Too much abdominal fluid to continue IVF cycle?

[T3]

Hello ladies,

So I've started my second IVF cycle a few weeks ago and did a base-line ultrasound today before starting the gonad-F cycle. They told me today that I still have too much fluid from the last over stimulation and can't continue the cycle. They want me to continue the lupron and do another ultrasound in 1 weeks. The chance of the fluid going down in 1 week is probably slim since it's been a month since my last stimulation and the fluid has improved but hasn't gone away completely. Has this happen to anymore? When doing IVF do you necessary have to skip a month so that all that fluid get resorb before starting another cycle?

I feel like I've just wasted a lot of money once again. I knew IVF can be depressing and confusing, but I didn't know if was going to be this bad.

Anyone with some answers... please help

thanks,
t3

[Ghost]

Hello ladies,

So I've started my second IVF cycle a few weeks ago and did a base-line ultrasound today before starting the gonad-F cycle. They told me today that I still have too much fluid from the last over stimulation and can't continue the cycle. They want me to continue the lupron and do another ultrasound in 1 weeks. The chance of the fluid going down in 1 week is probably slim since it's been a month since my last stimulation and the fluid has improved but hasn't gone away completely. Has this happen to anymore? When doing IVF do you necessary have to skip a month so that all that fluid get resorb before starting another cycle?

I feel like I've just wasted a lot of money once again. I knew IVF can be depressing and confusing, but I didn't know if was going to be this bad.

Anyone with some answers... please help

thanks,
t3

We've never had a patient like that in my memory, but we don't get much OHSS at my clinic.

Yes, OHSS can waste a lot of time and money, in addition to being painful and dangerous. You may want to find a clinic that is better at avoiding it.

If they put you on the usual Lupron protocol and triggered you with hCG, you may want to look elsewhere. A better approach may be to put you on an antagonist protocol (like ganirelix) so they can use Lupron for the trigger. Avoiding the hCG avoids the OHSS risk.

Some clinics will only do Lupron triggers if they freeze all the embryos because the luteal support protocol after a Lupron trigger is tricky. The University of Connecticut has worked it out nicely, and has good success with fresh transfers following Lupron triggers, but even if your clinic will only do "all freeze" cycles after Lupron trigger, if they have good FET success rates, then it's still a great option. Say goodbye to all that pain and delay.

If I was anywhere near the University of CT and was PCO, I'd see them.

Here's their SART page:

https://www.sartcorsonline.com/rptCSR_P ... cPKID=2072

I have no affiliation with them, by the way.

[T3]

Ghost,

Thanks for the info... I'm in Springfield and the clinic in springfield seems to have pretty good success rate with fresh embryos. I also work close to the area and CT would be an hr hike which would be difficult for blood test, u/s, etc.

Their success rate with frozen embryo seems pretty low, 22%. I have 1 frozen embryo after the first IVF, if this fluid does not go away by next week, you think they can just do the frozen embryo instead? I know it's a low chance with 1 embryo, but something is better than nothing right?

I thought most people do the lupron then gonadal F and trigger with hcg. I'll have to ask my fertility doc about that and maybe do another protocall.

thanks a lot for the help.
t3

[Ghost]

Ghost,

Thanks for the info... I'm in Springfield and the clinic in springfield seems to have pretty good success rate with fresh embryos. I also work close to the area and CT would be an hr hike which would be difficult for blood test, u/s, etc.

Their success rate with frozen embryo seems pretty low, 22%. I have 1 frozen embryo after the first IVF, if this fluid does not go away by next week, you think they can just do the frozen embryo instead? I know it's a low chance with 1 embryo, but something is better than nothing right?

I thought most people do the lupron then gonadal F and trigger with hcg. I'll have to ask my fertility doc about that and maybe do another protocall.

thanks a lot for the help.
t3

Yes, I'd use the frozen embryo before doing a fresh cycle. Frozen embryo cycles are much cheaper and safer than fresh cycles, and besides, if you are not going to use your frozen embryo, why pay the storage fees for it?

Yes. About 80-90% of cycles of ovarian stimulation in the United States use Lupron for pituitary down regulation, while using an FSH product (such as Gonal F, Follistim, Menopur, Bravelle, or Repronex) to stimulate the ovaries. In this case, you are pretty much stuck with using hCG for the trigger. This is called the long protocol or long Lupron protocol. Many clinics use this protocol for everyone out of habit, although it is dangerous for patients with many follicles.

Most of the rest of the cycles use a GnRH antagonist (such as ganirelix or Cetrotide) to suppress the pituitary, while using an FSH product to stimulate the ovaries. In this case, the trigger may be hCG or Lupron. If hCG is used, it has about the same OHSS risk as the Lupron cycle described before, but if Lupron is used for the trigger and hCg is avoided, then OHSS becomes virtually impossible.

If you are going to do a fresh transfer after a Lupron trigger, then the luteal support must be exactly like that published by the University of CT. The Lupron trigger eliminates OHSS risk because the LH surge is short-lived and is fading away about the time the eggs are retrieved. Lacking LH or hCG activity, the corpora lutea soon die and stop making the hormone responsible for OHSS (that hormone is called VEGF, and it causes vascular hyperpermeability, the reason you have fluid in your abdomen), but they also stop making estradiol and progesterone. There's the problem with a fresh transfer, and it's called luteal phase defect. Many clinics have tried Lupron triggers but had poor success because they did not adjust the luteal support to allow for the sudden loss of the corpora lutea. UConn allowed for it and gets good success rates. The eggs are fine and many clinics have found Lupron triggers work great if the embryos are frozen (or in donor cycles, where the corpora lutea in the donor are irrelevant to the recipient).

I can explain it further if you'd like.

[T3]

Ghost,
I understand the lupron cycle. I'll ask my fertilty doc about it. after the transfer I was on E and P replacement so the two protocol isn't all that different. How long do you think the fluid will take to reabsorb? You think I'll get to a point were I need a paracentesis to get it out? They only did two measurement so it's hard to calculate a volume. They said it's a 5.5 by 3 cm pocket.

Thanks, t3

[Ghost]

Ghost,
I understand the lupron cycle. I'll ask my fertilty doc about it. after the transfer I was on E and P replacement so the two protocol isn't all that different. How long do you think the fluid will take to reabsorb? You think I'll get to a point were I need a paracentesis to get it out? They only did two measurement so it's hard to calculate a volume. They said it's a 5.5 by 3 cm pocket.

Thanks, t3

I don't know how long it will take. Seems to me it's normally gone by now, but we rarely get OHSS cases (2 years since the last one), so I just don't know.