Venting about SGF

[Anonymous]

I had a small follicle count at Shady Grove. I had a cycle canceled for having one leading follicle that was too big compared to the 2-3 others and one cycle where they though I had 7 follicles but I got 8 eggs (2 immature).

1. Unless you are very young or they believe there is a reason you would respond very differently to another protocol, they are not going to cancel you for 7 follicles. It's a totally respectable number.

2. If you are going from 7 to 9 to 11, your doctor is going to view that as there being follicles that are hard to see and be appropriately careful in talking to you about completing the cycle or going through with the retrieval.

3. They talked to me extensively about looking for more at retrieval. It's standard protocol.

[Anonymous]

Op what all have you done at sgfc so far?

[Anonymous]

Anonymous wrote:Op what all have you done at sgfc so far?

Op here - Had an initial consultation and decided to proceed with a cycle. Previously I had 3 PGS frozen embryos at another clinic, in another country (I moved back to DC in the meantime). I lost one PGS normal embryo, so I am trying for more.
I have endometriosis (one cyst on one ovary) but that has not impeded the ovary to produce 7 follicles, the other (cyst-free) produced 4 this cycle. But as I wrote I got different counts on different days, which makes me nervous.
Especially because my endo (which was diagnosed based on the ednometrioma on my ovary). SGF is not overly concerned about the cyst, they only worry about them if they are >3cm. However, I am clearly a more complex case and therefore precise monitoring is important to me.

[Anonymous]

i am not understanding you’re concerns ...it sound like you have many follicles to harvest. concentrate on the end result. it’s note like ken they are mapping go your ovaries for your ovaries for precise follicle location. they will harvest whatever they can on the day of retrieval. And btw, those ultrasound techs are many times much better in measuring and locating the follicles than the doctors themselves.

[Anonymous]

Anonymous wrote:i am not understanding you’re concerns ...it sound like you have many follicles to harvest. concentrate on the end result. it’s note like ken they are mapping go your ovaries for your ovaries for precise follicle location. they will harvest whatever they can on the day of retrieval. And btw, those ultrasound techs are many times much better in measuring and locating the follicles than the doctors themselves.

I am concerned about disparity form one monitoring to another and as you put it well between technicians' skills and those of doctors on the retrieval day. There seem to be many cooks in the kitchen. One may be better than the other. You don't know who you will get on a retrieval day. It's all bit unnerving. Yes, I am now focusing on the outcome. I have max 4 more days to go, so what's done it's done. I just pray I get a doctor who is patient with ultrasound (who will take ample time to check for any "hidden" follicles) and who will be in good mood on my retreival day.

[Anonymous]

OP- I mean this as gently as possible because I've been there. This follicle counting issue is not a problem. Unless there is something else going on, this will not preclude your cycle from finishing. If you don't like SGF, fine, there are a variety of clinics for that reason.

[Anonymous]

I had way more follicles appear on retrieval day than ever before on an ultrasound. I asked why - I was shocked - and they said that once they retrieved some they had a better visual on the others. So I got the sense that as long as they are getting a general picture of what was going on and had a good read on the larger follicles, they don't need to know the precise number. Granted, I totally understand that if you're on the bubble deciding to cancel the cycle it matters a lot, but in that case hopefully they are looking very carefully and you wouldn't miss a "hiding" follicle.

[Anonymous]

Anonymous wrote:OP- I mean this as gently as possible because I've been there. This follicle counting issue is not a problem. Unless there is something else going on, this will not preclude your cycle from finishing. If you don't like SGF, fine, there are a variety of clinics for that reason.

Thank you. I appreciate it. I mentioned in my initial post that hormones make me nervous. I am bit more upbeat after this forum exchange

[Anonymous]

I am with SG in Leesburg. My doc was at almost every US appt, except on the weekend, during my IVF cycle and he did a couple of the exams himself. I only had 6 mature follicles that were big enough for retrieval. My doc said once 5 follies are over 18, that's enough to move forward with retrieval and isn't necessary to be super precise with the count after that. The follies on the xray are not as important as your E2 levels. Also, my left ovary is really hard to see and since that is my dominant ovary, it gets more crowded and is tougher to see everything.

My retrieval doc said they pop (don't think that's the right word) every follicle, even the small ones, to make sure they don't miss anything. My doc got all 6. I assure you they don't rush the procedure and they do their best to get as many as they can.

[Anonymous]

OP SGF is criticized a lot on this board...its a bit like chipotle, you move down the line, get the same thing as everyone else, the choices are straightforward, and they forget about you as soon as you leave the register. I have two gorgeous boys from SGF, going for a third boy? Next year. Now I personally like how inpersonal they are, but I don't like my hand held, and I knew that the doctor who did the intitial consult is not going to be one doing the retrieva and or transfer, but that's ok. I liked how you can go in and out and did not need to chit chat with anyone. I actually found the ultrasound techs to be pretty good, and quick and remember that retrieval is ultrasound guided and done by a physician so they will find all your hidden follicles. You cannot predict based on your monitoring appointments how many will be harvested. I remember that they counted 13 at my last monitoring appointment, retrieved 11, 9 fertilized and 6 made it to blasts. Trust the process.

[Anonymous]

For me, there was one time where I had a technician measure my lining much smaller. I don't remember what the exact numbers were but it went from say a 7 to a 5. They ended up bringing another tech in to do the lining measurement b/c I questioned it and asked to measure again.

[Anonymous]

i really like the previous posters self-advocacy. If you don't understand why your follicle count went down sit your butt back down and tell them you want another tech to come look. i have had a really good experience at SG. Part of that is my great doctor, amazing nurse (lucky I have her)... but part of it is my constant questioning and demands for answers when I am uncomfortable about something.

[Anonymous]

Anonymous wrote:OP- I mean this as gently as possible because I've been there. This follicle counting issue is not a problem. Unless there is something else going on, this will not preclude your cycle from finishing. If you don't like SGF, fine, there are a variety of clinics for that reason.

+1. OP you need to relax a bit. Worrying constantly about the number of follicles or the size of each one is not going to help with the process. This is your first cycle, and they have not given you a reason not to trust them. Also, I feel that you prob. need to go to a center that you trust, and not SGF as your questioning this and that as it relates to monitoring shows that you don't trust them ultimately to do right by you.

[Anonymous]

OP, I don't know what your insurance or financial situation is, but if this cycle doesn't work out, I'd recommend a consult with Cornell. They, like GW, only have doctors do the monitoring. In fact, they get a bit touchy if you do local monitoring in DC too far into a stim cycle as they prefer to do it themselves - and the blood draws - in order to make changes to protocol. They've tweaked DW's stims very specifically (she's done 4 cycles there) in the past, and they do the same with the trigger.

As for your endo, having a cyst on your ovary could very well affect the quality of the eggs your produce. This was Dr. Braverman's theory when my wife started working with him for immune issues (while continuing IVF with Cornell), and she subsequently got a lap under his advisement. They found endo on ovaries, and a few other places as well. The thing is, they often can't tell how extensive endo is until they get in there, take a look, and, in many cases, excise it. Whether it was the laparoscopy, the immune meds, or just luck, DW did get pregnant after all of that is now about 30 weeks.

FWIW, we left SG because DW was a more difficult case and we got kind of tired of doing so much advocating for ourselves. It became exhausting, and quite honestly working with Dr. Davis at Cornell was a breath of fresh air after that.

[Anonymous]

Anonymous wrote:OP, I don't know what your insurance or financial situation is, but if this cycle doesn't work out, I'd recommend a consult with Cornell. They, like GW, only have doctors do the monitoring. In fact, they get a bit touchy if you do local monitoring in DC too far into a stim cycle as they prefer to do it themselves - and the blood draws - in order to make changes to protocol. They've tweaked DW's stims very specifically (she's done 4 cycles there) in the past, and they do the same with the trigger.

As for your endo, having a cyst on your ovary could very well affect the quality of the eggs your produce. This was Dr. Braverman's theory when my wife started working with him for immune issues (while continuing IVF with Cornell), and she subsequently got a lap under his advisement. They found endo on ovaries, and a few other places as well. The thing is, they often can't tell how extensive endo is until they get in there, take a look, and, in many cases, excise it. Whether it was the laparoscopy, the immune meds, or just luck, DW did get pregnant after all of that is now about 30 weeks.

FWIW, we left SG because DW was a more difficult case and we got kind of tired of doing so much advocating for ourselves. It became exhausting, and quite honestly working with Dr. Davis at Cornell was a breath of fresh air after that.

OP here - thanks so much for this. I've been told my several REs as well as a regular gynecologist that removing the cysts would cause endo particles not visible to naked eye to spread all around uterus and ovaries and cause growth of new endo. Apparently endo and its particles are "alive". If you are grossed out by this picture believe me I was too. It sound like something from a Frankenstein movie. Another reason why all these people were opposed to me having lap is that that would remove any nascent antral follicles from the ovary, since the cyst is kind of embedded within the ovary. Another point that they all made is that the cyst would probably shrink during pregnancy, however that endo would come back with vengeance after pregnancy. So, who knows. I am definitely open to immune meds and I am planning to explore this option too. I am also trying to get an appointment with a gynecologist who specializes in endo to get a different opinion about laproscopy. I feel that no matter what I do endo is there as a factor to worry about. So far, SGF has not made any comments about the cyst being problematic and after trying to talk to them several times about it they kind of dismissed it. Not sure what to think about that.