To trigger or not to trigger?


#1

E2 on CD 8 was 48 and U/S on cd 9 showed 10 follicles growing, still small enough that this cycle might be saved. But this has gotten me so upset because this is exactly what they looked like last cycle and I had to cancel because they ALL grew.

I’ve seen ladies out there on this forum who’ve had 6 mature follies and went ahead with the cycle, but with TI instead of IUI. I don’t know if I could do this because the thought of selective reduction or having triplets terrifies me. What would you do?

THERE IS NO LOWER DOSE OF GONAL F, I don’t know what would be next? IVF may not be an option for us financially.

I’m so upset, but maybe there’s a way I could still do a trigger with too many follicles. How many does your doctor allow? Mine says no more than 3 or 4, which seems quite low compared to others I’ve seen out there. I could push for the trigger if I’m willing to consider selective reduction but I don’t think I would survive that. PLEASE HELP!


#2

You could trigger with half trigger. That is something i’ve heard people doing. Really to trigger or not is a personal choice. :grouphug: I would personally not worry about selective reduction or multiples. But I’m one that got pregnant with triplets on our first IUI.

I think IF you cycle again, don’t do injections. You responded well to femara. Stick with that and take meds to help your lining. If you are overstimming on the lowest does of injections. Then injections is to much for you. With femara sick with one dose everyday instead of taking different doses for those 5 days. Another thing is request monitoring earlier. You basically got a 30mm follie (cyst) because you weren’t monitored sooner and it grew into a cyst. If it was caught earlier you could have triggered and had a nice size follie.


#3

Thanks! I didn’t know about the half trigger. I will ask my doctor about that. Is that supposed to trigger fewer follicles? The other problem is if my doctor would even be willing to do a half trigger. I asked him about just doing TI and he said that intercourse doesn’t necessarily give you a smaller risk of multiples so he wouldn’t even recommend that with over 4 follicles. If I pushed it he might be willing though. He’s pretty conservative, especially with younger patients.

Doesn’t selective reduction or multiples scare you? I guess I just worry a lot about that and also don’t want to have triplets. I wouldn’t mind twins.

I should add this to my signature – my response to letrozole step wasn’t great, at the time I had the 30mm follie my estrogen was only 85 so they thought the chances of that being a good one were very slim and they cancelled the IUI for that reason and because the lining was thin. The other time I took Femara I had many mid sized follies, just like with Gonal F, but then didn’t ovulate because none of them became dominant. None were big enough to trigger either.


#4

What sizes are you follies?

I didn’t see it or over looked it…


#5

I didn’t say specifically. The follicles today were still small, thank goodness, about 8 or 9 mm each, because of the low dose and early in the cycle. There’s still hope that a few will become dominant and the others will fall off.
Last time this didn’t happen, despite switching to the 37.5 dose halfway through the cycle. All the follies were between 12 and 16 and there were around 8 to 10 of them so my doctor cancelled the cycle because there were too many. He prefers to only trigger if there are 3 or less, which seems a bit conservative. We go through this much, I should at least trigger at 4 follies! He is flexible though, i think he would trigger me with 4 follicles if I requested. The question is whether I would want to because I’m terrified of multiples (except twins of course) and selective reduction.
I think the reason I’m so worried is because I’ve NEVER had a successful cycle where I did a trigger and had a good lining, estrogen level and follicle. Each time has either been cancelled completely or my doctor said there was almost no chance of getting pregnant because of a ridiculously low estrogen level or thin lining and questionable looking follicle (because it was so big, looked more like a cyst). This makes me think that as soon as the conditions are right, all of them are going to implant and I’m going to have to go through the excruciating decision of whether to reduce or not. Any thoughts on this?


#6

TI withOUT a trigger isn’t a risky as with a trigger. WithOUT a trigger, you’ll be luck if 2 or 3 follies ovulate.

No, selective reduction or multiples don’t scare me LOL, since we got triplets on our first IUI. We’ve been trying for 10 years. I’ll take whatever we get as long as they are healthy. I don’t believe in selective reduction though. so i wouldn’t do that.

One thing is femara suppresses E2 levels. So you will have lower levels when its not a true reading. Learned that when i did a cycle with it. but 30mm is to mature for an IUI anyways. At that size is basically a cyst instead of a follie. 18-20mm is ideal anyways, which is why i said you need to be monitored sooner on it to prevent it getting over mature.

[QUOTE=aeason11]Thanks! I didn’t know about the half trigger. I will ask my doctor about that. Is that supposed to trigger fewer follicles? The other problem is if my doctor would even be willing to do a half trigger. I asked him about just doing TI and he said that intercourse doesn’t necessarily give you a smaller risk of multiples so he wouldn’t even recommend that with over 4 follicles. If I pushed it he might be willing though. He’s pretty conservative, especially with younger patients.

Doesn’t selective reduction or multiples scare you? I guess I just worry a lot about that and also don’t want to have triplets. I wouldn’t mind twins.

I should add this to my signature – my response to letrozole step wasn’t great, at the time I had the 30mm follie my estrogen was only 85 so they thought the chances of that being a good one were very slim and they cancelled the IUI for that reason and because the lining was thin. The other time I took Femara I had many mid sized follies, just like with Gonal F, but then didn’t ovulate because none of them became dominant. None were big enough to trigger either.[/QUOTE]


#7

I say just wait it out… I had 3-4 follies on each ovary between 5.5-8mm… two days later I only had 1 @ 18mm on the left, one @6mm on the right. Also, I’m actually pretty surprised that he cancelled your last cycle. Between 12-16mm is getting there, but your E2 was only 512 so you should have had some more time.
Just see how it goes this time… things can change very quickly.
Good luck and :babydust:


#8

TO Missingmy#2:
So what about the half trigger? Is that half the dose of ovidrel and does that decrease the number of follicles that release?
I think I was unclear about the decreased risk of multiples – my doctor said there would not necessarily be a decreased risk of multiples with intercourse only versus IUI, not with trigger versus no trigger. I didn’t think I’d ovulate at all without the trigger – last time I didn’t, probably because they gave me progesterone right away after tdoctor decided to cancel the cycle.
The reason I’m so scared of multiples is because there’s a lot higher chance that they won’t make it and then an even higher chance of mental retardation or other serious health problems because of preterm labor. My doc said that you go into labor an average of 3 weeks earlier for every extra fetus – so if you make it to 34 weeks with triplets you are lucky and that would be only 31 weeks with quads!
I think I’d do the selective reduction with anything over 3 because it gives the ones you keep a much better chance of survival and normal health but I would of course feel extremely conflicted about it.


#9

Yeah, I think that my doctor is conservative on these things. He made me feel that 512 was so high but obviously those doing IVF get in the thousands and continue and OHSS is still rare. He even told me at that point that I shouldn’t have sex if I had any discomfort because the ovaries were large and could rupture and bleed.
I think mostly he saw that all the follies were still growing and none had slowed down, but now that you say so I wish he would have given it a few more days. I hope I have a dominant one or two like you did! Thanks for the encouragement.

[quote=SweetyKitty]I say just wait it out… I had 3-4 follies on each ovary between 5.5-8mm… two days later I only had 1 @ 18mm on the left, one @6mm on the right. Also, I’m actually pretty surprised that he cancelled your last cycle. Between 12-16mm is getting there, but your E2 was only 512 so you should have had some more time.
Just see how it goes this time… things can change very quickly.
Good luck and :babydust:[/quote]


#10

From what i’ve heard, half triggers will help ovulation happen but won’t push ALL follies to ovulate. I’d do half ovidrel if anything. ovidrel is 6500IU. That’d be better than half of a 10,000IU trigger.

I guess i see it as, if i have more than 1 follie I’m going to run the risk no matter what. Our reason for more follies is for more targets since dh’s sperm isn’t always smart and swim in the right direction LOL.

I agree with sweetykitty though, just wait it out and see what happens. :cross:


#11

Did you have an ultrasound after your Estrogen was taken yesterday? Mine wants to scan me every few days during an injectable cycle, even with the low estrogen.

[quote=missingmy#2]From what i’ve heard, half triggers will help ovulation happen but won’t push ALL follies to ovulate. I’d do half ovidrel if anything. ovidrel is 6500IU. That’d be better than half of a 10,000IU trigger.

I guess i see it as, if i have more than 1 follie I’m going to run the risk no matter what. Our reason for more follies is for more targets since dh’s sperm isn’t always smart and swim in the right direction LOL.

I agree with sweetykitty though, just wait it out and see what happens. :cross:[/quote]


#12

[QUOTE=aeason11]Did you have an ultrasound after your Estrogen was taken yesterday? Mine wants to scan me every few days during an injectable cycle, even with the low estrogen.[/QUOTE]

No ma’am they didn’t. They are waiting until my E2 gets a little higher. But this is a new RE since we just moved. I go back on Saturday which is CD9 for me for more bloodwork… but no ultrasound. I’ll probably get an ultrasound around CD11 or so. But this is my 4th cycle on injections and i respond pretty much the same each cycle. I get no more than 4 mature follies on the dose I’m on.


#13

I wish I only had 3 mature ones. Are there others that are close in size that your doctor just doesn’t worry about?


#14

[QUOTE=aeason11]I wish I only had 3 mature ones. Are there others that are close in size that your doctor just doesn’t worry about?[/QUOTE]

3 or 4 of them are always 15mm to 18mm, IF i have smaller ones they are usually 8-13mm the day before trigger. My old REs never worried about anything below 15mm at trigger. Now my last IUI (#4) i only had 1 follie. It was the lowest femara dose 2.5mg and 50IU follistim. They were just seeing basically how i responded to a new dose since they knew what i did with 75IU follistim.


#15

Has anyone else had an experience with cancelling cycles or going ahead with the trigger with 4 or 5+ follicles? I’d really like to hear your experience!


#16

Well I’m having an estradiol on 11/13 and U/S on 11/14 so I’ll keep you updated. I’m praying for a few dominant follicles emerging!


#17

Update

So I’ve had 2 ultrasounds and estradiols since my last post. The first u/s on cd 13 and E2 on cd 12 showed no change (E2 still in the 40s and still about 10 follicles 6-9mm each) after 4 more shots of Gonal F 37.5. My doctor then upped me to 75 every other day and 37.5 units in between. Cd 16 estradiol was 135 and cd 17 u/s showed 3 dominant follicles at about 10-11mm each and the others stayed small (about 8mm each). YAY! Good news. I may be able to do my IUI after all. Now I will continue with the 75 every other day and 37.5 units in between and recheck estradiol in 2 days (cd 19) and then u/s and hope that the dominants will stay that way and there won’t be too many follicles.
Wish me luck! I’m praying that I will finally be able to go through with my first real IUI and am very nervous and excited.

[quote=aeason11]E2 on CD 8 was 48 and U/S on cd 9 showed 10 follicles growing, still small enough that this cycle might be saved. But this has gotten me so upset because this is exactly what they looked like last cycle and I had to cancel because they ALL grew.

I’ve seen ladies out there on this forum who’ve had 6 mature follies and went ahead with the cycle, but with TI instead of IUI. I don’t know if I could do this because the thought of selective reduction or having triplets terrifies me. What would you do?

THERE IS NO LOWER DOSE OF GONAL F, I don’t know what would be next? IVF may not be an option for us financially.

I’m so upset, but maybe there’s a way I could still do a trigger with too many follicles. How many does your doctor allow? Mine says no more than 3 or 4, which seems quite low compared to others I’ve seen out there. I could push for the trigger if I’m willing to consider selective reduction but I don’t think I would survive that. PLEASE HELP![/quote]


#18

I’m jumping in late here, but glad to hear that your results today went well!

I had a situation like yours when we were TTC, and it’s a hard decision. Our doctor, like yours, was pretty conservative and told us absolutely NO trigger or TI…told us to refrain for a solid week until we were sure we were in the clear! Although, our follicles were all over 14 mm at that point, and there were over 12 of them. Eeeeeek! It was SO tempting to go for it because we wanted a baby so bad, and “surely not many of them would take.” But, we ended up getting pregnant the very next cycle with ONE good follicle, and I felt happier and healthier having waited. We did NOT want multiples.

Sounds like you have some good, solid follicles with some great E2 numbers. Wishing you all the best!!


#19

I just wanted to respond to your question about experience with more than 3 follicles. Last month, our IVF cycle was cancelled for poor response. We had 5 mature follicles and our estradiol level was 1528 (but this was with IVF drugs). We proceeded with IUI after a 5000u Pregnyl trigger. Our situation was slightly different because we were already labelled as DOR and very poor egg quality from our July cycle. So, we were praying for a miracle…and would have been fine if we had 3! Obviously, ours didn’t work. So…just an “experience” post for you. Not everyone with several follicles gets pregnant with multiples, but with good egg quality…it could happen!

Best wishes on this IUI!


#20

Thank you! Your experience makes me feel better. At the beginning of the cycle I thought there was little hope and I would be doomed to overstim even on the lowest possible dose of gonal f but the cycle is going a lot better. I agree that multiples are a big risk and I take it very seriously too. I don’t want the babies to be premature because I was over eager.

[quote=Francesca13]I’m jumping in late here, but glad to hear that your results today went well!

I had a situation like yours when we were TTC, and it’s a hard decision. Our doctor, like yours, was pretty conservative and told us absolutely NO trigger or TI…told us to refrain for a solid week until we were sure we were in the clear! Although, our follicles were all over 14 mm at that point, and there were over 12 of them. Eeeeeek! It was SO tempting to go for it because we wanted a baby so bad, and “surely not many of them would take.” But, we ended up getting pregnant the very next cycle with ONE good follicle, and I felt happier and healthier having waited. We did NOT want multiples.

Sounds like you have some good, solid follicles with some great E2 numbers. Wishing you all the best!![/quote]