1 follicle, IVF versus IUI..HELP!


#1

Hello ladies!

I need your help.

I am 30 y.o, dx with POA a couple of months ago.
I am currently “stimming” for my first IVF cycle . I have 1 follcile. It was 14 mm today on the left ovary.I have no follicles on the right. My RE wants us to proceed anyways to IVF. He says there is good research that says young pts with 1 follcile have a very good pregnancy chance with IVF versus IUI.

Obviously money is a factor…I am trying to debate whether to continue to retrieval of my possibly 1 egg, or to convert to IUI and hope for the best.

The RE said there is a possibility I may have a better stim response with back to back stims, but obviously cannot be sure. I get my meds covered 100%, but am paying a crap load of money for the IVf, as its out of province.

Anyone out there have experienced this themselves?

Advice? Words of wisdom??

Angela


#2

[quote=angelalms]Hello ladies!

I need your help.

I am 30 y.o, dx with POA a couple of months ago.
I am currently “stimming” for my first IVF cycle . I have 1 follcile. It was 14 mm today on the left ovary.I have no follicles on the right. My RE wants us to proceed anyways to IVF. He says there is good research that says young pts with 1 follcile have a very good pregnancy chance with IVF versus IUI.

Obviously money is a factor…I am trying to debate whether to continue to retrieval of my possibly 1 egg, or to convert to IUI and hope for the best.

The RE said there is a possibility I may have a better stim response with back to back stims, but obviously cannot be sure. I get my meds covered 100%, but am paying a crap load of money for the IVf, as its out of province.

Anyone out there have experienced this themselves?

Advice? Words of wisdom??

Angela[/quote]

Sounds like you were not on the right protocol for you. I would absolutely not proceed with IVF for one follicle - it may not even be mature or fertilize! You are very young, and even with DOR (not sure what POA is?), you can get many more follies with the right protocol. Good luck.


#3

POA is premature ovarian aging. I am already on very high dose stims- Bravelle 450 in am, Menopur 150 in eve. I am scared I may never get much better than this.

In April, I only had 2 antral follciles per side. In may, only one per side…So there is not much to work with in there…


#4

Wow, this is such a difficult position to be in! Sorry you are facing this decision, I imagine it’s disappointing.

Logically, if I were in your shoes, I would do like maryevelyn suggested and call this a “wash” and try a new protocol, especially since you really haven’t lost anything since your meds are covered. I thought this through with our own first IVF…we waited a long time because of cysts and I wanted everything to be “just right.” Our meds were also covered, and if I had only made one follie, I would’ve triggered it and done a TI cycle and tried again later.

That being said, with your diagnosis, you probably feel like the clock is ticking. It’s hard to move backwards in treatment, especially when you know that time is against you. There were a few girls on my April IVF boards (I remember PDXgirl, specifically) that only had one or two follicles, and went through with it, anyway. I believe PDX is now is entering her second trimester. Even for us, who retrieved 10 eggs, only ended up with one good to to transfer and no frosties. It only takes ONE. The question is, will your one follicle fertilize, make it to blast, etc.

I’m so sorry you are faced with this decision. If it was me, I would at least give another cycle a “go” and see if the response is any better. But only you know what you can afford and what works for your family. I wish you all the best, whatever you choose. :grouphug: :grouphug:


#5

For me, this is a hard decision. Have you tried IVF before? What was your response?

I have a high FSH of 32 and am older than you. I have cycled tons of times (I actually ran out of room on my signature). I have also had numerous cancelled cycles. I was fortunate to have the meds covered by 1 of my insurance plans (for the most part it was all out of pocket). After I had my meds covered, I was much more inclined to cancel cycles than before. I just thought this was a real option that I did not have before when I was paying out of pocket for all the meds. This also was an option for me b/c my doctor did not charge monitoring fees after my first failed IVF.

With DOR, sometimes, we just will not respond well on a particular month. You can try the same protocol the next month and respond better. For instance, I once tried high stim EPP protocol. I had 1 follicle. I cancelled that cycle, tried the next month, and had a lot of follicles (I think it was 7 or something, I don’t remember for sure).

If you haven’t cycled before and only had 1 follicle, I would probably convert to IUI (if it is free or just BD). I say this only b/c your meds are covered. I may say something different if they were not. I do think there is a great shot that is a good follicle given your age, but I have found, at least in my case, my DOR tends to go hand in hand with fertilization problems. So, I have been unlucky enough to have no fertilization on 2 cycles. Unless you know you cannot get a better response than 1, I would try again. If you have tried on about 3 occasions with only 1, then I would probably proceed with only 1.

What type of protocol are you on? I have done better with MDL protocol, and various low to medium stim protocols. The low stim protocol tended to result in better egg quality for me.

If you are not already, there is a board for people with DOR called network 54 new high FSH board. It would probably be a good place for you to seek advice from people with your particular issue.

Also, don’t give up hope on this cycle if you decide to convert to IUI. I have seen numerous people over at the high FSH board get pregnant off converted cycles.

One more thing, I would discourage back to back cycles if you are using high stims (I don’t know if you are). I did this once, and although my response was better, my egg quality was far worse than it had ever been. I personally think it is best to wait a month, although I know the wait can be agonizing. Someone suggested this to me, and I did not listen. But, looking back on it, perhaps I would have had a different result from my IVF cycle had I paid attention.


#6

Sounds like your RE has $ signs in his eyes. If I were you, I will not proceed with IVF with just one follicle considering the cost.


#7

[quote=angelalms]POA is premature ovarian aging. I am already on very high dose stims- Bravelle 450 in am, Menopur 150 in eve. I am scared I may never get much better than this.

In April, I only had 2 antral follciles per side. In may, only one per side…So there is not much to work with in there…[/quote]

Sorry, I just read you are on high dose stims after I typed my initial response. I have actually responded better to lower/medium stims than high stims. I have an antral follicle count of 4 or below, just depending on the month. I have used some protocols suggested by Dr. D.av.is at Cor.nell and responded better than to high stims. One protocol used only 75 of menopur. That is it. Once a night, then Cetrotide to prevent ovulation. I also used Omintrope (growth hormone), which has been shown to improve egg quality. This was preceeded with estrogen priming. This didn’t result in a great response for me, but did result in better quality. There is another protocol that uses MDL combined with estrogen priming and medium dose stims (I forget, but could find the exact dosage). I actually responded better to this protocol with limited meds than to one with a ton of meds. Really, with DOR, I think more meds does not mean a better response. it just seems to fry the eggs.

You may not get much better than 1, but if you could just get 3 mature follicles, which sounds like 3 or 4 may be an option for you given your AFC, I think you would have a great shot at success.


#8

were you on long lupron? a microdose flare, antagonist, or estrogen priming protocol may be better for you.


#9

Thank you so much for your responses!!
I am on microdose Lupron. This is my first ever stimming and IVF cycle…

We were really on the fence with this…convert to IUI or retrieve anyways…

We are going to take the risk…flight is booked for thursday am…most likely retrieval friday am…we are making a huge gamble…if BFN, or no egg, or no fertilization, we will look at revised protocol, and I may keep on with injectables until we get 3 or 4 follies (otherwise convert to IUI). I have 100% paid meds for a total of 6 cycles…

If after 6 cycles, still no BFP, we will use donor eggs…

I will keep you all posted.
Thanks for all your advice. Much appreciated,

Angela


#10

Oh, and I was on estrogen patches for a total of 2.5 weeks before stims…


#11

Good luck!!