Dr. Potter --- do you think you can help me?

[winogurl]

I will try to make this brief. I am in the middle of the second IVF/PGD cycle and it looks like this one may be cancelled. With my first round, we did Long Lupron and used HMG to stim, at doses of 300-375 IU QD. I had 12 follicles the day of trigger, but yielded only 3 mature eggs at ER. Those 3 eggs did fertilize and grow and I transferred 1 fair quality XX. There was never a definitive answer as to whether I ovulated prematurely or WHAT happened. For this cycle, I was changed to the antagonist protocol and stimmed with Follistim 375 IU and Menopur 75 IU QD. I began Ganirelix on day 8. I've had 10 follicles all along, with 1 lead follicle. My E2 was 400 after 4 days of stims, and only 590 after 7 days of stims. Day 8 progesterone was 1.7, so Ganirelix was began. As of this morning (day 9), the lead follicle is GONE on u/s. Won't have a definitive answer as to what is going on until the E2 and progesterone from this morning come back, but it sounds to ME as if I have ovulated that lead follicle. --- Updated: E2 was 682 and progesterone was 2.59. Cycle cancelled.

All that being said…do you think I have any shot of being successful with a cycle with you? I am definitely changing REs after this happening a SECOND time. I don't believe I should have ovulated ONCE during an IVF cycle, much less TWICE. I no longer have faith in my RE but I am not sure I should have faith in my body at this point either.

Any advice?

[winogurl]

BUMPITY BUMP! Any words of wisdom here, Dr. P?

[Dr. Potter]

I will try to make this brief. I am in the middle of the second IVF/PGD cycle and it looks like this one may be cancelled. With my first round, we did Long Lupron and used HMG to stim, at doses of 300-375 IU QD. I had 12 follicles the day of trigger, but yielded only 3 mature eggs at ER. Those 3 eggs did fertilize and grow and I transferred 1 fair quality XX. There was never a definitive answer as to whether I ovulated prematurely or WHAT happened. For this cycle, I was changed to the antagonist protocol and stimmed with Follistim 375 IU and Menopur 75 IU QD. I began Ganirelix on day 8. I've had 10 follicles all along, with 1 lead follicle. My E2 was 400 after 4 days of stims, and only 590 after 7 days of stims. Day 8 progesterone was 1.7, so Ganirelix was began. As of this morning (day 9), the lead follicle is GONE on u/s. Won't have a definitive answer as to what is going on until the E2 and progesterone from this morning come back, but it sounds to ME as if I have ovulated that lead follicle. --- Updated: E2 was 682 and progesterone was 2.59. Cycle cancelled.

All that being said…do you think I have any shot of being successful with a cycle with you? I am definitely changing REs after this happening a SECOND time. I don't believe I should have ovulated ONCE during an IVF cycle, much less TWICE. I no longer have faith in my RE but I am not sure I should have faith in my body at this point either.

Any advice?

I am really sorry to hear of all of these troubles. The first questions I would as are:
1. How old are you?
2. What is your ovarian reserve like?
3. With the long lupron cycle, how many days of stim did you have before hCG and how big were the follicles?
4. Is there a possibility that the lupron was either spoiled (i.e. not stored properly prior to or after purchase) or not administered properly?
5. Did you use Ovidrel for hCG? If so, did you take 1 or 2?
5. ON the antagonist cycle, in hindsight, day 8 is a bit late to start antagonist. Usually it would be started when the lead is 14mm or so. Usually day 6 or day 7...

That said, it would be pretty unusual for me not to be able to prevent a premature surge in a long lupron cycle. I would love the chance to help you out. LMK

[winogurl]

I am really sorry to hear of all of these troubles. The first questions I would as are:
1. How old are you?
2. What is your ovarian reserve like?
3. With the long lupron cycle, how many days of stim did you have before hCG and how big were the follicles?
4. Is there a possibility that the lupron was either spoiled (i.e. not stored properly prior to or after purchase) or not administered properly?
5. Did you use Ovidrel for hCG? If so, did you take 1 or 2?
5. ON the antagonist cycle, in hindsight, day 8 is a bit late to start antagonist. Usually it would be started when the lead is 14mm or so. Usually day 6 or day 7...

That said, it would be pretty unusual for me not to be able to prevent a premature surge in a long lupron cycle. I would love the chance to help you out. LMK

Thanks so much for responding, Dr. Potter. See below for my answers to your questions.

1. How old are you? ABOUT TO TURN 33
2. What is your ovarian reserve like? FSH 6.2, E2 32, AFC 14
3. With the long lupron cycle, how many days of stim did you have before hCG and how big were the follicles? 9 DAYS OF HMG, 10,000 HCG ON DAY 10. FOLLICLES MEASURED AS FOLLOWS: R OVARY - 18.4, 15.6, 13.6, 13.0...L OVARY - 15.3, 13.9, 14.1, 12.3, 14.8, 14.8, 12.4. THIS WAS ON DAY 8….
4. Is there a possibility that the lupron was either spoiled (i.e. not stored properly prior to or after purchase) or not administered properly? NOT TO MY KNOWLEDGE. PURCHASED FROM IVFMEDS.COM AND SHOTS WERE OVERSEEN BY AN RN INITIALLY.
5. Did you use Ovidrel for hCG? If so, did you take 1 or 2? YES - 10,000 UNITS.
5. ON the antagonist cycle, in hindsight, day 8 is a bit late to start antagonist. Usually it would be started when the lead is 14mm or so. Usually day 6 or day 7…TOTALLY, COMPLETELY, 100% AGREED!!!

Thanks again, Dr. P!!! We are looking at our options and regrouping at this point. I may be talking to you very soon!