Fertility Clinic Appointments and Beyond..

[dogmam]

New thread for us to continue our fertility clinic appointment progress...

Some of us are waiting for initial appointments, some are having tests and some are starting treatment!

@Juno231 some months I would get them after ovulation too, which was fun. See this immature thing concerns me, I may well have a 30mm follicle by day 12 this month, which is when I'm booked for a scan. Last month I had 27 and a 17 when I triggered on day 10 and they would have grown for a couple of days more. Maybe I'll start Letrozole on day 3 instead of 2 (today) to try to counter this a bit.

Or rather, overmature. I'm going to read up on optimum sizes.

@thislittlebird people say over-large follicles release overmature eggs, but actually the eggs are immature, and font reach maturity, which is why they keep growing.

Ideal size is about 22mm. Max is 26mm. Anything over 14mm can release an egg.

Mine was 27mm and released the next day so could have been 29/30mm.

I'm not completely out as I have read stories of women who had 30mm+ follicles and went on to conceive, but its much less likely. I wonder if I have been ovulating with immature eggs for the past 16 months... as I think its a PCOS thing.

Ok so there seems to be a difference in IUI/OI and IVF. In IVF they want slightly smaller follicles, but in IUI/OI they don't seem concerned with 20 odd mm follicles.

This doctor from the Homerton talks about it a bit here:

'Standard practice in most assisted reproductive technology clinics is to trigger ovulation for intrauterine insemination (IUI) when the lead follicle is 1.8cm in diameter or greater. The present study examined almost 1000 IUI cycles receiving either clomiphene citrate (CC) or letrozole for ovulation induction and suggests that the clinical pregnancy rate is higher when the lead follicle is 2.3 or 2.4cm in diameter and endometrial thickness is 9mm or greater. In IUI cycles stimulated with CC or letrozole, optimal pregnancy rates may be achieved at follicle diameters greater than 2.3cm and with endometrial thickness greater than 8mm.'
facultyopinions.com/prime/713947814

'For both CC and letrozole, higher pregnancy rates were achieved when the leading follicles were in the 23 to 28 mm range. The optimal size of the leading follicle was not statistically significantly different between cycles using CC or letrozole. However, for each endometrial thickness, the optimal follicular size of the leading follicle was different. Each additional millimeter of endometrial thickness increased the optimal follicular size by 0.5 mm. Thicker endometrial lining led to a higher probability of pregnancy.'
www.fertstert.org/article/S0015-0282(12)00250-6/fulltext

So maybe all is not lost @Kay00, some sources are happy with that size. It does make me think about what day I will start.

On cycle one I started day 3, I had 1 x 22mm by day 11

On cycle two I started day 2, I had 1 x 24mm and 1 x 17mm (I checked, it was 24 and not 27 last month, I lied!) by day 10

@Kay00 just seen your message above this one! You're not being triggered are you? I'm not sure how many days a 27mm would go on growing for without intervention.

I don't think you're out out but if it grows to 30mm plus then maybe yeah. They don't seem super keen on the small follicles under 17/18 from what I've just read, best success seems to be low to mid 20s.

I don't think it'll work for me whatever size lol, but I think I'll aim to start late tonight or day 3 since they're only scanning me on day 12.

@Kay00 forgot to ask, what was your previous cycle like follicle wise?

@thislittlebird thanks for the info! It agrees with that I read; not all is lost with large follicles but it's less than ideal over 26mm. No, I'm not being triggered but I'm pretty certain I ovulated the next day based on temp increase etc so it might have grown more.

I think previously I had 1 x 22mm, 1 x 15mm and one x 14.5mm and I ovulated two days later.

Your follicles do seem to grow quite big quite quickly! Is it worth asking the clinic if delaying the letrozole by a day will help?

@Kay00 you might be fine then, if you ovulated the next day it might have been 28/29 maybe. I went into the rabbit hole of ‘they don’t want it to grow into a cyst if it gets too big’ and I’m like . I did not know that was a thing that could happen!

I’m going to start tomorrow, I think. That way it’ll only be one day more than my first cycle where I had a a 22. It might be completely different this cycle but it makes sense to me that the earlier you start the quicker/bigger they grow.

Hi @thislittlebird.

When I took Letrozole tablets 5mg/OD 5 x2 each day, I was told to start taking them on cycle day 3 and end on cycle day 7. On cycle day 3, I had a transvaginal ultrasound scan and that's what determined my gynaecologist to advice me to start taking the tablets.

On cycle day 12, got a peak on clearblue fertility monitor and had a transvaginal ultrasound scan that determined to take the trigger injection in the afternoon 'Ovitrelle injection 250mg 0.5ml'. Adviced to have sexual intercourse on CD 12, CD 13 and CD 14.

On cycle day 14, started taking one cyclogest pessary 400mg tablet evening before bed.

Hope this helps.

@EveryMumDay thanks, yeah I started today because I’m being scanned on day 12. I’ll likely trigger same day since I respond quite fast normally.

@thislittlebird good luck!

And yes, if the follicles grow too big they are considered cysts but really they are just overgrown follicles (which I guess kept growing because the eggs didn't mature?). The nurse told me not to worry if this happens as they go away by themselves.

Hello all, Hope its okay if I join. We are 32yrs old, trying since March 2020. Conceived once in sept 2020 then miscarriage at 12wks. We've been through GCRM (private in Glasgow) fertility assessment. DH perfect results, me extremely irregular ovulation (cycles 45-75 days) ultrasound and hormones all normal, AMH of 45.

Private clinic have offered literally any option - monitored medicated ovulation (letrozole plus a trigger), IUI (with same meds) or IVF. On NHS side have just been referred to assisted conception but they likely wont get in touch for a while (but not sure how long).

So we are trying to work out where to go from here at the moment. I'm wondering if we could do medicated cycles with GCRM private then if that fails see what the NHS would offer.

Looking forward to getting to know you all x

@Kay00 glad they go away by themselves! How’s it going with the clomid?

I am so SICK of commuting to the fertility clinic. I argued with them this week about how many times I need to go in, I bet I’ll go tomorrow and they’ll make me come again on Monday. Sigh.

@TheDaydreamBelievers welcome aboard! Sounds like you’re in the PCO(S) club with a couple of us. My hormones are mostly normal too (with low FSH and LH) and my periods are regular but my progesterone is crap naturally.

What you’re suggesting is what I’m doing right now. Private monitored Letrozole cycles with a trigger (with timed intercourse not IUI) while we wait for IVF on the NHS. We only get one round and hoping it will be start January, but not entirely sure.

@TheDaydreamBelievers Welcome m'dear!

Hey @Kay00 - I feel like the post pill thread isnt really my place anymore and was glad to see many of the same faces over here :)

@thislittlebird nice to have someone in the same boat! Private clinic would like me to do a Hycosy before intervention. NHS Glasgow where I am offers 3 cycles of IVF so I feel lucky in that regard. Officially, one consultant thinks I have PCOS (but no cystic ovaries) and one does not agree I meet Rotterdam criteria. To be honest in terms of treatment pathway it doesn't really matter!

@TheDaydreamBelievers yeah, I know what you mean. I keep up with the Post Pill Party because I feel I can offer a lot of advice to new joiners and I have been on the thread since the beginning... I'm an old timer now !

But I learn a lot more here, and I think we all understand how difficult our journeys have become and what we are all going through. The chat ain't to bad either

@TheDaydreamBelievers I’ve had exactly the same issue! One says I have PCOS, one said I’m borderline, one said I don’t have it so I’ve taken to considering myself to have it mildly??? I dunno lol. But I clearly don’t ovulate optimally. The same treatment, yep, my husband has low motility so its ICSI and Guys weren’t even vaguely interested in my dodgy ovulation. I would like an insulin resistance test though, when I get to speak to my GP next I’ll ask him.

I really wish we got three cycles 😩. I’ll be out on my ear after one so I’m waiting for that one and then going private if it doesn’t work. Might have done a private cycle already if I’d known the wait would be this long but here we are.

Actually, no that’s a lie. I’ll get three transfers as well as the egg collection so if I could get three embryos that would be very useful. Fingers crossed, I guess.

Oh and forgot to say I had the hycosy privately too. Didn’t love it, but it cleared up that my tubes were clear.

@thislittlebird this has been so helpful thank you. I think I'm settled currently on private hycosy, then ov induction, then see what the nhs wait is for IVF if needs be (hopefully not needed!)

@TheDaydreamBelievers yes, definitely get the hycosy done first, it’s good to know how your tubes are so you know you’re not throwing your money away on Letrozole etc.

I am on my way back from the clinic. I’m trying to remain chilled but I am annoyed with them. I told them I won’t be ready on day 9 and they insist on getting me in for a scan. Shockingly, I wasn’t ready on day 9 🤦. Now I have to go back again on Monday and I’m tired, I told them this would happen, it’s so pointless.

I have the trigger at home but now I might ovulate naturally over the weekend (unlikely based on how slow my body is naturally but let’s see...). She was like ‘your body loves Letrozole!’ and yes, it does, it also loves responding on exactly the same timescale which they simply ignore in favour of pointless scans. 😑

I had 2 follicles on the right at 12mm each and 2 on the left, one 15mm and one 16mm. My lining was 11mm. It’s always my left ovary that responds, my right just doesn’t seem so responsive and functional. Hopefully that won’t impact ivf too much.

@thislittlebird thats frustrating 😒 but it sounds like you have a good follicle or two brewing which is good!

I had my progesterone results back today: 42.5 which indicates I ovulated. They are pleased that I'm ovulating on 25mg of Clomid and I won't need to go back in again for scans or have my progesterone tested. I need to call them when I start my 5th Clomid cycle so we can arrange a follow up consultation and discuss next steps... unless I get pregnant of course.

She said not to up my dose to 50mg under any circumstances (due to chance of over stimulating), but the temptation is there especially when this cycle my 1 x follicle was oversized and likely a dud.

@thislittlebird three transfers as well?? I don't think I'm far from you but only get one fresh and one frozen :/ sorry about the pointless scans - you'd think we'd be used to being dismissed by medical professionals by now 😁

@TheDaydreamBelievers I could have sworn you joined this thread a few pages back!

@Juno231 I kind of swung in a couple of months ago but wasn't quite ready to leave the mainstream conception chat. But in the last week I've felt quite clear it isn't the place for me now so kinda feel ready to graduate into these threads