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Hi all. Just reading back through your posts and it’s so helpful to have such good advice and knowledge from this thread.

Queenie you must be getting excited now. Please do let us know when your little one arrives.

Briss, lovely to hear from you again.

Pritamin I’m glad your DH has supported you in trying again with OE, it’s such a difficult decision and good that he is supporting whatever will make you happy.

ATM I had an amazing 7 eggs collected on wed but sadly only 2 fertilised the rest were immature. I don’t know much about why this happens but wondering if pushing on a further day or two would have helped? Or made no difference? I’m wondering if we will have anything to transfer on Monday. We had a consult with James at the lister after the chemical pregnancy as my consultant was away and we asked about DE and whether we should consider it. He said he didn’t think we were their yet which gave me some reassurance. This is our last cycle in this package so will have to fund some more if we decide to go again.
 

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Pritamin said:
I just found the website interesting but not thinking about cycling in India. It gave a good overview of different protocols for low ovarian reserve women so I will use it as a starter point at my consultation.
Interesting what you say about long protocol as that is what I want to try now with Buserelin from day 21ish. Can you tell me more about estrogen priming? i don't know much about it.
One of my estrogen priming protocols (the only successful one) looked like this: Around 5 days after ovulation started Estrogen / Progynova and stopped when my period came. On CD 2 did one injection of Elonva. 75 Menopur around CD 13 and 14, triggered on day 15, egg collection on day 17

mouse, 7 eggs and 2 embryos is still a good result. granted it could have been better on fertilisation front and something to explore but overall there is lots of ground for optimism. Best of luck for Monday!

I agree with queenie, your estrogen levels can say a lot about egg quality. but the fact they were classed as immature could mean they needed a better trigger or more time to grow. but equally it could just be an indication of sub par quality.
 

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Hi ladies

Mouse I feel you should keep going you had a chemical which is progress
I agree with queenie
It’s better to get the two mature ones

Briss I am sorry about u feel - I do understand
Create would treat U and have different approaches
so would Argc...

I had two bad cycles at create no eggs as ovulated or collected early with stims
Just had one last week naturally

On trigger day follicle was 16.6
Lining 6
E2 1050
LH 25

By LH was high before so maybe it caused bad quality - or is LH being doesn’t mean anything?

Also did picsi as suggested for dna frag

Didn’t fertilise so gutted

However his motality had dropped from 40-20 from thawing a frozen sample

Previously we always got 100 percent fertilisation with ivf
And got to day 3 however this was several  years ago

So getting a egg was a  step but not sure what to do next...if quality is good or not...or was it the picsi procedure which messed it up
 

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Oh dorchestor, I’m so sorry about your last cycle, it’s gutting :( Hopefully your consultant will be able to shed some light as to what happened.. be kind to yourself.

Queenie / Briss - I’ve heard back from the embryology lab.
‘ I have reviewed the time lapse videos and your laboratory record. One of the eggs looked abnormal with a big polar body that may indicate it was not genetically normal. This embryo then stopped its development on day 2 with 2 same size cells. The second egg divided from one to 3 cells (same size) and stopped growing afterwards.

This outcome does not mean you will have the same thing happening next cycle because women recruit different quality eggs each time.’

Any thoughts? Xxx
 

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Just a quick one to Pritamin, may be this just wasn't your best cycle,  looks like something didn't work or maybe just not a good month in terms of egg quality.  Even though they fertilised they stopped developing pretty early on so I'd say most likely egg quality just wasn't that great this cycle. But as they said it could be totally different next cycle so every  hope for best outcome next time.
 

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Pritamin -  I'm sorry - I have had a giant egg, it sucks. 
Sounds like definately an egg quality issue, they didn't get very far this time,  what was your protocol again?

One of the things which helped me, was sorting out an oestrogen dominance issue (which I don't think clinics really test for or identify).  It's also why DHEA didn't work for me it just made it worse.

This is also why I got very picky about selecting which cycle to collect on and cancelling very early if it wasn't ideal.  It's really not easy to tell before egg collection how good your egg quality will be from month to month, but I agree with Briss and your consultant.  It does vary.

Dorchester - same for you,  if you have the funds and the emotional resilliance if you can keep your LH lower longer you may very well have a better egg another month.  You have a very very long cycle this month - the evidence does show that egg quality is less for collections over 21days.  But genuinly, I would consider saving money and cancelling early if it is not a 'perfect month'  there really isn't a good way to tell egg quality before collection other than 'gut feel' and if the follicle appears to be growing at the optimum 'normal' rate. 

Mouse - I agree with Briss,  2 reasons, a) not waiting long enough b) not enough trigger .  How many of your follicles were over 16mm on trigger day?  What was your E2 concentration?  What trigger did you use, (one does or double)? 
 

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Thanks for all your comments.

Pritamin how was your consultation today?

Dorchester sorry to hear about your cycle.

Briss I agree that there will definitely be some UK clinics that would treat you.

So out of 7 eggs I ended up with a single D5 early blast that could not be graded as it had not expanded which was transferred today. I’m not very hopeful but you never know it could just be slow.

In terms of estrogen I was concerned that it was too low before trigger but never got to find out the total number as they took bloods the day of the trigger so guess the duty doc looked at them and thought it was fine. But I do know that 2 days before my trigger it was 1800. Follicle sizes on day on trigger were 23, 20, 18,17,15,14 then one other one which was small so they weren’t tracking it. I had one giant egg they said and the reason the five didn’t fertilise was they weren’t mature. Lining was 9mm on day of trigger which is the best it’s been!

So if this cycle doesn’t work I’m going to start another fresh ivf next week. I’ve emailed the consultant to ask about whether there is anything we can do differently, I suspect they will say it’s cycle to cycle variation. The only thing is whether the increase in stims (375 of menopur) impacted on egg quality, or just general decline in egg quality. This will be round 9  and while 7 eggs and 1 embryo is ok, it was insanely costly so wondering if natural might be the way to go if we don’t get a better outcome in the next round.
 

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Mouse - Congratulations on a d5 Pre-Blast, that is an achievement - which with any luck with be your lucky one!

I know I rant about natural for many people, but, only if you are in the position me, Briss, Dorchester and probably Pritamin are in - ie if you can't make more than healthy 1 embryo per cycle.

You are a prime candidate for MILD. 375iu of menopur (in my opinion) is insane. There is quite a lot of evidence around high does stims being detrimental to quality for people with low reserve.

Have you tried just 150iu ?? Less is often more, and you may find you get 2-3 really healthy eggs instead of 7 where only 2 are good.

Please don't start planning your next cycle now, you have just had a transfer - honestly there is so much evidence on the role of positive thinking and 'beliveing' it will work - right from compliance with medication, to when you test, to lifestyle factors, stress response and circulation etc. etc.

On d7 post d3 transfer a friends husband asked me "Are you giving up yet?" I had to work really really hard not to hit him, but also to get my brain in the right place for the embryo to stick. I know it sounds crazy - it's all just biology right? But a lot of the supportive things you do (Like taking Asprin and making Pinapple smoothies) are realated to just believing it will work.

Your baby is alive, he/she is growing visualise them, I would really recomend something like :-
https://www.zitawest.com/product/guided-relaxation-for-ivf/
 

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Thanks Queenie, I am trying to believe it will work. It’s just hard after so many rounds. I agree re lower stims. My best cycle I was on 275 and from 4 eggs we had 3 embryos on d5. A much better outcome. I started this cycle on 300 but then my follicles didn’t respond at all so they put it up, I did query it and the impact on quality but the nurse was insistent that it was fine.
 

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I'll be  ^pray^ for you and your little one.  The only blast I have ever made was on d6,  your little one may very well be expanding right now! - take lots of ubiquinol - helps with the extra energy needed for expansion.  I'm fairly sure our little one expanded late, we would not have had a proper positive on a clearblue test on d14 post ov if we had taken one, it took a little longer for it to establish itself.  If your taking Asprin, consider 150mg and don't skip it till test day.  Get your progesterone tested on day 21 to see how high yours is to see if you need a little more and make sure you don't miss your supplimentary medication.  Eat 1/4 of a pinanpple a day, and go for a walk daily, do meditation and don't lift things.    9mm linning is really good, your little one can do this! and you can help him/her along.  I know what you mean about it being difficult to really believe it will work, you naturally want to protect your mental health and wellbeing.  I truely didn't believe our first transfer would work, and I think I comprimised the outcome because I wasn't fully invested or properly ready.  You are right, it hurts if it fails, and letting yourslef experience the down of failure sucks.  It's hard to pick yourself up again after a loss, but honestly worse if there is a chance of it working and you miss out.  We went to Athens in August of last year, and I am sure part of the reason it worked for us was becuase I just knew there would be another lockdown in the Autumn and we wouldn't be able to travel again, beliveing it was our only oppurtunity for the year did make a difference.  Keep believeing till you have a blood test 14days from today!

Your body only has limited co-factors, the 2-3 (or 4) eggs you can make need everything you have got and can give them.  low AMH means the granulosa cells in your ovaries are not as functional as someone who has higher AMH.  they struggle to produce the androgens and get mitocondria in the eggs to produce enough energy for meiosis and mitosis (and also blastocyst expansion).  Slow steady growth of 3 eggs with a lower dose, focus on optimising the lead follicles will likely give you better quality eggs.  Klik's protocol from CRGH with Estrogen priming till day 3 then letrazole and 225iu Every other day might work well for you?  Otherwise 150iu menopur daily from day 3 will also give you slower growth of fewer eggs, won't recurit eggs that don't really want to be recurited so will mean those which are grown will be the best you can make.  Giant eggs are more common with more meds, and also with larger follicles (ie. the 23mm one),  it's really tough to get the balance right I found the best eggs were from follicles between 19mm and 22mm with a double dose of trigger.  Back to back cycles can work well for some people, personally I think your ovaries may benefit from a month off let them clear out any bad eggs affected by the highish does stims this month and start again next month.  It would also mean you can put everything into really getting this one to stick, without having to feel like you had a back up plan up your sleave.



 

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Hey Mouse, I second everything Queenie has written. Our daughter was an early blast on day 5 when they checked. They didn't want to freeze it as an early blast as couldn't tell the quality and not as good when thawing so they waited till the late afternoon at which point it had turned into a hatching blastocyst. My doctor said it doesn't matter - all that matters is if it's a blast when transferred as it's going through a huge developmental change to get to that stage.

My best eggs were with mild doses including letrozole from day 2 and 150iu gonal f from day 7 ish with double trigger. I got 8 eggs on this equal to the high dose protocol with the difference that the mild protocol gave me 2 expanded blasts on day 5 and the high dose just one day 3 embryo. And in comparison to the long protocol - which gave me 17 follicles, 13 eggs, 2 mature and only 1 fertilised a day late making a 10 cell only on day 4. So protocol does matter. But everyone is very different and what works for one doesn't mean it works for someone else. I'd try mild or natural. We moved on to natural because of 1) cost and 2) I thought if making just one embryo I could as well try with one egg and hope for the best (and in my case 1 embryo on a natural cycle made my daughter; after lots of attempts though).

Also regarding 'immature': it was explained to me that 'dysmature' would be a better term as it just means the egg wasn't good enough..it could mean under or over mature or just bad quality. When it's really immature , as in under mature , then they distinguish between GV stage and M1 stage and this info will give you a better idea where your eggs were at. If M1 stage then it means they didn't probably grow large enough. If GV, Like most of mine most of the time, then they hadn't even made it to M1 in the process and basically didn't have a chance to start with. Then you have a general egg quality issue.

But... You have one blastocyst on board and that is a fantastic outcome after all! Good luck

Pritamin I saw your post in the gennet and reprofit threads. I was with both clinics. Our daughter is from reprofit because I found my doctor and coordinator better and it was less hassle in terms of documents they needed. But travel to Brno is a pain and I don't know how I'd do it during Covid times as most times I had to take a return bus from Prague as I travelled so frequently and at the last moment. Gennet are good as a clinic but I really didn't like my doctor at all. It's easy and central in Prague and that takes a lot of hassle out of the entire thing. They wanted notary documents from us as we were unmarried and that made it all too complicated and costly in the end so we didn't return (they didn't need this when we cycled with them and we did about 6 cycles there). Natural IVF was far easier with reprofit. If doing egg donation, I think gennet gives a guarantee and will save you money. I have several friends who have egg donated or embryo donated babies from there - they did very good matching. But, reprofit are great too. Don't expect too much handholding with either. If going to reprofit ask for Dr Pavel, the head clinician.
 

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Mouse80 - I know you might not feel super positive about it but congrats on being PUPO ^banana^ I’m crossing everything that your embryo on board is just a little bit on the lazy side :) ^pray^ I know it’s really hard (I certainly struggle with it) but try to be positive that it could and will work ^pray^
When is your OTD?

Briss / Queenie - thank you for your insight. You girls know so much.
My protocol was 300 menopur from day 1 (or 1.5 really as I had my period on Thursday evening and started stims on Friday evening) Trigger on day 13 then EC.

Queenie - based on what did you decide to abandon certain cycles early on? What did you look out for. Also what does double trigger do and how does it work?

We had our call with the consultant and although she was quite pragmatic about our chances and said DE is our best option she was also kind of on the same opinion as us to try one more time with OE. It’s all a numbers game and we never know when I will have that one good egg recruited.
She didn’t think changing the protocol completely is a good way forward as I did produce two eggs and both fertilised so the protocol worked in that sense. The only thing she said was to maybe even reduce stims to 275 but we will see about this on the baseline scan.
I’ll have to wait for my withdrawal bleed and we agreed that I’d have a scan around day 21 to make sure I didn’t develop a cyst (and get it sorted before next cycle if I do) then all going well starting on my next proper period.
We did briefly chat about DE and she suggested the same clinic I have my eyes on in Europe. She wouldn’t suggest we do DE in the U.K.
anyway, I’m feeling quite positive about the future because we have a plan in place.

Xxx

 

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Pritamin,  - I was doing mainly 95% natural cycles, so it was a little easier to 'feel' which were healthier months.  All I know is that on a natural cycle - this one which worked (and also the one we got our blast) were textbook cycles.  ie. nice high oestrogen, low(ish) LH and collection on day 13-16.  no sluggish growth, and also no racing away of follicles growing too quick.

Baseline bloods and a scan on day 3(ish) will help, you should have E2 not too low, not too high at that stage.  It may have been easier for me becuase I have some peri symptoms.  Basically if it was a month where I was having lots of hot flushes and moodswings in the first 5 days of the cycle, or if there was a large follicle already on d5 - then it was not a good month.  If you are not doing natrual it's harder to judge and you have to go off response to medication and E2 concentration.

Where are you cycling Pritamin?  300iu and only getting 2 eggs is a lot of medication,  I think both myself and Katkat have had 2 eggs without any drugs (but then I do have high baseline fsh).  and I disagree with them - if you made no healthy embryo's why do the same thing again?  It doesn't make sense. 
I have had 2 eggs without any drugs (but then I do have high baseline fsh).  Personally I would try a lower dose ie. 150iu or Briss's protocol of  Elonva and 75 Menopur later. 

Double dose trigger is used to ensure that the final maturation phase of the egg development is achieved.  There are a number of publications providing some evidence that particulalry in older women, or those with low AMH there is evidence of increased Oocyte collection rate, ivf fertilisation rate and live birth rate.  Not all clinics do it and I don't know for sure exactly how it works, but I think it's basically because the cells around the egg are less functional than in younger women and making sure that there is enough trigger is helpful for these cells to be able to produce the hormones and trigger a healthy meiosis.

I second what Katkat says about Reprofit - they are a good clinic (although they didn't work for us), Dr Pavel is a good Dr.  We drove from the UK last time we went during Covid, it was actually not a big deal and less stressful than worrying about airports and plane cancellations.  They gave us an emergency medical treatment letter and we sailed through the boarders. (but things may have changed).    Obviously I think Serum(Athens) are the best, becuase they have given me my little boy and blast in the freezer.  Do you have male factor as well?  We do and my DH's sperm didn't respond well to the techniques at Reprofit, Serum were more gentle with them.    Dr Pavel has a protocol which was our best with them which is both testosterone and oestrogen primming, then 125iu pergovaris, which might be a good lowish dose protocol for you, I bet you would get 2-3 eggs better quality eggs from that. 

 

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Mouse, well done on reaching the ET stage, best of luck for your little embryo I hope it grows well and finds a nice home for the next 9 months or so.

Queenie, thanks for mentioning the emergency medical treatment letter, I was just thinking how to travel and this seems to be the answer. I will ask Penny and Munich if this is something they can give me. Although I think Germany is entering into a new lockdown so might not be feasible to travel. Issue with Serum is the fact that we do not have sperm frozen there yet. DH took tonnes of AB and stayed off beer but then the lockdown continued so he started drinking again so all effort out of the window. I am so tired of this.
 

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Katkat - sorry, I totally missed your comment about Reprofit and Gennet. We’d do DE with them. It’s really good to hear that your friends had good experience with Gennet and were matched really well. I know it’s silly but I love to see my side of family in my daughter which I’d miss with DE. I made a comparison spreadsheet and both Gennet and reprofit (and actually Zlin too) do 2 blasto guarantee. We haven’t made a decision nor did we have a consultation. How do you ask for a specific consultant? I thought you’re just given one.
If we end up doing DE we wouldn’t actually have transfer until July / August so hoping the Covid situation will change by then. We could always go to Budapest beforehand (I’m from there) if the travel situation is still a bit unsure and drive up.

Queenie - thank you so much again. You’re so knowledgeable but I’m sure you wish you didn’t know all of this...
I’m with Croydon university hospital, they were are clinic in our NHS funded round which gave us our daughter so we stayed with them. They work in partnership with London women’s clinic in Hatley street (EC and ET are at LWC) but they are much cheaper.
I had my period today (withdrawal bleed) and asked for a scan around day 21 to check in case I develop a cyst. I’ll chat with the doctor again then about stim dose. I don’t think I could produce 2 eggs without medication, when we were at ARGC (I was 36 and my fsh at the beginning of the cycle was 14.4) I managed two with 75 merional and 75 fostimon and only one of them was mature. But I’ll defo ask her about doses again.
I think she’d be happy to go lower but I guess she’ll decide based on the baseline scan. I also asked for an endo scratch and I started having reflexology again, I’m planning to have it once a week.

Briss - I’m so sorry you’re feeling a bit fed up, it’s so difficult and as if ivf abroad wasn’t complicated enough a global pandemic was thrown into the mix... argh!! Sending you  ^hugme^
 

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Hello, ladies!

queenie, it's so so so amazing your little guy is nearly ripe! Your thoughts must be on the birth and everything after--it's so exciting and also kinda scary! Wishing you the very best of luck for a delivery as short and painless as possible of a very healthy and happy baby!

mouse: I'm encouraged by your recent chemical--I always thought chemicals were the second best result, after a true success. Best of luck on this one--may it actually yield the best result!

Briss: sending you hugs--I'm sorry there's been so much difficult stuff coming your way...

Pritamin: fwiw, oestrogen priming always prevented significant cyst formation for me (once I did have a cyst but it wasn't doing much harm), whereas norethisterone was more hit and miss... Good luck...

dorchestor: so sorry about no fertilisation... it feels to me that you were triggered a bit early, but they were forced to do that because your LH was surging... You could ask them about trying to keep LH down with Cetrotide or somesuch...

Sunshine: hoping the casual natural method gives you a nice surprise!

AFM: hopefully transferring my one blast on Saturday. Feels a bit surreal--last transfer ever at CRGH--and if I waited just one more month I'd probably get a vaccine--but there we go...
 

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Hi ladies how are you all getting on?

Queenie I’ve been thinking about you and wondering if all is well. Hoping to hear news of your arrival soon.

Briss how are you doing? Did you manage to sort out travel plans etc? I’m sorry you’ve had such a challenging time lately.

Kakat hope the transfer went well?

Pritamin I’ve been following you on the April thread and hope all ok with you.

ATM I’m just after a bit of advise. So I started stims on cd2 of 375 menopur and letrozole. After 5 days there was no follicles growing (maybe 3 at af size but really barely visible). They increased my dose to 450 and after 2 further days the scan revealed still nada growth, not a smidge! So I spoke to the duty doc who said it’s a bit premature to cancel and suggested continuing for a while longer to see if my cycle kicks in. I asked about why up the dose to 450 and she said because my LH was high. We agreed that dropping the dose back to 300 given the lack of response is the best thing to do for now and see what happens. Just wondered if anyone has experienced this before?
 

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Hello Mouse, you're still at the Lister, is that right? I had this happen once on a letrozole and low dose menopur protocol (150 u), and cancelled after a week with no follicle growth, thin lining and breakthrough bleeding. How have you been feeling physically? This combination shut down my ovaries and I had awful menopausal symptoms which took a few weeks to subside after stopping the drugs. I was advised to cancel but was glad I did but maybe they feel that your hormone levels are more favourable to continue (I think I probably started on a cycle where I had high FSH to start off with that month and the drugs just tipped me over the edge). But I know how stressful and depressing it is after you have psyched yourself up to start a cycle! I also had another cancelled cycle previously on a high dose Fostimon + Merional protocol. Thinking of you x
 

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Hi, mouse. Echoing Shady, I'm really sorry you're going through this--it's hugely disappointing. It feels to me like you're being given way too high a dose... queenie mentioned my protocol, which was moderate stims every other day, and perhaps you're a candidate for that?  FWIW, I've had really nice-looking embryos (though they never got anywhere!) come from cycles that started out super slow, but those were natural (no stims at all) and I've never had a persistently high LH problem... Is your LH usually high early in the cycle? If so, I think taking steps to lower it would be more useful than upping the stims dose. If not, then, as Shady did, perhaps waiting for a more auspicious hormone balance in your body would be more productive... But I'm sorry, it's really maddening when your mind is ready to go but your body isn't...

AFM: one more week til OTD. Ho, hum.
 

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Thanks both. I knew more cancelled cycles were highly likely but I just feel so exhausted from it all.

Shady yes I’m still at the lister. I’m not sure what my FSH was this cycle but the main symptoms I’ve been having is general tiredness. At first I thought it was the high stims but now I’m wondering if it’s my hormone levels this month. I’m back on Saturday and Monday and I guess I will know one way or the other whether this month is a goer.

Kilk hope you are surviving the 2ww. Will you wait till OTD to test?
 
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