Antagonist protocol at GCRM

[Jessewalt]

Hello everyone,
I am due to start ICSI on the above protocol in January. I was wondering if anyone can shed any light on when they had their egg retrieval ie how many days after starting injections. It looks like probably about 2 weeks, although I know it depends on scans etc.
Any info would be helpful, as I need to plan some annual leave for work. Trying hard to do this without telling boss/colleagues if possible.
Thanks

Hi Jesse and welcome!

I'm on the same protocol as you (I think) and we are having IMSI, so sounds like our cycles will be quite similar.

I started stims on 3rd Nov and have been advised that EC will be around 14th-15th Nov. It is really dependent on how you respond though, which you won't know until well into the stim process.

Do you have an HR department you could confide in? I think it would make life a lot less stressful if you told them what was going on - it's really nothing to be ashamed of and while I can completely understand you not wanting to 'go public' with the details of your treatment to all and sundry, I think it might be a good idea to let your employers know.

It's a personal choice though, and I do see your point.

Hi Jesse

I'm not at GCRM, however, I'm having my first antagonist ICSI cycle in December from what I've been told by my clinic it's normally around day 12 that they tell you to do the trigger then EC is 36 hrs after that so day 14 approx. I'm on a low dose of GF due to high AMH but will also need to have a few more scans than most so I don't get OHSS.

I started off down the route of not telling my boss but eventually keeping up with all the "appointments" was too stressful and I wanted to take as much stress out of the process as I could. I know that some of these things can be quite last min so you may only have a day's notice if they want you to come back the next day for another scan/another blood test.

Any other questions please ask as I may have done my first cycle by the time you'll start yours.

Thank you for your replies. I will discuss it with hubby, and the nurses at the consent appointment and take it from there. I suspect I will have to tell someone at work, as I don't want to leave them in the lurch, if I have to call in sick.
Good luck with all your treatments/journeys x

Hi, I think everyone else's answers would have helped you, but just to warn you that you may need to attend clinic regular when you are doing injections for scans and bloods. I was closely monitored for OHSS so my dosage changed a little. Roughly in the 2 week period before egg collection I think I went to the hospital about 8 times for bloods and scans. I didn't know what do to with myself in the 2WW. I was so used to going to the bloody hospital!

Thank you Allchat, this is exactly the sort if info I need. I am going to think long an hard about it and make a decision in the next month or so.

Allchat can I ask what your AMH level is as mine is 62 and I've been told they will need to monitor me very closely but I was only expecting approx 5 scans. What days did you have your scans and did they change your dosage?

Hi farzoz. I don't actually know what my AMH is. Clinic must know, but I've never asked. I probably had about 5 or 6 scans but more days when I had to go in for bloods. Yep, dosage changed few times. After 3 days they lowered it, then put it back up and I think it stayed then. I was fine though.

I asked today. My AMH is 55, they said average is around 15. I don't have psos by the way. They manage it pretty well by regular scans/bloods so I felt ok. Plus in the end I had 11eggs so I know the risk was reduced. I was happy with that as I'd read the fewer eggs can actually mean better quality (although ultimately didn't help me that time round).

Wow I didn't know the average was 15....I knew 62 was high but that's a lot higher than I thought. It's good that they were able to tell you and I'm the same I don't have psos. In a way I'm just pleased that I have enough eggs that we can hopefully get some to freeze due to male issues (we are having ICSI) we currently have one frozen sample in case the fresh ones (of which he has to do two) aren't any good.

Did they also do blood tests with each scan? My clinic haven't mentioned any blood tests so I'm not sure what they need these for?

From what I know, bloods are more important from a monitoring point of view. They are checking levels and that is how they determine dosage. You are bound to have them. Think my cycle went a bit like this, but please remember that everyone has different cycles/consultants etc. (bear with me because I can only really vaguely remember the days)

(cd3) tues - scan. start gonal injections
sat - bloods. change dosage
sun - bloods and scan
tues- bloods. change dosage
thurs - bloods
fri - bloods and scan
sat night - hog trigger
mon- ego collection

I might have had another scan in there (can't remember sorry) yep, so the whole thing was just under 2 weeks. It flew by. Hope that is vaguely helpful. Basically be prepared. I didn't expect to be at the hospital as much as I was. Bloods are very quick though. It's just scanning you sometimes have to wait around for (not at 8.30am on a sat and sun though!)

That's great thank you, so they do the blood tests and on the same day change the dose if needs be? So I assume you had your blood tests first then your scans?

I don't think my clinic does scans at the weekend so not sure if that will may a difference.

Can I ask if your treatment is via the NHS or private?

Blood test would be done in the morning. Usually before 10am. They get results same day, then nurse calls you in the afternoon to let you know whether to continue dose of change it. Very easy on gonal pen.

I was at guys. Some days they'd call me for bloods first whilst I was waiting for scan. I think actually I always had blood first, because the obviously need to get them to lab ASAP to get results back same day.

I thought all clinics were open 7 days a week, but that may be my ignorance. I had my embryo transfer on a sat too which is something they obviously cannot dictate. They have to put them back on the right day to give you best possible chance.

I'm secondary infertility so paying but at nhs hospital. The treatment is exactly the same whether you pay or are nhs funded.

Hope this helps.

That's great I've actually e-mailed my clinic and asked some questions based on what you've told me so it's been a lot of help.

Hope everything goes with your next cycle!!

Thank you.
Best of luck with yours too. I knew nothing before I started, but just try and go with the flow and have faith in the professionals x

I've just received the following response from the clinic and have now gone back and questioned why they aren't doing more given what's bern mentioned above.

You should only need to have a blood test at one of your appointments and they are to measure for the oestrogen hormone level. Oestrogen is produced by your eggs. The blood test is unlikely to have any impact on your drug dosage. You can have your drugs on the morning of the scan unless we ask you to wait until after the scan for any reason.

Hi. I'm sure every clinic is different and Im no expert, so please try not to worry. I'm sure your clinic has everything under control.
They've kind of highlighted your point on their answer though. The drugs are stimulating ovaries and therefore the way to test if they are being over stimmed is by measuring oestrogen in blood? Oestrogen needs to be kept in normal range and therefore that is why they take bloods. At my first bloods mine was a little over normal, so they lowered dose.

Why don't you start a new thread and see what other peoples experienced are??

I had a long chat with my clinic about bloods on the antagonist protocol today. They told me that they need to check Estrogen to see how the follies are developing and they use this to determine dosage of FSH injections (Gonal-f in my case) but later in the cycle, the monitoring of LH is the more important factor.

Basically the cetrotide is working to suppress your LH surge so it is really important to make sure it is working and that your LH is remaining low.

If the cetrotide isn't working as effectively as they want it to (measurable by rising LH levels in your blood) then there is a chance you might ovulate naturally and all your lovely eggs will be lost.

I have had bloods (LH, Progesterone and Estrogen) taken at every scan appointment I have had and I have been told to take all drugs in the evening, in case they need to adjust my dose based on the results of that day's bloods/scan.

I will stress that I am on an antagonist protocol, your arrangements might be different if you are on a different protocol.

I ended up e-mailing them again and saying I was concerned and got a reply back saying each treatment is tailored to the patient so it's put my mind at ease now.

Thanks for your advice it's been appreciated.

Yes, it is tailored but I'd say that if you get to day 5/6 (they count first injection as day one) and you haven't had bloods then maybe ask.
Good luck. I'm sure it will go fine.

Just another perspective, I have just done my 3rd antagonist cycle and haven't had any bloods at all during monitoring for any of the cycles (2 different clinics). They relied on scans alone, even when they suspected OHSS I had extra abdominal scans but no E2 bloods. I was slightly surprised at this but ever clinic is different.

Wow, no bloods at all? Do you mind if I ask which clinics these were?

Ivf wales and CRGW

Battery sorry I didn't spot your reply yesterday I'm also on an antagonist cycle and the clinics exact response was:-

You should only need to have a blood test at one of your appointments and they are to measure for the oestrogen hormone level. Oestrogen is produced by your eggs. The blood test is unlikely to have any impact on your drug dosage. You can have your drugs on the morning of the scan unless we ask you to wait until after the scan for any reason.

Indeed if you show signs of OHSS then you may need more blood tests and we can arrange these as necessary but if not then we will only need to do one test routinely. We tailor our treatment cycles to meet a patient's needs rather than just saying all patient's need one thing or another as we find this is a more successful way of doing things. OHSS does not happen within the first week of injections and once we start your scans we can arrange blood tests etc as required.

Mmm, again I'm no expert and I can only go on what I've read and was told by my clinic, but a patient will only develop OHSS after egg collection. That is why a cycle may be cancelled. Because they don't put embryo back in.
The fact that their email says that OHSS does not start within first week of injections, indicates they mean it could start in second week and I think that is incorrect.
The very fact bloods are taken is so that they can indeed tailor your cycle to you. Bloods are taken regardless of whether you are a OHSS candidate I would have assumed.

I can only assume a clinic wouldn't take bloods because of the cost implication?