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Confused about trying for 2nd mini-IVF

August 28 2012 at 8:46 PM
Emiley  (Login Emiley)

I'd like to hear other people's experiences w/minimal stim IVF at Co.oper. I just tried (w/o success) and am thinking ahead to #2.

I'm 40, high fsh, former diagnosis of POF before getting on Est which brought my cycle back. Dr. Co.hen told me she wouldn't expect I would get more than 1-2 eggs from a mini-stim.

I didn't start stims until Day 14 of the cycle (they started me on them, then stopped when my Est level appeared to drop). By the time I re-started, I already had a follicle of 14mm. I had ER on Day 18 with my own nice follicle (about 20/21mm) and apparently I had grown another follicle, but it was way too small. Egg fertilized, was 8 cell, 2B. Was hopeful but then bled thru Prog support (400 mg suppositories 3 x day, plus 200 mg pill at night). BFN.

We were ready to try IVF again this cycle, but now I'm confused. I'd like to have an IVF cycle where I at least have 2 eggs. Today I had my Day 3 b/w come back with FSH of 16 and no visible follicles on U/S.

Nurse said to repeat b/w in one week (Day 10) and u/s if I want (or I could wait and see if my E level indicates follicle growth). I pay out of pocket, which is why I'm not sure about getting the u/s. BUT...I don't want to be stuck in the same situation as last time, with all our hopes riding on one egg. The nurse was already kind of suggesting that I could wait until next month (do TI this month) and see if my FSH is better. How much better does it have to be before they like to stim? I guess they didn't care last cycle (I had stims to help grow the follicle I already had).

Comments, anyone?
Is Day 10 already too late for stims to grow multiple follicles?
Should I definitely get b/w and u/s on Day 10 (or earlier)?
What are the optimal conditions for mini stim? I don't really understand what they're looking for!
Thanks for any help you can offer?

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(Login Tripplebe)

Re: Confused about trying for 2nd mini-IVF

August 30 2012, 8:18 AM 

I'm currently in the 2ww with ivf #5. This is my second cycle at Coo.per, both were low stim. I am 42 and TTC #1.

I can't really comment on your situation, just haven't been in that scenario. Despite having HSH Ithink my stimming this time was pretty optimal (other then it got cut short from bad OOT monitoring).

With this IVF my CD2 fsh was 14, E2=32. I showed three follicles a 9,4 & 3mm. I was instructed to go back in for bw and ultrasound on cd 5. My follicles were 10, 6, two 5's, and a 3, Fsh=10.8, E2=89. I was instructed to start meds the next day. I stimmed for 8 days starting at 75ui and then went up to 225 when Ganirelix & Menopur was added. Retrievel was on CD 14. On the day of ER it was discovered that my follicles were a lot smaller then my monitor clinic stated. I strongly recommend if you are using OOT monitoring and at a ultrasound other then an RE's office, to go to Coo.per for an ultrasound around the time you are getting close to triggering. I most likely would have gotten four eggs if we had done that.

My AFC is always in the 2-3 range. This is the first IVF I didn't 4 eggs (only 3), but we did put back and 8 & 5 cell.

With your AFC being so low early in the cycle it's hard to tell if starting on Day 10 is the right thing. Sounds like things really start to take off when they do? Maybe you can ask to do a bw run on cd 8? Maybe that way you'd still have time to capture more then one? Can you request a callback from a Dr? A lot of times I think the nurses make the call on these things and it seems the answers can change drastically depending on who you talk with.

I do think that E2 dropping during stimming is a reason for concern. I had on a high stim ivf and my eggs were all immature even though size wise they appeared to ready for ER. That's when I decided I was through with high stim.

My first low-stim my fsh was 8 on cd 2. I started stims on cd 4. I didn't have as good of results as this time. I know Coo.per likes your fsh to be below 10 to start meds, but that not a show stopper. I think they just work with your natural fsh and then add in stims when your natural starts to drop off. I really think that approach helped with my egg quality. Plus waiting to add in Menopur late in the cycle.

Do you have a copy of the Minimal Stim protocol pdf from Coo.per? I can send you copy.

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(Login Emiley)


August 30 2012, 9:14 AM 

I appreciate hearing your experiences as I try to puzzle through mine.
I did decide to request a callback from a Dr. Very smart. You're right about the nurses-- you get different answers depending on who you talk to.

I think I'm starting to understand that my AFC is always low. My Day 3 b/w and u/s hardly ever shows E2 levels above 15 or follicle growth at that stage. This must be why they think I will only ever recruit 1-2 eggs. I'll definitely ask about what cycle day is too late for stims if you're going for multiples.

Hopefully I will get a clearer sense of my best case scenario, so I can make good choices about when to do my next IVF try.

All the best during your 2ww. I feel very hopeful for you. Despite the hiccups in that cycle, you have 2 beautiful possibilities. Will look for your update!


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