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rossssss said:
AnnaKay, just want to tell you that I've just finished my second IVF stimm and the result is 5 EGGS (FIVE) -Maturated. still can't believe it . I'm still undergoing it, but with the right medications there is a chance! My first IVF was the same like yours, same meds, same result-1 egg very poor quality. I'm currently in Athens, Serum. Even if this IVF to fail I'll try with Serum again. One of the girls here told me about Serum and I'm very thankful ^hugme^ ^hugme^ ^hugme^
Wish you all the best ^pray^
Dear Rosss, please share your protocol with me. PM me if you want. I cannot change clinics as we have surgically retrieved sperm samples at Reprofit. But I can change the stimulation protocol. Thank you so much for you message. Praying for your BFP !
 

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KatKat you can test earlier, on days 9-10 on a sensitive HPT that detects hCG levels as low as 10 units. But blood tests are undeniably the gold standard. Keeping fingers crossed for a BFP!

Sunshine, don't lose hope. If you can, you could try successive cycles, some REs believe that ovarian response improves with consecutive stimulations. Poor embryos do sometimes become babies, so why not hope for the best? Letrozole/Femara is usually included in mild stimulations, is this what you had this time?

Briss, German clinics are very good when it comes to bloods and personalised service. As you know, Brno don't do bloods, and that is not ok in my opinion, especially for poor responders/DOR patients. Truth is they are a bit superficial, although their labs and embryologists are good.

Today I was shocked to discover that my clinic sent me a protocol that contained a huge error. I will do estrogen priming starting later this cycle and they insisted I should start priming on day 26. I wrote them twice (once in December, once yesterday) to tell them that my menses begins on day 24, there is no day 26 for me. Besides that, estrogen priming is done before AF arrives, not after. They just assumed everybody has a 28 day cycle, so day 26 means 2 days before AF. It is crucial to know the patient's cycle length for IVF stimulation, and the info regarding my 24-25 days cycle was clearly mentioned in my file. What if I was a patient who just does what her dr. says, no questions asked? I am terribly disappointed with them, to be honest. My dr. does answer all my mails promptly, but the negatives regarding the protocols just keep pilling up. They keep using the same generic protocols and sometimes I feel they expect you to fail and accept DE sooner, ready or not, for everybody's sake.
 

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Sunshine I take 600 mg Ubiquinol (3X200/day). I also take myo-inositol, aspirin, folic acid, selenium (thyroid issues), vit D, Omega 3 and melatonin.
Mild protocol may be done with either Clomid/Femara/Letrozole+ FSH (recombinat or urinal)/HMG (Menopur, Merional, etc) or simply with FSH (urinal or recombinant) + HMG.

I will start estrogen priming on day 21, or perhaps 19, not sure yet, for 7 days (dr. said I should start priming on day 21, but if AF arrives on days 24, I would go for day 19). After 7 days of estrogen priming, I will start stimulation with 375 Gonal F, then from day 6 I will use 150 Gonal +225 Menopur. I wanted to use Pergoveris instead of Menopur (Pergoveris is recombinant FSH/LH at a 2:1 ratio), but the dr. told me that they don't use it in the Czech Republic. It is a newer drug, and it seems to benefit poor responders/older patients, as it has 150 FSH/75LH, unlike Menopur, an urinal with 75 FSH/75 LH activity.
 

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Mac: the most reliable way to check if ovulation occurred is by ultrasound. OPKs detect a LH surge, and it picks it from a certain level, the intensity of the second line varies, and yes, it can be visible for 2-3 days. As far as clinics are concerned, I have the impression that they kind of give up on `hopeless` cases like mine, after all, I'm a patient who barely has a chance to get one egg. I have been told by my dr. to stop reading about IVF, she probably feels that I have too many questions and suggestions and I'm trying to tell her what to do.

Helen:  Gonal F is a recombinant and is suppossed to have higher purity than urinary drugs. I want to avoid supplementary exogenous LH activity in the first 5 days, as my LH level is high in the first days of the follicular phase. LH is beneficial from day 6 until final egg maturation, that is why I wanted the LH activity included in the Menopur.  But...I may have the same response all over again.

To all you lovely ladies, have a great weekend!
 

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Ross: wonderful news, you're PUPO! Keeping everything crossed for a BFP! We're not mobile, I'm afraid to move sperm samples to another clinic, so I'll stick with Reprofit, triple check everything and continue to be a pain in their neck. They didn't even mention DE, as I told them from the beginning that we're not ready for that.

Sunshine - having frosties is wonderful, even if they are not top quality. Many B or C embryos became healthy babies, so you can definitely to hope for the best! I found something about the Letroozle protocol here, it may be useful - http://www.ivfmd.net/services/aggressive-ivf-protocols

LXP - I hope you get great news on Friday! 6 follies is great for low AMH, do you mind sharing how low it is? I would give anything for 6 follies next stimulation!

Babyhopeful - I hope you 2ww is going great, don't worry about symptoms, many ladies don't have any and they get their BFP. Or they feel the imminent arrival of AF, and when they test, she's at the South Pole :)

Kat - sounds like hormones causing the night sweats to me. They do cause changes in the way we perceive temperature, so it could well be this.

Briss - frozen sperm can misbehave, but, as you know, everybody blames the egg. I just read on a different FF thread that fertilization failure could be due to a reduced capacity of the sperm to activate the egg. I also know that there is a clinic in Ghent in Belgium that offers assisted oocyte activation, I'm not quite sure of their conditions, as, in my case, due to advanced age, the zero fertilization we got with our only egg was probably the egg's fault. But it's an interesting direction, since no one can really tell if a gamete is chromosomally competent or not just by looking at it.
Are you using ubiquinol or normal coQ10? I know that there is more than one source to extract it - one of them is tobacco, and that is not good.

AFM - My negotiations odyssey with my dr. goes on, as I'm approaching the dreaded day 20 when I'll start estrogen priming. Still undecided what to do - microdose flare or short antagonist. I guess I'll decide when my dr. tells me how many antrals I have. I stood my ground and did something probably stupid and useless- I asked my dr. to allow me to bank oocytes if I continue to get one egg each stimulation. I'll do modified/naturals if the next one fails. I know older eggs don't thaw well and it may be a terrible waste, but, crazy as it is, it's our last chance with OE. I literally threw everything at this cycle - myo-inositol, 4mg, 600 ubiquinol for 2 months, aspirin, vit D, Omega 3, folic acid 5 mg, euthyrox....I'll start blood thinners with stimulation, as it may be beneficial to have better blood flow, I have some thrombophilia mutations.
 

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Mac, I agree with Briss, a progesterone blood test can tell if you ovulated this month or not. It's not too late, usually drs recommend this tets 1 week after the suppossed ovulation day (usually day 14) so you could still go and have it these days.
 

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Ladies, I've been MIA, as I was feeling miserable after yesterday's RE appointment, but I feel I shouldn't lose contact with your news.

Ross: I'm so sorry, I was hoping for good news, but you really never know how things end up with IVF, one day you have eggs, fertilisation, embryos, high hopes, etc , only to see it all go away. Please don't lose hope, if you can, try again in 2-3 months. You had great response to the letrozole protocol at Serum, perhaps you could try mild IVF again, as it seems to suit you. Serum seems dedicated to helping poor responders, I think you still have a good chance with them.

Briss: indeed fertilisation can be delayed, but the longer it takes for cells to divide, the smaller the chances the embryo is viable. It is a cruel twist of events, and I'm so sorry you had to go through it. Egg maturity is a positive aspect, it is good to keep that in mind. I perfectly feel you regarding exhaustion, it is so so unbelievably painful and terrible. I know you probably don't want to hear cliches, but you have admirable strength. Munich is incredibly good, they seem hands on and trustworthy, I think they are completely involved in helping you the best they can. In other words, you make superhuman efforts for this to succeed. It would be absurd if this long battle didn't have a happy ending. I certainly hope it does! 

Katkat: sending you big hugs, DE is very very difficult indeed. One must be really sure that is the right choice before moving on, it is a life-altering decision that most of us never imagined having to contemplate. I'm glad to see you're holding up so nicely, attitude is not all but it surely makes a difference.

Babyhopeful: if free testosterone in within range, you can try DHEA. Not all REs agree with it, some give it to patients without any prior blood tests, and I think that is not ok. Also, you must test free T after 1 month of DHEA. I'm truly sorry for your BFN...it's so hard and unfair.

Klik: keeping fingers crossed for a nice hysteroscopy result !

MA661: Bemfola is a type of recombinant FSH that is not as expensive as Gonal F, but has good results, and I read one study that showed no difference in outcome (eggs, maturity, fertilisation rate, implantation) after stimulations with Gonal F and others with Bemfola. Many clinics use it due to friendlier costs and similar results.  Thyroid issues (hypo or hyper) either lower TSH levels or drive them up. 2.7 is not ok, 1-2 is ok for implantation. I have autoimmune thyroid issues, so my TSH is all over the place. But I will definitely check it in the unlikely case I get to do an embryotransfer.  Also, there are studies that show a detrimental effect of cysts on IVF stimulation. I have cysts all the time, but I won't cycle if they don't go away until I am due to start stimulation. My chances are "theoretical" anyway (as one very wise and tactful doctor once said to me). ICSI greatly improves fertilisation rates.

LXP: I'm rooting for you and your embryos, I hope they grow beautifully this weekend! Keeping everything crossed for great news!

Sunshine: waiting out is the wise choice sometimes. Stimulation is expensive and unpredictable, why not start with the best chances? Good luck, I hope spring brings more follicles !

Laura: welcome! Many people swear by Coq10 (or its better version, ubiquinol). You might want to look into that as well.

Mac78: openly talking about options is the best thing a couple can do, given the circumstances. I know oh so well how you feel. We keep having the same conversation over and over again. DH is adamantly against DE, he said he can live without children, so that is it, if we don't succeed with OE. I was really hurt to hear him say it out loud. I, on the other hand, don't want to move on without children. It is indeed a process, I hope he changes his mind (he had a painful surgical sperm retrieval, so he is committed). If he doesn't, I'm afraid that is it for us. I want a family with kids, it's not negotiable.

Helen: lining check is most accurate a few days after ovulation, when natural implantation usually occurs.

I hope I didn't forget anyone, but if I did...apologies and my warmest thoughts!

AFM: I'm cynically wondering what comes next, after the bitter conversation I had with DH about giving up TTC completely if OE fails. Yesterday I went to my local RE for a day 16 ultrasound, I had a 17 mm follicle on my left ovary (soon to become a cyst, as I should have ovulated by then if it were to happen...) and 2 more follicles on my left ovary (smaller ones). That is what my Sahara desert ovaries look like. My next cycle is uncertain, as I probably didn't ovulate this month and I'm sure I'll have a cyst (again). I was supposed to start estrogen priming on day 19 for 7 days, and after that check antrals and decide if we go for microdose flare or estrogen priming with antagonist. I'm still confused if the estrogen will help eliminate the cyst. Normally, it might. I asked the dr. if I could add an antagonist from day 21 until AF, she reluctantly agreed. Now I don't know what I should do. Would the antagonist suppress my lethargic ovaries too much? Should I risk taking it in the hope I get rid of that cyst? Any ideas, ladies? Thank you!
I immediately reached out to my Reprofit dr. for advice about how to proceed, but I got an automatic reply she is out of office until February 12th. I'm so tired of this clinic and their lack of care.





 

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Ladies, I'm trying to catch up as I've had a busy week helping my parents clean up their house and prepare it for renting. I exchanged IVF despair for bitter nostalgia, what a great deal!  :)
I hope you have a great time getting together, sending hugs and love to everyone!

Tily: 3 follicles so close in size is great, I think that is they passed the dreaded 10-11 mm size they will grow nicely. I'm using the word `dreaded`because I had a follicle stop growing at around 10-11 mm and perhaps the dr should have upped the dose instead of telling me that 'so is nature`. The Femara protocol has great results with DOR ladies, I'm keeping everything crossed for you!

MA66: I'm a bit surprised the RE said it's ok for follicles to be bigger than 10 mm on CD 2. Also, the presence of a cyst has a negative impact on IVF outcome, even if it doesn't produce estrogen. This is what I've been reading over and over again. As other ladies here have mentioned, BCPs can be oversuppressive for low AMH/poor responder ladies. They are good at suppressing cysts, though, so it's a double edged sword. Let us know what you decided.

LXP: how are you? when are you testing? will you do a frer or go directly for bloods? This is so exciting, I hope you enjoy this time and find nice ways to chill and hope for the best!

Laura: long protocol is great for normal responders, and sometimes not so great for others. Have you tried it yet? You could ask your RE to clearly outline the advantages of long protocol over the more often used short antagonist protocol.

Queenie: hope you get a decent amount of antrals next cycle!

Helen: thin lining is one of the risks of natural. 2,5x1.9 is a bit big for a dominant ready for ovulation. 2.2 is optimal (I know this as I used to monitor my dominants last year when I was clueless about DH's azoospermia and we were trying naturally). I've seen this happen so many times - big follicle turning into a cyst, not bursting at ovulation, just lying there uselessly. Positive OPK, no ovulation. I do hope this is not your case, please forgive me for mentioning it, I'm just sharing, not trying to upset you. Your levels are normal for day 13, I think. You should definitely do all you can to catch a good egg, you really never know what's inside a follicle. Yes, estrogen thickens the lining. Are you still in contact with Reprofit? (sorry if you already mentioned this!)

Babyhopeful - wishing you a nice, peaceful weekend! Maybe pamper yourself a bit? :)

Pickle: sorry to hear about your health issues, March is almost here! Regarding Dr's advice to stop reading, I honestly envy patients whose problems are light enough not to bother questioning anything their dr. says. Unfortunately, I'm a control freak and I've seen drs make careless, serious mistakes.

Mac - sorry to hear about your friend and cancelling drs appointment. Did you miss this cycle and have to wait for the next?
Briss- how are you? any plans for spring? sending you a big hug!

Shady, Klik - hope you are ok, have a great weekend!

AFM - I'm dreading my next RE appointment when AF arrives (hopefully this weekend!), as she will check my antrals and see if the cyst disappeared. If all goes well, I should start stimmimg this Monday. I've been taking 4mg oestrogen daily since  last Monday, so what had to happen has probably already happened, even if it means that the cyst disappeared or is still hanging around. I will not cycle with a cyst and I decided at the last moment not to take an antagonist from day 21 together with oestrogen. I felt like I twisted my dr's hand when I asked her to prescribe it. I was also afraid it might mess up my levels. So just waiting for AF, no hormonals this month, in all honesty, I despise the word FSH, I don't want to test it or hear it ever again. I read that oestrogen may not be so efficient at suppressing FSH levels, other sources claim it is. Who knows.
Thank you ladies for your kind words regarding the DE dilemma. It is far from easy and I don't blame DH for being skeptical or reluctant. I'm more aware of the situation as it is my body acting crazy and old, not his. I hate denial and I told him to be aware that DOR is the main cause of our first IVF failure, not dr's choice of protocol, medication, etc. Also, I was clear that we should decide what's best for us in the next year or so, I don't want to spend years and years hoping that one day we'll be on the same page. Unfortunately, we already postponed TTC for 2 years because he wasn't ready. I was ready at 36 (we're both the same age), he wasn't. I can't stop thinking 'what if', although that means we would have found out earlier I was DOR and he had azoospermia. But I'm certain our IVF chances would have been better.
However, I will not give in. I love him dearly, but I feel I've already given him enough time. It wouldn't be fair to say that I wasted my last years of fertility waiting for him to be ready, because ultimately it was my choice to be with a man I loved, but who wasn't ready for kids when I was. I firmly told him that egg donation is not child donation (I know, it sounds awful). I would receive a cell, not a child. DOR is irreversible, it hurts me in so many ways, our chances are very slim, we will keep trying, but he should at least consider this option as we keep trying. I don't want to fail over and over again, and spend another 2 years in tears, shock,  getting used to the idea of DE, rejecting it, then obsessing and going back and forth. I want a life, a family and this nightmare to be over.
 

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Ladies, I am so sorry to hear your news. I kept reading your updates, but felt unable to write, felt absolutely miserable lately. 
LXP, big hug, take your time to heal a bit, and try again soon when you're ready...

Tily - your pain and disappointment are awfully familiar to me. I am so sorry, I wish I could do something to ease the terrible intensity of this sad moment. Although I only have one failed IVF cycle, your experience with one egg not fertilising is exactly what happened to us back in November in Brno. We also used frozen sperm, and I had a bigger follicle and a smaller, empty one. Nobody would be able to give you an answer regarding what went wrong. I didn't even ask for one, I  told the dr. at our follow up that I'm aware they have no explanation so we should focus on other aspects.  There are many stages of egg development and maturation, they are all hormone-dependent, and they can't tell if the egg or sperm are chromosomally competent, they just look at them under the microscope, no `inside` view. Unfortunately, low ovarian reserve at our age often means lower egg quality, and the good eggs are rarer and more difficult to find. Frozen sperm has similar fertilisation rates to fresh sperm, so I wouldn't necessarily blame the sperm, unless of course it was just an unlucky draw.
To quickly answer your question regarding empty follicles - if a follicle is not big enough (usually above 16-17 mm), even if in fact it contains an egg, the egg remains attached to the inner wall of the follicle until it is mature. Only then it detaches and can be aspirated together with the fluid inside the follicle.

Please try to stay afloat, these are hard days. Mental health is crucial, your DH is so right to put it first. The feeling that a genetic child is unlikely is so incredibly painful, and not being able to get an answer regarding what went wrong only makes things worse. I remember crying and crying and not being able to get out of bed for days, feeling abnormal and defective and so incredibly alone. That one egg not being fertilised obsessed me for weeks, the ultimate measure of my reproductive failure. Try to actively avoid this frame of mind, it only drains the life out of you. This is just a suggestion, I apologise if it sounds bad or patronising - perhaps you could negotiate a bit and avoid drawing deadlines for treatment, it might put unnecessary pressure on you. DE is such a difficult decision, one that may have an impact for life. It is wise to shorten the process and not let things drag, as life cannot be on hold for too long. But you have to be gentle on yourself and act only when you are sure that you are ready. Sending you a big hug...

Helen - sending you warm thoughts, I am awfully sorry to hear that your one embryo came back abnormal...

I will try to catch up properly tomorrow.

Sending everyone my very best... 
 

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Hi, ladies, here I am, back again, trying not to lose track.

Tily - there is a so-called `LH window' that involves a threshold and ceiling value of LH needed for proper follicle development. It is considered that a maximal value of 10 IU/l can be accepted in the follicular phase, as higher levels can be detrimental to follicular development and egg quality. Clinical tests showed that stimulations with lower doses of recombinant LH resulted in more eggs of better quality than stimulations with higher doses. Letrozole stimulations follow different patterns, as it has direct influence on the activity of the pituitary gland. Letrozole inhibits aromatase, which is an enzyme producing estrogen in the body. The result of estrogen suppression is an ample response from the pituitary gland, releasing more FSH and LH to stimulate the ovaries. Some clinicians argue that while the FSH discharge is beneficial for follicular growth, early exposure to high LH can be detrimental for egg quality. Did you test LH during stimulation? I know they sometimes add an antagonist if LH goes closer to 8 on day 6, even if the protocol is not an antagonist one per se, but it depends on the clinic. As a general idea, I think these protocols that stimulate the pituitary gland to release endogenous FSH and LH may not be for everyone, hence my reluctance towards the microdose flare. They cannot estimate or control the magnitude of the FSH and LH release. A lot of endogenous FSH may be good, but not the same can be said about LH.
I'm glad you sound positive, there is no choice really but to take small steps everyday and keep a positive frame of mind. It is immensely difficult. But we have no choice but to keep going, one way or another. Sending you big hugs!

Later edit: congrats on your decision to foster, it is truly wonderful to open yourself to this experience. Your heart will lead the way...

Klik - I am glad your hysteroscopy went well and you have transfer plans for next month. Sometimes drs focus less on the uterus and it it can be a huge challenge, as it is the organ that in fact sustains pregnancy. It is a major milestone in your journey and it's great you sorted it in due time.

MAC- I'm glad your interview went well. I second Klik on her idea about considering the fact that you may have conflicting feelings about the process. Please don't forget that, although you need to take your time and do as you feel is right for you and DH, time is not on our side. It is a complex situation, but being honest to yourself about your true feelings is essential. I have a tendency to be in denial when things get really hard, so I'm not speaking from a `privileged` position. I hope I haven't upset you, but we are here to help one another.

Helen - I love your perspective on things. Those were wise words, thank you. Indeed, you can only do so much in this awful situation. Life goes on with or without us being present in it, I also feel this awful process can annihilate all other good things in life, leaving us empty and purposeless. An active choice to shift the point of view sounds like a real option for now. Sending you my warmest thoughts.

Babyhopeful - your positive attitude is inspiring. Thank you.

MA66 - I feel the same about trying DE first, if I somehow manage to accept that I'm done trying with OE. I know this sounds horrendous, but I have my own issues with abandonment, so although I think adoption is a wonderful chance for a family, I am far from considering it for us. Truth is I have a horrible relationship with my very traditional and conservative parents. I love them just because they are my parents and I do my best to be a good daughter, but we always have painful arguments that leave me drained and feeling like garbage. I was raised by my grandparents from 2 to 7 years old, so there is a big part missing in my relationship with them. We have so little in common. In fact, all we have in common is my very obvious physical resemblance to them. Our relationship has always been bad, as they got married and had me purely because everyone else in their generation got married and had children. I'll never understand why they sent me to the countryside to live with my grandparents, as they were factory workers, did not have careers to manage or complicated schedules to align. It is obvious they did not want me around and this had a massive impact on our relationship- I grew up adoring my grandparents and feeling that my parents were in fact mere strangers. Rationally, I have no reason to get stuck on the genetic link. My parents and I are different species from different planets. But I do feel I need the biological reality of pregnancy and birth. I know I would love a child no matter how it came to me, but right now adoption is the most remote and inaccessible option I can think of. I'm ashamed I am so selfish but this is the truth.

AFM- 10 days ago I had the dreaded appointment to check follicles and see if I could start stimulation. Although I had had 6 days of estrogen priming, the cyst was still present and we had to cancel. I had 3 follicles on my right ovary and a 24 mm cyst on my left one. No visible follicles on the left. I actually saw 2 drs, as my first dr. did not answer her phone for 2 days. When she finally called, she said she couldn't answer because she had been sick and couldn't speak. Well, last time I checked text messages had been invented. So I decided I cannot afford to have a dr that disappears when I'm due to start stimulation as I'm going to be monitored in my home country and go to Brno for EC. So I made some calls and got an appointment with another dr, who works at a bigger clinic and seems more available. He said the third follicle had an elongated shape so maybe we shouldn't count on it. He said he could puncture the cyst and go ahead with stimulation if estrogen is low, but I preferred to wait. My Czech dr. was back in office and confirmed we should wait until the cyst is gone. I hope this cycle is cyst free and I have at least 3 antrals so I can finally start stimulation. I will do estrogen priming again. Still undecided if I should go ahead with microdose flare or do a short antagonist. I asked my Reprofit dr. if, given that I have a short cycle and my 7 days priming ends on days 3-4 of the cycle, it would be of any use to have the flare so late in my cycle. She said I should start the agonist on day 2. What if I hadn't mentioned this? What would be the use of a flare on day 4? Everytime I emphasize something she should have asked, she adjusts the protocol. I am beyond tired of this incredibly frustrating manner of managing treatment. I cried a lot and took it really hard to be cancelled again. Got the DE speech, of course (new dr...), I was polite but firm and I stood my ground - no DE talk until all reasonable OE chances have been exhausted.

Sending lots of love to everyone.
 

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Mac, I am so sorry if my comment was out of place or hurtful. The last thing I want is to add to your pain and frustration. I apologise if I was out of place, my intention was to encourage you to actively pursue the path that you feel suits you best at this moment and not delay treatment if it has been offered to you. IVF can be both miraculous and monstrous. Funny thing, old Greek had a special word for this paradoxical situation - deinos.  It meant a lot of contradictory things, including wondrous and horrible. It can be a solution but it can also deepen one's sorrow.
POF is a cruel diagnosis, but it's not the end of of the road. At least not the end of all roads.
I know a POF lady who had 2 bio kids via IVF.  She just had two good months with normal FSH and a few antrals.  She was younger than us, but still.
My 2 cents - you can monitor FSH and antrals every month for 5-6 months. If your FSH level varies, it is reasonable to estimate it would do so in this interval. Practice shows that stimulations work better with lower FSH.
Again, I am terribly sorry if I was out of line. You don't need to explain yourself to anyone, even more so after all you've been through. Your story moved me deeply.  Warmest hugs!
 

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Helen- yes, microdose flare is the protocol I was offered and it is clear to me now they have a preset course for older patients- first they offer the Menopur only protocol, then microdose flare, then mini IVF, etc. Your first try with them was Menopur only, if I remember well...
The microdose variant I was offered implied estrogen priming for 7 days, then Diphereline 0.1 from day 2 of menstruation, then from day 3 375 Gonal F, followed by Gonal f+Menopur from day 6. I am not convinced this is the best approach, since two other drs warned me of the drawbacks of this protocol for poor responders. The literature is split on the issue, so I am really tempted to go ahead with estrogen priming and short antagonist. The Dr said she is certain the microdose flare is the best approach in my case, but she also said  she could not make me do something I have doubts about. Of course I have doubts, they give the same treatment to whole categories of patients. I insisted on estrogen priming, Gonal and some LH activity later in the  cycle.
I take 12.5 thyroxine to lower TSH, it was 2.80 a few weeks ago, will retest one of these days. I have autoimmune thyroidism, was hyper now it goes hypo. I will take steroids for immune suppression, Dr.  Prescribed 8 mg but if I get to transfer I will have a much more aggressive treatment since I have elevated anti -thyroid antibodies.
 

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MA66 thank you for your kind words. It is hard, on top of everything else. DH no longer speaks to his parents (long, ugly story), but I can't do the same. My father has advanced stage Parkinson's disease and if I ceased all contact with them they wouldn't be able to manage things on their own. As for cysts, there are 2 possible approaches - BPC for a 21 days, but it can be oversuppressive for poor responders with low ovarian reserve. I took BCP before my first IVF and it probably supressed me. The second option is progesterone in the luteal phase, from day 16, followed by estrogen priming (days 19 or 20 for 7 or 10 days), or simply BPC after cyst confirmation (after days 14-15, or when ovulation was supposed to occur).

Helenbeau - high Anti-TPO levels are the sign of autoimmune thyroiditis, be it Graves or Hashimoto's. Which antibodies are elevated in your case? The autoimmune component is diagnosed if one ore more of these antibodies are elevated, they are all anti-thyroid antibodies - anti-thyroid peroxidase (anti- TPO), anti-thyroglobulin (TgAb) or anti - thyroid-stimulating hormone receptor (Anti-TSHR or LATS). You should definitely ask an endocrinologist about taking thyroxine and after 2-3 weeks of treatment you should monitor TSH. If any of these antibodies is out of range then it definitely shows your body has some autoimmune activity and steroids are indicated to prevent embryo rejection.
My antibody levels are all elevated, I've had Graves disease for many years. Now, after so many years, my thyroid has been partly destroyed by the attack of antibodies, that's why it went from hyper to hypo. In fact, I blame Graves and the autoimmune component for the premature depletion of my ovarian reserve. It is still incredible to me that I'd been seeing an endocrinologist for 6 years and not even once did she mention anything about fertility check ups, not even after I refused surgery to remove the thyroid because I wanted children at some point (it is hard to pinpoint the right dose of hormones once the thyroid is gone). However, I do not encourage you to take thyroid drugs without seeing a dr. first.
Some studies suggest selenium is beneficial for autoimmune thyroiditis, I think you can include it among your IVF supplements.

Tilly - I know dr. Sher is a firm believer in the importance of LH control in IVF and there is a lot of scientific literature that supports his opinion. Excessive LH is detrimental to egg development, and follicles may become atretic or prematurely luteinized is exposed to high LH levels in the early follicular phase. LH 10 at baseline (you mean day 2?) is high. HRT mimics the normal cycle of progesterone/estrogen and it sends a signal to the pituitary gland that it doesn't need to overstimulate the ovaries by releasing a lot of FSH and LH. In theory, the agonist/antagonist conversion protocol is great for poor responders who have elevated baseline LH levels. In practice, the protocol is very long and extremely expensive, and few clinics outside the US use it.
The variant I had in mind was estrogen priming and late luteal antagonist to lower LH and FSH and hopefully get rid of the cyst. I didn't do it in the end, because premenstrual antagonist can oversupress ovaries as well. Dr. Sher's protocol uses antagonist from the beginning of menstruation precisely because he wants to avoid a premature LH surge. However, one can always monitor LH during stimulation, and, if it goes up, an antagonist can be introduced. In your case, if your LH is 10 at baseline, you should discuss this with the RE and ask about solutions - perhaps a few days of agonist or antagonist before menstruation to lower LH and FSH levels before stimulation ?
The bad dream sensation is a good sign - it protects you a bit from the bitter reality of this awful experience. Sending you warm hugs...

Hi to everyone!
 

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Helen, yes, you should bring up steroids for immunity suppression. High levels of antibodies may signal some sub-clinical condition.

MA66 - an antagonist (specifically, a GNRH antagonist) is used to prevent a LH surge that could trigger ovulation prematurely in an IVF cycle. Both GNRH agonist and antagonists interfere with the activity of the pituitary gland, the master gland that controls the hormonal flow in the body (it is, in its turn, controlled by the hypothalamus).
The principle of the flare protocol is simple - at the beginning of the menstrual cycle, a GNRH agonist (Lupron, Decapeptyl etc) is used. Agonists have a special effect on the pituitary - first, they make it release a massive amount of FSH and LH, then they suppresses it, blocking the internal FSH and LH supply. The first stage, when the pituitary is stimulated to release a lot of FSH and LH is the actual 'flare'. Since the second stage of agonist action means the pituitary no longer releases FSH and LH, these 2 hormones must be administered exogenously, as injectables.
The massive amount of FSH and LH released by the pituitary may help recruit more follicles and it helps their growth in the first stage of follicular development. Although studies show that it is a good protocol for poor responders, some REs believe that too much LH (released together with FSH) is not good for follicles and egg quality at an early stage. 
The literature is split on the selenium issue- some studies show improvement in cases of autoimmune thyroiditis, others show no improvement. However, it is not harmful, worst case it just has no effect. It is good for male fertility, too. Ask Create about it, they can confirm if it's ok to take it.
 

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Hi, ladies.
MA66 - if you plan on taking DHEA, test your free testosterone levels before and after 1 month. I did the same and my levels doubled. My endocrinologist warned me it could block my ovaries. Not everyone responds the same way, but I'd insist on testing.

Helen - good luck with your transfer. Is this the tested embryo ? Keeping everything crossed for you. Medicated cycles work differently, basically you should focus on you lining and progesterone levels. Glad to hear you still enjoy your taveling, IVF can suck out the life of anyone.
Susie - so glad to hear everything is fine! we are in dire need of good news on this thread! :)
Shady - waiting is so hard, but it is better to wait than to waste opportunities...

AFM - no cyst this month, but only 2 antrals visible on day 18. I know things are bad, but they seem to get worse and worse. Not sure if I should just start stimulation on day 2, no matter what, or have a scan then and see if any other antrals showed up and postpone if I still have 2. I wish I could just accept that my ovaries are done instead of waiting for a 'better" month, when I have 3 antrals instead of 2. I feel ridiculous, to be honest.
 

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Ladies, just just a quick one- I've been estrogen priming for 7 days now and no sign of AF.  No chance of natural pregnancy, DH has azoospermia.  Does anyone have any experience with estrogen delaying AF? Thank you!
 

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Hi, ladies, sorry about the long absence, last few weeks have been a nightmare. I have a lot to catch up with on this thread, hopefully I will do so in the next few days. Short selfish AFM, maybe it is of use to others considering the flare protocol under similar circumstances: I went ahead with the estrogen primed microdose flare protocol which turned out to be another disaster. Initially two follicles responded, but later only one developed, and it is now probably at 15 mm (yesterday, day 10 of stimms, it was at 14 mm and E2 was 265 ng/ML, dr said it is ok). I stimmed with 400-450 Gonal+Menopur, lowered agonist dose to 0.05 mg/daily (instead of the 0.1 at the beginning), added growth hormone in the first 5 days, and still my ovaries did almost nothing. DH wants to go ahead to Brno for EC, given I am not likely to ever have more than 1 follicle anyway. Now I'm terrified I may not even have an egg or it may not fertilize (as it happened in November). I'm afraid this is it for my ovaries. The Reprofit consultant said natural cycle IVF is 900 Eur, I'd be willing to bank a few eggs and try to fertilize them with one sperm sample instead of using an entire sample for 1 egg. Egg freezing is 300 eur, but hopefully they won't make me pay for the entire cycle since it actually stops at EC. 

Good luck and warm hugs to everyone!
 

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Klik it is a big difference from 7.6 to 6 in just one day. Lining does not measure equally, there are areas where it is normally thinner. I know stimms can affect lining, but it shouldn't happen under medication (estradiol) or in natural cycles. Perhaps you can ask the dr next time you scan?
 

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Briss, I'm sorry you are not very optimistic about this cycle. I too think that your 14 mm follicle could be a cyst. With estrogen priming, levels do tend to stay low. But bloods are only orientative, they cannot predict for sure how many eggs you will have. I've recently spoken to a patient who stimmed with Elonva and there was no growth until day 8. Perhaps you could wait until then to see? Cetrotide may slow down the growth of the smaller follicles, you could check with your RE if it is so. keeping fingers crossed for you...

Lovy, I've had 2 failed IVFs with 2 antral follicles. Knowing what I Know now, I wouldn't start stimulation with 2 antrals. Like Klik said, you could hope for 1 follicle. If it's mild stimulation, you could go ahead. If not, you could end up paying a lot for what you normally get for free quite every month...

Klik, you do know this is super early, so I hope you are not upset by the BFN. Your body couldn't have started to release BhCG so early. Cramping is normal, can you take No-Spa (not sure about the brand name)?

Helen, I'm sorry you got such a cold reply from dr. Hana. It is your choice if you want to try OE or DE, no matter the statistics. To be honest, I find it quite insensitive that some doctors imagine we don't know how low our odds are. We do know. If DE were easy, we wouldn't be striving for 2 good eggs and 1 embryo. So you're moving to Serum? You still have an embryo at Reprofit?

katkat sorry if I missed this info, but do you take progesterone vaginally or in injectable? Injectable tends to be assimilated much better.

Laura, great news! I hope your embryos are strong and sticky!

Everyone, Happy Easter!

AFM - hit really dark days with my last cycle. I had egg retrieval this past Monday and after 14 days of massive stimulation (450-400 Gonal/Menopur) I had 3 follicles - 12, 15, 20mm. They picked only one immature egg, and the big follicle was empty. I still cannot believe this happened. It was a very slowly growing follicle, but my protocol was way off and slowed me down terribly. I should have known that it is not a good sign if a follicle grows less than 1 mm a day, but my dr here encouraged me to continue. He did mention we can't possibly know if follicles contain eggs or not. My Estrogen level was 617 pg/Ml 1 day before trigger. I did estrogen priming so I though that could be the explanation for the low levels, in fact it was all a disaster.
Medication cost us a fortune, we were lucky that they only charged us EUR 460 at the clinic for egg retrieval with no eggs. I changed doctors, now I'm with dr. Pavel, who seems more efficient and hands on than dr. Hana. He is also a specialist in mini IVF and he was firm to tell me that he believes mild stimulation works better than stronger stimulation in poor responders. He promptly put together a Femara+Menopur protocol for May (I could cycle again after a 60 days rest). He also mentioned that mini stimulations can be done back to back. Although I'm at the lowest point I've been so far, with literally no hope, I started taking DHEA 50 mg /day, as it seemed to have some effect last year when my FSH dropped form 19.7 to 10 and I had 5 antrals after a month of DHEA. My free-T levels went up dramatically, but dr. Pavel said this has no negative impact on IVF.
The only good thing is they did not waste a frozen sperm sample for nothing, so they did not defrost one. I frankly told DH that I don't want him to waste his surgically retrieved sperm on me. I no longer have eggs, that is the hard truth I must face. 2 cycles and only 1 egg that did not fertilize (in November). Although I am aware that DE is my only option, I feel that if I wanted to do it I'd be on my own. I am tired of even trying to discuss this any further with DH, he keeps telling me we could think about it later, and we should focus on mini IVF. I feel in fact he is trying to postpone the inevitable - he doesn't want to do DE and is afraid to hurt me. I told him repeatedly that although I'm not ready at the moment, if I have to choose between DE and no children, I'll go with DE. I also told him that having a family is not negotiable, so if he wants to do it with someone else in the future it would be better if we amicably broke up. I'm horrified I have become so blunt, but some things need to be articulated honestly. this is far too serious so I don't want any ambiguity.
This whole process is beyond my ability to remain sane and function normally.. 
 

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Pickle, sending you lots of hugs. This journey is so hard and long and impossible. Take your time to breathe and figure out next steps. We are with you.

Thank you Shady, I will ask my dr. if 75 Menopur is not a bit low, maybe we should go for 150. Fingers crossed for your baseline.
 
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