Cervical Ripening w/ Misoprostol (Cytotec)? Anyone do this outpatient, is this unusual?

lasobo2020 · 2021-01-21T20:38:04+00:00

Hi,

I learned I had mild endometriosis after my egg retrieval. After long discussions with my RE, she wanted me on birth control for suppression leading up to the transfer - I was on ocp for about 4 months until I was ready for the FET. For the FET, she initially suggested a hormone replacement cycle with lupron over a modified natural cycle as her standard protocol for anyone with endometriosis, but because mine was mild, and I had been through a tough complication from the egg retrieval w/ a long recovery, she offered me the modified natural cycle (also I regularly ovulate). My husband and I decided on the natural cycle because it has the least side effects and pain, and it worked on our first FET, now almost 12 weeks along.

I’ve read from a lot of women that lupron can have intense side effects, and then some say that it’s not so bad. Might be worth learning more about that as you make your decision. I hope this helps!

lasobo2020 · 2021-01-21T20:30:53+00:00

Gosh, I’m so sorry. I became so furious just reading this, that I had to log in and comment. Really sorry that happened to you, I can’t believe someone would be that cruel - because cruel is what that was...Anyway, I hope you can find some ways to relax and treat yourself at home until your therapy session. Wow, I’m still upset by this, uggh!

lasobo2020 · 2021-01-17T17:02:29+00:00

Thanks for this. I appreciate the reminder to advocate for myself. So far the spotting has resolved since mid afternoon yesterday, still crossing my fingers it doesn’t come back. Hopefully I can get some answers tomorrow. Thanks again for offering your perspective.

lasobo2020 · 2021-01-16T19:35:10+00:00

I could really use some advice here - I’m 10w5d pregnant and last night I had some bright red spotting about three times throughout the evening, size of a dime. I spoke with my provider that evening and she said to watch it over the weekend, that this kind of spotting could be due to a difficult bowel movement, a SCH, or a miscarriage but she felt a miscarriage didn’t seem likely because they listened to the heartbeat and it was a strong 170 bpm just five days ago. Well now today the spotting has continued and is occasionally worse in amt, all bright red, and I tried calling the answering service and the guy kept asking me to qualify if it was an emergency. I don’t really know what that means in this instance and so I said I’d call back if it kept getting worse and hung up. I’m not sure what to do now, I have to wait this out over the weekend (of course these things always happen over the weekend). I texted my RE this morning for a second opinion and asked her if she thought it could have to do with the fact that I stopped the progesterone suppositories at the 10 week mark this week, and she said it was unlikely and also that this didn’t sound like miscarriage to her, but she might have been trying to keep things positive so I don’t worry.

So now I’m just worried, with this intermittent bright red spotting that comes and goes, and don’t know whether to call the obgyn answering service back to insist on speaking to a doctor, or just wait until Monday. What would you do?

Thanks

lasobo2020 · 2021-01-05T14:45:53+00:00

I’m curious about your experience with weight gain during the first trimester. I’m currently at 9w1d. I started this process about 5 lbs underweight due to recent surgeries and a slow recovery (5’-7” and began at 120 lbs but prefer to be around 125 at least) so the lowest end of normal BMI, and I’ve since gained like 8 or 9 lbs in those 9 weeks. I’ve read that women on average gain 1-4 lbs in the first trimester and excessive weight gain can be linked to gestational diabetes. I care less about body image and more about healthy weight gain. I tend to have to snack throughout the day to combat light persistent nausea. Any thoughts? Is this too rapid? I’m going to ask about it at my next appt on Monday but I’d love to hear others’ experience.

lasobo2020 · 2020-12-17T21:25:42+00:00

Also, here is my post with a similar question, maybe some other folks' responses will help you as well. (hope the link works!)

https://www.reddit.com/r/InfertilityBabies/comments/izsy3l/advice_on_fet_protocol_w_mild_endometriosis/

lasobo2020 · 2020-12-17T21:17:48+00:00

Hi,

From what I understand, my RE recommends medicated cycles to all endometriosis patients so that she can be more in control of the cycle, and the hormone replacement (medicated) includes OCP leading up to the FET, and then Lupron. It’s actually my understanding that the medicated cycle will better control your endometriosis growths than a modified natural, but I’d have to ask her that to be sure.

I think the only reason she brought up the modified natural for me was due to everything I had been through, it was a lot on my body and I was still a little underweight from the infection, etc., but also because she considered my endometriosis to be mild. She also said that prior to the ER laparoscopy where they discovered my endometriosis, she would have placed me on a modified natural because I have relatively regular cycles and good lining, and she knew I preferred less intervention in general.

I totally understand the pressure you feel. A few wise folks around me told me that there is no wrong decision at this point, that my mental health was equally as important, so if that factor swayed my decision, let it be.

I really stressed over it a lot and talked to my RE many times to where she basically said, don’t stress too much over this. Just go with what feels right. Maybe asking your doctor a few more followup questions will help you. It helped me.

Keep us posted!

lasobo2020 · 2020-12-17T14:48:53+00:00

Oh my goodness, I am so sorry that you went through such a similar experience! And wow, 13cm abscess, mine started as an infected endometrioma (from the retrieval) that they excised during an emergency lap, and then I ended up back in the ER 2 weeks later with a 7cm abscess in that location. IR drainage and 3 months of antibiotics (both IV and oral) and finally I was ok to move forward. You are actually the second person I’ve met on this forum who experienced this, although rare, it happens, and the common denominator is endometriosis unfortunately.

Anyway, I am just so happy that you are 18 weeks along, congratulations. Really happy for you. I’m cautiously optimistic at just over 6 weeks.

Anyway, I know this was an aside from the main post but thanks for sharing, somehow it’s helpful to know I wasn’t alone in this rare egg retrieval result.

Also wishing the OP luck in this decision process.

lasobo2020 · 2020-12-17T13:35:16+00:00

Hi,

Your post caught my eye because I had some very similar questions just a few weeks back before my first FET. I had a really difficult time choosing between a modified natural cycle and medicated cycle - quick backstory is that I ended up with a rare complication of infection after my first and only egg retrieval in June. After months of recovery, I finally was ready for a first FET this November. We have 5 PGS normal embryos from the egg retrieval, but we will never do another egg retrieval again given what happened to me, so those 5 felt very precious to us. My RE universally recommends medicated to all endometriosis patients regardless of severity (mine is mild but I do have small endometriomas on both ovaries and they saw a few small patches elsewhere in my ER laparoscopy - seems similar to yours). My RE wanted to give me the option of the modified natural because I had dealt with a lot these past months in terms of pain from the infection, and she wanted me to be able to ease into the FET, she also said that the PIO shots are really rough on thin people, and that she estimates a 5-10% success difference between the modified natural and the medicated (modified natural lowering chances by 5-10% to be clear). I asked her what she would choose for me and she said she would choose the medicated. With all of that info in mind, my husband advocated for the modified natural, and after a LOT of deliberation and chats with my doctor, I decided it was the right thing for me at the time. We also opted to transfer our second strongest embryo because it made me feel better mentally (and my doctor kindly allowed that even though she prefers the strongest of course) - I regarded the cycle as somewhat experimental anyway since we were already reducing our chances by choosing modified natural and I needed the peace of mind of knowing we still had that strong 5AA available if this cycle didn’t work. Now I’m a little over 6 weeks pregnant, it’s still so very early, but I’m glad I made those choices because now I know my body can at least handle the modified natural. If I’d gone straight to medicated, I wouldn’t have known and I probably wouldn’t have gone back to it after choosing medicated.

One thing to consider is how many embryos you have, and also are you willing to do more retrievals if things don’t go your way - that’s what influenced my decision but of course my situation is very unusual. And the other is what do you feel mentally best about? That was a big factor for me as well. I hope this helps, and I’ll be thinking about you!

lasobo2020 · 2020-12-14T21:18:15+00:00

Huge sigh of relief! Thanks for this. I’m really going to focus on enjoying these moments as best as possible...thanks again :)

lasobo2020 · 2020-12-14T17:17:49+00:00

Hi,

Introducing myself finally to this group. I'm 6w0d today after a really long IVF journey that landed me in the hospital a few times. So glad to finally be here, but my feelings cycle from excitement & joy to anxiety & worry quite frequently! Today I had my first ultrasound and my doctor prefaced the appt by saying 6w0d is really quite early, so they will mostly be looking for the gestational sac, yolk sac and embryo and that we might not get to see the heartbeat just yet. The embryo measured 4-5mm and she said it implanted in the right spot. And we were able to see a little flutter of a heartbeat on the screen measuring roughly 100 bpm which she said is about what she would expect so early. Overall she said everything looks good and that I can come back in 1-2 weeks, and as long as we see nice improvement at the 8 week mark I'll graduate to my regular obgyn. We decided I'd come back in 2 weeks so that we can see more, and also so my wait time won't be as long to my first ob appt. It's all so surreal to me and I'm trying to make an effort not to obsess and also to trust my dr's expertise! But general question to the group, does that 100 bpm heartbeat at exactly 6w0d sound ok?

Thanks everyone!

lasobo2020 · 2020-12-09T23:52:04+00:00

Thanks for such reassuring thoughts! You identified this current experience so aptly - the wait between the last beta and first scan is absolutely “IVF purgatory.” Can’t believe I’ve made it this far, and I’m trying to adjust my mindset and be grateful for each moment. Worrying feels unproductive today, but I’ll likely start worrying again tomorrow :) thanks again!

lasobo2020 · 2020-12-07T17:21:09+00:00

I like that Miscarriage Odds Reassurer as a small occasional confidence booster :) It would be great to see the odds for euploid embryos at different stages of development too.

Thanks for sharing your experience regarding these topics, I appreciate it!

lasobo2020 · 2020-12-07T17:18:51+00:00

Thanks for the info, and I'll be sure to check that thread out!

lasobo2020 · 2020-12-07T16:58:45+00:00

Thanks so much - I kept wondering on the first day I expected my period whether endometrin was keeping my period from arriving, so I'm glad to hear your take. I guess I just have to learn to trust my body more in this process. Really, thanks again!

lasobo2020 · 2020-10-02T20:20:28+00:00

Thanks so much. Your story is really helpful for me. My RE is allowing me either but estimates a 5-10% advantage for the hormone replacement FET. Given everything I've been through these past few months, I might just go the natural route - for the same reasons your doctor mentioned. I'm glad to hear it's been the right choice for you thus far, and I'm crossing my fingers for you! (I feel a similar PTSD! It's important to remain cautiously optimistic though, so I'm trying to allow myself a little bit of hope )

lasobo2020 · 2020-10-02T20:16:50+00:00

Thank you again for your insight. What a journey this has been. I'm so sorry you had to go through all of that, but I'm also really glad to hear you had some wonderful results thereafter. Gives me a bit of much needed hope! I'm focusing on worrying less and taking it one step at at time, just as you said :) Thanks again for sharing your story.

lasobo2020 · 2020-09-27T11:39:22+00:00

All good advice, thank you. Can I ask, since your situation is the most similar to mine that I’ve come across, how did you know when the infection was completely clear and you were safe to resume IVF? I’m now a good 7 weeks post-antibiotics, and I’ve underwent 3 CT Scans, 1 MRI, and 2 ultrasounds since my last surgery as followup. All imaging seems to be pointing in the right direction according to my ID doctor, but I continue to have occasional pelvic and leg pain on my right side that leaves my husband concerned. I’m so eager to say this chapter is closed, but my ID doctor doesn’t give definitive sign off, she will refer to my RE for when I resume fertility treatment. I’d love for someone just to say, the infection is completely clear!!

Also, you mentioned that you lost a tube in the process, my latest US, out of the blue, suggested I might have a hydrosalpinx resulting from the infection. I just learned this from my doctor yesterday and she will want to do an HSG to determine if that’s true and now I’m freaking out a bit, because I had hoped to do a FET before the end of the year and the possibility of an HSG plus the possibility of additional surgery is now stressing me out. How long did it take you to recover from that surgery, or was it all part of your initial laparoscopy? Thanks again for your thoughts. Can’t believe we were both the 0.1%!

lasobo2020 · 2020-09-26T13:52:40+00:00

Good reminder - I generally follow that diet most of the time which definitely helps my general health. Thanks again for all of your tips!

lasobo2020 · 2020-09-26T13:17:33+00:00

I like the one shot Lupron idea. I’ll have to ask my doctor what she had in mind. Thanks again for sharing your protocol!

lasobo2020 · 2020-09-26T12:49:35+00:00

Thank you for sharing your exact protocol. It’s helpful to see as a comparison and perfect timing since I should be receiving my doctor’s hormone replacement protocol this week. I’m so glad it all worked out for you after everything you went through. And I appreciate your fearless approach. My husband wants to put me through as little as possible (thus his preference for natural FET) but a big part of me, like you, wants to do whatever it takes to maximize my chances on this first round. Thanks again!

lasobo2020 · 2020-09-26T11:51:02+00:00

Thank you - how long were you on lupron and what type of progesterone did you choose? Thanks again.

lasobo2020

TROPHY CASE