question: natural vs. low stim

question: natural vs. low stim

BroodyHen
BroodyHen

April 4th, 2012, 6:29 am #1

hi ladies. i'm just looking for some input as i gear up for what will probably be my last cycle trying. or my last cycle with all the bells and whistles. i can't keep taking steroids, lovenox, ivig, etc... it is too risky, too expensive, just too much. i may keep trying naturally, but that seems moot due to the antiiphospholipid syndrome, clotting issues, nk cells, etc. without treatment, i think it is basically over.

my question - to stim or not to stim. i have a bunch of follistim in the fridge, so i'm ready to go. but i wonder if it is worth it to add more drugs into the ridiculous cocktail of chemicals i'm already soaking in. i read on this board a couple of weeks ago about how you need to stim for a certain minimum number of days for success. does this only apply if you are doing IVF? i should clarify that i would be doing low stim using follistim for TI. i have tried it 3 times - twice i got a lead follicle, and the last time i got 4 follicles in play but still a BFN. each time i started the follistim on day 2 or 3 and things went really quickly and i was triggering early like on day 8 or 9 = only 6 or 7 days of stims . i worry that accelerating my cycle so much can't be good. i normally would ovulate on day 12 or 13 (unless of course the progesterone support delays my cycle in which case i tend to get an early recruit and ovulate early).

what would you do? i tend to lean towards natural but i don't know what i'm doing! thanks in advance for any input. i really appreciate it.
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Kim
Kim

April 4th, 2012, 4:28 pm #2

Taking meds without any suppression (like BCP or estrogen priming). I too O early at days 11-12 but that has been normal for me since I was younger given my always shorter cycles. Any way, you could try the meds. Generally RE's like you to stim for 8-11 days for a good range, although I think women with shorter cycles will tend to stim on the shy side or 8 days. If you start out with the femera then add in the follistim, maybe you can get to the 8 days of stims if you start on day 2 of your cycle?
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Antonialisa
Antonialisa

April 4th, 2012, 9:43 pm #3

Hi Broody!

I think Kim is on the right track.

If you don't want to do lupron or bcp, you could also try doubling up on estace, taking it through the luteal phase until the day you start the stims. This is what I did this cycle, and I triggered on day 12 with 2 follicles at 20mm. I actually just went off estinyl on day 1 and let my own surging fsh do the stimming. I did a tiny boost of gonal f as well just in the last few days before ovulation.

Getting 2 follicles of exactly the same size just by doing what I described was twice as good as my 2 attempted IVFs at Coopers which both resulted in a lead follicle and cancellation. Sometimes I think we know better than the docs.

Good luck to you.
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BroodyHen
BroodyHen

April 5th, 2012, 5:58 am #4

Taking meds without any suppression (like BCP or estrogen priming). I too O early at days 11-12 but that has been normal for me since I was younger given my always shorter cycles. Any way, you could try the meds. Generally RE's like you to stim for 8-11 days for a good range, although I think women with shorter cycles will tend to stim on the shy side or 8 days. If you start out with the femera then add in the follistim, maybe you can get to the 8 days of stims if you start on day 2 of your cycle?
stims if you don't increase the number of eggs? i've asked this question before - is there some way that a gentle stimming helps that one egg?

femera is an interesting idea. i've never thought about that. i should have mentioned that i can't take estrogen because of the clotting disorder, but i think femera is a different mechanism. i don't know anything about it, so i'll look into it. maybe worth it to add to the mix for a last hurrah. or maybe i've already answered my own question - that i'm drugged up and enough is enough. there is, of course, also the stress of monitoring a cycle that makes me think maybe a more relaxed natural cycle is the way to go. aaargh! i've read on this board both sides of the natural vs ART debate and both are convincing.

thanks, kim!
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BroodyHen
BroodyHen

April 5th, 2012, 6:02 am #5

Hi Broody!

I think Kim is on the right track.

If you don't want to do lupron or bcp, you could also try doubling up on estace, taking it through the luteal phase until the day you start the stims. This is what I did this cycle, and I triggered on day 12 with 2 follicles at 20mm. I actually just went off estinyl on day 1 and let my own surging fsh do the stimming. I did a tiny boost of gonal f as well just in the last few days before ovulation.

Getting 2 follicles of exactly the same size just by doing what I described was twice as good as my 2 attempted IVFs at Coopers which both resulted in a lead follicle and cancellation. Sometimes I think we know better than the docs.

Good luck to you.
nice to hear from you. i've been wondering how you've been doing. sounds like you're in the middle of a great IVF cycle. i'm so glad to hear about your two juicy eggs. exciting! did you move on from c ooper?
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Kim
Kim

April 5th, 2012, 1:35 pm #6

stims if you don't increase the number of eggs? i've asked this question before - is there some way that a gentle stimming helps that one egg?

femera is an interesting idea. i've never thought about that. i should have mentioned that i can't take estrogen because of the clotting disorder, but i think femera is a different mechanism. i don't know anything about it, so i'll look into it. maybe worth it to add to the mix for a last hurrah. or maybe i've already answered my own question - that i'm drugged up and enough is enough. there is, of course, also the stress of monitoring a cycle that makes me think maybe a more relaxed natural cycle is the way to go. aaargh! i've read on this board both sides of the natural vs ART debate and both are convincing.

thanks, kim!
because sometimes it sounds like the egg can be a little immature. I know Dr. C office sometimes has the patients take 75iu of repronex then trigger the next day, so based on this I'm sure they are giving a little boost to the follicle to ensure it is mature enough to fertilize. I know from a retrieval that all follicles over 19mm fertilized right away and I bet the one lagger at 16.7mm at retrieval fertilized late because it was not quite mature. This was all natural fertilization (without ICSI).

Hard to say, but I think it is better to give the boost of meds around O time and then trigger or not. That way you give just a little FSH (and LH) at the end to make the best? I like this idea.
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Kim
Kim

April 5th, 2012, 1:37 pm #7

I've been playing with the idea this cycle to take 75iu of menopur soon as I should be surging in the next day. I just wanted to do natural this cycle though.

Let me know what you decide.
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Antonialisa
Antonialisa

April 5th, 2012, 2:38 pm #8

nice to hear from you. i've been wondering how you've been doing. sounds like you're in the middle of a great IVF cycle. i'm so glad to hear about your two juicy eggs. exciting! did you move on from c ooper?
Broody!

I'm laying low a bit. Based on our finances, DH and I decided not to do OE IVF but save up for DE IVF given the much better success rates. Costs a lot and we don't have insurance.

In the meantime, I'm doing creative TI cycles, with nothing to lose. As I said above, this cycle I simply went off estrogen early and let my own high FSH give me the boost and I got 2 eggs this way. (I also did a baby dose of gonal f but will explain that later in the thread). 2-3 months of 2 eggs each give give me as many eggs as an IVF cycle could ever...and it costs next to nothing.

If you can't take estrogen, I'm not sure what to advise because I don't have experience with other drugs.

Good luck, Broody! I really, really hope this is your cycle.
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Antonialisa
Antonialisa

April 5th, 2012, 2:50 pm #9

stims if you don't increase the number of eggs? i've asked this question before - is there some way that a gentle stimming helps that one egg?

femera is an interesting idea. i've never thought about that. i should have mentioned that i can't take estrogen because of the clotting disorder, but i think femera is a different mechanism. i don't know anything about it, so i'll look into it. maybe worth it to add to the mix for a last hurrah. or maybe i've already answered my own question - that i'm drugged up and enough is enough. there is, of course, also the stress of monitoring a cycle that makes me think maybe a more relaxed natural cycle is the way to go. aaargh! i've read on this board both sides of the natural vs ART debate and both are convincing.

thanks, kim!
As you may know, Dr. Ch.eck prescribes little boosts of gonal-f, around 75 to 150 max if your follicle is not growing at the optimum rate, 2mm per day.

There is a thread somewhere way, way down, from Kiwichick who was looking into this question about whether and little boosts help. She says that Ch.eck's research shows that pregnancy rates were higher for women who got little boosts than those who didn't. When I do a little boost my estrogen rate really soars nicely. I think it might have something to do with recruiting more or sensitizing the little receptors that surround the egg. These receptors are crucial in giving/receiving signals in all the hormonal/chemical reactions that are necessary in getting the egg to do the right things including implantation. I think it is these little receptors that also get fried by too-high stims and the signals stop working. I suspect it is something like this but I'm not sure how it all works.

So yes, based on what I know (not a lot), I give my self little boosts, always as low as 50 or 75 units gonal f for 2 or 3 evenings in the later part of the follicular phase. I know self-medicating is bad, but its very small and I really don't have anything to lose at this point.

BTW, I don't do TI with Ch,eck anymore because my physician was getting fed up with the monitoring, the drill is pretty predictable after a few months, and i can be a bit more creative and get 2 eggs instead of one.
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Kim
Kim

April 5th, 2012, 4:15 pm #10

so assume you did monitor this cycle through a local RE? It is so hard to find a doctor or place that you can locally monitor at to avoid having to take time from work and needing to travel to your RE. Any advice on how to manage to find a good place locally that charges less?
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