Customization of medications during the cycle?

[Anonymous]

I finished a cycle at SGF Rockville. I had one huge follicle that at day 4 already measured 21 mm. I had 4 of normal size and 3 that were below 10mm. They ended up extracting only3. Mercifully one became a blast and was frozen.
Here is what bothers me: upon seeing a large follicle (which by the end of the cycle grew over 30mm) should the RE have known that this a was post-mature follicle and should he/she have lowered my medications in favor of smaller ones below 10mm to grow more while simply letting go off the big one? I ended up having the extraction on day 10 of the cycle, which I felt was too soon because the big follicle got out of hand. I think there was a disconnect between monitoring and medications dosage (I also did key monitoring over the weekend - not sure if that's a factor). I feel I had a huge follicle and too many small ones due to high, unadjusted dose of medications.
Anyone with a similar experience and what did you do to get a better outcome next cycle? Btw, we extremely grateful for one blast we got.

[Anonymous]

We are doing IVF overseas and I was first checked on cd5 where they found 12 mm follicle and immeasurable smaller ones. cD8 another scan and one large (18) and 6 smaller ones 10-12 mm. Med's were adjusted from CD5 (increased to 250 gonal-f) and stayed that way until CD10 when we brought down gonal-f to 75. It was a joint decision to sacrifice the big follicle to give others a chance to grow.

Result was 5 eggs, one abnormal so discarded and 4 mature ones which they ICSI fertilized and we have 4 embryos now. Just waiting to see if we'll do transfer on Thursday or Friday. ICSI was for my low AFC, husband perfectly normal.

[Anonymous]

OP, you are not going to get this kind of tailored protocol at SGF. My wife had to strongly advocate that they stop amping up her stims (menopur and follistim) to the max doses because she didn't respond well to that kind of protocol. This was in fact proven with her first IVF cycle (with another clinic) because our son was conceived via mini IVF and low dose stims. This is one of the big reasons why we switched to Cornell. Once you start monitoring at Cornell, a doctor conducts the ultrasounds and they make really small changes to daily protocol based on blood results and what they saw on the u/s. If you're looking for this kind of care, you may want to consider doing some research to advocate for changing protocol or consider going somewhere else.

[Anonymous]

Anonymous wrote:OP, you are not going to get this kind of tailored protocol at SGF. My wife had to strongly advocate that they stop amping up her stims (menopur and follistim) to the max doses because she didn't respond well to that kind of protocol. This was in fact proven with her first IVF cycle (with another clinic) because our son was conceived via mini IVF and low dose stims. This is one of the big reasons why we switched to Cornell. Once you start monitoring at Cornell, a doctor conducts the ultrasounds and they make really small changes to daily protocol based on blood results and what they saw on the u/s. If you're looking for this kind of care, you may want to consider doing some research to advocate for changing protocol or consider going somewhere else.

+1

SG does a terrible job of identifying protocols and adjusting the meds.

Cornell has REs monitoring the cycle very closely (even doing the u/s) and adjusting meds.

[Anonymous]

Thanks, PP. Is there a clinic in DC area where RE monitors cycle and does U/S and adjusts meds?

[Anonymous]

Anonymous wrote:Thanks, PP. Is there a clinic in DC area where RE monitors cycle and does U/S and adjusts meds?

GW perhaps?

[Anonymous]

Did you have any kind of suppression beforehand to help coordinate the follicle?

[Anonymous]

Anonymous wrote:Did you have any kind of suppression beforehand to help coordinate the follicle?

I started with Lupron a day before stimulation. I now feel that was not enough. Also, upon further research I came to conclusion that flare protocol is not for me (DOR) and I need proper suppression beforehand or lower dose of stimulation.