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Microdose Lupron Flare

For those of you who have been following along. My hubby and I started trying to conceive over 2 years ago now.

We tried naturally for 6 months, and I had one chemical pregnancy/early miscarriage in October 2019. Then I was diagnosed with anxiety and depression late 2019.

In the spring of 2020, I found out I had low AMH and low antral follicular count. Then we had our first stimulation cycle, which was converted from an IVF to an IUI, then converted to timed intercourse, which was a bust.

We then did a mini-stim, which is supposed to be better for reduced ovarian reserve. I only grew one follicle, and they couldn’t find or retrieve the egg.

We rolled this into a duostim, something that they do for women with ovarian cancer that wish to freeze eggs or embryos prior to cancer treatment. That duostim cycle was cancelled 1/2 way through.

Now, this is the 4th stimulation cycle we are one. This one is the most aggressive as far as meds go. I’m on double the number of injections and a higher dose of FSH compared to all of the other protocols.

From my reading, there are three groups of protocols: GnRH agonist (long), GnRH antagonist (short?) and Flare. So, perhaps I will go through those. But for now, I'll just talk about this protocol and cycle results.

The Flare part of the protocol includes using Lupron to tell your pituitary to release its own FSH and LH pulses for growth of the follicles.

The only thing I did for priming for this cycle was Androgel, because I had this thought that the Estrace was over-suppressing my ovaries.

So, starting on Day 2, I did morning and evening injections of micro-dose Lupron, then started Rekovelle and Menopur on the 4th day (which they called day 1 of stimulation). I ended up doing five days of this prior to my first ultrasound.

Here is where my first disappointment came. I only had 3 follicles. Sure, the doctor said "This is 3 times the number that you had for the previous cycle" but I have still been clinging to the AFC of 8 or 10.

My original AFC was 8 when I did my baseline scan in spring 2020. I had a scan earlier this year and it was 10. So you can probably see why I was upset that I went from 8 to 2, or 10 to 3, whichever. There is a lot of attrition from the AFC to the number of healthy embryos produced during IVF. For example, the retrieval rate is around 60-75% depending on the practitioner, protocol and woman's anatomy. So, if you have 10 follicles (just making it a round number), then you can expect for them to collect 6-8 of those eggs. Of the eggs that they get, not all of them are mature and have the ability to fertilize. Then of those that fertilize, not all of them become blastocysts, and then of the blastocysts that you make, not all of them are genetical normal. So, overall, with an AFC of 10, you may be looking at 1 to 2 healthy embryos at the end. Then for a healthy full term pregnancy, you're probably looking at 2 to 3 genetically normal embryos per healthy pregnancy.

This much I knew going in. Since we were unsuccessful with one follicle, I was just hoping that 3 follicles would at least get us somewhere.

It's really difficult to keep going when you're not in contact with your REI. So I stuck myself with thousands of dollars of medications. Those three follicles grew to 16 mm, 16 mm and 20 mm prior to my trigger injection of hCG.

We had this last minute run around to get to the city that our REI works in which is four hours away from home, during the wintertime. We drove through the mountains, because of course, COVID restrictions say you either need a PCR test 72 hours prior, or complete vaccination for COVID prior to flying, and we were only vaccinated 13 days prior to the flight out. Hubby arranged for a driver, and I just closed my eyes and hoped that we would make it to the other side! Once we arrived in the hotel, things were great. We relaxed for a bit and went to sleep. The next day, we picked up a rental vehicle, and Hubby had his appointment to make his 'deposit'. My check in time was noon, and the retrieval was supposed to go at 1 pm.

The nurses were great with the pre-operative checks. Then, I met a new doctor. It wasn't my REI. I suddenly had my heart drop. I was suddenly nervous that it wasn't going as plan. The nurse noticed that my vitals, blood pressure and heartrate were suddenly up, and said, not to worry, she would give me something for this anxiety. This new doctor wasn't friendly, just very medical, not empathetic. Not heartless, but she didn't make any connection with me to put my mind at ease. The retrieval was quick, and I was in recovery with my husband and for the most part I have amnesia on how the rest of the day went. I think we found out that they only collected one egg out of the three follicles. The third disappointment in this cycle.

Fortunately, the lab called the next morning to tell us that our one egg fertilized. I was elated! We had a baby growing in the lab! I could breathe a sigh of relief that maybe all of this was finally paying off!

I'm not a person of faith. But I tried to maintain a positive outlook. We flew home, and it was back to work.

Let's take a look at some stats. So, if you have an AFC that is greater than 5, and you are age 41-42, there is a success rate for on-going pregnancy of 23%. Of the women in that same age category, with an AFC of less than 5, the pregnancy rate is 0%.

So when the lab called on the Day 6 update and told me that the embryo was still growing. She seemed positive, that I shouldn't worry. That the embryo was still growing, just slower, but that it had made progress, and the lab would call the next day.

No one called the next morning.

I went to work, and we had a meeting. I got busy, and then I had a euthanasia scheduled. Then I got a call. It turned out to be my REI. I knew just then that he wasn't calling with good news. I wanted to cry. But I had to go into a very sensitive appointment, so I had to swallow my own tears to be the support system that a pet family needed me to be.

Do you know how hard that is?? Euthanasias are difficult. They aren't even the hardest part of my job, but they aren't easy.

Now, try to do that when you have your own personal problems.

You compartmentalize. You are not allowed to grieve while at work.

So, instead of grieving then, it got pushed to the back of my mind. I called my husband during my break to let him know, but I didn't get a chance to grieve until weeks later while Hubby and I were trying to look for a sofa for the living room, I had a meltdown in the parking lot of the furniture store.

At least fifteen thousand dollars spent on this cycle, with ultrasound and blood work, and tons of medications, then driving to another city, spending $10k for that one embryo, and flying back home, for nothing but another failure.

So what do we do now??

My hubby and I had to sit down and have a heart-to-heart discussion. Because now, all the savings that I did have are dried up. Now we're looking at financing to build our family. What we agreed on was that we would try once more with my eggs, then we would have to look at alternatives to building our family.

But, I'm again, still clinging to that 8-10 AFC. So when we meet with our REI in a few weeks, I'm going to ask him if we can be selective about which cycles we stimulate. Prior to injecting a bunch of expensive medications into my body, can we get an ultrasound to see what's going on first? That's the smart thing to do.

As always, I will keep you posted! Until then, feel free to share your story if you need someone to talk to.

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