GW monitoring concerns

[Anonymous]

I went for monitoring visits at baseline, and after 4 and 6 days of stims. The day 7 visit (6 days of stims) was this Friday. I get an email Friday that I should take my trigger shot Sunday night for egg retrieval on Tuesday. No monitoring visit at all between Friday and the procedure. I was doing daily monitoring before the deciding the trigger date at other clinics.

I’m a poor responder so I really need this right. This is my worst cycle ever, only four follicles (have done better elsewhere). I’ve been thinking of just not going through with the retrieval. It’s just too emotionally difficult to handle this going badly. I don’t know what to do.

Has any other clinic not monitored anyone for several days before retrieval and had it come out okay?

[Anonymous]

No, and that wasn't my experience at GW as a poor responder either. I think their office practices have changed since COVID, but I would 100% push back on that and call the RE on call today. Who is your RE and nurse?

[Anonymous]

Anonymous wrote:No, and that wasn't my experience at GW as a poor responder either. I think their office practices have changed since COVID, but I would 100% push back on that and call the RE on call today. Who is your RE and nurse?

OP here. My RE is Dr. Frankfurter and the nurse is Joelle. I wonder if they just didn't want to monitor on the weekend, which I've seen people complain about on this board, but it could be COVID.

I think it was Dr Humm making these decisions. She did call Dr F when I questioned if I should go to retrieval versus IUI, and got instructions to add an extra dose of Ganirelix and proceed with retrieval after she called him. It's probably too late to do anything at this point, not sure why I even posted really. I've just been thinking of not going through with it with this worse response and the lack of monitoring. I guess all I can do is raise hell if I get immature eggs, if I can get myself to go tomorrow. Just really tired of having to fight for everything in this process and depressed.

[Anonymous]

Anonymous wrote:

Anonymous wrote:No, and that wasn't my experience at GW as a poor responder either. I think their office practices have changed since COVID, but I would 100% push back on that and call the RE on call today. Who is your RE and nurse?

OP here. My RE is Dr. Frankfurter and the nurse is Joelle. I wonder if they just didn't want to monitor on the weekend, which I've seen people complain about on this board, but it could be COVID.

I think it was Dr Humm making these decisions. She did call Dr F when I questioned if I should go to retrieval versus IUI, and got instructions to add an extra dose of Ganirelix and proceed with retrieval after she called him. It's probably too late to do anything at this point, not sure why I even posted really. I've just been thinking of not going through with it with this worse response and the lack of monitoring. I guess all I can do is raise hell if I get immature eggs, if I can get myself to go tomorrow. Just really tired of having to fight for everything in this process and depressed.

I’m so sorry. It makes me crazy how they all collaborate but don’t really share with patients what they’ve discussed and instead just give you marching orders. When we have so much at stake that is just not ok.

They’ve never monitored me between trigger and retrievals. I am not a poor responder in terms of numbers but my egg quality has been poor. Even then, no checks during that interim period. I have had weekend monitoring but that was pre-Covid.

Honestly I would call the after hours number and tell them you need some guidance. If you get lucky Dr. F will answer. If not, leave a message for him.

What was the point of the extra Ganirelix? Have you ovulated prior to retrieval in the past?

[Anonymous]

Anonymous wrote:I went for monitoring visits at baseline, and after 4 and 6 days of stims. The day 7 visit (6 days of stims) was this Friday. I get an email Friday that I should take my trigger shot Sunday night for egg retrieval on Tuesday. No monitoring visit at all between Friday and the procedure. I was doing daily monitoring before the deciding the trigger date at other clinics.

I’m a poor responder so I really need this right. This is my worst cycle ever, only four follicles (have done better elsewhere). I’ve been thinking of just not going through with the retrieval. It’s just too emotionally difficult to handle this going badly. I don’t know what to do.

Has any other clinic not monitored anyone for several days before retrieval and had it come out okay?

This exact thing happened to me at my last GW retrieval (last monitoring Friday day 7 of stims, trigger Sunday for a Tuesday retrieval). I honestly think it’s weekend thing. I pushed super hard to come in on Sunday just to be sure but they refused. Every doctor I did a consult with afterward was like wtf was that. Also there are studies that show should stim for at least 9 days. After the fact when I told dr humm, no you stimmed for 9 days, and then got weird when she looked at the schedule.

I left after that cycle (I have one frozen day 3 from this cycle with them. I think it’s a really bad practice and I’m sorry this is happening to you.

[Anonymous]

OP here. The extra dose of ganirelix is because Dr. Fr thinks progesterone is bad for egg quality. I've never ovulated during stims previously, but I've never done an antagonist protocol before. I would think mis-timing the trigger would be way worse for egg quality!

Thanks for the support. It's too bad because I really liked Dr F during the consults and he seemed to get good feedback on this board. I don't think I'll cycle here again after this. As draining as this is, I need confidence in the process.

[Anonymous]

Ugh, I'm sorry you're dealing with this. I would definitely have concerns about it! My wife did an egg retrieval with GW last year where they did the exact same thing -- no monitoring the morning of the trigger shot or the day before that -- and the cycle went badly. We had way fewer mature eggs than we expected based on her AMH/AFC. When we got a second opinion from a CCRM doctor later, they were horrified she hadn't been monitored daily leading up to the trigger shot.

I also did an egg retrieval more recently. We went with Shady Grove because my wife's egg retrieval made us lose faith in GW. They definitely monitored me every single day including the day of trigger, and the info they got on those days was important in figuring out the best day for trigger. I had a vastly better result.

I hope everything goes well for you, whatever approach you take!

[Anonymous]

Anonymous wrote:Ugh, I'm sorry you're dealing with this. I would definitely have concerns about it! My wife did an egg retrieval with GW last year where they did the exact same thing -- no monitoring the morning of the trigger shot or the day before that -- and the cycle went badly. We had way fewer mature eggs than we expected based on her AMH/AFC. When we got a second opinion from a CCRM doctor later, they were horrified she hadn't been monitored daily leading up to the trigger shot.

I also did an egg retrieval more recently. We went with Shady Grove because my wife's egg retrieval made us lose faith in GW. They definitely monitored me every single day including the day of trigger, and the info they got on those days was important in figuring out the best day for trigger. I had a vastly better result.

I hope everything goes well for you, whatever approach you take!

I should add, the days that GW failed to monitor my wife were also a Saturday and Sunday.

[Anonymous]

Good luck today, OP. I have a friend that ended up with twins from her worst cycle - I think she got 4 eggs from 4 follicles and also was thinking about cancelling before retrieval. That's some luck, but hey, someone's gotta get lucky.

[Anonymous]

OP, I too wanted to say I'm sorry to read what you're dealing with at GW. Though I didn't do IVF, I was a patient at the GW clinic and had concerns of my own about their monitoring process once pregnant. I became pregnant twice while with them, both losses. The second time they only had me in to check betas every 3-5 days, depending on the day of the week (never weekends) despite the fact my numbers weren't rising as expected. I'm a hyper-anxious person, so being told on a Thursday afternoon that something might be wrong, but that I didn't need to come back in until next Tuesday to check again was just downright awful.
That pregnancy did keep progressing until I was further along than I'd ever been, so I finally got to do my first OB sono. At that time (early 2018, not sure if they have changed things) OB sonos took place during regular morning monitoring, which is again is absolutely a terrible environment for the patient if you get bad news at the sono (patient has no time to process because there's a literal line of women waiting for blood draws that the upset patient now has to walk past). My sono didn't look right, it was probably clearly evident to my RE (who was coincidentally doing monitoring that day) that I was headed for a loss, yet my nurse later emailed with my beta from that day (also clearly not where it should have been) telling me that all was well and come back in a week! That was a Tuesday. I had to push my RE to let me come back in for another beta on Friday morning; my RE called back Friday afternoon to tell me that the beta dropped so I was going to miscarry.

When I switched to Dominion, I was even monitored daily for unmedicated IUI. One morning they told me to come back in 2 days based on my sono, but called me a few hours later to say that my blood work was showing I should come back for monitoring the next day and it was based on that second day that they decided the timing of my trigger shot. Once pregnant, they had me routinely coming in every 2 days regardless of the day of the week for betas, and eventually my OB ultrasounds were like a regular appointment.

I'm glad some other women have had good experiences with the GW clinic, but I found the way they practice to be terrible. I had additional problems with how my RE handled - moreso, failed to handle - my losses beyond the bad monitoring experience and poor communication with two nurses.

Good luck OP. I really hope you get a good outcome.

[Anonymous]

I am sorry about your experience, OP. SGF gets a lot of bad rap here, but I found their monitoring system and efficiency to be vastly superior to GW's. It seems that the GW doctors/practice are not interested in setting up procedures that would prioritize and maximize their patients' chances for success. I hope you find success wherever you go next.

[Anonymous]

Anonymous wrote:OP, I too wanted to say I'm sorry to read what you're dealing with at GW. Though I didn't do IVF, I was a patient at the GW clinic and had concerns of my own about their monitoring process once pregnant. I became pregnant twice while with them, both losses. The second time they only had me in to check betas every 3-5 days, depending on the day of the week (never weekends) despite the fact my numbers weren't rising as expected. I'm a hyper-anxious person, so being told on a Thursday afternoon that something might be wrong, but that I didn't need to come back in until next Tuesday to check again was just downright awful.
That pregnancy did keep progressing until I was further along than I'd ever been, so I finally got to do my first OB sono. At that time (early 2018, not sure if they have changed things) OB sonos took place during regular morning monitoring, which is again is absolutely a terrible environment for the patient if you get bad news at the sono (patient has no time to process because there's a literal line of women waiting for blood draws that the upset patient now has to walk past). My sono didn't look right, it was probably clearly evident to my RE (who was coincidentally doing monitoring that day) that I was headed for a loss, yet my nurse later emailed with my beta from that day (also clearly not where it should have been) telling me that all was well and come back in a week! That was a Tuesday. I had to push my RE to let me come back in for another beta on Friday morning; my RE called back Friday afternoon to tell me that the beta dropped so I was going to miscarry.

When I switched to Dominion, I was even monitored daily for unmedicated IUI. One morning they told me to come back in 2 days based on my sono, but called me a few hours later to say that my blood work was showing I should come back for monitoring the next day and it was based on that second day that they decided the timing of my trigger shot. Once pregnant, they had me routinely coming in every 2 days regardless of the day of the week for betas, and eventually my OB ultrasounds were like a regular appointment.

I'm glad some other women have had good experiences with the GW clinic, but I found the way they practice to be terrible. I had additional problems with how my RE handled - moreso, failed to handle - my losses beyond the bad monitoring experience and poor communication with two nurses.

Good luck OP. I really hope you get a good outcome.

I am so so sorry. How horrid all around. I am a patient of Dr. F and when I got pregnant (later miscarried) my first ultrasound was scheduled in the afternoon, so I do think they have changed that. Sending me for the RPL panel downstairs in the lab where I sat with pregnant ladies doing their glucose test was a terrible postscript, though.

[Anonymous]

OP, I’m so sorry you’re going through this. I had a similar schedule to you (trigger on Saturday for a Monday retrieval) and they opened the office to monitor me over the weekend (and this seemed standard for them). I would absolutely push back on them. I found all the doctors to be caring and understanding and I insisted on a few minor changes to my protocol (adding some supplements, etc) and I found them to be receptive. I may be in the minority but I found it to be a great practice and I got 27 mature eggs in my cycle, 5 embryos and 4 that were normal. You’ve been through so much already - I would absolutely push for monitoring and go forward if you can.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, I too wanted to say I'm sorry to read what you're dealing with at GW. Though I didn't do IVF, I was a patient at the GW clinic and had concerns of my own about their monitoring process once pregnant. I became pregnant twice while with them, both losses. The second time they only had me in to check betas every 3-5 days, depending on the day of the week (never weekends) despite the fact my numbers weren't rising as expected. I'm a hyper-anxious person, so being told on a Thursday afternoon that something might be wrong, but that I didn't need to come back in until next Tuesday to check again was just downright awful.
That pregnancy did keep progressing until I was further along than I'd ever been, so I finally got to do my first OB sono. At that time (early 2018, not sure if they have changed things) OB sonos took place during regular morning monitoring, which is again is absolutely a terrible environment for the patient if you get bad news at the sono (patient has no time to process because there's a literal line of women waiting for blood draws that the upset patient now has to walk past). My sono didn't look right, it was probably clearly evident to my RE (who was coincidentally doing monitoring that day) that I was headed for a loss, yet my nurse later emailed with my beta from that day (also clearly not where it should have been) telling me that all was well and come back in a week! That was a Tuesday. I had to push my RE to let me come back in for another beta on Friday morning; my RE called back Friday afternoon to tell me that the beta dropped so I was going to miscarry.

When I switched to Dominion, I was even monitored daily for unmedicated IUI. One morning they told me to come back in 2 days based on my sono, but called me a few hours later to say that my blood work was showing I should come back for monitoring the next day and it was based on that second day that they decided the timing of my trigger shot. Once pregnant, they had me routinely coming in every 2 days regardless of the day of the week for betas, and eventually my OB ultrasounds were like a regular appointment.

I'm glad some other women have had good experiences with the GW clinic, but I found the way they practice to be terrible. I had additional problems with how my RE handled - moreso, failed to handle - my losses beyond the bad monitoring experience and poor communication with two nurses.

Good luck OP. I really hope you get a good outcome.

I am so so sorry. How horrid all around. I am a patient of Dr. F and when I got pregnant (later miscarried) my first ultrasound was scheduled in the afternoon, so I do think they have changed that. Sending me for the RPL panel downstairs in the lab where I sat with pregnant ladies doing their glucose test was a terrible postscript, though.

For miscarriage in November 2019 I found during morning monitoring, even though they knew I was coming in because of bleeding. Also they couldn’t fully visualize because of their crappy ultrasound machine so they wanted me and my husband to wait in the waiting room with everyone there for monitoring for 45min -1hr until they could get us into the MFM for them to do a more detailed ultrasound, even though it was basically a foregone conclusion. Thank god one of the nurses came to get us after 5 min and let us wait in the consultation room. Then yeah waiting in the MFM waiting room with all those women was pretty terrible too.