October check-in

[dove]

wanderingback, Oh no! I'm so sorry! Fingers crossed this second dose does the trick for you.
This cycle has been brutal for you. You deserve a break.

[thedutchgirl]

Oct 26, 2021 11:43:23 GMT -5 wanderingback said:

Oct 25, 2021 17:05:37 GMT -5 thedutchgirl said:

Fingers crossed! I hope you don't need another shot.

Updated that I do, grr!

Insult to injury--having to terminate when if it were just in the right spot, and then having side effects. I'm sorry!

[thedutchgirl]

I'm set for transfer on Thursday! I'm super nervous, because we only have one euploid embryo from our second set of 4 donor eggs. Puts a lot of pressure on this FET.

[ilovecandy]

Oct 26, 2021 11:44:20 GMT -5 wanderingback said:

ilovecandy - how did your phone consult go? Hope you have a good experience with this new doctor.

It was just going over history so it was fine, if not a little annoying/emotional to go over everything for the millionth time.

How are you feeling?

[turboteal]

Oct 26, 2021 10:52:43 GMT -5 stellelinds25 said:

TW and vent ahead...

Do the HCG blood works checks ever stop?

I'm sorry. It sucks. I had a MMC last year, had a D&C on Oct 22, and didn't get negative hcg (below 10) until the day after xmas. It dropped so much at first and then it just creeped down the last bit. I kept going back thinking surely it's gone by now and kept getting annoyed. If you know you won't do an FET until the new year, I would maybe just try to forget about it for now, set yourself a date to go back for recheck in like 4 weeks and then if it's still not gone set yourself another date like 4 weeks away again. Sorry it sucks so much, that's just my thought on how to make it less of a constant thing in your mind.

[turboteal]

FET cancelled. My lining was 5.8 after 2 weeks of patches, we did another 6 days and it was only 6.1, so my doc didn't want to keep trying to wring out a good enough lining for a transfer. Not sure if it was a problem with the patches or me, they will discuss possibly trying with oral estrogen instead, but if we do that I think he said he would want to so an ERA to make sure my lining was receptive before risking a transfer (I guess since they don't normally use oral estrogen for FET). Uuuuggggh why does it always have to be so hard and take so long 😖

[turboteal]

thedutchgirl Good luck!

[thedutchgirl]

turboteal, thank you!

I'm so sorry your FET was cancelled. I thought I'd mention what worked for me on lining, as my previous cycle was cancelled too, for the same reason. I had a lot of trouble on patches. My lining wasn't thick enough, and it didn't look great. My RE moved me to a modified natural (she thought they'd over medicated me), and it looked great, but it was a bit thin. My doctor put me on vaginal estrace (the same as you take orally), and it worked like a charm. I started with two per day, and ultimately went to three. But I got to over 8, and I went up from 7-8 in one day when we added the third estrace per day.

It's a lot of monitoring (I had four ultrasounds last week, and 5 blood draws), but it is so nice if you do ovulate on your own or can with a trigger. Without the estrace, I would have only started vaginal progesterone 5 days before, and then nothing else aside from an antibiotic and medrol in the lead-up to transfer.

[seeyalater52]

Oct 27, 2021 15:27:50 GMT -5 thedutchgirl said:

turboteal, thank you!

I'm so sorry your FET was cancelled. I thought I'd mention what worked for me on lining, as my previous cycle was cancelled too, for the same reason. I had a lot of trouble on patches. My lining wasn't thick enough, and it didn't look great. My RE moved me to a modified natural (she thought they'd over medicated me), and it looked great, but it was a bit thin. My doctor put me on vaginal estrace (the same as you take orally), and it worked like a charm. I started with two per day, and ultimately went to three. But I got to over 8, and I went up from 7-8 in one day when we added the third estrace per day.

It's a lot of monitoring (I had four ultrasounds last week, and 5 blood draws), but it is so nice if you do ovulate on your own or can with a trigger. Without the estrace, I would have only started vaginal progesterone 5 days before, and then nothing else aside from an antibiotic and medrol in the lead-up to transfer.

Just to add to this in case it’s helpful, of my 6 embryo transfers my two most successful were with a modified natural cycle using letrozole and a trigger, so there are lots of ways to do that sort of cycle. Personally it not only worked better for me but was also a lot less difficult side effects wise, even though it does require a bit more monitoring/is a bit less predictable in terms of timing.

[thedutchgirl]

Oct 27, 2021 16:05:42 GMT -5 seeyalater52 said:

Oct 27, 2021 15:27:50 GMT -5 thedutchgirl said:

turboteal , thank you!

I'm so sorry your FET was cancelled. I thought I'd mention what worked for me on lining, as my previous cycle was cancelled too, for the same reason. I had a lot of trouble on patches. My lining wasn't thick enough, and it didn't look great. My RE moved me to a modified natural (she thought they'd over medicated me), and it looked great, but it was a bit thin. My doctor put me on vaginal estrace (the same as you take orally), and it worked like a charm. I started with two per day, and ultimately went to three. But I got to over 8, and I went up from 7-8 in one day when we added the third estrace per day.

It's a lot of monitoring (I had four ultrasounds last week, and 5 blood draws), but it is so nice if you do ovulate on your own or can with a trigger. Without the estrace, I would have only started vaginal progesterone 5 days before, and then nothing else aside from an antibiotic and medrol in the lead-up to transfer.

Just to add to this in case it’s helpful, of my 6 embryo transfers my two most successful were with a modified natural cycle using letrozole and a trigger, so there are lots of ways to do that sort of cycle. Personally it not only worked better for me but was also a lot less difficult side effects wise, even though it does require a bit more monitoring/is a bit less predictable in terms of timing.

Yes! I have almost no side effects, which is so nice.

I will also mention that my RE said vaginal estrace works the fastest, since it is right there, so to speak.

[turboteal]

thedutchgirl I don't ovulate on my own (or very sporadically), so not sure how my lining would develop by itself (or how long it would take). I thought I remembered someone taking about vaginal estrogen, so I asked lmy doc about that yesterday but he didn't seem to think that was a thing?? He was like it's either oral, patches, intramuscular, or vaginal cream (like for perimenopausal women with vaginal atrophy). I will email the clinic and ask again. Could you tell me what the brand or generic name of the pill you used is? Like is it just estradiol tablets (in which case what mg)? ETA: would you mind telling me what clinic you use so I can give them that info if they want to ask your clinic about vaginal estrace?

[wanderingback]

Oct 27, 2021 16:51:35 GMT -5 turboteal said:

thedutchgirl I don't ovulate on my own (or very sporadically), so not sure how my lining would develop by itself (or how long it would take). I thought I remembered someone taking about vaginal estrogen, so I asked lmy doc about that yesterday but he didn't seem to think that was a thing?? He was like it's either oral, patches, intramuscular, or vaginal cream (like for perimenopausal women with vaginal atrophy). I will email the clinic and ask again. Could you tell me what the brand or generic name of the pill you used is? Like is it just estradiol tablets (in which case what mg)? ETA: would you mind telling me what clinic you use so I can give them that info if they want to ask your clinic about vaginal estrace?

Obviously thedutchgirl will chime in and I don’t know the nitty gritty about IVF, but your doctor mentioning vaginal cream for menopausal vaginal atrophy is the same thing as vaginal estrace that she is talking about. Estrace is just the brand name and estradiol is the generic. Now when it comes to IVF I do not know if brand vs generic makes a difference but if your doctor mentioned vaginal estrogen cream then that’s what they were referring to. Unless I’m not understanding your question

[wanderingback]

Oct 26, 2021 18:12:06 GMT -5 ilovecandy said:

Oct 26, 2021 11:44:20 GMT -5 wanderingback said:

ilovecandy - how did your phone consult go? Hope you have a good experience with this new doctor.

It was just going over history so it was fine, if not a little annoying/emotional to go over everything for the millionth time.

How are you feeling?

No side effects from the methotrexate like I had over the weekend, so hopefully it stays that way! Thanks for asking.

[seeyalater52]

Oct 27, 2021 18:12:52 GMT -5 wanderingback said:

Oct 27, 2021 16:51:35 GMT -5 turboteal said:

thedutchgirl I don't ovulate on my own (or very sporadically), so not sure how my lining would develop by itself (or how long it would take). I thought I remembered someone taking about vaginal estrogen, so I asked lmy doc about that yesterday but he didn't seem to think that was a thing?? He was like it's either oral, patches, intramuscular, or vaginal cream (like for perimenopausal women with vaginal atrophy). I will email the clinic and ask again. Could you tell me what the brand or generic name of the pill you used is? Like is it just estradiol tablets (in which case what mg)? ETA: would you mind telling me what clinic you use so I can give them that info if they want to ask your clinic about vaginal estrace?

Obviously thedutchgirl will chime in and I don’t know the nitty gritty about IVF, but your doctor mentioning vaginal cream for menopausal vaginal atrophy is the same thing as vaginal estrace that she is talking about. Estrace is just the brand name and estradiol is the generic. Now when it comes to IVF I do not know if brand vs generic makes a difference but if your doctor mentioned vaginal estrogen cream then that’s what they were referring to. Unless I’m not understanding your question

Some REs also have patients insert the oral estrace tablets vaginally, either instead of or in addition to taking it orally, estrogen patches etc. My clinic doesn’t prefer this method because they think it’s harder to track dosage and estrogen levels for the cycle due to the way it absorbs but it’s pretty popular from what I’ve seen on forums.

[turboteal]

Oct 27, 2021 20:01:06 GMT -5 seeyalater52 said:

Oct 27, 2021 18:12:52 GMT -5 wanderingback said:

Obviously thedutchgirl will chime in and I don’t know the nitty gritty about IVF, but your doctor mentioning vaginal cream for menopausal vaginal atrophy is the same thing as vaginal estrace that she is talking about. Estrace is just the brand name and estradiol is the generic. Now when it comes to IVF I do not know if brand vs generic makes a difference but if your doctor mentioned vaginal estrogen cream then that’s what they were referring to. Unless I’m not understanding your question

Some REs also have patients insert the oral estrace tablets vaginally, either instead of or in addition to taking it orally, estrogen patches etc. My clinic doesn’t prefer this method because they think it’s harder to track dosage and estrogen levels for the cycle due to the way it absorbs but it’s pretty popular from what I’ve seen on forums.

Hm I wonder if those issues are why my doc didn't say anything about this being an option. wanderingback As far as the cream, I had asked if there was a vaginal suppository option of estrogen, and he was saying no, closest thing would be the cream, but he didn't say anything further about that being an option instead of patches or oral estrogen. I was asking about a vaginal dose bc he mentioned how oral estrogen gets processed through the liver first and therefore not much of it makes it to the bloodstream, vs the higher systemic levels you are supposed to get from patches, so he doesn't like using oral as much for that reason. Of course patches were not working well for me this time, so that's why I was looking for a third option, and he made it sound like there wasn't one. I will still ask again, though I would want to know what kind of dosage/exactly which tablets others have used when I bring it up to my clinic.

[wanderingback]

Oct 27, 2021 22:35:54 GMT -5 turboteal said:

Oct 27, 2021 20:01:06 GMT -5 seeyalater52 said:

Some REs also have patients insert the oral estrace tablets vaginally, either instead of or in addition to taking it orally, estrogen patches etc. My clinic doesn’t prefer this method because they think it’s harder to track dosage and estrogen levels for the cycle due to the way it absorbs but it’s pretty popular from what I’ve seen on forums.

Hm I wonder if those issues are why my doc didn't say anything about this being an option. wanderingback As far as the cream, I had asked if there was a vaginal suppository option of estrogen, and he was saying no, closest thing would be the cream, but he didn't say anything further about that being an option instead of patches or oral estrogen. I was asking about a vaginal dose bc he mentioned how oral estrogen gets processed through the liver first and therefore not much of it makes it to the bloodstream, vs the higher systemic levels you are supposed to get from patches, so he doesn't like using oral as much for that reason. Of course patches were not working well for me this time, so that's why I was looking for a third option, and he made it sound like there wasn't one. I will still ask again, though I would want to know what kind of dosage/exactly which tablets others have used when I bring it up to my clinic.

Yeah I would definitely ask again for clarification. Like I said I don’t know the details for IVF, but there’s def vaginal estrogen cream suppositories. I prescribe this semi-regularly.
Example here: www.empowerpharmacy.com/drugs/estradiol-vaginal-suppository

[thedutchgirl]

turboteal, yes, as seeyalater52 indicated, it is just the regular old oral estradiol but inserted vaginally. I am on 2mg pills, three times a day now. I think I mentioned this before, but it made my lining go from just under 7 to over an 8 in 24 hours.

The ability to monitor levels may be an issue, but that's probably why I had blood tests testing E2 and P4 every time I had an ultrasound last week. They tested them again before my transfer this morning. No more testing until my beta now--just continuing with what I have been doing for estradiol/estrace and endometrin. I am on two patches now too, but that was always part of the protocol. The estradiol is a deviation.

I am with Dr. April Batcheller at CCRM Minneapolis The various CCRM clinics are affiliated although separate practices. My understanding is that they all use this sometimes. If you google, you can find a lot about it--people refer to looking like you had sex with a smurf. Blue-green pills leads to, well, you can fill in the blank.

[thedutchgirl]

Oh, for what it is worth, Dr. Batcheller requires brand name for patches (Vivelle) and progesterone (Endometrin), but the estradiol is generic. It cost me like 97 cents with insurance. (I'm super fortunate to have fertility coverage, but even without, it is cheap and available at any pharmacy.)

[wanderingback]

My hcg finally dropped, so I get to avoid surgery, phew.

Now thinking about the future I’m not sure what to do with trying going forward. My dr said he’ll do another hsg once we’re at that stage. My first one my right tube didn’t fill but my dr seems to think it might’ve just spasmed. The ectopic is in my left tube.
So he said if my left tube looks clear again it’s really my choice whether to try natural, with clomid or go straight to ivf. He said he has patients do all options.

I recently spoke to a friend who had 2 ectopic pregnancies back to back and since I know having 1 increases your chances for another, plus with my right tube possibly not being great, I’m not sure if I want to deal with the unknown there and going through another long drawn out ectopic process.

At the same time the monitoring for ivf seems very daunting and I’d like to avoid that as well.

Well I’m just rambling now lol. If anyone has any specific experience or thoughts I’m all ears!
I have a few side effects starting last night from the methotrexate but I have a massage booked for tomorrow so hopefully I’m feeling better by then!

[dove]

Yay for no surgery wanderingback!
I think you have valid points/ thoughts on either scenario.

I’ve done 3 clomid/IUI cycles (currently in 2ww of #3). The monitoring for clomid is just 1-2 ultrasounds, which has been pretty manageable, IMO. I will not be pursuing IVF; that is strictly a personal choice based on my previous medical history.

Enjoy the massage!

[thedutchgirl]

wanderingback, I'm glad you don't have to have surgery! I might try another HSG, as that sometimes can clear tubes for a couple of months. It would give you a better sense of that right tube too.

Then again, it would make a lot of sense to get right into egg retrieval too, to avoid more delay. I don't know or can't recall exactly how old you are. Later 30s or so I might move right to IVF to get eggs sooner rather than later.

[wanderingback]

Oct 29, 2021 14:03:23 GMT -5 thedutchgirl said:

wanderingback, I'm glad you don't have to have surgery! I might try another HSG, as that sometimes can clear tubes for a couple of months. It would give you a better sense of that right tube too.

Then again, it would make a lot of sense to get right into egg retrieval too, to avoid more delay. I don't know or can't recall exactly how old you are. Later 30s or so I might move right to IVF to get eggs sooner rather than later.

Yeah def going to do the hsg and then go from there based on what the results are.
I’m just past my mid 30s, so I feel like I’m at that age where it’s kind of a gray zone, like not in a super rush cause I know I have time but obviously I’m not 25 anymore.

[thedutchgirl]

wanderingback, that sounds like a good plan. You definitely aren’t at the cliff yet as you know so deciding at each step makes sense.