Ovulating BEFORE Retrieval?!!


#1

Long story short…

I did an egg freeze last year (I am single and have no significant other, so I was trying to ease my mind so I could find that guy without that clock ticking so loudly!) which resulted in 10 eggs that were able to be frozen. At that time I was told by the Dr. there to “hurry and get pregnant in the next 6-8 months”… fantastic… more pressure to find Mr. Right.

I decided to go the donor route… found a donor and purchased all they had as he was not actively donating… Started with Clomid which resulted in 4 follicles, but the side effects made me crazy so they gave me Letrozol (sp) which produced 2-3 follicles in subsequent months. I asked the Dr. if we could do a Clomid/Follistim protocol to see if we could get more eggs for my IUI cycles and up my chances, he said NO, if I produced more than 4 eggs he would NOT do an IUI as it was too risky for having multiples. He wanted to do a controlled IVF cycle.

He had me do an Estrogen primed Follistim/Antigon/Menopur protocol… which resulted in 2 follicles, it was canceled and converted to IUI. On the way to do the IUI I get a call from the Dr. that they "defrosted the wrong sample (IVF) instead of IUI of my donor… I tried to remain calm, knowing that the stress wouldn’t help me at this time. Not Pregnant.

I ask if we can do my suggestion of Clomid with Follistim and he says yes, only after I asked for my medical records so I could get a second opinion.

11 follicles! 6 major contenders and 5 smaller but still growing… I ask about antigon, he says he’ll think about it and we should wait and see how they are growing in a few days… I kept asking each visit about the antigon and he just said, “No, we’re not going to use it, we’ll just trigger you and go”

I wake up from the “retrieval” with my Dr. looking like he just ran over my dog… I ovulated all 6. He was able to get 4 of the smaller ones, but says he wants to do an IUI that day to try and “catch” the 6 (especially since he thought the 4 were too small)

The next day, he calls to say 3 of the 4 fertilized… he wants to implant them all…

NOT PREGNANT… BFN 11/14

Switched RE’s with the same clinic as they are going to do the next cycle at no charge…

All was going well again… 9 Follicles. This time they are adding the Antigon to the protocol.

11/29 (today) was my retrieval day… I OVULATED AGAIN BEFORE RETRIEVAL!!! I’m SO angry. :grr: I don’t even know what to do/say. I spoke with my RE from my egg freeze at NYU Fertility and he says in his 20 years he has NEVER seen such a thing. Told me to switch clinics for sure. I have a phone consult with CCRM on Friday…

Here is my question to you guys… Have you ever heard of such a thing? I totally understand that at my age it is already VERY difficult to get pregnant, but what I thought I WAS paying for was for their medical expertise and monitoring! I know he knows he messed up, because they didn’t charge me for the IUI procedure… AND he said “we’ll talk about this later… we just want to get you pregnant”. I am so angry that when I asked him about doing this protocol as an IUI he said no because it is too risky, yet when he messes up he’s not only willing to do it, but then add 3 embryo’s into the mix… Now with round 2 having the same early ovulation and a Dr. in NY never having this happen, do any of you guys know how this could happen?

Has anyone done a retrieval before the standard 36 hrs?


#2

Oh my! That sounds like an absolute train wreck! Where the heck is this clinic? I agree that you definitely need a second opinion. I have never heard of a dr not using either lupron or some other agonist, or some type of antagon. Is this Dr a board certified RE? Good luck to you in whatever your next step ends up being!


#3

Yes, this happened at UCSF (San Francisco). I just went through it this morning… so I’m still in shock. This cycle they used Antagonist protocol and it still happened. My Dr. in NY said in the 20 years he’s been doing this he’s NEVER had this happen and doesn’t know what they are doing, but advised me to move on asap.

My consult with CCRM (Colorado) is on Friday.

I could accept it if it’s just part of the “game” but it’s not. This is the only thing they are supposed to have control over… I’m getting worried now that my time is running out, all because of outside factors…


#4

That is odd to happen twice in one patient. We see early ovulation once in a great while, less than 1% of cycles, but it does happen.

Makes me wonder if you have something unusual about your hypothalamus (unusually large GnRH production) or pituitary (maybe unusually large number of GnRH receptors)?

Perhaps they need to double up your antagonist dosage, or perhaps put you on a long agonist protocol and add the antagonist in for extra measure. The usual protocols are obviously not working in your case.

Just a thought. All up to your future RE, of course.


#5

I did an egg freeze at NYU last year with standard Follistim/Ganarelix and then trigger… NO problems at all. I asked my RE from NYU if the HCG shot could be the culprit, as this one is taken with a small needle, not the big inter-muscular one and he said he didn’t think so. I will write your ideas down to go over with CCRM consult on Friday…

I’m really worried… it’s one thing to have your embryos not take, but to not even get to that point… I don’t know what else I can do, these Drs. don’t seem to have their act together.


#6

[QUOTE=Ghost]That is odd to happen twice in one patient. We see early ovulation once in a great while, less than 1% of cycles, but it does happen.

Makes me wonder if you have something unusual about your hypothalamus (unusually large GnRH production) or pituitary (maybe unusually large number of GnRH receptors)?

Perhaps they need to double up your antagonist dosage, or perhaps put you on a long agonist protocol and add the antagonist in for extra measure. The usual protocols are obviously not working in your case.

Just a thought. All up to your future RE, of course.[/QUOTE]

Yes, I thought the last cycle was a fluke since my Dr. didn’t give me antagonist. I felt like I went from 40 to 60 miles/hr. as apposed to being at a stop sign and then being asked to go 60 (how I felt being on the antagonist during my egg freeze cycle).

I did my trigger shot Sat night and by Sunday (yesterday) evening my ovaries were pumping like crazy… so much so that during the night I kept waking up from them feeling over stimulated. They said this am that there is NO way for me to ovulate early since I was on the antagonist this time… but 40 mins later, I woke up to find that isn’t true.

With the protocol where you described being on “a long agonist” what does that mean exactly? Push it to 15 days? I did CD2 Clomid and started Follistim on CD4 and Antagonist CD9 with trigger AND Follistim on Day 12.


#7

[quote=Omegagirl]
With the protocol where you described being on “a long agonist” what does that mean exactly? Push it to 15 days? I did CD2 Clomid and started Follistim on CD4 and Antagonist CD9 with trigger AND Follistim on Day 12.[/quote]

In the US, “agonist” = Lupron. There are other GnRH agonists (Triptorelin, Buserelin, Synarel), but Lupron is by far the most used GnRH agonist in the US. GnRH agonists act much like GnRH from the hypothalamus, so they activate the same pituitary receptors that GnRH does, and they cause an LH surge just like GnRH does. But they also deplete the receptors, and it takes time (several days) to generate new receptors. In the long agonist protocol, the agonist is given daily so the pituitary is not allowed that time to replenish.

A long agonist protocol is the most common protocol for ovarian stimulation for IVF. Basically, daily Lupron is started in the luteal phase of the prior cycle and continued through the follicular (stimulation) phase of the IVF cycle. Lupron (or any other agonist) will initially cause a surge of LH (and FSH) from the pituitary, but daily use desensitizes the pituitary. The theory, which usually works, is that the pituitary cannot provide an LH surge if the receptors are already destroyed by daily Lupron use.

The antagonists (Ganirelix, Cetrotide) also bind to that same pituitary receptor. However, they do not activate it (no LH surge). Their principle is that they keep GnRH from getting to that receptor to activate it.

You can add an antagonist to a an agonist protocol at any time for a little extra assurance. The reverse is not true. You cannot add an agonist to an antagonist protocol, because that would cause an immediate LH surge. That’s why Lupron can be used as the trigger in antagonist cycles.


#8

[QUOTE=Ghost]In the US, “agonist” = Lupron. There are other GnRH agonists (Triptorelin, Buserelin, Synarel), but Lupron is by far the most used GnRH agonist in the US. GnRH agonists act much like GnRH from the hypothalamus, so they activate the same pituitary receptors that GnRH does, and they cause an LH surge just like GnRH does. But they also deplete the receptors, and it takes time (several days) to generate new receptors. In the long agonist protocol, the agonist is given daily so the pituitary is not allowed that time to replenish.

A long agonist protocol is the most common protocol for ovarian stimulation for IVF. Basically, daily Lupron is started in the luteal phase of the prior cycle and continued through the follicular (stimulation) phase of the IVF cycle. Lupron (or any other agonist) will initially cause a surge of LH (and FSH) from the pituitary, but daily use desensitizes the pituitary. The theory, which usually works, is that the pituitary cannot provide an LH surge if the receptors are already destroyed by daily Lupron use.

The antagonists (Ganirelix, Cetrotide) also bind to that same pituitary receptor. However, they do not activate it (no LH surge). Their principle is that they keep GnRH from getting to that receptor to activate it.

You can add an antagonist to a an agonist protocol at any time for a little extra assurance. The reverse is not true. You cannot add an agonist to an antagonist protocol, because that would cause an immediate LH surge. That’s why Lupron can be used as the trigger in antagonist cycles.[/QUOTE]

You know your stuff! I think they said that because of my age they didn’t do the Lupron protocol… I’m open to whatever this new clinic says, since I’ve clearly had NO luck with where I’ve been these last 8 mos. I know when I spoke to my RE from NYU he was shocked to hear I had ovulated before retrieval and has never had that happen in his 20 years… and it didn’t happen when we did the egg freeze. I’m not sure if my body is just ready to release the eggs and the 10,000IU is too much, or what.

Hopefully I’ll have more answers on Friday :slight_smile: :cross:


#9

I am going to try antagonist protocol again but this time no lupron no bcp it means I can ovulate on my own despite of having ganirelix. I asked my RE and he said one of his patient ovulated before retrival second time same protocol she was fine and got pregnant with twins. My understanding is they try to prevent early ovulation with antagonist but god forbid it could still happen.


#10

[QUOTE=ozlem]I am going to try antagonist protocol again but this time no lupron no bcp it means I can ovulate on my own despite of having ganirelix. I asked my RE and he said one of his patient ovulated before retrival second time same protocol she was fine and got pregnant with twins. My understanding is they try to prevent early ovulation with antagonist but god forbid it could still happen.[/QUOTE]

that’s interesting cause my RE in NY said in his 20 years he’s never seen it happen and even at UCSF they were so shocked they didn’t charge me for the 2nd cycle (even though they messed up my meds again and I ovulated 12 hrs before my retrieval!!!) All the nurses and staff were completely shocked… they said they’ve never had it happen before either…

I think there is something with the HCG shot… too much or something cause the night before my ER my stomach is burning and aching so much that it wakes me up at night with pain… NOT normal and not what I experienced at NYU last year.

weird.


#11

[quote=Omegagirl]You know your stuff! I think they said that because of my age they didn’t do the Lupron protocol… I’m open to whatever this new clinic says, since I’ve clearly had NO luck with where I’ve been these last 8 mos. I know when I spoke to my RE from NYU he was shocked to hear I had ovulated before retrieval and has never had that happen in his 20 years… and it didn’t happen when we did the egg freeze. I’m not sure if my body is just ready to release the eggs and the 10,000IU is too much, or what.

Hopefully I’ll have more answers on Friday :slight_smile: :cross:[/quote]

Thanks, but I don’t know enough. I missed the point that you were ovulating too quickly after your hCG shot. Most premature ovulation cases are from a failure to control the pituitary, which is what I was babbling on about. You have a more unusual problem, in which you ovulate more rapidly than normal once given the hCG injection. That is rare. We had a patient do that a couple of years ago. It looks like your clinic may want to shorten the time between injection and retrieval. I doubt a reduced hCG dose would achieve that. I say that because protocols for varying the hCG dose don’t include adjusting the retrieval time based on that dose.

Most clinics set the retrieval time at about 35 hours after hCG injection. They try to balance egg maturity against ovulation risk. More time = more mature eggs, less time = less ovulation risk.


#12

I am in Bay area as well. What happens is they have to give antagonist very fragile time frame not so early not so late as well. When biggets follicule reaches 18 mm they suppose to give antagonist in order to protect early ovulation. If you were doing Lupron protocol your system will be shut down from pitutary in early phase of your cycle since you are kind of antagonist protocol, it is very crucial dr timing to give antagonist to you. Who was your DR at USCF?


#13

GHOST- When I did my egg freeze in NY last year we just did it the old Follistim/Antagon and HCG 36 hrs before retrieval with NO problems… So I was expecting that here. I am having a consultation with CCRM on Friday and will go over all this with them to see what they think.

I started the antagon when my lead was at 14 or something. (here at UCSF). I know in NY, my lead was closer to 16-17 because on the day of retrieval it was 20-21mm.

I’m scared to even do the retrieval earlier than the 36 hrs especially since the 1st time I O just a few hrs earlier (no antigon) and this time she said my follicles were already closed up with no fluid around, so she said 12 or so hours before.

OZLEM- My Dr. WAS Sohn and now it’s Cedars (she’s the head of the Dept.) but I’m going to CCRM in January… I don’t have time to waste (or money) and they have better stats for women my age and appear to be more individualized than UCSF. :slight_smile:


#14

I totally understand your frustration. My last cycle at retrival timemy follicules were lost too and they could not explain CCRM seems very good clinic. I will be talking with Dr Schoolcraft, who is your doctor over there? you can call me 408 368 8312, if you like.