canceled IVY due to over stimulation

[moonk]

Can someone please help me. I just went through my first cycle and everything was going fine until two days before my retrevial date. Then my cycle was cancelled due to over stimualtion. Has anyone had this happened and can you offer advice? I want to try again but noe I have to wait till august and I'm very nervous that this same problem may occur again. Any suggestions?

Karen

[EYCI]

Did you doc give you a reason for why they couldn't proceed with at least the retrieval? I think the risk they are concerned with is OHSS (ovarian hyper-stimulation syndrome.) But, I think in most cases they still do the retrieval and then delay the transfer until another time... meaning you have to do a frozen embryo transfer. I would ask the doc my first question and that may give you a better understanding of what went wrong. I would also ask the doc what they will try to do to prevent this from happening again.

So sorry for your cancellation! I'm sure the disappointment is immense and frustrating. Hang in there!

--Julie

[angelbaby]

even my 1st cycle was cancelled before ER (right the day I was supposed to taake the HCG shots). I had a severe case of OHSS, due to PCOS.

Do you have PCOS? I agree with Julie you need to ask your doctor why your cycle was cancelled.

If you have PCOS the next cycle the doctor will watch you more closely and give you smaller doses of the stimming drugs.

Take care and stay strong

[Ghost]

Can someone please help me. I just went through my first cycle and everything was going fine until two days before my retrevial date. Then my cycle was cancelled due to over stimualtion. Has anyone had this happened and can you offer advice? I want to try again but noe I have to wait till august and I'm very nervous that this same problem may occur again. Any suggestions?

Karen

If I may ask a few questions:

How many mature follicles did you have? Do you know your last E2 level on stim?

Were you on Lupron? Or an antagonist (like ganirelix acetate)?

If you were on antagonist for down regulation, there was no need to cancel for OHSS risk. But some clinics don't know this.

[moonk]

I actually had about 60 mature follicles that was the problem that there were too many of them and the risk for hyper stimulation was extremely high. I also was on Lupron and then bravell.

This cycle I'm starting with the pill which is different from the first cycle and going to use the Gonyl (not sure on the spelling) pen and then lupron instead of HCG at the end if I can get their this time. I'm not scheduled to start my medications until the miidle of July. I am considering getting a second opinion. Any advise?

Thanks,
Karen

[Ghost]

I actually had about 60 mature follicles that was the problem that there were too many of them and the risk for hyper stimulation was extremely high. I also was on Lupron and then bravell.

This cycle I'm starting with the pill which is different from the first cycle and going to use the Gonyl (not sure on the spelling) pen and then lupron instead of HCG at the end if I can get their this time. I'm not scheduled to start my medications until the miidle of July. I am considering getting a second opinion. Any advise?

Thanks,
Karen

Looks like your doctor is doing the right thing, in my opinion. Many won't do the Lupron trigger.

You are a high responder (extremely high). Many women would kill to have half of your response, or even one tenth. But you have extreme risk for OHSS, and that's not much fun. You don't want to get a gallon of fluid drained from your ovaries every few days, and be vomiting for 3 weeks.

If they gave you hCG with 60 follicles, it would have started the cascade of events potentially leading to OHSS.

In a Lupron cycle, there is no alternative to hCG for maturing oocytes.

In an Antagon (or other antagonist) cycle, there is an alternative to hCG. Ironically, that alternative is...Lupron! From what you wrote, it seems that is where your doctor is taking you.

The science: Lupron is a GnRH agonist. It imitates GnRH and stimulates the pituitary, causing the same LH surge that GnRH would induce. When given regularly for many days, the initial flare passes and the pituitary becomes suppressed. It's as if it's constantly releasing small bursts and can't store up a meaningful quantity. No LH surge can occur. An antagonist works the opposite way. It directly suppresses the pituitary, preventing an LH surge. When the doctor wants the LH surge, he can just give the Lupron and boom, your eggs are ready in 36 hours. Studies show this approach is just as good, perhaps a little better, for getting good oocytes and embryos. But pregnancy rates are lower, almost certainly because of an endometrial effect. This defect is not clearly understood, but there seems to be a lot of early pregnancy loss following Lupron triggers. The trick is to freeze the embryos and transfer them later, when the endometrium can be properly primed.

You will likely have 50+ eggs and oodles of embryos, so after one stimulation, you'll have many good chances for pregnancy. In our experience, this works beautifully, and the risk of severe OHSS is gone, or virtually gone. We've triggered somewhat higher responders than your 60 follicles (they just don;t get much higher than that), with no sign of OHSS. Sure beats a canceled cycle or getting your ovaries drained every few days.

If you get significant OHSS (more than discomfort) after the Lupron trigger, I'll be surprised, unless they supplement it with some hCG (some clinics do this).

You have a decent shot at a "BFP" (positive pregnancy test, or big fat positive) in your fresh cycle, but also a good chance of losing it before 10-12 weeks. Be mentally prepared for that. You also have a good chance of pregnancy in FET cycles, and if so, you will probably keep it.

There is currently a raging debate, mostly in European journals, on the effectiveness of Lupron (agonist) triggers. It's very interesting to see the point-counterpoint.

There is one clinic in the US claiming 70% ongoing pregnancy rate with Lupron triggers. Amazing. I'd like to see his protocol for luteal support. But his data set was small, so we shall see if he can sustain it in the long term.

In any case, you are on the right track. Best of luck.

[moonk]

Thanks so much for the reply you have put my mind at easy. Now it's just the month long wait. How about yourself, how many cycles have you gone through?
Thanks again for the help it really helps to hear encouraging words.
~Karen

[Ghost]

Thanks so much for the reply you have put my mind at easy. Now it's just the month long wait. How about yourself, how many cycles have you gone through?
Thanks again for the help it really helps to hear encouraging words.
~Karen

Never did IVF. I just work at a clinic.

[kristin]

dear Ghost
as ever your responses and thoughtful comments are really helpful to us! Many many thanks!
I have a question as I am getting increasingly preoccupied with the BFP I got 5 days ago and wanting to propel myself into the future to know what will actually happen!!!

Anyway, I was mildly overstimulated. They collected 30 follicles of which 18 were frozen. My E2 levels were not particilarly high but I had terrible symptoms of pain and bloating etc... for a week or so later. Now some of the symptoms have returned since the BFP but if I drink a couple of tons a day it seems to help. Do you still think that I would be at a higher risk of miscarriage because I have been overstimmed? My abdomen is definitely larger than it has ever been right now? They said at the time that my endometrium looked just fine. They do not take betas at my clinic, i just did a HPT and they have booked me in for a scan next week.... seems pretty different to these other places that seem to check bood levels on alternate days.
Would be grateful for your thoughts, i am much calmer the more I learn!!!

thanks
kristin

[Ghost]

I've never heard of any relationship between OHSS and miscarriage.

Your case, as bad as you may feel, sounds like it would be classified as mild. Note that hCG used to trigger "ovulation" (technically, final oocyte maturation) induces OHSS, and is the same compound your pregnancy is producing. In fact, your hCG concentration now is much higher than after the shot, and will likely continue to rise (let's pray it does). A potential consequence is that you may experience a second stage of OHSS from this source of hCG. Sounds like what you are seeing. It won't last very long.

You wrote that you had 18 "follicles" frozen. Obviously you meant either eggs or embryos. Did you have eggs frozen? That is pretty rare. Most clinics don't freeze eggs, but embryos.

[kristin]

thanks so much ghost!
Sorry for claiming they could freeze my follicles (a new british innovation)! No I was very lucky as they were able to freeze 18 embryos. I suppose I was trying to understand what you meant below when you wrote (and whether you were implying differential miscarriage rates depending on procedures etc...):

"You have a decent shot at a "BFP" (positive pregnancy test, or big fat positive) in your fresh cycle, but also a good chance of losing it before 10-12 weeks. Be mentally prepared for that. You also have a good chance of pregnancy in FET cycles, and if so, you will probably keep it."

Many thanks again! I feel reassured!
Do you have any ideas as to why my clinic justs scans and does not take betas?

best wishes
Kristin

[Ghost]

thanks so much ghost!
Sorry for claiming they could freeze my follicles (a new british innovation)! No I was very lucky as they were able to freeze 18 embryos.

That's a lot of frozen embryos. You're very fortunate.

I suppose I was trying to understand what you meant below when you wrote (and whether you were implying differential miscarriage rates depending on procedures etc...):

"You have a decent shot at a "BFP" (positive pregnancy test, or big fat positive) in your fresh cycle, but also a good chance of losing it before 10-12 weeks. Be mentally prepared for that. You also have a good chance of pregnancy in FET cycles, and if so, you will probably keep it."

I was referring to the high rate of early pregnancy loss in pregnancies following the use of Lupron instead of hCG to trigger "ovulation", and transfer of fresh embryos. This is found in multiple publications of prospective randomized trials (generally, the best kind). Sorry if I caused any confusion. It seems you received hCG, so that does not apply to you.

Do you have any ideas as to why my clinic justs scans and does not take betas?

Not a clue. You must have had some hCG measurement at some point, or else you would not know you are positive?

[gbnut]

Karen

Did they not keep cheeking your levels and the amount of eggs you had??? on my first course i had 25 and very high levels and they got worried about me but stoped my injections for two days and they i only took a 1/4 of the dose that i was originally on. This helped and i was able to continue.