No ovulation after trigger shot?

[peperethecat]

Hi everyone

I hope you don't mind me posting in here.

I'm doing my first cycle of timed intercourse with a trigger shot (Ovitrelle). I ovulate on my own (never earlier than CD18-22, occasionally CD 25 or 26), and I get pregnant easily, but all my pregnancies have ended in early losses. My doctor suggested doing a medicated cycle with Ovitrelle and then supporting with progesterone in the luteal phase.

On Thursday (CD14) I had an ultrasound which showed my follicle was 18mm and my lining was thick enough. I did the trigger shot on Friday (CD15) and got a positive pregnancy test a couple of hours later, so I know the HCG got into my system OK. My doctor said I should ovulate 24-36 hours after the shot, so between Saturday night and Sunday morning.

It's now Monday (CD18) and my temperatures yesterday and this morning were still low and suggested that I had not yet ovulated.

Does anybody know what the chances are of a trigger shot not working at all, or of ovulating with a few days' delay after a trigger shot?

I've spent today mining the internet in search of answers and some sources suggest that temping isn't accurate when you're doing a medicated cycle, but I'm not sure whether that's the case when the only medication you've taken is the trigger shot, or whether it's only when you are on other meds as well.

Would doing a progesterone blood test tomorrow morning give me a definitive answer? (I have a prescription.)

Any insight / experiences would be massively appreciated.

Thank you.

[physicskate]

If you're being supported by progesterone during this cycle, a blood test is unlikely to show much... and definitely not until a week after suspected ovulation if no progesterone support.

Temping is NOT fool proof. Just one of many indicators.

All you can do is keep dtd. Not sure why a medicated cycle with trigger would prevent miscarriage, but some docs will try anything, even if the science isn't really there. Biology is as much art as science, really!

What recurrent miscarriage tests have you had?

I'm sorry for your losses. Bit shit you're now having this uncertainty too....

[peperethecat]

Hi @physicskate. I haven't started supplementing with progesterone yet. I'm supposed to start that on Wednesday, which my doctor estimated would be at least 3 DPO.

I've had basically all the recurrent miscarriage tests except for an endometrial biopsy, which we will hopefully do next cycle if I don't get pregnant this cycle. My fear is that I will get pregnant and have another miscarriage, meaning we'll have to wait longer to do the biopsy.

This is my first cycle with a new gynaecologist. He reckons a lot of his recurrent miscarriage patients have managed to get and stay pregnant with Ovitrelle. When I had my ultrasound on CD14 I was quite surprised to see that my follicle and lining were mature because I knew I wouldn't ovulate on my own for at least another four days, based on previous cycles. It got me wondering whether the reason I keep miscarrying is because my follicles mature at a normal rate but for some reason my LH surge is always late and so my egg is past its best by the time I ovulate. So it's quite upsetting to have taken the trigger shot and apparently not have ovulated any earlier than usual.

I'm not in the UK so I realise that ways of treating infertility and miscarriage might be slightly different here.

[ivfgottostaypositive]

Hi @peperethecat

I've never really heard of infertility being treated this way especially if you ovulate on your own.

That being said I've taken ovitrelle a few times (is way about 8 times now 🤦‍♀️ I cant actually remember) both for egg collection and to force a natural ovulation for a frozen embryo transfer and it's always seem to have done whatever its job is

I'm pretty sure I've always triggered around 18mm - with transfers if the follicle has reached a certain size but I hadn't had a LH surge then I'd usually take ovitrelle then and pretty sure ovulation has usually been within 36 hours. I've also requested it before even if i have had a LH surge as I read somewhere that having high doses of hcg in your system can actually increase chances of success (I spend a lot of sleepless nights on google 🤣)

In IVF I believe ovitrelle has the function of not actually making you release the egg but to ensure that the number of chromosomes in the follicle halve to the right number and is then mature enough to be harvested with a good chance of fertilisation and helps "loosen" the egg ready to be released

Have you had your progesterone tested before so do you know it's definitely a factor in your early losses?

I can never be bothered temping as I always get it wrong - plus having high doses of hcg in your system will throw your body temperate out of whack - ovitrelle sends ones of my male cats crazy and even though he is neutered he turns into a sex pest a few hours after doing the shot and wont leave me alone! 🤣

[ivfgottostaypositive]

because my follicles mature at a normal rate but for some reason my LH surge is always late

The only way of knowing this is to have your e2 levels tested though the cycle - it should start out close to 0 during your period and should rise - in IVF they look for a level of 200 per visible follicle - if it's low for the number of follicles they can see on the scan then it's most likely the eggs aren't mature enough (I had this one cycle and my IVF was abandoned that month)

[peperethecat]

@ivfgottostaypositive I don't know for sure that low progesterone was a factor in my previous losses. The third loss was a missed miscarriage and I was supplementing with progesterone since a couple of days post ovulation. That one implanted the best and lasted the longest but we think it was probably chromosomally abnormal. Unfortunately we tried medical management first and I passed the embryo and sac at home, so we didn't get to do a tissue analysis, and then I had retained products so had to have the surgery anyway.

Where I live they seem much more willing to prescribe progesterone than in the UK.

Interesting what you say about Ovitrelle being used to ensure the egg has the correct number of chromosomes. I hadn't heard that before.

I've been temping for over a year and always been able to pinpoint my ovulation accurately. This is the first time I've ever taken any medication other than aspirin and progesterone in the luteal phase (after three high temps to confirm ovulation) and so not having got that temp rise after Ovitrelle has made me really anxious.

I'm thinking of getting my progesterone levels checked on Wednesday if I haven't had a temp rise by then. I don't want to start popping the progesterone pills if I haven't ovulated yet.

[peperethecat]

The only way of knowing this is to have your e2 levels tested though the cycle - it should start out close to 0 during your period and should rise - in IVF they look for a level of 200 per visible follicle - if it's low for the number of follicles they can see on the scan then it's most likely the eggs aren't mature enough (I had this one cycle and my IVF was abandoned that month)

This is the first cycle I've had ultrasounds and E2 levels checked prior to ovulation.

At CD14 my follicle was 18mm and my E2 was 283, but my LH was low (10), and I didn't get a positive ovulation test before I triggered on CD15, so it looked like my follicle was fully mature but there was no sign of the LH surge happening naturally.

[ivfgottostaypositive]

It's impossible to get progesterone on the NHS here even through recurrent miscarriage clinics - I attend one and asked and was fobbed off even though there has been a few studies lately about the benefits of taking it

That being said I've taken it 4 times now - 2 were IVF BFN. 1 was a naturally conceived miscarriage and the other a ruptured ectopic. But we only get the ones you have to insert here 🤣

That being said I'm due to transfer again in maybe 3 weeks and I've asked them to check my levels via blood test on transfer day and if it's low get the progesterone injections which are supposed to be much more effective x

[ivfgottostaypositive]

283 sounds spot on then for one follicle

I've done loads of follicle tracking in the past when I was trying naturally and although IVF and controlled fertility treatment environments like to see a surge starting around 18mm I'm pretty sure mine have gone to 22mm or 24mm in size before the surge it's just then my surge has been really short and quick and I'd ovulate the next day

Your follicle will still continue to grow after the ovitrelle shot and because I'm a control freak geek I've kept spreadsheets of my last 4 egg collections and any follicle which was 14mm or bigger on day of trigger shot (which tends to be a day or so earlier than when you would normally get it naturally) they collected a mature egg from x

[peperethecat]

Is there a size beyond which the follicle is too mature?

[ivfgottostaypositive]

@peperethecat

I'm sure I've read somewhere over 24mm is over mature

Follicles can grow up to 2mm per day so if you were 18mm on day of trigger and ovulated then average 36 hours later then you'd be in the perfect range for follicle size of around 20mm-22mm

[peperethecat]

But if I ovulated today then it was probably too late. Ugh. FML.

[peperethecat]

I was 18mm on the day before the trigger so I'd guess more than 24mm by today.

[ivfgottostaypositive]

I wouldn't worry too much - the 2mm growth is a maximum range and yours could have grown less than that x

[peperethecat]

I guess there is nothing we can do but wait and see now.

My husband asked why I can't just stop temping and we keep having sex and try not to worry about it. So I explained that if I start the progesterone when I haven't ovulated yet it will fuck everything up, and he looked really sad and said he wished it could be the same for us as it is for everyone else we know. They all just seem to have unprotected sex for a couple of months, get two lines on a pregnancy test and have a baby 8 months later.

[ivfgottostaypositive]

It's hard isn't it. It's just not the fairy tale We thought it would be. This whole thing steals the fun and the joy out of it all. There is a feeling of being robbed. That we can't have sex without it being timed, that we can't do a pregnancy test and feel hope and excitement and make plans for the next 9 months, that we can't plan the children and the siblings we imagined.

I suppose one "good" thing about losing both my tubes is that the whole pressure to have sex issue is gone. It has to have been about 6 years since we had sex just for fun.

[peperethecat]

I can't even imagine how hard your journey has been.

I suppose as soon as you get to the point where you know that having a baby isn't going to be straightforward, sex becomes a means to an end rather than something you do for fun. If both your tubes are gone then there really is no point having sex unless you want to, so it can become recreational again! But I'm sure you'd rather have your tubes.

[ivfgottostaypositive]

@peperethecat

In a perverse way I'm glad they've gone. It sounds bad but in a way I can "deal" with miscarriages but ectopics are a whole other ball game - I couldn't go through that again. I almost left my DD motherless twice and I felt terrible guilt for that for a long time as well as having to abort 2 perfectly healthy babies because they were in the wrong place. If I still had my tubes I'd always get my hopes up every month of getting pregnant and the disappointment would just go on for years if it didn't happen. It's in many ways easier now to know they're won't ever be a miracle baby or an "oops we weren't even trying baby" or "we relaxed and it just happened baby" - we'll hopefully have 6 embryos soon and 6 chances and then I'll be at peace with our decision to stop and will be able to move on without any lingering pressure of am I / am I not pregnant every month

[physicskate]

@peperethecat I completely understand the uncertainty messing with your head (been there, done that).

It's the not knowing what going on now and the uncertainty of the future that can drive you mad.

I personally found counselling a bit helpful to gain some perspective on that.

None of it is fair.

My ivf was successful. My daughter is 14 months. Other people constantly ask about 'number 2' and I'm just like, I can't even think to hope about anything to do with getting pregnant. Infertility left me low for awhile, very low. People on here told me to kill myself, I was such a killjoy (obviously I didn't take their advice.

And yes, follicles grow 1-2 mm a day. We all have to work on averages, but 2mm growth isn't certain.

[peperethecat]

Congratulations on having your daughter, @physicskate. It sounds like you had a really hard time. I can imagine what you mean about the second baby comments. I haven't managed to have one yet and I already feel like I'm revising my life plans to "if we can have one then that'll be great, maybe we'll be one and done" rather than wondering whether we'd have enough time and money to have more than two.

I can't believe people on here told you to kill yourself, that's terrible.

[peperethecat]

@ivfgottostaypositive What you say makes total sense. Fingers crossed that one of your embryos results in a healthy baby.