PCOS ladies doing IVF

karenthescorpio · Post by **karenthescorpio** » Sat Dec 05, 2009 12:41 am

Hi ladies. I wanted to know what protocol any of you PCOS ladies are on for IVF. What meds? If you already had a fresh cycle, did it go well? What, if any, complications/issues did you have? How many IVF cycles did it take to get pregnant/baby?

I'm starting IVF #2 next month...and it seems the issues I had with #1 have lead my RE to treat me like a full blown PCOS patient. My pituatary gland wouldn't keep quiet during #1 and caused my lining to start luteinizing too soon. My estrogen would go up and then down. So had to freeze all embies. Plus had mild OHSS after ER. I had 17 eggs during ER but only 10 mature and RE said they looked like they were chewed on by dogs. We did get 5 blasts from the batch, though. Now I'm going to be on the lupron down regulation protocol...which RE says is better for me issues. I'm a bit worried about over suppressing. Has has your experience been with IVF while managing PCOS? Ironically, our initial reason for IVF is DH low sperm/motility/poor morph.

Ghost · Post by **Ghost** » Sat Dec 05, 2009 2:07 am

karenthescorpio wrote:Hi ladies. I wanted to know what protocol any of you PCOS ladies are on for IVF. What meds? If you already had a fresh cycle, did it go well? What, if any, complications/issues did you have? How many IVF cycles did it take to get pregnant/baby?

I'm starting IVF #2 next month...and it seems the issues I had with #1 have lead my RE to treat me like a full blown PCOS patient. My pituatary gland wouldn't keep quiet during #1 and caused my lining to start luteinizing too soon. My estrogen would go up and then down. So had to freeze all embies. Plus had mild OHSS after ER. I had 17 eggs during ER but only 10 mature and RE said they looked like they were chewed on by dogs. We did get 5 blasts from the batch, though. Now I'm going to be on the lupron down regulation protocol...which RE says is better for me issues. I'm a bit worried about over suppressing. Has has your experience been with IVF while managing PCOS? Ironically, our initial reason for IVF is DH low sperm/motility/poor morph.

My clinic uses the protocol published by the University of Connecticut (Engmann et al, 2008) for PCO patients. Antagonist cycles, trigger with the Lupron, not hCG. OHSS is not a concern because there is no hCG to support it. No coasting needed, either.

Hopeful Heather · Post by **Hopeful Heather** » Sat Dec 05, 2009 4:47 am

I have PCOS and also had issues with my pituitary gland. Im 36 and DH is 41. He also has low sperm count. My journey started in January this year. I had a high prolactin level and discovered my ovaries were enlarged, hence the PCOS. My IVF specialist put me on Metformin 500 mg to start off with and 1 Dostinex twice a week (which had really bad side effects) for the high prolactin level and by June I was up to Metformin 2000 mg a day for the PCOS and my prolactin level had come down and I was only taking 1 Dostinex once a week. I then started b/c pills and took them all of June and July as I continued the Metformin 2000 mg and the Dostinex once a week. My IVF specialist didnt put me on Lupron because he said my bloodwork looked good. So I started on Follistim and Menopur. Did those for 10 days. He did a low dosage so I wasn't OHSS. We used 10,000 hcg trigger and I ended up with 11 eggs, 2 weren't matured, fertilized 9 with icsi. Ended up with 3 grade AA and transferred 2 and froze 1. This was my first IVF and Im now currently 20 weeks pregnant.

karenthescorpio · Post by **karenthescorpio** » Sat Dec 05, 2009 3:22 pm

Hopeful Heather & Ghost:

Thanks for your feedback! I'll be using Follistim...not sure about Menopur this time. I used both with IVF #1 and triggered w/ Ovidrel. Not sure what they will use to trigger this time. I will share Ghost's insight with him regarding the trigger med. My RE said I need the Lupron during stimming to keep my pituatary quiet. Is this true? This was my biggest issue from #1 and why we had to freeze all. I had a good response otherwise to my stim meds.

Even though my prolactin, insulin and blood sugar have all been normal, thank goodness, my RE did have me start Metformin the day after Tgiving. I'm working up my dosage to 1500 (3 pills at dinner). Also had to switch to a low fat/low carb diet. I don't even need to lose weight, but I have noticed a slight weight loss already by just removing extra carbs. I only eat whole grain carbs now, and little of them. No sugar at all. He believe all of these will help improve any effects from the slight PCO. And as long as I can tolerate the Metformin, why not. So far so good. I just want to make sure I'm on the best protocol for PCO.

Ghost · Post by **Ghost** » Sat Dec 05, 2009 4:02 pm

karenthescorpio wrote:Hopeful Heather & Ghost:

Thanks for your feedback! I'll be using Follistim...not sure about Menopur this time. I used both with IVF #1 and triggered w/ Ovidrel. Not sure what they will use to trigger this time. I will share Ghost's insight with him regarding the trigger med. My RE said I need the Lupron during stimming to keep my pituatary quiet. Is this true? This was my biggest issue from #1 and why we had to freeze all. I had a good response otherwise to my stim meds.

Even though my prolactin, insulin and blood sugar have all been normal, thank goodness, my RE did have me start Metformin the day after Tgiving. I'm working up my dosage to 1500 (3 pills at dinner). Also had to switch to a low fat/low carb diet. I don't even need to lose weight, but I have noticed a slight weight loss already by just removing extra carbs. I only eat whole grain carbs now, and little of them. No sugar at all. He believe all of these will help improve any effects from the slight PCO. And as long as I can tolerate the Metformin, why not. So far so good. I just want to make sure I'm on the best protocol for PCO.

I agree about the carbs 100%.

rikirees · Post by **rikirees** » Sun Dec 06, 2009 4:28 am

I have PCOS and after many failed IVF cycles including OHSS, I changed to an RE that had extensive experience with PCOS. I got a BFP with my first cycle with him, resulting in my DD and again this August I had ER. We used Follistim for the stims, however we did 2 things that were totally different at the end 1. NO HCG trigger, we used Lupron to trigger ovulation 2. Froze all fertilized eggs on day 1. The Lupron trigger approach does not usually result in a fresh transfer. It does something to the lining that makes the lining not optimal for fresh transfer. By freezing all, it gives your body recovery time after ER. Then they can focus on just your lining for an FET cycle. The down side to this is it is more time consuming and more $ since oyu need to do an ER then FET. But i have to say it has worked for me TWICE

If you have any more questions, let me know. Good Luck!

Ghost · Post by **Ghost** » Sun Dec 06, 2009 5:01 am

rikirees wrote:I have PCOS and after many failed IVF cycles including OHSS, I changed to an RE that had extensive experience with PCOS. I got a BFP with my first cycle with him, resulting in my DD and again this August I had ER. We used Follistim for the stims, however we did 2 things that were totally different at the end 1. NO HCG trigger, we used Lupron to trigger ovulation 2. Froze all fertilized eggs on day 1. The Lupron trigger approach does not usually result in a fresh transfer. It does something to the lining that makes the lining not optimal for fresh transfer. By freezing all, it gives your body recovery time after ER. Then they can focus on just your lining for an FET cycle. The down side to this is it is more time consuming and more $ since oyu need to do an ER then FET. But i have to say it has worked for me TWICE
If you have any more questions, let me know. Good Luck!

The Lupron trigger kills the corpora lutea, so they can make no more VEGF (hence no OHSS) but they also stop making estradiol and progesterone. Therefore these hormones need to be supplemented immediately.

But the freezing is a great idea, too. No surprise it worked.

me2009 · Post by **me2009** » Sun Dec 06, 2009 8:37 am

karenthescorpio wrote:Hopeful Heather & Ghost:

Thanks for your feedback! I'll be using Follistim...not sure about Menopur this time. I used both with IVF #1 and triggered w/ Ovidrel. Not sure what they will use to trigger this time. I will share Ghost's insight with him regarding the trigger med. My RE said I need the Lupron during stimming to keep my pituatary quiet. Is this true? This was my biggest issue from #1 and why we had to freeze all. I had a good response otherwise to my stim meds.

Even though my prolactin, insulin and blood sugar have all been normal, thank goodness, my RE did have me start Metformin the day after Tgiving. I'm working up my dosage to 1500 (3 pills at dinner). Also had to switch to a low fat/low carb diet. I don't even need to lose weight, but I have noticed a slight weight loss already by just removing extra carbs. I only eat whole grain carbs now, and little of them. No sugar at all. He believe all of these will help improve any effects from the slight PCO. And as long as I can tolerate the Metformin, why not. So far so good. I just want to make sure I'm on the best protocol for PCO.

not to scare you, but they had me on metformin the month before i stim and through my trigger...

i too am a thin person and dont have weight issues.

so be warned.. it made me super sick for about 2-3 weeks. i have sever nausea and vomiting... ended up going to the ER one night since i couldnt stop puking. about week 3 i started to get used to the med.

i couldnt keep up with all of the protine intake...im a picky eater as it is.. well im a light eater. (not complaining)

so just becareful everyone has different reactions to metformin.

when i started to get nauseated, i would drink OJ just to get the nausea to stop, hence my blood sugars were dropping... then i try to eat something protien...

i think i had a bad experience, but im 4- almost 5 weeks prego, so in hind site it was worth the crap of the meds!...

good luck!

karenthescorpio · Post by **karenthescorpio** » Sun Dec 06, 2009 1:56 pm

me2009- I appreciate your feedback. I have been fortunate so far with the Metformin. Hopefully things will stay that way! I've been pretty careful to not let my blood sugar get low. That's why I eat whole grain carbs in small amounts. I know what you mean about the protein. My appetite has really dropped. But I guess that's a good thing! I'm planning on eating a small amount of holiday sweets, so I'm sure that'll make up for it!

HopefulHeather- congrats on your pregnancy!!!!

Hopeful Heather · Post by **Hopeful Heather** » Sun Dec 06, 2009 3:11 pm

Thanks! I also wanted to let you know that I had previous IUI's that failed due to the PCOS and being overstimulated. My previous "Specialist" took me off Metformin as soon as I became pregnant in 2008 and had a miscarriage at 9 weeks. Its VERY important to see a Specialist that does the proper blood work. While in the hospital having a d/c the hospital did lab work and I found out my A1C was elevated and it was probably the cause of the miscarriage. The babies heart couldn't function with my blood sugars that were obviously elevated since being taken off the Metformin. I was later diagnosed with Type 2 diabetes. So I'm on insulin now with this pregnancy along with Metformin and I'm doing really well. My advice is to read a lot! Ask a lot of questions, no question is dumb or stupid if you have a care or concern! I interviewed many Specialists until I found the one that liked the fact that I did research and asked questions. I had to drive 1 1/2 hours to my doctor visits and had to drive 3 1/2 hours to have my procedures, and my husband was deployed to Afghanistan during my IVF process but I wouldn't trade a minute of it. Sure it was quite comical him coming home to a newly pregnant wife, but all his soldiers were very supportive. We are very thankful.

PCOS ladies doing IVF

PCOS ladies doing IVF

Re: PCOS ladies doing IVF

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