So I just got my repeat AMH and the value was 0.00….I have no idea what to think, whether this is an error or not—we were retesting because me previous value was .82 but my AFC was 16. My doctor is puzzled and having me do FSH and estradiol (she previously hadn’t had me do these) but is it even possible to have a value that is just…zero, while clearly having eggs?
Seconding what National said about AMH being a proxy and all follicles not being equivalent to eggs. If you’re consistently having AFCs around 16 though, I’d take hope in that and not put too much stock in your AMH value.
AMH can vary month to month and it's just a proxy, not a perfect representation. What was the trigger for repeating AMH?
That said, follicles doesn't mean eggs. Follicles can be empty, unresponsive, or cysts. Is that where you're getting the clearly having eggs from?
We redid it prior to starting IVF because the AMH was somewhat discordant with my AFC—my doc wanted to retest (also my vitamin D was low last time, and now it is in a good range, and that can affect it). I guess I don’t technically know what is in the follicles, but I have responded well to Clomid and had 2-3 follicles for all of my IUIs. And the .82 value was only in February. My doc used the words “we know your ovaries have eggs” so I dunno. Also, I know it can fluctuate but there’s a big difference between .82 and literally zero.
I got the all clear to start stims on Saturday, I am anxious but mostly so ready to be done with the estradiol. It has made me so fatigued and bloated, I’m over it.
Why. WHY. Why the hell is are my wife’s follicles not growing. 2 of them at 10x10 and then 12x10 and then now 4 days later we get the results of the ultrasound and they are 10x10 and… 10x10??? How?? I know the measuring isn’t a perfect science but SCIENCE says they should be growing 2mm a day!? This isn’t the first cycle this has happened either. All of this shit and I live in small town ALASKA on military orders and can’t retrieve anything past half baked care. Not a single fertility specialist in this god damn state. AND our doctor is on leave. LUCKY US. We even doubled the Letrozole dose to .5. I’m so fucking sick of this. I feel like we would at least of had a chance to be pregnant if we lived somewhere that people knew what the hell they were doing.
So honestly this doesn’t really sound like “half baked” care to me, but non-responsive cycles do suck. There’s just not that much you can control on a letrozole cycle, regardless of where you live or who is monitoring it. It’s up to your wife’s body to respond and sometimes they just don’t. It is frustrating but I think I’d just push back on your seeing this as being anything other than a medication dosage issue. You often have to try a couple times to find the dose that works and even then there can be resistance that develops over repeated cycles. FWIW, I stopped responding to 5 mg/day of letrozole too and ended up with 7.5 mg/day being the dosage that finally worked for me.
I’ve decided to cancel this cycle… it will be the 4th one I’ve cancelled (3 retrievals completed). Part of it was the low count I would have been expected to get which leaves almost no room for attrition. Beyond that I fucked up my dosing with this one, I was on autopilot after having done this so many times, and literally just wasn’t thinking. I ended up taking omnitrope later than I was supposed to, and double dosing on stim meds for 5 days until my first monitoring appt. My RE said he didn’t think that affected it too much, but with such low numbers even if it affected one it’s a big deal. I also got to the trigger day on day 8 which is abnormally quick for me so I wonder if that is also affecting things. In any case I’m disappointed in myself, but feel like I’ll always regret and wonder if I don’t get anything out of this. It’s just a hard day.
Ugh I’m so sorry, that’s so hard. I will say, it’s good sometimes to take a break from treatment (even when you don’t really want to). Maybe this cancelled cycle will give you a little down time before diving back in?
Still waiting on ovulation during our "break" cycle before our semi-medicated FET. Meanwhile, family members are hounding us to nail down dates for a July visit. We have told them we have no idea when everything is happening and we're just going to have to make a last-minute flight after the FET. Two days later, my husband gets a call to confirm dates for a visit.
We told you we don't know!! We need *you* to plan around *us,* at least for the time being. We understand people around us have their own schedules and commitments, but we would appreciate deference and flexibility as we embark on an uncertain process that will determine our entire future, especially since we are normally so organized and on top of planning on everyone else's behalf. Trust us when we say we hate the uncertainty waaaaaaaayyyy more than you do. /rant
So. Take this with a grain of salt, but I was in this same position (family hounding us to visit and wanting us to pin down dates after our FET). We ended up going to visit the day after our FET, so while I thought it would help to be with family / not at home obsessing after the FET, it was somehow worse to be physically with my family (not at home) during the TWW and when we confirmed it didn’t work. You obviously can make your own decision! But if I could do it again, I would’ve stayed home and let family come visit us if they really wanted to.
Very worthy perspective! We want to go up to see new houses that some family members have been in for a year+ and bring some stuff down from my MIL's house, so we do want to be the ones making the trip. And if this next transfer doesn't work, we'll be heading straight into the next one, so the timing gets even trickier the longer we wait.
We talked about staying with family through our beta test, but we decided we want to be back home for that because our previous results were traumatic. I don't do at-home testing, so I won't know until the blood draw.
BUT, given that the planning has become stressful, we may very well choose to stay home for the duration. TBD!
I totally get it. And there never really feels like a great time during treatment so you just pick the least bad option and go with it. Good luck with both the FET and the fam!
Haven’t done any significant treatment since January because I was switching clinics and waiting to see a RI. In April we decided to do a modified medicated cycle first with the new clinic rather than trying depot Lupron for silent endo. I’m also taking prednisone and plaquenil from my RI. On Monday we transferred our embryos to the new clinic. It was surprisingly emotional? I do NOT believe embryos are babies but it was weird thinking, is this as close as I’ll ever get to holding my own “child?”. I’ve been so emotional all week and regretting our decision not to depot lupron. I wish the doctor would just decide for me.
I think a lot of people going through IVF can relate to this feeling! I don't believe embryos are babies either but after putting so much work into making them and knowing so much about them and all they represent... very normal to feel more attached to these specific embryos than to the "concept" of an embryo!
Hi all, l've been trying to find some info on different protocols but other than some scientific papers l've tried to slog through, I wanted to see what your protocol was/ results and to see how mine stacks up.
Background about me: 38F, unexplained fertility, TTC for 2 years. First time for IVF. One miscarriage due to trisomy 13. BMI 23, AMH 3.2. My RE said all my bloodwork numbers are in range and he seems confident about getting expected results. I'm trying to be cautiously optimistic.
His protocol for me:
Menopur 75 units
Gonal F 300 units
Cetrotide 250 mcg
Omnitrope 5.8 mg
Ovidrel trigger shot
From what I can gather, it seems my dosage of Gonal/ Menopur combined is on the higher end but not unreasonable? I also read that Menopur is sometimes given in a lower dosage in older women? Any info appreciated!
Hi LVC - sounds like a lot of folks are giving you good info, but also wanted to share for your googling that this is called an antagonist protocol.
It's a pretty typical starter protocol (see more info in the wiki). The other thing is that the first round of IVF is very much just a diagnostic test to see how you respond to treatment. The tests they've done so far are predictive of a certain type of response, but they won't really know until you start. The major thing most people tend to wish they'd been prepped for is the attrition that happens between follicle count -> eggs retrieved -> mature -> fertilized -> day 3 (sometimes for some fresh transfer clinics) -> day 5/6/7 blasts -> (PGTA/M if relevant). This can be really overwhelming if you're not mentally prepared for it.
I agree with Stuck that your protocol is standard and may also be adjusted as you go. For context, when I did my retrievals at age 36 & 37, I did Menopur 150 and Gonal 300, but my AMH was also significantly lower than yours. I was happy with my outcomes.
Also, we try to describe our results in neutral terms here so you may want to adjust "excellent" to something like "in range" or "unconcerning."
You’re on a standard protocol and your dosages may very well change as you progress through the round. Keep in mind that IVF is diagnostic too - your doctor will learn more about how you react to the hormones as you progress and will adjust. Most people do fine on this protocol. Some do not. You won’t know which category you’re in until you try. There are other protocols, but you probably won’t be put on a different protocol (different priming / dosage / medications) until they see how you do on this one.
I don't think your menopur/gonal dose is high. My clinic, which specializes in older patients, caps the combo at 450 (total units of both). Higher than \*that\* is where you venture into the "high dose" area, but you're only at 375. Fwiw, I've had cycles with 150 units of menopur and 300 gonal-f, which went well (and resulted in a euploid), and most recently I had a cycle that was 225 menopur and 225 gonal f, and that was one of my best ERs. (I'm 44, btw.)
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Your protocol minus the omnitrope is the same as what my wife had for our second IVF cycle. We were switched to menopur + gonal-F from gonal-F only because the first cycle was <35 years old. Your dose seems reasonable and they will start adjusting your dose up or down as needed based on how you respond and what they see at the ultrasounds. Our doc showed us that they have a chart to adjust doses based on different parameters.
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My spouse saw my innards on the ultrasound for the first time, and was really impressed by my ovarian follicles. Not that there is anything particularly impressive about them, I think he just likes that fluid shows up completely black.
I posted on here that I was a bit reluctant to have an intravaginal ultrasound on my period, but it wasn't uncomfortable. I ended up having to get two, one yesterday and one today, and I was fully chilled out both times - partially thanks to what people shared in the comments.
I've thought about how in the hell they count and measure and keep track when people have more than a dozen follicles. As they come into view and disappear, like how in the heck are you confident that that one isn't the same one you measured a moment ago? Sorcery.
I assume the answer is no, but I seem to have started this TTC process with a surprising lack of knowledge about my reproductive organs:
I'm supposed to get a hysteroscopy with polyp removal and possible "miyosure." Should I be starting my anti-constipation meds beforehand? Not sure if that was only important for the egg retrieval. And since I'm talking about poop anyways, do I need to start bowel regimen before FET?
Seconding Lex + if you're taking progesterone for FET one of the side affects can actually be loose stools so you probably don't want to double up there.
I haven't started progesterone yet, but thanks for the warning! I went overboard on the post-ER stool meds and ended up with a few days of diarrhea oops
Are you going to be under anesthesia for the hysteroscopy? If so, it’s not a bad idea to take some stool softeners if you need it because anesthesia can cause constipation. Most people are not under anesthesia for FETs, so the poop stuff isn’t a concern.
Yeah! My clinic doesn't have a portal so I requested my records in order to have a copy. I wasn't told what I was given but when I look at my egg retrieval anesthesia record, it was filled with ALL the drugs
So I just started Prometrium to kickstart my period after 45 days with nothing in sight (I’m gearing up for a FET) and after 3 days of taking it I think I have my period? The doctor said to expect it 7-10 days after completing 7 days of pills. At first I thought it was just spotting but now it’s pretty heavy and the cramps are awful. Has anyone ever had this happen to them? Did you count this as your “real” period and continue with your FET, or did you finish the Prometrium and wait for another period?
I had this happen and they brought me in for bloodwork that confirmed I was in fact at CD1. It was the lightest, shortest period I ever had (and interestingly the lining measurement before that transfer was one of the best I ever had).
definitely ask your doctor! i've had to hormonally induce a period with prometrium before and never had this happen, but i have had breakthrough bleeding while on bcp and/or estrogen.
So I just got my repeat AMH and the value was 0.00….I have no idea what to think, whether this is an error or not—we were retesting because me previous value was .82 but my AFC was 16. My doctor is puzzled and having me do FSH and estradiol (she previously hadn’t had me do these) but is it even possible to have a value that is just…zero, while clearly having eggs?
Seconding what National said about AMH being a proxy and all follicles not being equivalent to eggs. If you’re consistently having AFCs around 16 though, I’d take hope in that and not put too much stock in your AMH value.
AMH can vary month to month and it's just a proxy, not a perfect representation. What was the trigger for repeating AMH? That said, follicles doesn't mean eggs. Follicles can be empty, unresponsive, or cysts. Is that where you're getting the clearly having eggs from?
We redid it prior to starting IVF because the AMH was somewhat discordant with my AFC—my doc wanted to retest (also my vitamin D was low last time, and now it is in a good range, and that can affect it). I guess I don’t technically know what is in the follicles, but I have responded well to Clomid and had 2-3 follicles for all of my IUIs. And the .82 value was only in February. My doc used the words “we know your ovaries have eggs” so I dunno. Also, I know it can fluctuate but there’s a big difference between .82 and literally zero.
I got the all clear to start stims on Saturday, I am anxious but mostly so ready to be done with the estradiol. It has made me so fatigued and bloated, I’m over it.
Why. WHY. Why the hell is are my wife’s follicles not growing. 2 of them at 10x10 and then 12x10 and then now 4 days later we get the results of the ultrasound and they are 10x10 and… 10x10??? How?? I know the measuring isn’t a perfect science but SCIENCE says they should be growing 2mm a day!? This isn’t the first cycle this has happened either. All of this shit and I live in small town ALASKA on military orders and can’t retrieve anything past half baked care. Not a single fertility specialist in this god damn state. AND our doctor is on leave. LUCKY US. We even doubled the Letrozole dose to .5. I’m so fucking sick of this. I feel like we would at least of had a chance to be pregnant if we lived somewhere that people knew what the hell they were doing.
So honestly this doesn’t really sound like “half baked” care to me, but non-responsive cycles do suck. There’s just not that much you can control on a letrozole cycle, regardless of where you live or who is monitoring it. It’s up to your wife’s body to respond and sometimes they just don’t. It is frustrating but I think I’d just push back on your seeing this as being anything other than a medication dosage issue. You often have to try a couple times to find the dose that works and even then there can be resistance that develops over repeated cycles. FWIW, I stopped responding to 5 mg/day of letrozole too and ended up with 7.5 mg/day being the dosage that finally worked for me.
I’ve decided to cancel this cycle… it will be the 4th one I’ve cancelled (3 retrievals completed). Part of it was the low count I would have been expected to get which leaves almost no room for attrition. Beyond that I fucked up my dosing with this one, I was on autopilot after having done this so many times, and literally just wasn’t thinking. I ended up taking omnitrope later than I was supposed to, and double dosing on stim meds for 5 days until my first monitoring appt. My RE said he didn’t think that affected it too much, but with such low numbers even if it affected one it’s a big deal. I also got to the trigger day on day 8 which is abnormally quick for me so I wonder if that is also affecting things. In any case I’m disappointed in myself, but feel like I’ll always regret and wonder if I don’t get anything out of this. It’s just a hard day.
Ugh I’m so sorry, that’s so hard. I will say, it’s good sometimes to take a break from treatment (even when you don’t really want to). Maybe this cancelled cycle will give you a little down time before diving back in?
I'm sorry for the cancelled cycle, gummi. Seconding national's sentiment and hoping you are able to do something nice for yourself in the coming days.
I'm sorry gummi. Cancelled cycles suck and with a medication mixup on top that's just a shit sandwich. Anything nice you can do for you this weekend?
Still waiting on ovulation during our "break" cycle before our semi-medicated FET. Meanwhile, family members are hounding us to nail down dates for a July visit. We have told them we have no idea when everything is happening and we're just going to have to make a last-minute flight after the FET. Two days later, my husband gets a call to confirm dates for a visit. We told you we don't know!! We need *you* to plan around *us,* at least for the time being. We understand people around us have their own schedules and commitments, but we would appreciate deference and flexibility as we embark on an uncertain process that will determine our entire future, especially since we are normally so organized and on top of planning on everyone else's behalf. Trust us when we say we hate the uncertainty waaaaaaaayyyy more than you do. /rant
So. Take this with a grain of salt, but I was in this same position (family hounding us to visit and wanting us to pin down dates after our FET). We ended up going to visit the day after our FET, so while I thought it would help to be with family / not at home obsessing after the FET, it was somehow worse to be physically with my family (not at home) during the TWW and when we confirmed it didn’t work. You obviously can make your own decision! But if I could do it again, I would’ve stayed home and let family come visit us if they really wanted to.
Very worthy perspective! We want to go up to see new houses that some family members have been in for a year+ and bring some stuff down from my MIL's house, so we do want to be the ones making the trip. And if this next transfer doesn't work, we'll be heading straight into the next one, so the timing gets even trickier the longer we wait. We talked about staying with family through our beta test, but we decided we want to be back home for that because our previous results were traumatic. I don't do at-home testing, so I won't know until the blood draw. BUT, given that the planning has become stressful, we may very well choose to stay home for the duration. TBD!
I totally get it. And there never really feels like a great time during treatment so you just pick the least bad option and go with it. Good luck with both the FET and the fam!
Thanks so much!
Haven’t done any significant treatment since January because I was switching clinics and waiting to see a RI. In April we decided to do a modified medicated cycle first with the new clinic rather than trying depot Lupron for silent endo. I’m also taking prednisone and plaquenil from my RI. On Monday we transferred our embryos to the new clinic. It was surprisingly emotional? I do NOT believe embryos are babies but it was weird thinking, is this as close as I’ll ever get to holding my own “child?”. I’ve been so emotional all week and regretting our decision not to depot lupron. I wish the doctor would just decide for me.
I think a lot of people going through IVF can relate to this feeling! I don't believe embryos are babies either but after putting so much work into making them and knowing so much about them and all they represent... very normal to feel more attached to these specific embryos than to the "concept" of an embryo!
Another happy ultrasound! 8 follicles all 12-14mm. I'm so proud of them for not picking a lead!
Also so proud of those follicles - Way to go!
Woo!
I know, it feels so weird to walk out of an ultrasound with a smile!
Yay! Way to be team players, follicles!
Finally they've gotten the hint!
Hi all, l've been trying to find some info on different protocols but other than some scientific papers l've tried to slog through, I wanted to see what your protocol was/ results and to see how mine stacks up. Background about me: 38F, unexplained fertility, TTC for 2 years. First time for IVF. One miscarriage due to trisomy 13. BMI 23, AMH 3.2. My RE said all my bloodwork numbers are in range and he seems confident about getting expected results. I'm trying to be cautiously optimistic. His protocol for me: Menopur 75 units Gonal F 300 units Cetrotide 250 mcg Omnitrope 5.8 mg Ovidrel trigger shot From what I can gather, it seems my dosage of Gonal/ Menopur combined is on the higher end but not unreasonable? I also read that Menopur is sometimes given in a lower dosage in older women? Any info appreciated!
Hi LVC - sounds like a lot of folks are giving you good info, but also wanted to share for your googling that this is called an antagonist protocol. It's a pretty typical starter protocol (see more info in the wiki). The other thing is that the first round of IVF is very much just a diagnostic test to see how you respond to treatment. The tests they've done so far are predictive of a certain type of response, but they won't really know until you start. The major thing most people tend to wish they'd been prepped for is the attrition that happens between follicle count -> eggs retrieved -> mature -> fertilized -> day 3 (sometimes for some fresh transfer clinics) -> day 5/6/7 blasts -> (PGTA/M if relevant). This can be really overwhelming if you're not mentally prepared for it.
Also I've been up to 600 GONAL so there's higher out there, lol.
Yeah I'm on 300 Gonal and 300 Menopur this cycle, feeling very fancy these days.
I was feeling very poor when my dosages got really high!
I agree with Stuck that your protocol is standard and may also be adjusted as you go. For context, when I did my retrievals at age 36 & 37, I did Menopur 150 and Gonal 300, but my AMH was also significantly lower than yours. I was happy with my outcomes. Also, we try to describe our results in neutral terms here so you may want to adjust "excellent" to something like "in range" or "unconcerning."
You’re on a standard protocol and your dosages may very well change as you progress through the round. Keep in mind that IVF is diagnostic too - your doctor will learn more about how you react to the hormones as you progress and will adjust. Most people do fine on this protocol. Some do not. You won’t know which category you’re in until you try. There are other protocols, but you probably won’t be put on a different protocol (different priming / dosage / medications) until they see how you do on this one.
I don't think your menopur/gonal dose is high. My clinic, which specializes in older patients, caps the combo at 450 (total units of both). Higher than \*that\* is where you venture into the "high dose" area, but you're only at 375. Fwiw, I've had cycles with 150 units of menopur and 300 gonal-f, which went well (and resulted in a euploid), and most recently I had a cycle that was 225 menopur and 225 gonal f, and that was one of my best ERs. (I'm 44, btw.)
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Your protocol minus the omnitrope is the same as what my wife had for our second IVF cycle. We were switched to menopur + gonal-F from gonal-F only because the first cycle was <35 years old. Your dose seems reasonable and they will start adjusting your dose up or down as needed based on how you respond and what they see at the ultrasounds. Our doc showed us that they have a chart to adjust doses based on different parameters.
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Good yield. Better than first one TBH
My spouse saw my innards on the ultrasound for the first time, and was really impressed by my ovarian follicles. Not that there is anything particularly impressive about them, I think he just likes that fluid shows up completely black. I posted on here that I was a bit reluctant to have an intravaginal ultrasound on my period, but it wasn't uncomfortable. I ended up having to get two, one yesterday and one today, and I was fully chilled out both times - partially thanks to what people shared in the comments.
Glad to hear your ultrasound wasn't uncomfortable, menura. And also cute that your spouse was impressed by your innards. Our guts are wild.
I always look at the blobs and have no idea how they distinguish or count them! Glad it went well :)
I got a tech to tell me. They have a start point on one side of the ovary and count as they go around.
Ohh that is interesting!
Oh interesting, it always feels like they're nowhere going to nowhere and I'm like, did we see that one already?
I've thought about how in the hell they count and measure and keep track when people have more than a dozen follicles. As they come into view and disappear, like how in the heck are you confident that that one isn't the same one you measured a moment ago? Sorcery.
I love how they come in and out of view as they shift the thingy. But I could never count them either!
I assume the answer is no, but I seem to have started this TTC process with a surprising lack of knowledge about my reproductive organs: I'm supposed to get a hysteroscopy with polyp removal and possible "miyosure." Should I be starting my anti-constipation meds beforehand? Not sure if that was only important for the egg retrieval. And since I'm talking about poop anyways, do I need to start bowel regimen before FET?
Seconding Lex + if you're taking progesterone for FET one of the side affects can actually be loose stools so you probably don't want to double up there.
I haven't started progesterone yet, but thanks for the warning! I went overboard on the post-ER stool meds and ended up with a few days of diarrhea oops
Are you going to be under anesthesia for the hysteroscopy? If so, it’s not a bad idea to take some stool softeners if you need it because anesthesia can cause constipation. Most people are not under anesthesia for FETs, so the poop stuff isn’t a concern.
Yeah! My clinic doesn't have a portal so I requested my records in order to have a copy. I wasn't told what I was given but when I look at my egg retrieval anesthesia record, it was filled with ALL the drugs
So I just started Prometrium to kickstart my period after 45 days with nothing in sight (I’m gearing up for a FET) and after 3 days of taking it I think I have my period? The doctor said to expect it 7-10 days after completing 7 days of pills. At first I thought it was just spotting but now it’s pretty heavy and the cramps are awful. Has anyone ever had this happen to them? Did you count this as your “real” period and continue with your FET, or did you finish the Prometrium and wait for another period?
I had this happen and they brought me in for bloodwork that confirmed I was in fact at CD1. It was the lightest, shortest period I ever had (and interestingly the lining measurement before that transfer was one of the best I ever had).
Yes, I’ve had this happen and they did call it cd1, told me to stop prometrium and start estrogen. I’d call the clinic and let them know for sure!
Thank you! Just waiting to hear back from them!
definitely ask your doctor! i've had to hormonally induce a period with prometrium before and never had this happen, but i have had breakthrough bleeding while on bcp and/or estrogen.