IFV stimming – help

[NSC1982]

Hi, Just wondering if anyone can help/advise on the timeline for stimming/trigger shot/egg retrieval as my appointment today has left me a little (very!) confused.

I've done two days of injections so far (menopur 300), injecting at 8pm as advised by the clinic. In advance, I was told that it would be between 10 and 16 days of this (most likely 12–14).

Today I had my baseline scan and they said I was responding well with 19 follicles (9 each side). The nurse then said I need to start the antagonist tomorrow (day 4 of stimming).

The problem is: I spoke to two different nurses in advance to confirm my not being around this coming weekend would be ok (I'm at a funeral on Friday followed by a memorial weekend, back Monday afternoon). They said this was fine as I'd need scans Monday, Wednesday and Friday this week then could delay next Monday's scans to the afternoon. However, today the nurse I saw told me I have to come in Thursday, Saturday, Monday mornings. When I explained my situation again, she then went to check with her manager and said Wednesday, Friday and then Monday afternoon would have to do but it wasn't ideal! So now I'm a bit stressed about that and what effect it will have on the whole process. If the trigger shot/egg collection is delayed because I'm away will the eggs be ruined by that point? By the time I have the scan Monday afternoon I will have been stimming 9 days which is well within the original timeline given...

I'm glad I'm responding well (age 42 so know odds are low) but now I'm left in a bit of a spin about it all!

I guess all this gets run past my consulant too (I was wondering if Menopur dosage should be reduced) but I don't have their direct contact details and feel like the clinic weren't that helpful today when they were the ones that gave me the ok to start this month.

Sorry for very long post but if anyone has any advice it would be very gratefully received...

The trigger shot needs to be timed so that you have the best chance of getting the most eggs which are mature on egg collection. Different clinics determine when to do it differently, but the basic idea is after X amount of eggs reach Y size then they'll trigger...say if you've got 19 follicles growing, they might trigger it when you've got half of them at the right size, which might be 12mm or so. (For me I have severely diminished ovarian reserve so I only have 1 follicle usually and so I get triggered when my follicles is 17mm but I'd imagine if you've got lots growing then it would be a lower size they trigger at)

So this is where it's difficult for them to give you exact guarantees as to when they can want to trigger you or scan you etc...it's all about how your body reacts to the meds. They can't guarantee anything.

Usually once you've started the antagonist meds (again, in my experience) they want to scan you every other day at least to keep an eye on the follicles growing.

I think unfortunately it'll be a case of playing it by ear and seeing how your follicles are growing and you might have to wait for the scans towards the end of the week to see if they have more idea of when to trigger.

The trigger injection is around 36-38 hours before the egg collection so, for example if you had a scan on Fri morning, the earliest you could have an egg collection would be Sunday morning (as you'd take the trigger Fri night and then Sun morning would be the egg collection).

Hope that helps and sorry it's not an easier answer. I had to miss lots of things whilst doing IVF.

My experience is the same as the last poster. It’s all determined by the monitoring scans, so while they will give you an indication, it can change based on the number of follicles and their size at each scan. My provisional appointments held throughout stims, and then at the final scan before trigger shot they decided to extend stims by 2 days. On the day of egg collection I was then advised to do a freeze all, so in my experience even starting out with ‘the plan’ - everything can still change with each appointment!

I suggest you prepare to potentially miss the funeral and memorial day as it will be 50/50 chance whether you need to be at the clinic or not until the scan right before. It’s really unfortunate timing but there is only so much they can control.

@Rosiestraws and @AlmostTime Thank you so much for explaining this – that's really helpful. They didn't tell me the size of follicles yesterday so going to ring to check today and to get the blood test results from yesterday. I'm starting the antagonist injection today too so I'm guessing the largest follicles have already reached a certain size and can see why they want to keep a close eye on it from now on. (Just a little frustrated that I asked before I started and they gave me the all clear to go to this funeral etc... wish I'd delayed the treatment to next month now but too late for that now). I don't think they'd give me the trigger Friday night as apparently they don't do it before 8 days of stimming – which would mean the earliest I could do it would be Sunday (so perhaps they could give it to me on Friday to take Sunday but I don't know if it works like that)... I guess I'll know more after tomorrow's appointment.

I know I should be glad to be responding but I'm also just a bit worried that the fast response is going to mean quantity over quality. I had two miscarriages (and an ectopic) last year so doing IVF with pgta testing to try and get a quality embryo...

How is it all working out for you both?

Also just spotted my typo in original post. 9+9=18 not 19 😂

@NSC1982 do definitely note the follicle measurements each scan and keep track of blood results. They are auto plotted onto a graph at my clinic - if they do this at yours you can take a photo of the screen each time. It can be important to have a sense of things yourself if you are dealing with multiple clinicians or need to challenge decisions (eg. If they want to trigger too early).

It can't be definitively predicted in advance when follicles will be at optimal size but you should know by Wednesday whether your Friday and weekend plans will be fine. I have similar AFC to you and aim to trigger with a range of 16-22mm.

So, ironically enough after me replying to say how it's all very dependant on follicles growing and nothing guaranteed, I may actually be triggering today, on day 4 of my cycle, having taken no IVF meds!! I had a day 3 scan and there was already a 17.5mm "follicle" growing and they thought it must be a cyst. But now they got the bloods back (and did another scan today where it's grown to 18.5mm) and the bloods indicate oestrogen high and progesterone low, so they think it IS a follicle and hopefully with an egg. I usually do natural modified IVF where my clinic focuses on the idea that the egg your body would have naturally selected to ovulate is the best, and they just give a mild dose of hormones to boost this. (Women do usually get more than just the 1 egg, even doing this process but I don't usually as I have such a low egg reserve). So this time they said we might just follow what my body is doing naturally and no injections apart from trigger - and probably they will want to trigger me tonight! The problem with that for me is that I don't have my trigger injection yet (private prescription and they dont stock it) so they might also want to use another trigger which makes me nervous..

But.. I guess this shows completely how your body's reaction can change everything!

I also agree with the poster above and you can ask questions re the follicles growth etc.

Argh @Rosiestraws i have a lot I want to communicate to you about this as I had a very similar situation and have just drafted a very long letter of complaint about the cycle. Can I pm you on the subject (if I can work out how)?

and hey op, sorry I felt the urgency of sending the above message before responding to your post.

first of all wowee 18 follicles is so good, I’m v low amh and know how much of a better chance those numbers will give you :) best of luck.

as youve already had excellent advice re:follicle size I just want to comment in general. Apart form your amazing follicle count I’ve had a v similar back story to you (MMC, ectopic) though can’t do pgta as my embryos can’t even get to day 5 in the lab it seems (currently with a day 3 on board). Planning around ivf is soooo shit. I mean it’s impossible. I’m really sorry you’re going through that stress most especially with a funeral that’s important to you. Is there any way you could get the scan and attend whatever parts of the funeral/wake you can after? I have missed so many important things/travelled 100s of miles to get to scans to try make life+ivf happen. Or perhaps as the other posters said, maybe wait and see closer to the weekend. The rate of growth (for me anyway) is prettt steady, so unless you’re nearing their cut off surely it’s still ok to attend.

@sirensong, thanks so much for suggesting this. I emailed to ask for them and they sent them straight across so now trying to interpret them but looks like just one follicle was
12mm and the rest were below that (it’s written in a table so no exact measurements until they get to 12 but will be useful to see how quickly they’re growing at tomorrow’s scan!). Estradiol was 994 which they said was good.

They said they’ll review dosage etc after tomorrow’s scan so think I just need to stop panicking about the weekend and see what happens tomorrow.

thanks for the info - feel like I’m learning so much every day!

@Rosiestraws Oh wow! That’s very quick but it seems like every journey is so different. Hope you were able to get a prescription of the trigger you wanted but I’m sure the other one would be fine too. Really hope there’s an egg in there for you.

I’m learning so much from this forum and definitely know the right questions to ask at tomorrow’s scan now!

@Nosejug thank you for the message. I should be happy with number of follicles rather than going into panic mode but hopefully scan tomorrow will bring some reassurance. I emailed the clinic today and they sent back exact results to Monday’s scan so feel like i have a clearer idea of what’s happening now and hopefully it will all work out around this funeral and I can stop stressing.

sorry to hear you’ve also been through ectopic and MMC - both so horrible in different ways! What clinic are you at (if you don’t me asking)?

No that’s fine :) I’m at create, I had two nhs rounds but my second had only one egg so I wasn’t allowed a third. In the 2ww with (technically) round 2 but have had two cancelled cycles between. The pregnancies were spontaneous and between rounds, which is weird considering all the treatment! But we had 2 years ttc before ivf began and nothing. Sadly I’m now 39 so my hopes are very low.

in my last round I had a very similar situation to the above poster and was advised by two doctors to go ahead, triggered, turned up for egg collection and was told by the senior dr that the round should have been cancelled after the first scan and that we shouldn’t go ahead. Not really ok! I was in the surgical garb and everything and had shoved uneccesary meds into my body that was the whole reason we went with this company (to lower exposure to meds).

Hi @Nosejug Feel free to message me? I don't think you have? Is that why you're warning about your experience- as the cycle was cancelled at egg collection? Why did they cancel it?

It’s so hard to plan.

I really didnt want to, but I had to tell my employer why I needed time off as my options to plan time off over a major client commitment with travel was impossible to navigate with the moving things around. I considered taking 2 weeks leave, although it would have probably not been approved at that time. As a result, when I returned 2 days later I learnt I’ve had 50k hours wiped off my portfolio and been put on ‘small works’ so it’s impacting my career before I’ve even had a chance of getting pregnant! Undecided on whether to formally start action as I’m aiming for low stress, if they want to pay me way over the odds for basic work then I’m going to enjoy the easy ride for a bit. But mentally is messed with my moral!

I can empathise with your frustration though, even with some perspective it has been a bit of an emotional roller coaster. I was so upset at having to do a freeze all as in my head we’d built up to egg retrieval and then the fresh transfer a few days later. I was expecting to be doing a pregnancy test a few weeks after that. A full 6 weeks since egg collection I’m now on day 28 waiting for a belated AF to arrive (I’m never late, except now lol) so I can start medical prep for a frozen transfer in October.

This was a decision based on my progesterone result on trigger day being elevated, it was borderline. The consultant said they could transfer, but my odds would be better with frozen transfer as studies had shown the womb is more receptive when progesterone rises later in the cycle. Due to my great stims response all my additional follicles were producing more progesterone than a natural cycle. So while this was an expected response and outcome medically it was hard to hear while sat in my hospital gown after egg retrieval. In reality I should be so so happy that we even have any embryos let alone some to freeze. We lost 3 in the lab phase, which is expected, and 1 was aneuphloid following PGT-A testing.

When reading on here and posters say the best advice is to ‘take each step at a time’ i’ve always assumed they meant in a more emotional stability, take a deep breath, have a cup of tea kind of way.

In reality, it’s quite literal advice, I have found you do have to quite literally wait for each step and then proceed with the next as it comes.

Our referral was based on male factor (0% morphology) my body has responded as expected each step of the way so far, and we have 3 high quality euphloid frozen. I think we’re a pretty textbook follow the exact template pair of patients but it’s still been pretty unpredictable to plan life around it with any kind of certainty.

Hello all, joining in as had first follicle scan earlier. On day 8 of the meds and they are not quite at the measurements required, unsure if that is normal or if it is still early on in the protocol for this cycle, my first cycle. I am back for a scan on Wednesday. I was trying to get my head around potential egg collection timings but I suppose it is hard to predict. I did not ask what the required measurement or number of follicles needed for the collection and so wondered if anyone had some experience of this? I guess if they don’t reach a certain size then I would move to another cycle? The trying to avoid plans is quite hard I feel like I’m neglecting people!

hey @IndigoBluey 100% i'd ask your clinic, they'll have the best idea, but it depends on both follicle size and blood tests. estradiol indicates whether follicles may contain eggs, so they're looking for that to rise in conjunction with your folllicles. day 8 of stims could be early for some, or late for others. I've had one round with 17 days of stims, and another with 4 (different protocols) so you can see how different things can be. And the EC day can change at the drop of a hat, the prediction is a very rough guide and mostly is not accurate! best of luck :)