Sunday, September 18, 2011

The Cycle From Hell

This is officially the cycle from hell! I am on CD15 and I am still stimming. As of Friday I was still at baseline as my E2 dropped from 26 down to 25 and my follicles didn't show any sign of growth. My Follistim was upped from 450 to 600. So what does this mean? Well, first off I am still at baseline (perfectly) so we are still moving forward with this cycle. The nurse manager told me that many PCOS patients (which I don't have) stim for 25-30 days as they need to stim very slowly to prevent OHSS. They get pregnant so obviously there is no effect on egg quality when you stim this long. The other thing that this implies is that my hopes for doing a low-stim IUI cycle have been crushed. This cycle proves that I no longer respond to low dose gonadotropins and that my ovaries need very high levels to even get started. My ovaries are shot! We are learning a lot from this cycle and this new found knowledge has by husband and I engaging in some serious discussions. Since we know that taking Femara and low dose Follisitim doesn't work, and the whole point in doing that was to limit the amount of meds my body had to process, that IUI may not be the way to go. If I have to take mega doses of hormones just to get my ovaries going, why put all that stress on my body only to have a 15-20% chance of success with IUI? Why not do IVF which, if everything goes well, gives you a 50-70% chance of success? Now just because the odds are higher doesn't necessarily mean that it is going to work. The endometrial lining needs to be nice and plump with a trilaminar appearance, the uterine cavity should be free of fluid, and the follicles must be exposed to optimum growing conditions. If, and only if, these conditions apply will we move forward with IVF. I will say, however, that my lining has always been an issue. From the first day of stims I have had a trilaminar endometrium but it is way to early to tell what my lining is going to be like. We know that I will never have a lining that is 9mm or more so we are not expecting that to happen. We are shooting for a lining 6.5mm or greater. Yes, this carries a reduced chance of pregnancy but this is all I have to work with...I have no choice. So here are our plans (and this is assuming that I start responding to the meds):
  1. Stick with original plan and do IUI if 1). there are not many follicles when it comes time to trigger, 2). lining is less than expected or 3). some other type of barrier gets in the way reducing my chances of success.
  2. Convert to IVF only if everything looks great, meaning that my lining looks healthy and that I have a good number of follicles.
  3. Convert to IVF but freeze all embryos on Day 1 and prepare for a FET. We would do this if I have a good number of follicles but my lining isn't good. 
Either of these options are fine with me. It is what it is and there is nothing I can do to change things. It took 7 injectable cycles for me to realize this! I am very thankful that this was the cycle that I learned that I had to "let go." With the way things are going, if this were any other previous cycle, I would absolutely be losing it right now. After 5 days of Femara and 5 days of low dose Follistim (150-450) I have had no response; my E2 levels have been dropping because of the lack of response; my lining shrunk because of the lack of estrogen production; and I have started bleeding after having AF end 8 days ago. That is enough to drive anyone crazy! I go in first thing tomorrow morning for another ultrasound and more blood work so I am hoping that there is some type of activity going on in my ovaries. Damn ovaries!!!

2 comments:

  1. I wish you the best! P.S.: I stimmed for 30 days during this last cycle (longest ever for me), and it was successful! Good luck!

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