Have the clinic massively cocked up here.... im devastated

[Pass1818]

Hi all.

Bit of background.

5 cycle (one DS on 4th cycle)

High responder...AMH is 57.

Last cycle - Simmed for 20 days, 38 eggs and OHSS.

This cycle, same clinic. I was put on a higher doseage as last cycle it took me longer to respond. On my day 5 scan (1st scan) it was lowered to 150iu. 3 days later and after only 7 days of stimms i was apparently ready for EC. I was shocked. I had lots of follies but from what i could see, measured 12-13mm.
Come EC yesterday, out of a shocking 70 follicles, they only retrieved 12 eggs. I aked the doctor how? Why was the number so low, she said had they left me til friday, i would have got too many. 🤔
Ive just received the call that only 2 of my 12 were mature and NONE fertilized. The embryologist even said herself that something wasnt right and they are shocked as i was.

Now, im gut is telling me that EC was too soon, they have massively f**ked up this cycle and i either want to be fully reimbursed or a free cycle.
What are my chances? Has this ever happened to anyone at around my age (34) with my AMH?

Im devastated. 😪😪😪😪

Anyone????????

Hi @Pass1818 how incredibly disappointing for you - I'm not surprised you're heart broken!

I would ask for a debrief meeting ASAP - all I know is that they like follicles to be 18-22 on the last scan prior to collection (or that's what my clinic seemed to like) so it would def. be useful for you to go through your notes with the consultant and find out what went wrong where.

Best of luck

I have one on wednesday. Im going to to put it in writing anyway. After alot of research, it seems they triggered me too early. I love this clinic and feel so diappointed.

Let us know how you get on. It'll be interesting to hear the consultants opinion. I wouldn't write off the clinic - mistakes can happen at the best clinics but it's how they respond and learn from them which show how good a clinic it is really.

I wont write off the clinic but they owe me an apology and most defiantly my money back. Ive written a 5 page complaint letter!

How gutting for you. I don't have a lot of experience of this (only done one cycle) but I didn't get triggered until I had follicles over 20mm and others catching up (and it took me 5 days to get from 13mm to 20mm).

Given you want to continue with them, I'd suggest perhaps going along and asking a lot of questions about the treatment process rather than going in with the complaint letter straight away? (from what you've said, they may see they made a mistake and volunteer the refund anyway...)

I have to go for bloods today, so im going to see if there is anyone i can speak to to suss out where they are with this and how they will deal with it of i dont put a complaint in. If they wont budge (which im guessing they wont as no clinic wants to admit they fucked up) i will have no choice.
Ive woken up so low. Cant stop crying and in some discomfort. Im hoping OHSS isnt on her way

With that many follicles, it may have been that they had no choice but to trigger you early, for the sale of your own health and OHSS avoidance. It's a fine balance they have to find.

I wouldn't go in all guns blazing about them messing up. Ask lots of questions by all means. I can understand how absolutely disappointed you must feel but apportioning blame is not going to help you.

If you'd have got more eggs you'd be feeling different now, even though the made the same decision on timing, but they don't know numbers when they trigger you.

The oestradiol blood test will give them an indication but with PCOS or over-responders it can be difficult to estimate based on that. I imagine your levels were probably through the roof and it was not safe to wait any longer.

I hope you get the answers you need. It's a tough process and when you go through a round that doesn't even give you a shot at pregnancy it's a horrible feeling after all the effort you put in feels wasted. There's nowhere for all that emotional charge to go as you don't have a two week wait ahead of you to channel it in to.

I hope you start to feel better over the coming days. It's a massive strain on your body so hope you can get some rest.
Good luck with the clinic discussions.

Hi,

I have a similar AMH and my last few cycles were short protocol to avoid the risk of OHSS. Your clinic sounds negligent in letting you stimm for 20 days! With a high AMH the approach is supposed to be super low dose of stimms with a Buserelin (rather than HCG) trigger. With a short protocol, 7 days of stimms sounds about right.

Hi,
Ive spoken to the nurse today who has advised for me to put a complaint in.
She looks at the follies and only 6 were at 18mm. I had a good 40 follies and only 6 were at 18.
My bloods were at 11000.
Im super emotional and dont want to come across rude by any means to anyone. But i think people are forgetting that 10 of my 12 eggs were immature. If all 12 were mature, or even 10 then i could accept this but this just backs up that i triggered too early.
I was blasted too quickly.
They should have cancelled or coasted me and done a freeze all cycle and done a FET at a later date. I think the nurse actually agreed with me on this too.
She did say that i do have a chance where the clinic will fund another cycle for me, but in order for this, i would need to put it in writing.

Hi @Pass1818 , I'm glad the nurse was receptive. I'm surprised they didn't talk to you about cancelling the cycle - sounds like they were worried about you over stimulating? But they really should have been open and discussed it with you.

I hope they fund your next cycle! Let us know how you get on

Thank you

It appears they hadnt even considered it.

Its disappointing.

Hi Pass,

Glad you had a positive conversation with the nurse and she seemed to understand your point of view. Just wondering, was there a communication issue more generally while you were having treatment? It sounds as though they didn't really talk to you at each stage why they were making the decisions they were making?

In your shoes I think I'd want to know why the protocol was so different this time although you had a similar number of follicles (I assume if you got 38 eggs on cycle 1, you also had 40 or more follicles that time)
If they were worried about OHSS, why did they not trigger with Buserelin instead of HCG? (or did they?)

I felt like my clinic really made efforts to manage my expectations the whole way through about things that could go wrong (almost too much!) and the % chance of things going wrong.
In the event, it did work for me but if it hadn't I would have understood why they made the decisions they did, even if the outcome hadn't been what I wanted.

I really hope you didn't get OHSS too...

Thanks out..

Yeah, there were issues with communications this time, more between the consultant and the nurses about what dosage i was on and i kept having to tell the nurses what i was on.

Protocol was the same as last time, we just started on a higher dose this time as it took a while to get things moving last time.

I know that they did this too early. They should have continued and done EC on the friday not the Wednesday. Im lucky in the fact that although i am not clued up like the profressionals, i have done enough research in the past 7 years to know when something isnt right. And this isnt.
They can say all they want that my bloods were at 11000, that there were 6 follies at 18mm.... but the fact most of the 58 other follicles were too small and 10 of my eggs were immature.... speaks for itself..
Im driving myself crazy. I feel so low, emotional and im trying to pick myself up for my 3.5yr old DS.
He asked me yesterday why my eyes looked sad, that broke me knowing this was impacting him.

Wednesday, i will know more.

But i sense a fight... they are not just going to hand over a free ICSI cycle, just like that.

Ps, im quite swollen. Bloods have come back ok at the moment xx

It’s tough isn’t it, because you don’t want to question the professionals, but there is a lot of information out there and you can easily find out what kind of protocol is the ‘norm’ for your situation, when it deviates it’s natural to ask why - and I think clinics should feel prepared to talk to you - and be honest when they do make wrong decisions.

I really feel for you. It’s a tough old process (I found the drugs made me quite emotional, on top of what is already a stressful situation). Big hug to you & hope you get this resolved soon. (And what an empathetic little boy you have) xx

Thank you

He is massively empathetic little boy, its just his nature. Melts my heart.

Ive been googling the shit out of my situation and although it sort of leads to early trigger, there isnt anything concrete.

Although im pretty well certain this is most definitely a clinical error and they have caused this issue, i just dont know if i have the energy or the information to fight them if they dont agree to give me a free cycle.

Totes shit this is....

Good luck

How are you getting on, Pass? Did you manage to resolve this with the clinic?

Hi,

Thanks for asking

I went for my review and the consultant did say as i have PCOS and a high follicle count, its very hard when it comes to IVF and which way it would go.
He did say if we were to have another cycle, he wouldnt do it how we just have done and wouldnt do EC so early....
Is that an admittance?
So, the senior consultants have a meeting on Thursday where they will discuss my case and decide whether to fund me another cycle or not.

I will update once they tell me their decision but i wont hold my breath...

With pcos the priority is always, ALWAYS, to ensure you don’t get OHSS. You will not be reimbursed and may even get a lecture. Your best bet is to go to a clinic with an expertise in PCOS. Many clinics offer extra monitoring with high impact drugs. Also, take inofolic and co-enzyme Q as that helps massively with egg quality.

Erm, how am i going to get a lecture? What have i done?

I dont think its as black and white as you make this out to be.
I may not get my money back, there is a high chance i wont, however, the clinic have admitted that in hindsight, they should have taken other routes and made potentially better decisions so im not sure how you are so sure that they havent done anything wrong when the clinic have practically admitted it themselves.

Because the same thing happened to me during my paid for cycle. I produced 30 eggs, 3 able to be fertilized, 1 fertilized. They took the lessons learned from my first cycle and applied it to the second where I produced 40 eggs, 14 mature eggs, and 4 freezable embryos. But they didn’t refund because their priority is for me not to get OHSS. If you get a refund great but I wouldn’t hold your breath — reduced egg quality (ie the production of mature eggs) is a known problem with pcos. Their priority is nearly always the health of the mother but many clinics with pcos expertise will provide extra monitoring.

Your best bet is, with co-enzyme q10 and inofolic and metformin improve your egg quality as much as possible in advance of the hormone cycle.

Yeah, i get what your saying and i agree not to hold my breath... its a long shot but i know they were at fault.

I also have read up so much on my situation and learnt alot about PCOS but even so, every case is different and in the 4 previous cycles ive had, ive always had a good maturity/fertilisation rate.

See, my situation is the opposite to yours in the fact that this was my 2nd cycle with them, my first went fantastic, well for me, lol! It took a while to respond, but i ended up with 38 eggs and OHSS.
OHSS isnt high up on my clinics priority list is seems.
Although i dont hold my breath as such, im clinging onto the fact he said next cycle, we will do it how we did my first cycle with them. I just want some hope... not that it matters now as D day is tomorrow so i will soon find out what they decide.