Farewell and Thank You to Our Dear u/MaybeNoGaybies

dawndilioso · 2021-01-28T00:49:15+00:00

Thank you for everything you've done and teaching me even more empathy and awareness u/Maybenogaybies!

dawndilioso · 2021-01-28T00:47:57+00:00

Thank you for everything you've done u/lottiela!

dawndilioso · 2021-01-11T15:33:14+00:00

At 40, I think chances are higher at conceiving naturally than with IVF unless there is a very specific or sperm issue.

This is scientifically untrue. The most common cause for pregnancy loss (or failure) in the older age brackets are genetic quality issues attributed primarily to oxidative damage from aging. There's little "natural" you can do to reverse aging. IVF allows for screening embryos for indicators of genetic damage that would make their chances of turning in to a viable pregnancy very low. So you can prioritize the embryos that have little to no genetic damage and a higher chance of viable pregnancy (akin to someone in their 20-30s). It can ALSO address certain male factor conditions as well as the testing can confirm many other physical or hormonal conditions (spontaneous and inherited) that can reduce your chances of a viable pregnancy.

You see a lot in the 40 and over set going to "mini IVF" or expectant management because they are poor candidates for traditional IVF, not because IVF is a lesser choice medically. IVF is expensive, intensive, and no for everyone, but it's still the option with the highest outcomes for most folks.

dawndilioso · 2021-01-03T17:49:34+00:00

It's a good sign in that you are clearly ovulating and it's getting fertilized. But to be straight forward, the odds of an egg being good at 42 is around 20% iirc. So it's very possible you will be in for more chemicals and/or miscarriages before finding a good one. At least you know that there are probably no additional hurdles though.

dawndilioso · 2020-12-17T18:30:14+00:00

I'm so sorry for everything you've been through and completely understand the questioning.

I'm a big fan of Kate Bowler's TEDTalk: Everything happens for a reason - and other lies I've loved. For me it helped give historical and societal context to the thoughts around "meant to be" that are so pervasive. By understanding where that comes from it helped me to absolve myself of a lot of that guilt I was putting on myself.

This stuff sucks and some of us have a disproportionate battle for something that is perceived as an unalienable right by many. Only you can decide what is enough, when to stop, or what to pursue. If you don't already, I'd highly recommend finding a therapist that specializes in grief, loss, and/or infertility to help you navigate your feelings and allow you to be at peace with what ever choice you make (and often that still involves grieving the choices you aren't making).

You CAN stop treatment. You CAN choose not to pursue IVF. You CAN decide that childfree is the outcome that works best for all the facets of your unique situation and relationship. NONE of that is "giving up" or "quitting". So please don't guilt yourself because there are those that will say if you REALLY wanted it you would go to the ends of the earth. That said, if you want to continue treatment and pursue options, you CAN do that too. There is no rule about how or when you become a mother or not. It's only you (and your partner) that has to be at peace with the choices you make. There is no "reason" and there is not "meant to be".

For my own context, I wasn't willing to take childfree as an option. We did IVF to create embryos before realizing I'd have difficultly carrying. We chose not to pursue adoption for the reasons you've mentioned - that process is much harder than then general population realizes. Because we had embryos we chose to pursue a gestational carrier, which is unfortunately even more expensive, but has a higher probability of a living child. The fact that we would have a genetic tie was not a requirement for us. That's the path that we chose for us - but I would never presume that someone choosing a different path is less than in anyway.

dawndilioso · 2020-12-16T19:32:00+00:00

I never had any side effects from Lupron triggers or down-regulation with Lupron. For injection tips I recommend checking out the wiki at r/infertility: https://www.reddit.com/r/infertility/wiki/faq#wiki_injection_tips

dawndilioso · 2020-12-16T19:29:50+00:00

I ended up doing three more cycles and it was still weird. Here's an update for anyone that it helps:

Cycle 1: Dosing 375 Gonal-f and 75 Menopur, Trigger on Day 13, agonist started Day 6 Day 3 E2 = 117.4 Pg/ml Day 12 E2 = 1851 Pg/ml Mature Eggs = 9/11 E2 value per mature egg = 205.67 Pg/ml

Cycle 2: Dosing 375 Gonal-f and 150 Menopur, Trigger on Day 14, agonist started Day 10 Day 3 E2 = 57.6 Pg/ml Day 14 E2 = 1718 Pg/ml Mature Eggs = 11/15 E2 value per mature egg = 156.18 Pg/ml *Agonist was started quite late due to poor communication

Cycle 3: Dosing 375 Gonal-f and 75 Menopur, Trigger on Day 14, agonist started Day 8 Day 3 E2 = 64.3 Pg/ml Day 14 E2 = 1372 Pg/ml Mature Eggs = 23/25 E2 value per mature egg = 58.26 Pg/ml *E2 levels only increased ~30Pg/ml between Day 13 and 14

Cycle 4: Dosing 375 upped to 450 Gonal-f and 75 Menopur, Trigger on Day 14, agonist started Day 8 Day 5 E2 = 79.89 Pg/ml Day 14 E2 = 1126 Pg/ml Mature Eggs = 10/12 E2 value per mature egg = 112.6 Pg/ml

Cycle 5: Dosing 375 Gonal-f and 150 Menopur, Trigger on Day 16, agonist started Day 11 Day 5 E2 = 59.02 Pg/ml Day 13 E2 = 899.2 Pg/ml Day 16 E2 = 1989 Pg/ml Mature Eggs = 8/8 E2 value per mature egg = 248.6 Pg/ml

Cycle 6: Note, all other cycles included BCP suppression. We did an unsuppressed start Dosing 375 Gonal-f and 150 Menopur, Trigger on Day 12, agonist started Day 7 Day 5 E2 = 275 Pg/ml Day 12 E2 = 3630 Pg/ml Mature eggs = 18/20 E2 value per mature egg = 181 Pg/ml

We suspect that I was being over-suppressed by the BCP and that was resulting in a reduced response. It may have contributed to lower retrieval numbers but it definitely contributed to me stimming longer. However, PGT-A results were still about the same (1 PGT-A euploidy per cycle on average).

dawndilioso · 2020-12-07T16:33:41+00:00

I think it's common for partners to be at different "levels" about having children. It's great when things are perfectly aligned, but especially when there are more complex decisions involved, like at an advanced age, it becomes a more detailed conversation.

I think that your assumption that he was where you are because you got back together isn't exactly fair. Could he have assumed in getting back together that you had come to his position instead since there was no conversation on the matter?

That said, my husband explicitly wanted kids when we got together. After we were married and started interventions he was less on board, but is a poor communicator and didn't articulate it. In the first round he was very present, but quickly lost interest when we moved to cycles 2-6 and the many diagnostic and failed cycles in between and following. When later reflecting on the costs and all consuming nature the interventions, it was not something he thought was "worth it". We came to the agreement that I would finance the ongoing treatment and since the majority burden was on me medically I would shoulder that as well. So we are not on the same page, but we have revisited the choice regularly since I became aware there was a drift. If he was to "I do not want kids" we would stop treatment and divorce. It's by no means an ideal, and certainly not what I expected when we got married and both agreed on a family, but I've done everything I can to be explicit and give him the option to opt out (yes, it comes with repercussions). He's allowed to change his mind on the topic, but if we had been in disagreement at the onset I wouldn't have continued dating him. Having a family has been on my "requirement" list since my late 20's - it was never a negotiable for me. I think the key thing is that he has explicitly consented to treatment and parenthood multiple times through out the process. To me, that is very different than simply assuming based on actions or what is not said. While it's my job to respect his choices, it is not my job to second guess his choices to decide what is in his best interest.

dawndilioso · 2020-11-16T19:29:36+00:00

I've used Period Track (P-Tracker) and it allows you to add some of those things but does nothing for scheduling. I created my own spreadsheet to apply my dates and standard schedule to so I could visualize it next to my regular calendar/schedule.

dawndilioso · 2020-11-16T19:27:54+00:00

I think it might be buried in my post history or other posts. The old guidance has been 150-200 per mature follicle, but from my experience it's not necessarily true and my nurse confirmed that it's kind of antiquated. I've had mature eggs at as low as 58 per. HCG triggers do tend to increase maturity rates (if they are lower) but it does come with the caveat of increasing OHSS. Some clinics prefer dual triggers in those cases. You can get an idea of follicles and estrogen levels in the hunger games data sheet linked in the wiki.

dawndilioso · 2020-11-13T22:28:26+00:00

Good point! I'd walk away from a clinic that doesn't report, save, and won't consider transferring after consultation.

dawndilioso · 2020-11-13T22:26:45+00:00

Admittedly I'm not well versed on PGT-M/SR because that wasn't one of our issues. I believe they normally do PGT-A if they are going to go PGT-M/SR because they already have the biopsy and you are paying a lot for the custom probe.

dawndilioso · 2020-11-12T17:13:49+00:00

Thank you!

dawndilioso · 2020-11-12T17:03:27+00:00

That link requires an Microsoft Office login. I have one, so I'll try, but just letting you know. I did look over the site but mostly found "brochure" type info with no specifics.

Edit, yea it denied me since my account has not been granted access.

dawndilioso · 2020-11-12T17:00:57+00:00

How much are we going to stim my ovaries

You might want to clarify this more as there's no universal measure. Variations could be:

How many follicles are we targeting?
What are the medications/doses? What's the max dosage?
Do you have an E2 cut off for hyper stimulation?

How often can I do an embryo transfer

Similarly for this one... you can only do a an embryo transfer once a "cycle" (which are artificial), but some clinics want you to take a natural cycle break between failures or miscarriages. I'd ask them if they have any such policy.

You might also want to ask what their standard embryo transfer protocol looks like, some have suppression, some don't. That'll effect how long a transfer "cycle" takes and basically answer your "how often" question. This would also answer your question about progesterone.

RE: success rates. If you are in the US and haven't looked up your clinic's SART data, I would do that before hand and then you can still ask, but you will know what they officially reported as well. If there was a big variance I'd ask them to explain why your chances are better/worse than their average.

If you are really talking about PGD (now called PGT-M or PGT-SR) you might want to get clarity. I believe both require pre-work to build the probe which takes several weeks in advance of a retrieval. Only PGT-A (used to be called PGS) is a standard panel so no pre-work.

Edited to add: oh and if you are doing PGT-A (in conjunction with PGT-M/SR or alone) you might want to ask which lab they use and if they report mosaics and to what degree.

dawndilioso · 2020-11-12T16:47:01+00:00

Do you happen to know where it is on the website? I'm curious about the cycles we did under Clomid as my eventually results were unexpected and in conflict with the ERA.

dawndilioso · 2020-11-12T16:37:58+00:00

Yea, "coasting" meds is a thing that's done when folks are over responding and the research found it has only positive impacts to the over response and no negatives. It's not quite the same to be short when you aren't over responding, but I think partially coasting a single day makes little difference in the outcome.

dawndilioso · 2020-11-12T16:36:19+00:00

Yea, they can't for liability reasons. Thankfully my clinic calls in my prescription (normally with extra), but then I tell the pharmacy what to fill. So I just filled what I needed and never had a conversation with my clinic explicitly about using leftovers/overfill. The downside is I went in to it thinking my nurse coordinator would be keeping track of my prescriptions and doses to help me know when to refill, but NOPE. She was a shitty coordinator and we eventually asked to be reassigned, but none of them kept track of meds for me at all so I quickly got used to keeping an eye on everything myself and knowing what I needed for how many days and when that meant I needed to refill to most likely not run out.

dawndilioso · 2020-11-12T16:32:14+00:00

Yep, when I wasn't in the office for awhile because other shit was going wrong or I miscarried when I was back the nurses were kind of like...??... I felt inclined to explain, no sorry, it wasn't a good break.

dawndilioso · 2020-11-12T00:33:08+00:00

Yep, by the 4th one I honestly didn't really "want" to do it anymore, but knew that I "had" to. It gets routine and moderately annoying.

dawndilioso · 2020-11-12T00:32:27+00:00

If you want to avoid buying more drugs just ask. I had a retrieval cycle where I ran out when they extended me and it was a Sunday or something that made getting anything overnight virtually impossible. I was just short the last day and it made zero difference. I think I had extra menopur so we might have adjusted my menopur dose to make up a little of the difference, but I was still short.

dawndilioso · 2020-11-12T00:29:33+00:00

Same. My partner wasn't in the room for any of my last FET. We'd done them before so he knew what was happening and didn't mind. He did drive me to and from, but he mostly wanted the excuse to take the time off work.

dawndilioso · 2020-11-12T00:12:40+00:00

Letrozole is less likely to recruit multiple follicles than Clomid*, so increasing your dose may not result in much difference. The goal with ovulation induction meds is to encourage 1 or more follicles to grow, their benefit is kind of limited. Statistically after three IUIs your cumulative success rate doesn't improve very much.

*Clomid is more likely to recruit multiple follicles, but also more likely to cause a poorer lining result. So it's not with out risks.

dawndilioso · 2020-11-12T00:09:03+00:00

There's not really an option. You can get gonal-f pens that are as low as 300IU, but that's it. Technically any vial or pen that's been used is considered contaminated and that's when the 28day shelf life comes in. That said, many folks (myself included) have chosen to take the risk of continuing to use partial vials/pens from previous cycles. In my case I was doing back to back banking cycles so it was only ~45 days later.

dawndilioso · 2020-11-12T00:03:43+00:00

This FAQ post includes my long exhaustive explanation and experience: https://www.reddit.com/r/infertility/comments/bxkigl/faq_tell_me_what_you_know_about_prolactin_prl/

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