CREATE - timing of trigger shot?

[GingerRCD]

Hi,

I'm having my first egg retrieval on Weds morning and have been advised to have my trigger shot 35 hours beforehand. My fertility acupuncturist said the trigger is usually 36-38 hours before and that studies show better outcomes at 36 hours.

Does anyone using Create know why they do the retrieval earlier, at 35 hours, rather than 36-38 hours after retrieval? I have very low AMH (likely to only get one egg on each collection) so want to do what's optimal.

Thanks x

@GingerRCD I asked the same question (I'm with Create) when I had my first EC with them. Am I right in thinking you're having natural modified? If so, I was advised it is to ensure that they do not want to risk you ovulating too soon so natural modified IVF patients have their collections earlier to prevent that from occuring as there are less follicles to collect from

Thanks @Sunflower360 . Yes, I'm having natural modified IVF. Have all of your ECs been 35 hours after, then? How have you got on at Create if you don't mind me asking? Have you stuck to the natural modified protocol or have you ever asked to go for a mild cycle if you've had a better follicle count? I had five follicles this month, which is amazing for me, but I only started stimulation on Day 6, so those follicles had kind of died off with the emergence of my dominant follicle.

@GingerRCD I had a AMH of around 4 pmol when starting with Create and got advised natural modified would be beneficial, especially as my failed NHS cycle at another clinic led to only 2 mature eggs of which neither fertilised (high dose stims). Create asked if I agreed, which after my disaster NHS round I completely did. I did the following with Create:

Cycle 1: natural modified, 5 eggs collected, 4 mature, 3 fertilised successfully:
1 x day 3 (as yet to culture once thawed to see if it gets to blastocyst or not) and 1 x blastocyst frozen

Cycle 2; natural modified, 2 eggs collected, both mature, both fertilised, both reach blastocyst:
1 x frozen, the other discarded on day 6 as poor.
Notes from this cycle were that I had a number of follicles that could have possibly caught up; so more eggs (possibly 4 in total could have been collected but the follicles were not big enough and eggs would have been immature, so mild advised for next time to see if it was possible)

Cycle 3 1st attempt: false start, cycle cancelled. I did back to cycles and in hindsight shouldn't have done (I pushed for it). I developed a polyp later which needed a Hysteroscopy, and in all hoensty I'm glad I had the Hysteroscopy as my periods have improved since as adhesions were removed too (better flow, no period pain), seen it as a prep for FET. But I do believe the polyp arose because of the stims and back to back cycles...hence now doing natural FETs to avoid meds where possible. So if you get a good response with natural modified, you may want to consider a one month break between cycles as natural is only meant to collect 1 or 2 eggs.

Cycle 3: mild, 7 eggs collected, all mature and fertilsed, 5 reached blastocyst:
4 x day 5 and 1 x day 6 blastocyst frozen

So overall, I got 8 embryos frozen - we were prognosed to only get 2-3, so whatever happens, it was more than we could have hoped or expected at this stage.

I just completed my FET of the best grade from cycle 3 but unfortunately that was a BFN so I'm now going straight into my next natural FET with an embryo that is the same quality from cycle 1. I did not do PGTA.

Overall, I have found the clinical care with Create good, I have done my own research along the way too and am making my own decisions on how to approach which they are in support of.

How have you found it?

Thanks so much for your reply, I really appreciate it.

I have very low AMH (0.55) and I'm doing a 6 cycle natural modified program. My first cycle was cancelled before I started stims, as my estrogen was low and my dominant follicle was a funny shape.

This cycle, I started stims (Gonal F 150) on day 6. I was scanned on Day 3 and had four follicles (which is good for me) but by the time I started stims, I had a dominant follicle so the other follicles haven't grown. I know that's the approach of natural modified- they want the one golden egg - but I feel like I've wasted those follicles.

What cycle day did you start stims with natural modified? What day did it start with mild?

That's great that you got that many embryos, you must have been thrilled! I'm sorry your first transfer wasn't successful. Wishing you all the best with the second x

@GingerRCD thank you, will see how this next FET goes! I am considering another EC if a few FETs don't work as I'm 38 so age is not exactly on my side to delay further ECs, but will see what happens.

In the natural modified cycles I didn't start stims until day 6 in one cycle and day 7 in another if I remember correctly, I didn't end up starting on day 5 in either as my lead follicle was always a bit slow to get going and I think they start stims when it's 10mm if I recall correctly.

In mild I started stims on day 2, as the aim was stimulating more than one or 2 follicles.

Hope your EC goes ok!

Thank you. I'm excited to have reached this stage this time, and praying we get a good one!

Were yoh signed up to the 3 cycle package? If so, I'm guessing you just had to pay a bit more for the additional drugs in the mild cycle?

I've recently turned 39 so I feel the same, and just want to seize as many opportunities as possible.

@GingerRCD yep just paid for the extra meds for the mild, so cost was no extra bar from that

And yes I had a 3 cycle package