#antagonist protocol

With my protocol and what I suspected would happen, did. We are going with the same protocol as before. So the estimated dates are as follows:

Last day of birth control pill – July 17th

Baseline appointment – July 18th

Begin injections – July 21st

Retrieval day – Either Aug 1st or 4th

Transfer day – Either Aug 4th or 6th

Remember the retrieval day and transfer day could vary. This is based on…

As the last IVF. My doctor called today to go over any questions I have and to discuss next steps. Of course I have questions but like I told her, I don’t think there’s a way to know for sure. But she said to ask anyway, so I did. I basically wanted to know if when the three embryos were transferred back inside, did they stop growing, did they just not hatch anymore, or did they hatch by my…

As a little girl, I dreamed of the day I could complete my first IVF cycle and maybe, or maybe not, gaze into the eyes of my first born child.  I daydreamed of the names of which gonadotropin drugs I'd get to inject into my belly.  Would it be be an agonist, antagonist, or flare protocol?  Maybe my doctor will let me use a 1" needle for my progesterone shot instead of a 1.5" because he's worried about all those shots in my petite frame ... oh, one can only hope!   

Now that that's out of my system, let's talk about what led us to this point.  We've been ttc for almost four years.  I'm a healthy 34-year old woman with unexplained infertility, but we do have a combination of factors going against us.  I have endometriosis.  I had a laparoscopy to deal with that last year, but, alas, still no baby.  My left fallopian tube is blocked, but the right one is normal.  I have all the signs of regular ovulation, but my AMH level is 0.3.  That means my ovarian reserve is in the "very low" range. I got that news at the age of 32, and it hit me like a ton of bricks.  It took weeks to get over that one.  Did I mention I've already started short cycling?  Looks like I have early menopause to look forward to in addition to the trials of infertility.  My DH's semen analysis was normal, except for the forward motility.  That was in the high end of the low range. So here we are, moving on to IVF.

Due to my low AMH level, my RE decided to put me on an aggressive antagonist protocol. He's afraid we may not get very many eggs, but assures me that they should be good quality due to my age.  We skipped the Lupon and birth control pills because he's afraid of over suppressing my ovaries.  I'll go straight into my IVF cycle once my period starts. I'll be taking Gonal-F, Menopur, and Ganrelix.  If all goes well, my RE said I could eventually move from the progesterone oil injections to suppositories.  That will be more expensive, but I think it's for the best given my small frame and aversion to needles.  We'll also be doing ICSI or partial ICSI.

ขั้นตอนการกระตุ้นไข่เพื่อทำเด็กหลอดแก้ว (Antagonist Protocol)

ขั้นตอนแรกของวิธีการ IVF คือ การใช้ยากระตุ้นเพื่อเพิ่มจำนวนเซลล์ไข่ในรอบนั้นๆ…

I’ve taken a little Tumblr breather as far as posting goes, but I’ve been checking my dashboard. There are some other ladies currently undergoing IVF and gearing up to start new cycles, so I’ve been following closely and cheering you all on. I’m excited for everyone!

I had an ultrasound and also a cycle review to discuss our failed IVF cycle with our doctor a couple of days ago. After two weeks on the pill, he said everything looks good. No cysts and the lining looks pretty thin. All is quiet. I have to wait for a withdrawl bleed and then I go in on Monday to check my FSH & estrogen levels. If all is to my doctor’s liking, then I start up the pill again for 2-3 weeks.

After finding out that it was another chemical pregnancy, I was of course disappointed. But, my doctor thinks that our chances are still very, very good - as implantation did happen - which is a great sign for the future! Doc says that the embryos likely didn’t stick because they were not chromosomally healthy, so it’s a matter of getting lucky and transferring the ones that are gonna go the distance.

I was surprised to hear that my doctor is strongly leaning towards changing my protocol to the more traditional Long Lupron protocol. He warned that I will most likely have some degree of OHSS, as I even had some effects of it with the Lupron trigger protocol b/c of the small doses of hCG that went along with it. So using a higher dose of hCG to trigger will likely make the bloating, sore ovaries, & breathing difficulties even worse than last time, but he still thinks it’s the way to go if I can handle it.

As much as I’m dreading the physical discomforts, I’m willing to tolerate it. My biggest fear is actually having to do a freeze all cycle if severe OHSS symptoms arise. I would be so disappointed if that happened. He said that I will likely have to go in every day for bloodwork so they can fine-tune my FSH dose. And Dr. S said that “coasting” is always an option if my estrogen levels get too high. After my bloodwork results on Monday, a final decision will be made, but he’s about 90% sure it will be the Long Lupron. Should I be scared of the side effects from the Lupron?

With the antagonist protocol, I was over-suppressed. As soon as I started with the Ganirelix injections, my estrogen levels started to plateau instead of doubling every 48 hours. Because there were a couple of days where this happened, my overall stim time was cut short. And this resulted in a lot of immature eggs at the time of egg retrieval. Next time, we’re hoping for at least 9 days of FSH injections to give the eggs time to mature properly before egg collection.

Great article from Reproductive Biology & Endocrinology regarding different methods of triggering in an IVF cycle and the luteal phase support needed.

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And it turns out, both estrogen & progesterone supplementation is needed after a lupron trigger. I got a call from my doctor today, admitting that his nurse was wrong and that she is new to the clinic! So my "crazy" email to her wasn't so crazy after all. My husband is eating humble pie for dinner.