Ghost or anyone-- No U/S-Bloodwork during Stims?

[JenMink55]

Okay, so my RE doesn't believe in mid cycle monitoring. I have been on Stims since Sunday and I don't have an appointment until Monday the 4th for an Ultrasound. I am really worried because Fresh cycle #1 I almost overstimulated and they were monitoring me every 3rd day of stims. Should I insist RE checks me before Monday?! Is this normal to not monitor mid Stims? I am really crampy and today is day 4 of stims. I am sure this is normal, but what would be the symptoms of OHSS?

Any feedback would be great. Thank you in advance Ghost!

Jennifer

[Ghost]

Okay, so my RE doesn't believe in mid cycle monitoring. I have been on Stims since Sunday and I don't have an appointment until Monday the 4th for an Ultrasound. I am really worried because Fresh cycle #1 I almost overstimulated and they were monitoring me every 3rd day of stims. Should I insist RE checks me before Monday?! Is this normal to not monitor mid Stims? I am really crampy and today is day 4 of stims. I am sure this is normal, but what would be the symptoms of OHSS?

Any feedback would be great. Thank you in advance Ghost!

Jennifer

Well, my clinic always does the monitoring, with ultrasounds and blood tests for E2 level. Are you on a Lupron cycle? Or an antagonist (ganirelix or cetrotide) cycle?

There is no true OHSS on day 4 of stims. If OHSS occurs, it starts after the trigger shot, not before.

[JenMink55]

Used Lupron (10) for suppression and now on 300 Gonal-F and 175 Menupur, 5 Lupron. They never even checked to see if I was suppressed or did bloodwork for E2 levels. This clinic does things a lot different than my old clinic. Just wondering if this is standard?

[Ghost]

Used Lupron (10) for suppression and now on 300 Gonal-F and 175 Menupur, 5 Lupron. They never even checked to see if I was suppressed or did bloodwork for E2 levels. This clinic does things a lot different than my old clinic. Just wondering if this is standard?

Well, my clinic would not do it that way. If I was you, I would ask for the monitoring or some assurance that the lack of monitoring is not an issue.

How are their success rates?

[riogirl71]

This is what my clinic did:

day 0 I started AF Estradiol and progesteron levels
day 1 started follistim/menopur/Femara
day 2 I did Estradiol/progesterone levels and had a baseline US
day 5 Estradiol/progesterone levels and had a US - that's when I started Ganirelix and did it for 4 days
then again E2/prog/US on day 7 and 8 and triggered on day 8
ER day 10

I thik it is really weird they don't monitor you at all to chage med doses based on response, red flag...

Good luck!

[JenMink55]

Hi Rio!

Yes, it's odd... I contacted my clinic today and shared my concerns. The nurse assured me that it was fine and they would see me on Monday. She said after the U/S if there were any concerns that the RE would order blood tests. Seriously though I am really freaking out about this!!!! Nobody I have talked to has an RE that doesn't check mid stims.

I guess I have to put my faith somewhere so I guess all I can do is wait until Monday (

[Ghost]

Hi Rio!

Yes, it's odd... I contacted my clinic today and shared my concerns. The nurse assured me that it was fine and they would see me on Monday. She said after the U/S if there were any concerns that the RE would order blood tests. Seriously though I am really freaking out about this!!!! Nobody I have talked to has an RE that doesn't check mid stims.

I guess I have to put my faith somewhere so I guess all I can do is wait until Monday (

I have heard of it, but not in high responders. If you were on a ganirelix protocol, I could understand. Then they could trigger with Lupron and then no OHSS. But you are using Lupron for down regulation, so the trigger must be hCG. If you have a huge number of follicles, then they will have three options: Withhold the trigger and cancel the whole cycle, give the trigger but freeze all the embryos (risking brief OHSS), or else give the trigger and proceed with fresh transfer and risk a serious case of OHSS.

[Ghost]

JenMink, I wish I could put your mind at ease, but I do think it is unusual not to be monitored during stim. My clinic does daily labs during stim and U/s about every other day. Can you call and ask to speak to your RE? Just remember that if everything looks okay on Monday you're chances are great for a babe this cycle and don't let the lack of monitoring psych you out. I think monitoring is the safest way to go, but if all looks good on Monday and they are least check your E2 once before your retrieval, I think you should still have lots of PMA!

Agreed. I was a bit upset when I read her posts. I like your more supportive tone. I need to learn that.

It's not a huge thing, I suppose. Most patients have little adjustment to their cycles during stim, and most times the monitoring achieves nothing but to confirm expectations.

[riogirl71]

100% with SD - you don't need to change anything, your honesty is much appreciated!