High AMH IVF - what trigger did you have?

[thislittlebird]

Hi all, I'm starting IVF soon and today realised the trigger I have been prescribed isn't quite what I was expecting, I was too busy fretting about other things to think about it until I saw it in my house. Can I ask what trigger you were given with high AMH and did you have OHSS? I've been given Ovitrelle.

I'm quite nervous about OHSS and the young doctor I saw didn't make me feel very confident, she rushed through my file, glossed over my high AMH (31) and AFC (38) and focussed purely on my age (38) before recommending maximum doses of meds. I protested because I'd had private consultations and they had said I needed lower doses than that (as well as a non-HCG trigger), but didn't think to discuss the trigger because it was all such a whirlwind.

I'm fretting about the trigger and OHSS, possibly too much, but it would be useful to hear if others had ovitrelle with high AMH and were ok and I'm worrying unnecessarily.

I had a busrelin trigger. I had a very high follicle count and AMH (both over 100), I would have been overstimulated with an hcg style trigger. Maybe best to double check!

@Scottishrunner thank you! Obviously mine isn't as high as yours but I'd previously been told I'd need an agonist trigger, but then an HCG one turned up so I'm thinking I might raise it on email with the nurses.

Hey @thislittlebird

I don't have high AMH or AFC, but on my last round the consultant changed the trigger from ovitrelle to antagonist because I was at risk of OHSS. Better doublecheck with your clinic?

@Yuliaaa thank you! It feels like they've sent me standard items and paid no attention to the details, other than my age. It's useful to hear yours was changed, I'm going to email them and ask for this to be double checked.

Hi! My AMH is 42 and I had one antagonist trigger and x2 ovitrelle injections for my last round. Managed to avoid OHSS.

@Glamisastateofmind oh interesting! Glad to hear you were ok because this OHSS thing is a worry. Was there a reason they did the three?

My first round I just took one ovitrelle but the number of fertilised eggs was relatively poor compared to the number of eggs at egg collection. So the doctor decided to change the trigger to reduce egg quality. I think that bit worked as I got twice the number of fertilised eggs! Currently in the TWW.

@Glamisastateofmind the number of fertilisations is a worry yeah. did they change it to a non-hcg trigger? It’s interesting the difference these small changes can make. This is my first round and it’s our nhs funded round, I’m hoping it will produce at least a few embryos.

My AMH is 33 or 4.65 depending on which units you use. I had 12 days of 150 Ovaleap, 0.25mg Cetrotide for 9 days then an Ovitrelle 250mcg trigger. I also had thrombosis injections after as a precaution. The Ovaleap was quite a low dose and I actually ended up taking it for almost double the time intended. My doctor said it can happen when a lot of follicles grow because it takes longer for your body to grown many in parallel. She was never worried and just kept me on the same steady dose.

I did not get OHSS and I did get pregnant. I did have quite sore ovaries. I actually didn't worry too much about OHSS. I'm not sure why. I think most people who get it don't really have so serious issues but do have to skip the fresh transfer. I think I was more worried about missing my fresh transfer .

Good to hear you also had ovitrelle @CycleGirl20!

Whereas I’m more worried about getting OHSS and getting sick. I also quite like the idea of frozen embryos over fresh when my body is less stressed, I suppose.

I emailed the clinic and they said not to worry, they’ll change it if I respond enough that I need another trigger, which is a relief. Not really sure why they prescribe it beforehand but hey ho.

Hello,

I just wanted to pass on my experience in the hope it helps others out.

I was at risk of OHSS due to high AMH (58) high follicle count on prior scans (avg 14), low weight and lower age (for ivf).

When I did my cycle, I did a short protocol, I had over 40 follicles and was extremely bloated but the nhs still gave me Gonsai 5000 (they shouldn't have).

I ended up with over 25 eggs and OHSS, where I struggled to walk and my stomach quickly swollen after egg collection. This did start to go down, so they still did a fresh 7 day transfer (again, they shouldn't have)

I did get a BFP but I ended up with severe OHSS, I got to the point I couldn't breathe, my stomach was extended as far as possible filled with Fluid and I was hospitalised for over a month, on drips and being monitored. Honestly it was absolutely horrendously, I've never felt discomfort like it. And it continued until I was 12 weeks pregnant as it's the HCG that makes OHSS worse, this does not stop doubling until the placenta takes over at 12 weeks. I missed months of work, I was in agony for the whole first trimester and it was throughly miserable, to the point I was crying for it to be over every day. I was having my urine output and liquid input measured, as well as my stomach measured like a turkey each day.

Obviously it's hard to say I wish I'd have pushed for a frozen cycle instead because it did actually work and I am grateful, however if I'd have researched properly back then and understood how bad OHSS can be I'd have definitely have pushed them to give me an alternative trigger and probably a frozen cycle so my body could recover.

The OHSS has caused complications to my pregnancy in that I now need to take daily blood thinning injections, and I'm at a higher risk of pre term birth, all of this could have been avoided with a frozen cycle.

Good luck for you cycle! I have everything crossed it works and you don't have to suffer OHSS.

@Ashleighz88 thank you for sharing. Can I ask at which point in the process you knew you had OHSS and what the signs were? I’m very tempted to ask for an elective freeze all tbh. I’m quite an anxious patient as it is, and the OHSS risk is worrying me. I think my anxiety will be huge around all this by the time of EC and that alone makes me want to push for a freeze all.

I’m definitely going to push them on the trigger nearer the time.

Thanks for the well wishes! I hope your pregnancy goes well despite the horrible experience you’ve had so far. x

@thislittlebird hello, sorry I've only just seen you replied to this.

I definitely had it after egg collection, my friend had ivf before me and seemed to find egg collection and recovery a breeze, I did not. I couldn't walk going in (loads of follicles) and then the day after it my stomach swollen and I felt generally unwell. However, because there was no HCG at that point it did go down by day 5 (doctor confirmed I still had some fluid in my abdomen on the ultrasound at transfer but still did it).

Then it was 7 days to the day after the transfer I woke up to my stomach looking 9 months pregnant, and I knew I had it then.

I really would push for a freeze all if theres any risk of you getting it. Severe OHSS is very rare but I'd eliminate any risks possible, also surely our bodies have a better chance at starting a pregnancy with everything in a good place to start with.

Good luck ❤️❤️

@Ashleighz88 thanks again for sharing, I wanted to update you! I pushed for the freeze all because I was having breathing difficulties and shoulder too pain, but no bloating, that had gone by Monday (EC was Friday). They couldn’t see any free fluid so hard to say if ohss or anxiety or something else but it seemed strange that it started Saturday. She did say some bleeding could cause it and it would go away if nothing was transferred. So we did a freeze all at the last minute, mostly because I was a very stressed that my breathlessness would get worse if it worked. I’m older still in April than I am now 😩 but I think it’s the best choice for me so that I’m not unwell or even more anxious for the first transfer.

Hi @thislittlebird . Just wanted to say well done for making such a difficult decision. I know how eager we all are to have our transfers but I totally feel you on the OHSS angst. I have a very AMH and am of a slim build. They collected 31 eggs from me and Tuesday and my recovery is awful. I expected to feel tip top by today! It's my first round of IVF and I can't help but feel inferior to the rapid recovery of others after egg collection.
Anyway, I too am on a freeze all round and reading @Ashleighz88 experience, I am so glad I am. It really puts me at ease to know my rough recovery is likely a result of OHSS too so, thank you for sharing.

@Jazper it really is hard! I'll be 39 in May, It's so hard to walk away from (in my case anyway) a first ever proper chance to get pregnant. I was lying on the bed while she scanned me and even after bursting into tears because I was so stressed at the thought of my breathing issue getting worse post-ET I still started to think but maybe we could still transfer one hmmm.

I've been so worried about it since we started the process, and my health has been far from perfect since we started ttc in 2019 and the thought of getting ill was really upsetting me. I had a lot fewer eggs than you, there were 24 at baseline, 19 grew with the stims and 15 big enough collected, but it was still too much of a risk for me feeling like I do so I totally think a freeze all is the right with your numbers, I've chatted to people with 12 that have got OHSS so it's totally understandable feeling like you do, even if it doesn't happen every time. Hopefully the next few weeks can be used for me to feel healthier and fitter, lose a few pounds I've gained and so on.

Was your EC last Tuesday or yesterday? I think it's very individual, some people are back at the gym a few days later but I can totally feel my ovaries still when walking, don't fancy running around just yet.

@thislittlebird You've done the right thing. You don't need to be so stressed and worried going in to transfer. You need to be calm and relaxed. Also, my doctor told me that, while not clinically proven, there are many studies to show that women who allow their bodies to recover from OHSS yield better success in terms of implantation and a positive pregnancy test.
I can see your anxieties if you've known people suffer from it with less eggs than you too. I hope you can relax in your decision now. I too am going to use the next couple of months to get my fitness back up and shed the Christmas pounds I never managed to fully lose. I calculate my ET will be in about April too.
My egg collection was just last Tuesday, so the day before yesterday. Perhaps I was being naive or too optimistic but everyone I have followed on Instagram seemed to be fine the next day and I am just wiped! My ovaries are so tender and my abdomen is bloated and rock hard. In fact, just like you, I can feel my ovaries almost 'bounce' as I walk. Thankfully though, my shoulder pain is better now as that worried me the most.
P.S. That's a lovely number of eggs for your age. I am not much younger than you (35) and whilst I am really chuffed with the number of fertilised eggs we got, I am concerned of a big drop off on day 5. Fingers crossed. It's all such a waiting game isn't it.

@Jazper I really do hope that’s the case for me too, I’ve heard FET success can be as good or even better.

Probably a bit optimistic with those eggs collected, yes! But you will get there. I feel better again today (but I am on amoxicillin and prednisolone for my breathing troubles so maybe they’re helping!). I kept napping too the last few days. Very tired in the afternoon and I’m off work sick.

You had shoulder pain too? I had that until today. It was worrying me because the tips of my shoulders would hurt, worse still when I coughed.

You may well have a big drop off but as long as you get some decent ones then that’s a great start. We had a day six update today. We’ve now got 4 frozen and 2 more slow ones that they’re giving another day to see if they catch up. Fascinating process really. I never meant to be this old when we had a chance to try but it is what it is, we started trying when I had just turned 36 :/

Hi @thislittlebird 👋🏼 Yes, the shoulder pain really worried me. I even called the on-call nurse at almost midnight on Tuesday for some reassurance. She decided that symptoms of OHSS usually don't present until 3 days post egg collection and that the pain was likely due to the position I was in while under. It was a 40 minute procedure so I can see why I might ache afterwards. It was dreadful though, like you, I couldn't cough or laugh and I had to sit up to sleep the first night. I too am napping and day time naps are just not something I do usually so I feel you on the tiredness 😴
Congratulations on your 4 Frosties and wishing you so much luck on your 2 littlies 🤞🏼 Do let me know how they get on!

@Jazper did they explain the shoulder pain at all? I wasn’t loving it. I’m not sure I buy all the stuff they say to explain these things that isn’t OHSS. I’m pretty sure if lots of us get shoulder pain it’s related.

Yes, will let you know if those last two lazy chaps make it to the final stages lol. I am pleased because at 38 going on 39 with male factor issues it feels like such an unknown quantity and I consumed my body weight in water and protein during stims, plus the usual supplements, I really hope it helped. Fingers crossed for your update too.

I asked if they explained it before I went on to read that they did in fact explain it!

Hi @thislittlebird , I've been thinking of you and wondered how your last two little 'lazy stragglers' got on at blast?
I had my last OHSS monitoring appointment today and have been all but signed off (pending my last blood results). Yay! So on to transfer now 🥳
6 of my 23 fertilised made it to blast with a straggler being given an extra day to catch up. I find out about him tomorrow ☺️
So there's the drop you warned me about but of course, I am really chuffed with my 6 definite's.
Also, I'm curious, did you have to book a nurse or doctor/consultant consultation to move forward with your transfer plan? I've been told by one nurse it will be a nurse consultation and another told me it would need to be with my fertility doctor. I will call tomorrow to make the necessary arrangements but I fear a lengthy waiting list 😖

@Jazper one of them made it! So we have four frozen, which I can’t complain about really all things considered out of 9/13 mature fertilised. I think it was about the standard rate of fertilisation and embryo development which I’m happy with considering dh has reduced motility. I’m assuming we’ll used them across three transfers (luckily we have three funded) because the last one was a day later and I’m guessing lower quality but I forgot to ask.

When are you anticipating the transfer? Great news on 6! Honestly that’s really good. I’ve rarely heard of people who start off with high egg numbers coming out with crazy numbers of blasts, I guess there’s only so many that can mature at once.

They told me to contact the nursing team when I get my period after the one due soon, so late March. I think my clinic like the ovaries to go back to normal size but I won’t lie, the wait is already proving hard.

@thislittlebird I'm a few days behind you and finding the wait hard myself too. I thought I felt fine about it but now I'm not suffering the effects of OHSS, I just want to crack on. I do want to be medically fit of course but they keep telling me they are short staffed and so even getting a nurse consultation could be a wait (3 months they mentioned!)... So, in answer to your question, I don't have a time scale in which to expect my transfer just yet. I do intend to call the private patients office (we are self funding unfortunately) tomorrow and see what they can arrange so fingers crossed. I'm pinning my hopes on April.
Absolutely chuffed for you that one of your lazy one's made it. That's fantastic news. We suffer male factor too - low everything here, morphology, motility and count so, as with you, I too am grateful for the number of blasts.
Do keep me updated on your transfer, I'll be thinking of you.

@Jazper Yep, as soon as I felt fine the frustration kicked in. But on the plus side AF arrived today so I'm into the countdown to call the clinic again! Did you get your last update on the stragglers?

Unusual for private to be so slow, that seems unlucky. 3 months!