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Ok - looks like got a green flag to stim but concerned

May 15 2012 at 11:19 AM
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Kim  (no login)

My FSH is 10.5 on day 2 with estrogen priming (E2 71 - but still wearing the E2 patch). Seems like last December is the last cycle where my FSH was at 6 with estrogen priming. Yicks kind of scary. Feeling like the Big M is getting closer.

Had 3 antrals - all at 4mm, and none on right. So looks like 3 might be the best I do this cycle. The good news is that I've never seem them all line up so well - all sized the same at the start!!

Going to be doing 150iu Follistim in am and in pm (so 300iu per day) starting on day 3 today. Using HGH (20 units) starting today. Go back on Friday - day 6.

Would feel better starting with 225iu Follistim? Should I have any concern with the 300iu? Guess I could do my own stimming and try the 225iu:) Worried about stimming too fast b/c my natural cycle I surge on day 9-10 - even with lower FSH when I was younger - and because my natural cycles are 24 days even when younger and lower FSH. Well the estrogen priming does slow things down a bit.

 
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anne
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i wouldn't worry

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May 15 2012, 4:23 PM 

at that fsh level things will probably be fine. i don't know what to tell you about the stimms; for me, after the first month my body would get used to the dosage and would need to go higher.

i'm sorry i don't have any advice on it, but best of luck to you kim for this one!

 
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BroodyHen
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Re: Ok - looks like got a green flag to stim but concerned

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May 15 2012, 5:32 PM 

hi kim.
i understand your concern. i, too, would worry that 300 is too much. are you comfortable talking to your RE about dialing it back a little? also, i really found kiwichick's posts from a while back very helpful on the subject. my last stim cycle my RE wanted 225 every evening starting on CD3. i modified the protocol based on kiwichick's plan, and did 225 for the first two days and dropped down to 150 the rest of the way. i think the idea is to give an extra boost in the beginning to try to get more antrals in the running, and then to go more slowly so as not to fry 'em. i did way better that cycle than usual. but you probably shouldn't listen to me, i am totally uninformed!! but again, maybe your RE will have something to say to give you comfort with your current plan, or agree to lower the stims.

either way, it is super exciting that you've got 3 about the same size. a perfect start... i'm rooting for you, kim!

 
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Kim
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Thanks BroodyHen and Anne

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May 15 2012, 5:43 PM 

I've read Eve's posts over and over again and like the idea of the 225iu to start especially since I have only the 3 follicles - but with E2 priming you never know what others are hiding. I've had one more pop out of nowhere too. Just have not started at such a high dose in forever. I'm thinking of scaling back myself a bit. I just feel like that is cheating some how!

I also have been toying around with taking the extra dexamethasone I have lying around. It is over a year old but sure it may have some impact? Just not fond of going behind RE's backs - which I've never done. Guess I could ask my RE if I can do a slightly lower dose since I have less follicles.

Would you scale back regardless of what the RE says?

 
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BroodyHen
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Re: Thanks BroodyHen and Anne

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May 16 2012, 11:07 AM 

what was your response when you tried higher stims before? how long ago was that? your previous response may be a good guide for you. MIR just said that less than 8 days of stims is bad, so do you think you'll make it that long? i honestly don't know if 300 vs 225 will make a huge difference. i never came close to 9 days of stims doing 225 or less. i'm hoping the addition of femara will make the difference - thank you so much for that suggestion, kim!!

so, i have gone against my RE's recommended protocol and done less stims without telling. i know it is wrong and probably a bad idea, but i don't really get any hand holding or ongoing support from the office so i feel like i have to be my own advocate. i probably shouldn't "recommend" that anyone else do the same, but obviously i don't think it is crazy to do what you are comfortable with. if you like your RE and have a good relationship, why not just ask if you can do 225 and discuss the options?

finally, what about trying clomid or femara to slow the cycle in the beginning? have you tried either?

 
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Kim
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Ok so I did ask (child mentioned)

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May 16 2012, 12:46 PM 

my RE about scaling back to 225iu due to less antrals. He said the higher dosage is not significant and better to scale back a little later. I'm thinking right - it's 33% higher! and seems like a lot to me - but he has a point on the scaling back after a few days b/c sure he wants to recruit all three follicles (and would be nice but not hopeful - more follicles lurking as very, very small ones). Oh well, I followed his protocol last night and maybe today - then I'll scale back to the 225iu possibly tomorrow and see what happens Friday.

Had done a couple high stim cycle - with only once going to retrieval. With higher stims (525iu per day) I stimmed fast (6 days) but had not suppression that cycle...looking back that cycle was plain nuts! I did one other higher stim cycle that completely shut me down and had only 1 (after 7 days of stims). These cycles were done over a year ago, so since then always very low to very low moderate doses. On very low doses of meds, I stim typically 9-10 days, then 8-9 days on low to very low moderate stims. So guessing and hoping for 8-9 days of stims this time out?? All I can say that since December my cycles and FSH with priming have been higher than last year. I think it is because I have fewer and fewer good follicles left - so maybe they'll need a little more push, but would love to stim at least 8 days this time out and triggering on day 10.

At least my current RE listens, as I told him that I conceived on 24-day "exact" cycles with my child and probably surge on days 9-10. He agreed that would be about right for someone with a 24-day cycle. So I went on to say that the estrogen priming slows things down, so when using very low doses to start out (75iu per day) seems to prolong my FP too much. (My RE's schedule still has me triggering on day 11 - so who knows). While having longer FP is fine for other woman not so sure my body and eggs prefer the slower processing b/c it's un-natural for me. I think he is the first RE to really listen to me. One the of RE's at my first place...I told him that I have short cycles and always had....he said "are you sure". I just dropped it b/c he was not going to listen. I remember in college going to a GYN b/c I was afraid something was wrong when I would get my period 2x in a month. I went on BCP for 3 months to stretch out my cycles to 28 days, but once I went off them back to short cycles, sigh! Probably one of the reasons I'm running out of eggs is that I have more cycles per year than the average woman, or just plain lucky:)

Long story, huh, thanks for the advice! I am changing things myself willingly. I added the 1mg of dexamethasone yesterday at the start and will continue each day until it runs out - estimating the day of trigger so I'll be one day short I'm guessing. We have this one last shot so I'm doing what I can to make it work out! We need to get on with our lives and move on from fertility treatments, so hoping to get to retrieval just one more time and hoping this cycle is it!! Just hoping for three to get me to retrieval!! Worry about my higher FSH starting out this cycle with E2 priming - and hoping the follicles respond! Maybe the dexamethasone will ensure that? Thanks again for making me feel better about not following protocol!!

 
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anne
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just a couple things

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May 16 2012, 5:08 PM 

kim, your fsh is still pretty good and should respond well to stimms. i understand about doctors, i'm glad you got one who actually listens. no one listened to me especially after 44. it's disheartening to say the least.

also, i don't believe that women 'run out of eggs'. the jury is out on that one regardless of what some doctors say. the eggs may not be good or developed because the ov's stop making estrogen but you are not going to go through the thousands you have left in a few months. heck the oldest natural mother was 59 when she conceived and that's because she used extra estrogen for a romantic weekend.

yes, i'm just about ready to move on because i think i'm damaging mine with all this manipulation for so many years. once i do have some i'm getting everything taken out.

anyway, good luck with this, i don't think 300 is way high as i've had many docs put me on 450 and above but do whatever you are confortable with. keep us posted how everything works out okay?

 
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Kim
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Asked my GYN a couple of weeks ago

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May 18 2012, 11:33 AM 

and she did not think getting everything taken out when I get older was necessary. Her thoughts was that it has not been proven to be an issue with cancer. I might go in for extra monitoring (at least yearly if not more paps, etc. don't mind paying for extra pre-caution) when I get a little older in order to catch anything!

 
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BroodyHen
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sounds like a good plan

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May 17 2012, 6:44 PM 

it sure is overwhelming to try to figure out all these details. interesting about your cycles being naturally short, that does make sense that a longer FP might not be right for you. and i'm glad you have an RE who listens, that is huge. so i think you've got a good plan and your cycle really seems off to a good start. i'm really rooting for you to get those 3 eggs and maybe even more...! the dex might help, too.

good luck, kim! and please keep us posted...

 
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Kim
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Thanks Anne and BroodyHen

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May 18 2012, 11:22 AM 

Plodding along. Have the three on the left (2 at 9mm and 1 at 5-6mm?) and lining 4mm on day 6 of my cycle (will be 4th day of stims today). Reminds me got to drink raspberry tea again today to keep the lining growing as it stalls sometimes, sigh. We are planning on using G-CSF this time again, if I get so lucky to do the transfer!! I'm ok with putting 3 back if we get so lucky but not sure what my RE thinks about only 3! He was talking about freezing and batching another cycle. Not so sure freezing is good for my fert. eggs.

Going to follow Dr. J's protocol from now on b/c sure he knows better than me at this point. I think the splitting the dose am and pm works better for me than one large dose. It's like the grow more smoothly. Hope he continues this approach.

 
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anne
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well best of luck and keep us posted! n/t

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May 23 2012, 4:20 PM 


 
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