Moving onto IVF from IUI... Advice? Overstimming?

rachael07 · 08-17-2009, 05:25 PM

I think my doc is going to push us to do IVF after our failed IUI cycle. I wonder if anyone wants to share their experience of moving on to IVF?

I didn't respond to the follistim at all, then they up'd my dose just a tiny bit and my follicles went crazy. My E2 jumped up to 1040 in several days. I had 5 that they thought were mature at the time of trigger and a bunch of little ones. I had a bit of hyperstimulation. It was not dangerous, and it was a drop in the bucket compared to what I read about online, but I had fluid in my abdomen, ovaries were huge, and I was in a lot of pain. It kept me fully bedridden for a day and not able to work for several days. I can deal with that again, but I'm scared of it getting worse.

Won't IVF pretty much guarantee that I will overstim? If you did IUI and IVF, how did the experience compare?

I would appreciate any advice. TIA.

supermouse · 08-17-2009, 06:26 PM

IVF is a controlled overstim---now the RE has some idea of what various doses will do to you, and will try to dose you accordingly. However, should things start to get a little out of hand, they can give you a drug (cetrotide or ganirelix) to suppress the response. The idea for IVF is to get between 8 and 25 follies all maturing at the same rate.

I did a conversion cycle, meaning my RE pretty much overdosed me with Gonal F (on purpose) knowing I would hyperstim, but that it would be likely that I'd end up with many follicles maturing at the same rate. This was true for me, and as a result, my IVF cycle was shorter than it would have been on a "planned" IVF cycle where most women start with 2weeks bcp, then llupron and several other drugs to prime the ovary for a controlled hyperstim. I believe most women have their retrieval 4 to 5 weeks after starting the bcps.

At any rate, IVF reduces your chances for HOM, because the number of embryos transferred is controlled---most RE's won't do more than 2, unless the quality is very poor, or the woman is "advanced maternal age (more than 35 or so).

Would your RE do a conversion, if you started to hyperstim on this round of Follistim?
Eitehr way, good luck.

PaintingChef · 08-17-2009, 06:34 PM

I haven't done IVF yet, I have one more IUI cycle to try and then we will be moving on as well. But a google search the other day brought me to this link and I found it VERY informative. It described each step of the process in TONS of detail and I'm far less scared about the prospect of IVF now that I've read it. So while I can't give you any personal stories, I just thought I'd share something that made me much much more confortable with the whole notion.

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rachael07 · 08-17-2009, 06:52 PM

Thank you, supermouse and paintchef, for your responses. I'll definitely ask about the conversion option, and also that link was so helpful.

I guess one thing I'm confused about is the hyperstimming... I understand that the IVF is a controlled hyperstim. Does that guarantee that the post-HCG recovery will be painful? My light OHSS was so painful that I am scared of something worse.

J Sister · 08-17-2009, 07:06 PM

Rachael07, My last cycle (my first injectable cycle) sounds very similar to your experience. I was very slow to respond to the Follistim, so the RE upped my dose. I did really well for a few days and then my E2 shot WAY up. The RE cancelled my cycle because of the risk of OHSS. I ended up with a mild case. Even with a mild case, I missed 3 days of work. I don't ever want to risk it, again. I felt awful.

My RE made the comment that too bad this wasn't an IVF cycle (because I had so many follicles). I am thinking that he may also try to talk us into IVF. I am not sure that I am ready for that.

I am looking forward to seeing the responses this thread.

rachael07 · 08-17-2009, 07:10 PM

Hi J Sister -- yes, I feel a bit wimpy... but honestly the pain was so bad, I am really scared of it being worse.

I had a funny thought today, though... I've been ttc for 9 months now... after all of these painful periods and shots and overstimming and mood swings and provera and dietary changes and bloating and etc, etc, etc... this ttc can't possible be worse than actual pregnancy, right?!

J Sister · 08-17-2009, 07:23 PM

Rachael,

I had the worst of the OHSS, last week. I am still nauseous! I told my husband that if this nausea was anything like what pregnant women go through...then I am just not cut out for it. Last week really left me questioning if I even want to continue.

But...I am feeling better now. We had planned on doing 3 IUI cycles and I think that we will stick to that. I just have a feeling that the RE will try to talk us into IVF. It just seems like a huge step forward financially/emotionally/physically.

J

rachael07 · 08-17-2009, 07:32 PM

J Sister, I'm curious about the specifics of your protocol -- how high did your E2 get before they canceled? I always assumed that canceling would avert the worst of OHSS due to the lack of HCG, but it sounds like yours was bad even without the trigger shot.

Let's see if I can remember this now... I think I did 75 follistim from CD3-15, then 100 from CD15-17, then 75 CD18, then trigger CD19 and IUI on 20/21. My E2 jumped up to 1040 (oops 1400 in my first message was a typo), and I had easily 8-10 follies in the 10-14 range, then 5 that were 14+. Lining was 10.1. I felt O pain from 0-1DPO, got a little better, then got bad from 3DPO-6DPO. It went away very quickly once things finally got better.

I hope you feel better soon!

amkhappy · 08-17-2009, 07:35 PM

PaintingChef, that was a good link...thank you.

Rachael, I know this is a hard time for you. My last cycle, my RE said I may need to move on to IVF too if this second cycle's a bust. Last time, I had a hemorrhage cyst if you recall. This cycle, I will be stimming/injecting for 20+ days and it may be cancelled b/c of too many follies. So, IVF would be the next step for us too.

supermouse · 08-17-2009, 10:37 PM

I can't say how YOUR recovery would go, but mine wasn't bad at all. I had 25+ follicles at my retrieval, and they got 16 mature ova from that. I was definitely bloated for two weeks afterwards, and I was a little sore the rest of the day of retrieval. Also, the anesthesia didn't agree with me and I puked on the way home. But, I basically spent the rest of that day napping and went to work the next day. I was eating eggs and drinking gatorade, like they told me to, and taking it easy. I didn't have OHSS.

Im glad you got some good links to info about IVF--I would hope your RE would sit you down and explain it to you, if that's the route you go, but if he/she doesn't----ASK, ASK, ASK!! Keep asking until you get the answers you want.

J Sister · 08-18-2009, 01:58 AM

Painting Chef, Thanks for the link!

Rachael, Thanks! I am feeling better.

Here is how my cancelled cycle went...
Baseline E2-49
CD 6 E2-116 several small follies
CD 9 E2-348 1 follie at 8, 2 follies at 9 and 1 follie at 10-so far so good!
CD 11 E2-774 1 follie at 12, several smaller ones-getting concerned about E2
CD 13 E2-2021 1 follie at 14, several smaller one-too many to count-Cancelled

Dx. mild case of OHSS, prescribed Dostinex .5mg for 8 days

supermouse · 08-18-2009, 10:13 AM

Just wanted to clarify---I meant "ask until you get answers to your questions that you understand." Of course, you can't guarantee the answers that you want, no matter how many times you ask.
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(we all want the RE to tell us that we'll definitely get pregnant on this cycle, and he can't give the answer we want for that question!)

toetoe · 08-18-2009, 11:41 AM

Thank you VER MUCH, that link was EXTREMELY helpful...as I'm hoping to do IVF in January.

britta75 · 08-18-2009, 11:47 AM

IVF is a huge step forward. I had 4 unsucessful cycles of Clomid with my OB and then in my first RE visit he talked me into IVF. At the time I had no idea what other steps were available, but as I started to read posts here I got kind of freaked out about moving too fast. I had my ER yesterday, and while the process has been kind of overwhelming (1st cycle cancelled due to cyst) I hope it will be worth it! Anyway, it is not has hard or scary as I thought it would be!

rachael07 · 08-18-2009, 12:43 PM

Just wanted to say thanks all for your replies! If anyone else is in the mood to share their story, it is very interesting and helpful.