!
 

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Sorry, gals, this will be very incomplete--only a couple of personals and an update from me... I'll try to catch up in the next few days, but I'm sure a lot will slip by me...

tily: I'm so sorry... Unfair doesn't begin to describe this. All your sacrifice... My guess as to what happened is simultaneously enraging and hopeful: I still think they triggered you too soon. Unless LH has started to think about surging (had it?), and even then an antagonist (cetrotide), perhaps even in double dose might have helped... Yes, Letrozole cycles do require larger follicle sizes, according to Cornell. In such cycles, they like follicles to be, ideally, at least 23mm before collecting, and yours was 22. (I haven't seen any papers, though, sorry...--just what Dr Davis told me...) So "borderline mature" makes perfect sense to me, and unfortunately the non-fertilisation also makes perfect sense (and your little one was just way too small for a Letrozole cycle). Even your E2 is "borderline mature" for a single follicle, though as we know the Letrozole needs to wear off completely before we can pay close attention to that number. In my personal experience, cycles that start with oestrogen priming and have either clomid or letrozole introduced are cycles where the follicle develops very slowly. Of course I don't know that this is what happened, but I think you just needed one more day, maybe even two. I think Lister mismanaged this. I think they scared you too much when they panicked about low E2. If they're going to offer a protocol, they need to understand it--it's not like this has never been done before. I'm sorry, I don't want to rubbish any particular clinic--all clinics can be shockingly stupid sometimes when it comes to protocols they're not used to. It's quite typical off fertility clinics, I think--I'm just furious that this had to happen to you, as if you didn't have enough of a mountain to climb already. Never mind all the suffering and cost: the clock keeps ticking, which makes every mistake very hard to forgive. So, I'm furious with Lister, though in that kind of "ain't that typical of fertility clinics?" sort of way... But I'm also hopeful for your eggs. I really don't think it's their fault... I just don't think they were ready quite yet.  The idea of fostering sounds amazing... I really hope you get to do that AND have your bio-baby. For now, though... I send you hugs... I'm so sorry...

LXP: I'm so sorry about your BFN... When a cycle starts out so promisingly, the potential disappointment can be crushing... Be good and kind to yourself... You don't deserve this. Nobody does.

Mac: Sorry, this will get all therapy-ish of me, but it does seem like your TTC attempts get obscured by everything else in your life... I think to some extent you're avoiding it, my dear. I really don't mean that as criticism--I doubt there is even one of us who doesn't have huge doubt and conflict about this process... especially given how uncertain the outcome is. So, this is something to think about... to what extent are you letting other things get in the way? Is assisted conception something you really want to even try? Sorry, this question may very well make you angry! But we do all have conflict, and we have to embrace it and give ourselves a mental hug--this stuff is so hard, and so painful... and then hopefully find a bit more peace with whatever really is in our hearts--whether or not that includes putting ourselves through this IVF hell. I mean, both choices stink. On a much better note, I am so, so glad to hear your interview went well! I hope you get the job, and that this puts you in a better place where there is hope and activity and creativity and good energy--maybe this is what you need for TTC, too! May this be the start of good things for you!

Sunshine, Shady: still hoping for natural BFPs for you!

Helen: you've done so much soul-searching... Giving up the illusion of control is one of the hardest parts of this (especially while trying to remain clued in and assertive)... Sounds like you've been doing a lot of work on this, and I really commend you... I send you hugs...

Everyone else: huge hugs... and huge thanks to those who sent good wishes. Very rude of me not to send individual thanks, but I do want to go to bed early tonight... I just want to know, I appreciate every single one of those wishes, and I just don't want to risk forgetting to thank anyone!

AFM: hysteroscopy went as well as possible, really. Mr Trew said they encountered exactly what the HSG showed--adhesions in that exact spot. He said they were extensive, but they were of the filmy type (thank goodness!). After resolving those, he took the hysteroscope further into the cavity and everything else looked normal and as it should be. He then put in this gel to avoid the walls sticking to each other again, and the gel should come out by itself. He is completely confident that a follow-up HSG and surgery are not needed, so I'm free to transfer next cycle (assuming CRGH agrees and I don't have a cyst). I put in a call to Dr Ozturk (who should hopefully call back tomorrow)--I want to ask him to change my FET protocol back to "natural" from "stimulated," as I'd love to see what my uterus does just with my natural hormones, after this surgery. If it gets to at least 8 I'll be ecstatic! I'm quite anxious about speaking to Dr Ozturk because I need to be straight with him and yet I don't want him to feel I'm accusing him of breaking my uterus with the D&C (or his colleague with the ensuing hysteroscopy). But hopefully we can talk this through and agree on next steps... and hopefully next steps will mean an FET in March... And then all anxieties relating to that will come flooding back in, but at least those anxieties are now familiar to me--they'll feel welcome by comparison! (I say that now--watch me be a wreck in a month or so...)
 

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Hey, everyone! So sorry, this will again be short-ish and incomplete... Also I've been really spacey so I can't remember where anyone is at the mo...

First of all, Mac, what an amazing life... I think it's very fair to say that you will NEVER be defined by one thing only, whether it's TTC or anything else. You've already lived through so much--and you've got so much more ahead of you! Congratulations on pulling yourself up by your bootstraps--it's incredibly hard to do. I'm not sure what your future will be, parenting-wise, but it seems quite clear to me that you would be an amazing mother--loving and strong... I hope you end up having at least one baby... On a practical note, the most recent reason I thought you were conflicted was that it was a headache, IIRC, that stopped you from taking your HRT... I believe HRT tends to help with headaches... rock-bottom oestrogen tends to cause them, and HRT tends therefore to relieve them... But your experience may be different, of course--our bodies are so different--unique in fact... Either way, I hope you're ok, I hope you get that job, and I also hope one way or another you get that baby!

Babyhopeful: thanks! So glad your AMH results were not so low! I cannot remember now your last protocol and results, but for "poor responders," getting to know our bodies and finding the right protocol (and fine-tuning it) is sometimes a long and gruelling battle... I hope in your case it turns out to be quite easy, and that your next protocol hits the spot!

katkat: thanks! I think  anti-sperm antibodies are really just about sperm's specific form, but to be honest I've never really looked into it... I think the immunes tests are meant to catch any issues you might have with attacking embryos, and you've done those already... I'm sending you good thoughts--I can't remember whether you're using or sitting out this cycle, but either way I hope it's your cycle--if sitting it out, then I hope you get a natural miracle, anti-sperm antibodies notwithstanding!

MA66: Thanks! Oh, sadly a lot of it does seem to be trial and error, yes... But some of us keep going anyway in the hopes that someday we can look back and say it was all worth it... Oh, BTW, many of us "supplement" with selenium (to build lining, in my case) by eating Brazil nuts--yum!

Blue: thanks! How are you?! What are you up to?!

AnnaKay: Thanks! Now please tell your superego to take a hike. You have every right to want to carry a child--no need to feel guilt about that! It is a unique experience--one that our body is built for, and that helps define us as women and connect us to our progeny. Unfortunately--tragically--not all women are able to do so. Some don't care that much, which is totally fine... But you care, a lot, and that is totally ok. Your guilt is misplaced!

Briss: thanks! Looking forward to the transfers! I hope you get to a transfer too, soon...

Laura: thanks! Still waiting?!

tily: I've been thinking about your musings on trauma and whether that causes DOR... Of course it's possible--at least to some extent--that it causes DOR, physically... But the psychological aspects are very interesting to think about, too. In my case, trauma certainly caused me to start trying late--I did not want children before I was 33-34 (for very good reasons, I think) and, at that point, the guy I was with dumped me--so I had to go through this whole process of finding a man to have kids with. Not so easy in your mid-late 30s, and it took me 5 years! Had I tried to conceive in my early 30s, I might never have known I was DOR at all. Also, it's possible that our trauma has transformed us (the women in this forum) into fighters, into people who refuse to give in, who say "this is NOT fair and I'm NOT going to take it." That is certainly the case with me. For better or worse, probably many DOR women choose other paths earlier--DE or adoption, say--rather than face repeated heartbreak... Hm... Oh, as for Sher, I have very little respect for him. I spoke to Dr Check (Cooper--a specialist in DOR) about LH--I think the real issue with it is that it brings progesterone up, which is what actually causes premature luteinisation--and he said it's actually better to have too much progesterone than too little. Frankly, I suspect that like everything else it's hugely personal... Each woman is different, and for some of us, sky-high LH is probably totally immaterial and for others it's probably disastrous...

Helen: Thanks! Absolutely, take levothyroxine and bring your TSH under 2. I know a woman who had a couple of miscarriages until she got her TSH under control (so, under 2) and then her pregnancy finally took. It's a single data point so you can't prove that it's cause-and-effect, but I certainly wouldn't risk it, personally. I don't know so much about the antibodies, but I seem to remember the prescription for that is to take thyroxine anyway. Oh, you might have to switch clinics--ugh! When do you decide?!

Sunshine: thanks!

queenie: hugs! Holding out hope for your next cycle!

AFM: spoke to Dr Ozturk on... Wednesday. His secretary hadn't sent him my long email where I'd explained about the Asherman's diagnosis, so I had to explain it all on the phone. He seemed interested/surprised that an HSG could in fact pick up adhesions that the 3D HyCoSy could not. He asked me to confirm that Mr Trew had indeed given me the go-ahead to transfer next cycle, and when I confirmed, he agreed to proceed. He tried to get me to do a medicated FET (7-10% better chance of success, but that cannot be the case, he says, if the lining is the same quality and thickness) but I turned that down--I'm really hopeful that without the adhesions my lining can get back to at least 8 by itself, which is all a medicated FET had gotten me in the past anyway. I'm still a bit crampy and still bleeding, but I'm hoping it's just the bits of scar coming out. I forgot to ask Mr Trew how long I should expect to bleed for... Started norethisterone today--I expect transfer to be in about a month. I cannot wait, frankly, and I'm a little scared of how hopeful I feel now that this adhesion malarkey is presumably behind me...
 

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Hello, dear ladies!

Mac: how are you?!

Shady: still holding out for a natural pregnancy for you! If not, I'd love to be cycle buddies next cycle--I'm hoping your lining will thicken beautifully in that "post-m/c is the most fertile time" sort of way.

susie: As for ejaculation timing, I must say my DP's anecdotal evidence points to "the least time between the last ejaculation and the sample, the better." I got that impression from other women on here, too... So perhaps (since we are all DOR here and even stims wouldn't get us quintuplets) the ideal thing would be BD'ing in the morning when a sample is due to be provided (which often is the morning of egg retrieval--so if they leave any eggs behind or if you ovulate too early you also have a chance). Most importantly, though, hurray for a successful and reassuring 20-week scan! Amazing!!! Wonderful news... How has pregnancy been treating you?

Blue: I'm so sorry about your bereavement... I'm glad you're slowly easing yourself back in--giving ourselves time and space to mourn is very important... It's been lovely having you along on this forum and I look forward to cheering you on if/when you decide to cycle!

katkat: I really want to hope you're pregnant but I'd wager you've tested already... Otherwise, yeah, cysts sometimes delay periods... Hang in there...

Helen: as Anna said, as long as your lining is ok, the exact timing of transfer is immaterial when your ovulation has been suppressed. That's one of the advantages of a medicated transfer: assuming your lining thickens well, the timing can be adapted to suit your needs. As for flying back, from one perspective I'd say the earlier the better--I'd rather fly before my embryo has even started to think of implanting. However, a transfer is a hugely emotionally intense event, so possibly you want to take it easy that day just so you don't pile even more stuff on top of that intensity. I'd say those are the trade-offs...

MA66: I have Brazil nuts quite consciously between when AF arrives and ovulation, to help thicken up my lining. I like them, so I have a lot more than two--I don't really think about how many. There is such a thing as too much selenium, but I'm not too worried that I'll be crossing that line. As for DHEA, I think the idea is that it converts to oestrogen, which yeah, is a problem for endo. I think you'd have to think about how bad your endo is and weigh that against how low your natural testosterone levels are (I've never taken DHEA, so please take others' advice on exactly what to test!)

queenie: Can't believe Lister told you they weren't doing this and then they did it anyway... So frustrating--I'm sorry...

tily: yes, from the moment I sought to understand why CRGH kept cancelling me for natural cycle IVFs even when I didn't have a cyst (FSH is too high), I've been entirely convinced that AMH and FSH are about quantity, not quality. Good to have even more evidence of that!

Anna: Don't feel ridiculous. It's natural to want to maximise your chances. You have to decide for yourself, but my personal approach has always been, for egg collections, the earlier the better, no matter my AFC. Well, in fact, it has been to keep collecting, through the ups and downs of my AFC. Because as we know, quality deteriorates with age... and as DOR women, chances are (unfortunately) that we'll need more than one collection... So for me, it's always been "just do it." But it is a hard choice... Especially because multiple collections mean lots of money, time, emotional investment, physical impingements--not to mention its effect on the couple... I hope another antral pops up in any case and makes your choice easy--but if not, good luck with whatever you choose!

AFM: Bleeding stopped a couple of days ago... I'm on norethisterone so I know roughly when AF should come. And then it starts again. It's been kind of nice to take a break, actually! On the other hand, I'm feeling quite impatient to have another transfer...
 

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Welcome, Lulu!

I have some questions for you, but based on what you've said so far (and on my own experience) I'd recommend a mild-dose antagonist cycle after oestrogen priming--something like:

previous cycle: estrogen patches starting one week before AF (on average, starting one week post-ovulation). Happy to give you more details about it, but if you happen to have endo (hopefully not!) then there are probably better alternatives...
CD 3-7: 2x50mg Clomid (evening)
CD 3 onwards: 225iu Merional alternate days
CD10 onwards: indometacin 3x/day

I'm not sure why your last cycle was cancelled. If they only manage to fertilise one of your eggs anyway, in practice it doesn't matter much how many mature eggs you start with...

Which makes me wonder why only one is fertilising. How mature is mature? How big were the follicles at trigger, and what was your oestrogen? Possibly waiting a little longer to trigger might help. Also, have you been using ICSI? If so, how good is the clinic's lab at it?

The oestrogen priming (or potentially norethisterone, or even BCP for a week or two) helps quieten your ovaries, which makes it easier for the follicles to all grow together when you need them to. So if you haven't been doing any priming or downregging before your short protocol, this is something to think about...

Also, I'll wager you don't need these high doses. A mild dose will probably get you just as many eggs, and the ovaries won't have been stressed by so many meds while growing the follicles...

In my case we avoided using an antagonist, because antagonists do make it harder for follicles to mature. We just watched LH like hawks--luckily on the above protocol it didn't rise appreciably for me before the follicles were really ready (ideally >20). But if it starts even thinking about surging, using an antagonist would be vital...

That's just my experience--I responded quite well to this, and my AFC is like yours though my AMH is much lower. Some women do better on flare. It's hard to know until you try... but yeah, like I said, I'd focus on (a) some sort of priming or down-regging in the previous cycle, (b) lower doses and maybe using Clomid to try to recruit as many follicles as possible and (c) trying to find out why you only got 1/4 or 1/5 mature eggs fertilised...

Good luck!
 

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Hey, katkat! Yeah, an immaculate conception might have been difficult... Re. LH, I think a surge is defined by an increase, rather than a level. In particular, if your LH increases by about 50% from its baseline for that particular cycle, you need an antagonist. But that does mean blood tests every day from when your lead is getting close to being mature, so it can get expensive. I never used an antagonist in my natural cycle IVFs (only indometacin). At Cornell they always used an antagonist, as did CRGH 5 years ago when I did full stims. For these 3 recent mild-stim cycles at CRGH, though, we didn't use an antagonist for the first two. The third one, they didn't take an LH measurement until my lead was already 16, so we didn't have a baseline to compare it with and I used an antagonist just to be on the safe side... Real bummer about your timing... I'm hoping you get to have EC and ET this cycle despite your work commitments--as your AF is late, it's possible your follicles have already grown a bit anyway. If so, I'll hopefully be about a week behind you on the transfer!

Lulu: wow, if my oestrogen was that high with two mature, wild horses couldn't stop me from retrieving--it's a great oestrogen for 2 mature! I think you definitely need to prime with something--oestrogen is my personal favourite (100mcg patch, changed every other day, starting a week before AF--at AF, stop changing patches but only remove the last patch on the day you start stims; don't worry if it falls off, though), though norethisterone or BCP are also good contenders. I think you need to get your ovaries sleepy in the luteal phase of the previous cycle so you have a chance of getting all your follicles to grow together. Clomid is then particularly good, apparently, at encouraging those follicles to grow. So yeah, I'd totally try the oestrogen priming + Clomid + mild injectables protocol in your place... So you'd be cycling at a new place?! Hopefully they're better at ICSI than Guy's, though I would have though Guy's would have a good lab... Anyway, you'll be using artificial oocyte activation--what is that?! I've never heard of it! Hopefully that will help with the fertilisation rates and with, finally, getting a good embryo!
 

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Shady: my AF would be due around the 8th... lol, you know me so well! I'll hold out hope for your 1-2% chance of a natural pregnancy... but if not, I hope your AF does arrive between today and tomorrow, as presaged by your cramps... Re. the new job, ditch the guilt and take it! You're a lovely person for worrying about how your current boss will feel and how the new place will feel if you need to take maternity leave quite soon, but, really, just do it! He'll get over it, they will cope, everyone will understand you're doing the best for you. Please, get out of your hell and go to the new place, which seems lovely and understanding and--if I'm reading it correctly--flexible enough that you would be able to cycle at Lister and work from home when needed... I'm so glad you've got this in your pipeline! I hope it's the start of wonderful new things for you!
 
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