First timer IVF and not sure what's going to happen - help!

Discussion forum for those particularly interested in IVF and embryo transfer including frozen embryo transfer.
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Bonnycat
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First timer IVF and not sure what's going to happen - help!

Post by Bonnycat » Mon Jan 08, 2007 7:34 pm

I am due to start my first cycle of IVF in Feb at the ARGC due to unexplained infertility. I have to go in on day 1-2 of that cycle for an initial blood test and apparently the results of this will dictate whether I start on day 3 or day 21. What exactly will I start and why day 3 or 21? I want to know approximately how much time I will need to take off work as I do not live near enough to commute and will have to live in London for a time - but how long? I know these seem like questions I should be asking of the clinic but it is so hard to get to speak to someone there and the doctors are not readily available or easy to understand. Can anyone put me on the right lines? I'd be espcecially interested in anyone attending the ARGC who has any pearls of wisdom to offer!
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L & C
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Post by L & C » Mon Jan 08, 2007 8:18 pm

Hi Bonnycat

I know what you mean about getting answers from the clinic. And I remember how stressful it is on the first IVF. You will be OK, just hang in there.

Here's how my IVF worked. I started Lupron shots on day 21. Then when you get your next period, you are supposed to call them and they will have you come in for a blood test and a scan. If those are alright, then you will start the other injections on day 3 (mine were bravelle and menopur). These are what produces more follicles/eggs.

For my cycle, I always took the Lupron in the evening and when it was time to start the other shots, I took those in the morning and continued the lupron in the evening... so a shot twice a day.

For my cycle, after I went in for that first blood test and scan, they scheduled me every day starting a week later. It didn't mean I had to go in every day, it always depended on what the scan and blood tests looked like whether they'd have me come in the next day or not. It was always in the morning also.

I hope I helped a little bit. During the lupron shots (or whatever you will be taking), you shouldn't need to miss any work. It's just that one week or so before your retrieval and transfer.

The best of luck to you!!!!!!!!!! You'll be OK. Leslie

Bonnycat
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Post by Bonnycat » Mon Jan 08, 2007 9:10 pm

Dear L&C

Thanks for your reply - things are starting to look a little clearer. Have I got this right then - if I start on day 21 of my February cycle then it will be March before the egg transfer etc happens? And by Lupron shots you mean I have to inject myself as I am rather squeamish?
Cheers, Bonnycat.

L & C
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Post by L & C » Mon Jan 08, 2007 9:26 pm

Hi Bonnycat

I'm gonna give you my exact dates to hopefully help you.
July 15... day 1 of period
Aug 4... day 21.... started lupron to suppress ovaries
Aug 13.... day 1 of next period
Aug 16... start cycle appt where they tested blood and scanned ovaries.
Aug 18... started bravelle and menopur shots to produce more eggs
Aug 23... started potentially daily office visits to get scanned and blood tests.
Aug 29... egg retrieval
Sept 1... embryo transfer (I didn't work for a week after this by choice. The doc recommended rest for 3 days, but everyone is different.)

As for the shots, my husband gave me all of mine. There's no way I could do that myself either.... weak stomach here. They are subcutaneous though (just under the skin), so it's not that bad.

I will be starting my 2nd IVF cycle at the end of Jan or end of Feb. I hope for the best for you. :D

Take care, Leslie

sassynlv
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Post by sassynlv » Tue Jan 09, 2007 1:20 am

bonnycat:
Welcome to the board!
my schedules were pretty close to L&C's, and i imagine yours will be, too. the only main difference for me, is that for each of my cycles, i started on day 3 (i didn't need the lupron for suppression). o/w pretty much the same. Cycling is exciting, and you have lots of women here that have been through it, so ask away!!! And good luck!!!
6 fresh IVFs plus one cancelation
Last Chance FET--- Pregnant with triplets!
[img]http://b1.lilypie.com/XhKKm8/.png[/img]

amanda-jane
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Post by amanda-jane » Tue Jan 09, 2007 12:28 pm

hi can anyone tell me what the pelvic scans are for.
we had our first appt, we have to return for scans and semen sample (don't know any abbreviations!)
then next appt in march, not sure what to expect or what process is.. :?
a.j.hewlett

sassynlv
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Post by sassynlv » Tue Jan 09, 2007 4:07 pm

amanda-jane: i am assuming you are referring to a pelvic ultrasound? They will probably be doing a "transvaginal" us where a long us probe is inserted vaginally (aka, the "dildocam"... you will be having this done a few times a wk while cycling). They will be looking at your ovaries and uterus to see if everything looks normal (ie., no PCOS). These are very benign... rarely uncomfortable. You could also be referring to a saline sonohystogram (where saline is injected into the uterus to inflate is slightly... to see if there are any uterine abnormalities, fibroids, etc). Some women have pain w/this procedure that dissipates rapidly. Women also usually have a HSG (hysterosalpinogram) that is often done in a radiology center. Dye is injected into the uterus and tubes to check for abnormalities or tubal blockage. Have you had that done, or is that what they were referring to?

Anyway, good luck on your testing!!
6 fresh IVFs plus one cancelation
Last Chance FET--- Pregnant with triplets!
[img]http://b1.lilypie.com/XhKKm8/.png[/img]

amanda-jane
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Post by amanda-jane » Tue Jan 09, 2007 7:42 pm

thanks so much
been doin my readin startin to get the gist off you ladies
thanks and good luck xx :)
a.j.hewlett

Bonnycat
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Post by Bonnycat » Tue Jan 09, 2007 8:59 pm

Hi Leslie and all the girls out there,
Thanks for your advice - it helped me pluck up the courage to ring the clinic today and I managed to find out that I am having a "long protocol" and was given a run down of what to expect over the next 6 weeks. I was relieved to find out that I'll be taking a nasal spray rather than having to self-inject - phew!!
Just waiting now for day one so that I can have my initial blood test. Good luck with your IVF Leslie - I'm rooting for you!

Cat

amanda-jane
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Post by amanda-jane » Tue Jan 09, 2007 10:30 pm

hi, bonnycat
i too am doing long protocol, i got reading today also!
when do you start nasal spray and did you have a choice over drug type?
mandy :)
a.j.hewlett

L & C
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Post by L & C » Wed Jan 10, 2007 4:19 am

Hi Cat

Thank you so much for rooting for me. :D I'm rooting for you also. I have to say I'm very jealous about the nasal spray. :lol: I didn't know you could even do that!!! I am so dreading those injections again. I hope to keep reading about your successful progress. May we all have positive results in 2007!!! Take care!!!

Leslie

Bonnycat
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Nasal spray!

Post by Bonnycat » Tue Jan 23, 2007 8:58 pm

Hi Leslie and Mandy,

Sorry haven't replied earlier but just got back from London from my monitoring mid cycle scan and blood tests. I start the nasal spray on the 31st Jan but I'm afraid I was a bit premature about the injections as I do have to have them. The nasal spray is just to down regulate and then the injections start 2 weeks after that to stimulate. Oh joy!! No I didn't have any choice over the medication I'm just going with the flow and keeping everything crossed for a positive come March!
Keep smiling girls!! :D

Cat x

karma_k
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thank you all

Post by karma_k » Mon Jan 29, 2007 2:05 am

This string was so helpful.
Thank you all for sharing and Bonnycat for posting...
similarly, I'll be starting soon and it's all so confusing. :?
This helped.

Ghost
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Post by Ghost » Mon Jan 29, 2007 6:45 am

There are two main protocols in use.

The most common is the "long protocol" (sometimes called the long Lupron protocol, although there are some alternatives to Lupron). This is the one you are on, where they give a GnRH agonist (commonly Lupron, or in your case, probably Buserelin or Synarel) to shut down the pituitary gland. Ironically, these drugs shut down the pituitary by stimulating it. When any of these first hit the pituitary, they cause a surge of LH and FSH. With continued use, the pituitary remains stimulated and cannot store up a meaningful surge. Kind of like breaking the dam causes a flood, but keeping it broken assures no future flood from a damburst (broken dam can't burst again). This method takes some time for suppression, and is therefore called the long protocol.

The next most common is the antagonist protocol. Antagonists work opposite of the way the agonists do. Antagonists go to work immediately shutting down the pituitary, with no surge involved. Thus there is no need to start them way in advance, so they are normally started after stimulation is started. The antagonists are typically only used for 5 days or so.

Of course, these are not stimulation drugs.

FSH and hMG (under many brand names) are still needed for the actual stimulation of the ovaries. hCG is needed for final oocyte maturation. And estradiol and progesterone are commonly used to prepare the endometrium and sustain the pregnancy. Additional meds may be employed.

A variation of the long protocol is the flare protocol (sometimes called Lupron flare). This protocol seeks to take advantage of the FSH surge mentioned in the long paragraph above, to get the stimulation started. These are comparatively rare, maybe a few percent of all cycles.

The long protocols have been around much longer, so there is much more experience with them. The GnRH antagonists were approved only about 5 years ago.

A last footnote: In a GnRH antagonist protocol, a GnRH agonist can be substituted for the hCG (or used in conjunction with hCG). Remember how GnRH agonists break the dam and release an LH surge from the pituitary? Well, hCG and LH have very similar effects, except that hCG takes much longer to clear the body. This technique is rarely used on low-normal responders, but some clinics use this on high responders in order to reduce the risk of OHSS.

Hope this helps.

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