A few Questions on what to expect.....

[Jools]

Hi All

As I'm getting closer to the main event now, I'm getting a million questions popping into my mind, and hoped some of you who have been through it before, could help?

OK, I did an injection to down reg on day 21. It's now day 27 and no sign of AF (usually 22 - 28 days). Does the down reg ever delay AF? I'm just getting a bit worried as we're having the tmt in Italy, and I'm worried if it does come late, I'll have to extend my flights/holiday booked.

The Italian Dr has told me to take 300 vi of Gonal F daily from day 2 to day 12. When I've read the intructions, this seems a really high dosage. Does it to anyone else?

The Italian Dr has told me he doesn't need to see me until day 7 of my cycle. If I'm on a really high dosage of Gonal F, could I be at risk of OHSS before he sees me?

If I do get OHSS, does that mean the treatment is abandoned, or do they carry on but cut down the drugs? What symptoms should I be watching for if I'm at risk?

Is EC done on day 14, or does it vary if your cycle usually varies? I'm sure that I usually ovulate around day 10 even if I do go 28 days, as that is when I get ovary pain?

How many days is it between EC and ET? I'm guessing a couple, but I'm not sure. The Italian Dr said he needs to see me up until day 20 of my cycle, so once they've done ET, what happens then?

From other threads, it seems like some of you have to go into the clinic after ET for blood tests to moniter some levels during the 2WW. What are these levels, and what should be showing if it's likely to be working/not working? FSH (?) and progesterone seem to be mentioned?

Do the Dr's give you any medication after ET to help implantation? If so, what is normally given and how long for?

Sorry if I'm sounding really thick, but this is my first time (couldn't afford to persue IVF+ICSI in the UK), and as I don't speak Italian (only basic), I'm having to rely on DH and his sister to ask all questions for me. I'm a bit of control freak anyway, and it's definitely freaking me out not being able to speak to the Dr myself!

ANY advice would be really gratefully received!!!

AAAAAARRRRRRRRRRRRRRGGGGGGGGGGGGGGHHHHHHHHH!! 3 days til I fly out!!!!!

Shame they don't have an emoticon for sh*t scared!!

Jools xx

[hope2004]

Jools,
I'm sure you will get lots of responses, here is what I did.
I got AF after taking Lupron for 7 days. I took 250 of Gonal-F starting day 3 then went in for bw and scan on day 7. 300 does not sound high to me and you should be OK re: OHSS because they will see you on day 7 and can lower the dosage. Are you taking anything else? I also took lupron and low dose HCG the whole time. EC is scheduled when your follicles get to the correct size and FSH and estradiol are the right levels. Your cycle is completely being controlled by drugs so forget when you usually ovulate. ET is done usually 3 or 5 days after EC. This is something you should talk about with your doctor. Also you will get a report each day of how your embryos are developing. Starting the evening of ET I took progesterone until pg test. Also Medrol was prescribed for a few days to help implantation. I went back on day 5 after ET for a progesterone blood test, it should be 20 or greater.

I hope this helps. Do you know if anyone in your dtrs office speaks english? Can your DH call and ask them questions in Italian?
Good luck!!

[Mia]

Jools,
I am going to try my best to answer some of your question, but the first thing (and most important) is that every case is different, especially the drug protocol.
1. I did not down reg as there was a concern about ovarian reserve. I can not help you there at all.
2. my dosage began like yours at 300. 3 vials of repronex and 1 vial of gonal-f. EVERYONE'S DRUGS ARE DIFFERENT, and are customized to your situation. I was on 3 and 1 until cylce day 7 when the dosage was reduced to 2 and 1 due to a rapid rising E2 level. Remember, however, I did not down reg and that is likely the cause of my high E2.
3. I think Hope covered the issue of EC and ET very well. An issue that I had with my husband is that he wanted to know when things were going to happen. He could not wrap his head around the idea that things will happen when my doctor says my body is ready and there is no real way of exactly planning when that will be.
4.You will not get OHSS before day 7. I was at risk for OHSS. This can occur if you have greater than 30 follicles or a high E2 level. If E2 is high enough to put you at risk there is number of things you can do. One, the clinic can let you "coast" continue without drugs until E2 falls back to a managable level, or they can continue to EC but postpone ET until another cycle. If you are at risk for OHSS you should not have symptoms until after the HCG (trigger) shot or if you become pregnant. Here is a site I used to monitor any symptoms
http://www2.mc.duke.edu/ivf/hypersti.htm
My doctor was most concerned about rapid weight gain ( explained on the site). OHSS is a factor toward the end of the cycle not in the beginning. You will be fine until you see the doctor.
After ET I was not given any medication nor did I have to go in for any bloodwork until test day.
Good Luck! I know all of this sounds very complicated but a month from now you will be an expert. Trust me
Lots of love,
Mia
P.S. Remember don't let us having the same begining dosage and me being at risk for OHSS scare you. First, I didn't down reg and second I was just at risk no symptoms that were unbearable!

[DebraP]

Hi Jools.....as the pps have said, everyone is different so their drug regimes aren't the same, plus some clinics have their own way of doing things. Having said that, here are some (very) sort-of-answers to your Q.

For my full IVF tmts, I was on Synerala and Puregon so unfortunately have no tips re. drugs except to agree with Mia that OHSS is usually prompted by a very large number of follicles, which take time to form so you're unlikely to have too many/OHSS risk before your doctor has had a chance to see you.

Hope made a good point that once you're on the drugs, forget your old cycle. The meds take over the timing so that the doctors know exactly what to expect and when.

I'm having a FET this time and my clinic scan 4-5 days before ET to check and see that the uterine lining is thick enough. When having a full tmt, there is a scan a few days before EC to count the follies and at this point sometimes the dates change and/or the meds dosage is upped to get things as close to perfect as possible. They might have another scan/check a few days later. Hence Mia's DH being anxious about the lack of control. This not knowing exactly when EC will take place isn't uncommon. Sometimes they think an extra day or two will be needed and so EC is delayed slightly.

My clinic do ET 2 days after EC. The eggs are left to fertilise shortly after EC. We're called in the next day to be told and shown (via a magnified screen) how they did overnight and see how many are left. It's common that some don't fertilise. They should have started to divide by this time so the clinic can give you an idea of how many might make it. The Dr/Bio-Engineer might explain any 'fragmentation' with you. This describes the dividing cells having small pieces breaking off. Too much and they're null and void but a little is seemingly no problem. Provided there are at least 1 or 2 eggs doing well ie. having fertilised and divided overnight, ET goes ahead the following day. Other clinics do things differently, usually a little longer as their protocol is a 5 day transfer. Again, on arrival for ET, it's not uncommon to be told that some didn't make it. That's why you might read that someone has, for instance, 25 follies, then 15 eggs, 10 fertilise, 6 make it to ET, the best 2 are transferred back and if lucky, 4 for freezing for later FETs. I've never had more than 9-10 follies but always had enough for tmt and some for freezing. It seems to be the luck of the draw. It was this freezing of fertilised eggs that I read is now illegal in Italy. Did you discuss it with your clinic?

I suspect the above is super-garbled. Just remember, your cycle/clinic/drug regime will be different from everyone elses so don't worry too much if your tmt doesn't sound exactly the same.

Good luck! and I want to read all about it when you're back and grinning from ear to ear

hugs
Debra.

[Jools]

Dear Hope, Mia & Debra

Thanks for your help, it's a bit clearer now. I'm getting really antsy now waiting for AF to turn up so I can start my stimming injections! I'm not the most patient person in the world so any waiting seems to take forever! God help me on my 2WW (providing it all goes to plan)!

Love Jools xx

[alicia]

Jools,

It looks like you have gotten some very good answers from people who know a lot more about this than I do. Will you have internet access at all in Italy? It might be helpful for you to be able to ask us questions or talk to us if you get nervous. Of course, we aren't doctors, but we do have a lot of collective experience. If nothing else, we can probably help put your mind at ease.

All the luck to you on your cycle. Where in Italy will you be? We love it there and are planning a trip there as soon as we can get away, because we miss the food, the people and the countryside. Hope your dreams come true there!

Alicia

[Jools]

Hi Alicia

I don't know if I'll be able to use the internet whilst I'm in Italy, unless I can pop round my sister in laws and use her computer. I'm soooo going to miss all you girls if I can't! This site has become a lifeline, and I don't know how I would have coped otherwise! Finally, thank the lord, AF arrived properly today (first time I've ever been happy about it!!), so I can finally start my stimming injections tomorrow! I'm still only 80% convinced I've started properly though (always have several false starts), and just waiting for the agony to kick in! I'm getting a bit excited now! Last day at work tomorrow, then bella Italia on Thursday! We fly into Naples where DH's sister lives (and where we'll have tmt), and then we drive about 40 minutes inland to stay with his Dad. It's so beautiful there, and we have the most fantastic view of a mountain out of our bedroom window. I hope it'll be the perfect environment to relax and get our BFP! The only thing I'm gutted about is not being able to take advantage of the bargain wine! I'm presuming you can't drink whilst on the stimming injections, but please feel free to tell me otherwise if I'm wrong!

Anyway, take care of your BFP, and I hope to hear all about the glories of morning sickness when I return! (although I won't be offline til Thurs!)

Love Jools xxx

[alicia]

Jools,

When AF came after downregging for me, it was very light and only really one day. So don't think it isn't the "real" AF if it is short/light. It still counts.

Alicia

[ogr1]

i want to go to italy with you

try and relax
cant help with the info you needed. that was my hubbys department.
i have taken baby asprin lupron estrace clomid progestrone.
good luck ! and try and enjoy

becky