GHOST- Stimming for FET and ovulation

[BlissfulCS]

Hi Ghost. It has been awhile!
I am in the middle of a FET and am completely confused because it seems my RE does things a lot differently than most.

First & main question- will gonal f suppress ovulation at all?

I started a low dose of gonal f on CD5 (also 4 mg of estrace vaginally). First ultasound on CD 10 showed lots of little follicles that were all just below 10. However on the left ovary there was one that the tech measuread at 13 but looked like it could be a cycst with a septation (if measured as a cyst it would have been 24). Since I am over 3 hours away I monitor at a local hospital and decided to do my next u/s at my clinic and make the drive to make sure it was a cyst and not a lead follicle developing.

So yesterday on CD 12 the u/s at my clinic showed almost no growth of my follicles. All follicles except the cyst were still just under 10 and no apparent dominant follicles developing. I asked if it was possible that I ovulated and was told "we don't think so". So the plan from here is to keep stimming through the weekend and then an u/s on Monday. However I am not on anything to supress ovulation and I normally ovulate on CD11 like clockwork. Plus the RE is not doing any bloodwork. He never measures P4, only an estrogen.

I am really confused as to why they wouldn't just do the blood work to know for SURE that the "cyst" is really a cyst and not a follicle which has released an egg.

But my biggest concern is, what is to stop me from ovulating over the next three days? Do menotropins themselves do anything to suppress ovulation? I asked the nurse this question and she said "we aren't worried because your follicles are so small".

[Ghost]

Hi Ghost. It has been awhile!
I am in the middle of a FET and am completely confused because it seems my RE does things a lot differently than most.

First & main question- will gonal f suppress ovulation at all?

I started a low dose of gonal f on CD5 (also 4 mg of estrace vaginally). First ultasound on CD 10 showed lots of little follicles that were all just below 10. However on the left ovary there was one that the tech measuread at 13 but looked like it could be a cycst with a septation (if measured as a cyst it would have been 24). Since I am over 3 hours away I monitor at a local hospital and decided to do my next u/s at my clinic and make the drive to make sure it was a cyst and not a lead follicle developing.

So yesterday on CD 12 the u/s at my clinic showed almost no growth of my follicles. All follicles except the cyst were still just under 10 and no apparent dominant follicles developing. I asked if it was possible that I ovulated and was told "we don't think so". So the plan from here is to keep stimming through the weekend and then an u/s on Monday. However I am not on anything to supress ovulation and I normally ovulate on CD11 like clockwork. Plus the RE is not doing any bloodwork. He never measures P4, only an estrogen.

I am really confused as to why they wouldn't just do the blood work to know for SURE that the "cyst" is really a cyst and not a follicle which has released an egg.

But my biggest concern is, what is to stop me from ovulating over the next three days? Do menotropins themselves do anything to suppress ovulation? I asked the nurse this question and she said "we aren't worried because your follicles are so small".

Gonadotropins (including menotropins) will not prevent premature ovulation. This was a major problem for stimulation for IVF until the early 1990s when they released GnRH agonists (like Lupron) and we could start using agonists to prevent premature ovulation.

At this point, a GnRH agonist would cause you to ovulate immediately. You'd need to start them long before the current cycle and continue daily use to deplete the pituitary's ability to release an LH surge. An agonist causes an LH surge when first taken, but desensitizes the pituitary with continued daily use.

The other way to prevent a surge is with the GnRH antagonists (like ganirelix or cetrotide). These work immediately to shut down the pituitary. No LH surge occurs with the first dose of antagonist, and they are routinely started well into stimulation. The antagonists were developed and approved for this specific purpose.

There are other ways to suppress ovulation, and some have been tried in research. Estradiol blockers (like Clomid), for example, just might work.

Are you taking anything else?

Since you are collecting eggs for a future FET, your progesterone levels might be considered irrelevant. Progesterone matures the uterine lining, and you are not going to use this lining, but a future one instead. However, progesterone does play a role in inducing the hypothalamus to release GnRH, which then causes the pituitary to release LH (and FSH).

[BlissfulCS]

No I am only on the gonal f and the estrace. Just to clarify, I already have 8 frozen embryos and am stimming to transfer three of those. The RE always stims during FET. It seems that is pretty unique. They have only measured estradiol and didn't even do that today. My ultrasound today has my biggest follicle at 10 and I'm on CD15 now. The "cyst" now looks a little more like 2 follicles at 12 and 15. RE says he doesn't think I have ovulated and we are now just basing trigger and transfer on follicle size.

[Ghost]

No I am only on the gonal f and the estrace. Just to clarify, I already have 8 frozen embryos and am stimming to transfer three of those. The RE always stims during FET. It seems that is pretty unique. They have only measured estradiol and didn't even do that today. My ultrasound today has my biggest follicle at 10 and I'm on CD15 now. The "cyst" now looks a little more like 2 follicles at 12 and 15. RE says he doesn't think I have ovulated and we are now just basing trigger and transfer on follicle size.

If I may ask, which clinic is that?

[BlissfulCS]

The fertility center grand rapids (Michigan reproductive and IVF)

[Ghost]

The fertility center grand rapids (Michigan reproductive and IVF)

I was curious about the success rates with that method and wondered why it should be worth the added expense of stim drugs.

Their frozen success rates on SART seem about average.

[BlissfulCS]

I assumed that is why you were asking. They are the only clinic I have ever used and until this cycle assumed all clinics stimmed for FET. I will say this, that beautiful girl in my signature below came from the same type of FET with this clinic.

We did an LH and a P4 yesterday and it appears I haven't ovulated. Ultrasound tomorrow. I wonder if the stimming for FET would have anything to do with the fact that they are also one of the only clinics I know of that does 2 day transfers and also does not monitor progesterone at all.

[BlissfulCS]

Ghost- just had my appointment and the follicles still arent developing so RE is recommending that we just treat it like a suppressed cycle and move forward. He will be calling me with a plan later today. Transfer should be soon.

I asked why we stimmed for FET since it seemed pretty rare. He acknowledged that it is a really old protocol and very few clinics still use it. Their theory has always been that perhaps ovulation has implantation benefits that we dont know about yet. He says they use other protocols and the success rates have been the same. So I am not sure why they have stayed with it given the extra cost to the patient, I dont know what the benefit is for the clinic either because it seems like they would be able to control timing better using another protocol. Oh well, I am just happy to be moving forward.

In all the excitement I forgot to ask why my follicles arent developing and why I am not ovulating when that hasnt been an issue in the past but I forgot to ask. I will follow up later wiith him on this but as always interested in an thoughts you might have.

Thanks

[Ghost]

Ghost- just had my appointment and the follicles still arent developing so RE is recommending that we just treat it like a suppressed cycle and move forward. He will be calling me with a plan later today. Transfer should be soon.

I asked why we stimmed for FET since it seemed pretty rare. He acknowledged that it is a really old protocol and very few clinics still use it. Their theory has always been that perhaps ovulation has implantation benefits that we dont know about yet. He says they use other protocols and the success rates have been the same. So I am not sure why they have stayed with it given the extra cost to the patient, I dont know what the benefit is for the clinic either because it seems like they would be able to control timing better using another protocol. Oh well, I am just happy to be moving forward.

In all the excitement I forgot to ask why my follicles arent developing and why I am not ovulating when that hasnt been an issue in the past but I forgot to ask. I will follow up later wiith him on this but as always interested in an thoughts you might have.

Thanks

So they will convert it into a typical hormone replace FET cycle? Not sure why, but I'm glad to hear that. It just seems odd to stim for FET. I've heard of it, but we've never done it that I know of and I don't recall discussing such a cycle with anyone before.

As for lack of follicle development, it may be that the "low" dose they started you on was just not enough, and you are a little older now?

[BlissfulCS]

Yes- converting into a typical hormone replacement cycle. Started progesterone last night for a transfer of 3 2day embryos Saturday. I did read some research on stimming with FET when the lining tends to be thin, which has been the case for me but I have the impression that this is still the clinics primary FET protocol. RE even called it an "old" protocol and said they tried others but saw no difference in success rates. I get the sense that they still believe there may be some benefit to ovulating. I know they do 2 day transfers because the clinic believes Mom is superior to an incubator. So if it is possible for a clinic to be "naturalist", its mine! I think they just try to mimic the natural cycle as closely as possible and also stick with what has worked for them which in many ways I like that.

As far as lack of response, I had regular 26 to 27 day cycles before having Evelyn. After stopping breastfeeding they lengthened to 31 days. But still consistent so I assume I have been ovulating.

RE did originally order 2 mg of estrace and I called and got approval to increase to 4 because that is what I did with my daughter. At one point my estradiol was over 2500. He thinks maybe the extra estrogen shut down the receptors. Not sure exactly what that means. Ill worry about it if I DON'T get pregnant this cycle.

Thanks so much Ghost.