I think my cycle might be cancelled

[Anonymous]

I've been on 450 of Bravelle for 7 days and my estrogen is not rising like they like to see and I don't have that many follicles developing. I am so bummed about this. Has anyone had this happen and not have their cycle cancelled. Also, if one cycle is cancelled due to poor response, what can be done. Do they switch you do a different medicine or do something else?

TIA

[Anonymous]

Is this an IVF cycle during which you took bcps or lupron?
If so, you might just have been over-supressed and an easy solution could be to drop the bcps or half the lupron dose or both. Another option that doctors use is a different protocol entirely (such as an antagnoist protocol) where the ovaries are prevented from ovulating on their own using a different drug than lupron entirely (one that doesn't cause ovarian supression).

Having a cycle canceled stinks but it's by no means the end of the road. There are lots of different protocol options which might work better for you.

[Anonymous]

OP here. Yes, I have been on lupron. I knew that this was not the end of the road, but it is still so frustrating. I am going to take a little break if the cycle gets cancelled and start back in a cycle or two.

[Anonymous]

I had an IVF cycle like that, they kept upping the doses and every visit there were fewer and fewer eggs. 8, 6, 4....

Finally they said they would not do the IVF b/c there were not enough eggs. The cycle was converted to an IUI. They said that if I had block tubes or any other actual diagnosed reason for needing IVF they would have gone ahead with the IVF. The Doc told me they would carefully review my protocol for the next IVF.

BUT, I got PG with the canceled cycle.

So, OP, first, there is hope. And second, they should be able to revise the protocol next time.

[Anonymous]

OP here. I went back to the doctor today after 9 days of 450 of Bravelle. I have 2 follicles on one side 18 and 15 and then a 13 on the other side. I am very frustrated because I had previously responded to 150 of Bravelle with TI the exact same way. The only difference is the Lupron. I kept asking if they thought I should stop the Lupron and they said no. You have to have the Lupron to keep you from ovulating.

We are paying out of pocket so I don't want to go forward with so few follicles. Maybe we could convert it to an IUI, but TI didn't work for us, so I don't have that much hope for an IUI working.

Sigh.

[Anonymous]

I kept asking if they thought I should stop the Lupron and they said no. You have to have the Lupron to keep you from ovulating.

Who the heck is your doctor?????????????

This is NOT true at all. I'm a SG patient who responded poorly on my first IVF cycle. We stoppped the lupron after 4 days of stims because I was over-suppressed. I ended up with a decent response (and got pregnant).
For child #2 we purposely stopped lupron when I started stims. This is commonly done and is known as the "lupron stop proctocol". I was on nothing to suppress me from ovulating throughout the entire course of stims and I didn't ovulate on my own. Apparently lupron has a residual effect so once you have taken a week+ (as I did and you would have at this point), it will continue to suppress ovulation. I was concerned about ovulating prematurely and so I spoke to several of the senior docs at SG and one said he had seen this happen ONCE in his 10+ years of practice with thousands of patients. The other had never had it happen with patients on the lupron stop protocol.

Whoever your doctor is appears to be giving you crazy advice. In my experience, the first thing to do in this situation (poor response) is to STOP the lupron!!

good luck!!!!!!!!!

[Anonymous]

I just want to say I agree 100% with poster 13:48. I'd both cancel your cycle and change clinics. I had the same experience as the PP (except did not get pregnant).

[Anonymous]

OP here. I understand now why they didn't stop Lupron in the middle of a cycle. This was my very first IVF cycle and the doctor needed to see how I responded to the common protocol. I understand that sometimes this stuff is trial and error. I am going back in tomorrow. It looks like we will probably convert it to an IUI. It was surprising that I didn't respond well because I have responded fine in the past and my FSH is 7, but I am 41. I'm also going to talk to him about different protocols and if they might work for me.

[Anonymous]

I am pp 13:57. In my opinion there is no reason to keep you on the standard protocol once it is clear that it is not working. That is why they monitor you during the cycle!! My RE started me on long lupron, but immediately switched me to lupron stop once he saw my estrogen levels. I ended up with 7 eggs and 3 embryos that looked good for a day 3 transfer.

[Anonymous]

I agree with other posters. There is no reason why you have to continue on a protocol that is not working for you. But that does not mean you have to cancel the cycle either. On my first IVF cycle, it appeared that I was oversuppressed. Instead of canceling though, we stopped the Lupron and upped the other meds. We only got 7 eggs - 4 mature, and 3 fertilized. I had a 3dt of 2 embryos and am now pregnant with twins. So, yes, it's trial and error, but there should be the flexibility to change course if necessary. BTW, I too was a patient at Shady Grove. Good luck!

[Anonymous]

13:48 here again.

The thing is, your doctor is giving you crazy and WRONG information by telling you that if you stop lupron you will ovulate on your own. That simply isn't true. Either he doesn't know what he's doing or he's given up on you and wants to cancel this cycle (and remove it from his stats) and is giving you a line of bull why canceling is the only option.

OP here. I understand now why they didn't stop Lupron in the middle of a cycle. This was my very first IVF cycle and the doctor needed to see how I responded to the common protocol.

Lupron is stopped in the "middle of the cycle" ALL THE TIME. My 3 year old twins are the result of a really crappy cycle in which I was responding horribly until day 5 of stims when we stopped the lupron and upped the stims. As someone else mentioned, why even do monitoring if you're not going to make changes WITHIN THAT CYCLE (not the next cycle)???? That's the entire point of the monitoring appointments----not to gather data for the next cycle but to make real time changes within the cycle and hopefully get you pregnant during that cycle!!


I'm still curious who this doctor is. Honestly, I'd leave this practice asap.

[Anonymous]

I'm wondering if this is one of the docs at Columbia Fertility...dr. rifka? he's big on lupron and never once recommended the micro dose or lupron stop. very disappointing.

[Anonymous]

OP here. PP 20:00 Ding, Ding Ding, we have a winner. I see Dr. Rifka, who I really like. For a variety of reasons, I don't want to go to Shady Grove, but I will if the plan for the next cycle doesn't change.

[Anonymous]

There are other clinics besides SG, but I would change REs ASAP after this cycle. Maybe try Dr Gordon at Dominion or Dr Frankfurter at GW, assuming you want a smaller clinic. You need a doctor who is going to adjust as the cycle progresses - not someone who is going to keep you on a set protocol just to see what happens as if you are his science experiment!!! And to make matters worse you are paying out of pocket - if I were you, I would ask for a discount!

[Anonymous]

OP here. I just got back from my appointment with Rifka and he answered all my questions about the protocol to my satisfaction. It looks like this cycle will be converted to TI rather than IUI because my husband doesn't have issues. Next cycle we will be doing a different protocol. Rifka was very responsive to my issues. I don't want to change clinics and I actually love Dr. Rifka. I spoke to him about different protocols and why he prefers to use one over the other and discussed ones that he doesn't normally use like estrogen priming, preferred by Dr. Sacks.