On ivf - hospital too lazy to call me back about drug dosage - do I up it?

[totallynaive]

I have a history of ivf admin ***-ups with an NHS hospital (though I'm paying privately) that has good results but appallingly lackadaisical nursing staff. (On 3 occasions, for example, they have forgotten to order my drugs, and on 2 of those I've had to chase it up myself at less than one-day notice in order to begin/continue on my ivf cycle). I stuck with them because despite it all I got pregnant last time and have a lovely baby.

Now I'm trying again. I'm in my early forties but, according to my consultant, my tests and scans are very good and would suggest I'm 10 years younger in reproductive terms. On this basis he decided that I would go on long protocol ivf and take a dose of 300IU per day of my gonal-f (follitropin alfa) in the run-up to egg collection.

But yesterday I had my ovaries scanned by the nurse (you never see a consultant for scans) and she said my eggs were poorly developed and on Monday she would ask if we should up the dose of follitropin-alfa to 450IU. Interestingly, when I started that part of the course a week ago, her view had been that 450 would be the normal dose that she'd expect me to be taking, and she only put me on 300IU because she saw the notes written by my consultant (who has now left).

It seems to be that Monday would be too late to up the dosage, as egg collection would be any date between next Tuesday and next Friday and, according to the guidance I've received, not later. This nurse was not completely on the ball when I saw her yesterday. When I'd left the hospital, I left around 6 messages for her to call me back, stating the problem. She didn't get back to me before the unit shut at 4:30 and it is now closed for the weekend.

This is probably my last chance to conceive using my own eggs. I have enough drugs to up the dosage. What would anyone else in my situation do/is there a fertility expert in the building? Help!!!

[MrsHY1]

Jeepers, sounds like a total effing nightmare and not what you want/need when you're going through IVF! I have had 3 cycles with a NHS hospital (1 cancelled fresh and 2 failed FETs) and while I think my unit did the best they could with the paltry resources available, I had similar experiences to you (although was put on entirely the wrong drug regimen for one cycle, which was peachy).
I'll probably get my post removed/get banned from the site but if I were you, I'd up the dose. Nothing catastrophic will happen and you're being closely monitored anyway. Best of luck!

[MuddyWellyNelly]

I have just completed my first round of IVF (in 2ww) and have a very low AMH. I was on 225 of Gonal F and although in the early stages it looked like nothing was happening, they said there was no point increasing the dose as, for my size, I was getting as much as my body could use, and I'd just pee the rest out. I should point out I was on the Flare protocol as a low responder.

From your post I am a bit confused though, as scans can tell you zilch about the eggs - only the follicle size. They can't even tell if there is an egg in there or not. Secondly, they would surely not go to egg collection until there were enough good sized follicles. Mine ended up being about a week after the first date they'd given me.

I feel for you with the treatment you have received though. I went private (private clinic as opposed to private NHS) and really can't fault them. Well apart from their advice to cancel, which I am glad I disagreed with as I have 2 embies on board right now :)

Best of luck, I know how scary the pressure is of feeling like it's your last chance saloon.

[akuabadoll]

Sorry to hear you have to deal with this on top of the IVF itself. I just finished a (failed) LP myself and just want to add to what nelly said. A lot of fellow IVF'ers on MN have made comments about changing doses for poor response (I agree with nelly as far as I know they can tell nothing but size of follies over time and number of follies of course) but my dr was not interested in upping my stimms, he said from his experience it makes no difference. I took same extra days to get there on the same dose. Surely your 'poorly developed eggs' actually means the follicles are still small. I'm not saying my dr was right but that was the perspective in my case. I guess the bottom line is a higher dose may work but may make no difference. Your ET should be when the follicles are the correct size, no? Good luck.

[akuabadoll]

EC not ET, sorry

[totallynaive]

Just to thank everyone who responded, and gave me such a lot of help. In the end I just stuck with the prescribed dose, and this seemed to be the right thing, as the hospital didn't see the need to increase the dose when I went back in on Monday for a scan. Having egg retrieval on Monday - very late due to poor follicle response to drugs, I guess - but keeping upbeat. Once again, thanks.

[Dozer]

Hope it works out well for you OP. whatever happens, if/when you can handle it, you should complain about the nurse's comment and lack of follow-up, it may make her think twice before doing the same to others.