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  1. #1
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    Default Puregon dose increased...is this bad?

    I'm a little worried - This is my first IVF cycle...I had my first blood test yesterday CD12 and was advised to increase my dose from 150 to 200..my first scan is Friday.

    I asked when I would be looking at egg retrieval and was told mid to late next week..that would make it from CD20 to CD 22! This can't be right?? Can you even have an egg transfer this late? I usually have 26 day cycles give or take a day.

    I'm feeling so upset right now. I just know it doesn't look good..is it over before it's begun?

  2. #2
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    Don't worry, in ivf the fs is controlling your cycle with all the drugs, you won't ovulate until you do the trigger. It's quite common on your first cycle to increase the dose part way through as they are learning how your body reacts to it. Good luck!

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    Thanks Mrsoc - I'm so scared that I can't even remember the basics of this...is it normal to wait so long for EPU in the first cycle? I'm hoping its the increased hormones that are making me feel so upset right now

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    Try not to worry. I had my dose increased from 300 to 400 after 5 days as my first scan was only showing one follicle and it wasn't that big. The increased dose help more follies to grow and although I didn't get loads of eggs (only 2) in the end it was more about quality than quantity.

    I was also really upset after the first scan as I thought the cycle would be cancelled but FS explained that she was adjustingthe dosage to give me a better chance of some more follies. This is my first cycle too so I didn't know that this is quite common in a first cycle.

    Try and relax and wishing you the best of luck xxx

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    Don't worry my drugs are changed all the time when I'm on a cycle and it changes every cycle depending what is going on and the break between cycles. It's all normal and the thing they will be looking at for transfer is the lining of the uterus so don't be worried if they change anything. It'll just stress you out more than I'm sure you already are (first cycles are hard as you battle the unknown).

  6. #6
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    Renvind - stop focussing so much on CD#.

    Reading your other thread (which day was egg retrieval) I see you're on Synarel. That makes CD irrelevant as your natural cycle hormones are being interfered with. The day you started stimming (on a down-reg cycle) is essentially CD1 for your ovaries. You counted that as CD6 based on LMP, and now you're looking at EPU 14 days later (on your CD20), which is "textbook" ovulation timing.
    (n.b. this is why in your other thread I told you days of FSH rather than CD# for EPU.)

    As your follicles grow they will produce the oestrogen and progesterone required to thicken your uterine lining and get things ready for pregnancy, so you uterus is also on the "delayed" schedule established by starting FSH on CD6. Your clinic should be monitoring lining thickness so if for some reason your lining and embryos aren't ready at the same time they can freeze the embies until the correct time for your body on the next cycle.

    I expect you'll also be on supplemental progesterone after embryo transfer to help keep AF away, so you got yet another reason to ignore your usual 26 day cycle length while you're doing an IVF stim cycle.

    (Once you've started the Synarel and commenced the subsequent bleed, then every day is essentially CD0 until you start stimming or miss a dose of Synarel. You can stay on Synarel for months before starting stims, and every day would be hormonally the same as the day before, CD0.)
    Last edited by felicita; 01-03-2012 at 06:26.

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    Thank you everyone! I feel a bit better this morning although still a bit teary. I can think a bit more clearly. I think it must be the higher dose hitting me plus the pressure of it all.

    I'm just so confused by all of this and nice as they are, the FS and staff are always quite busy and I don't think of these things until after I talk to them. The results of my first blood test were just dragged out all day, so the anticipation and the feeling of dread that something was wrong hence the delay in giving me the results has completely put me on edge! Thanks for your reassuring words.

    Felicita - thank you so much for your detailed info - you made it make sense for me and when I understand things, I feel more in control. I feel the pressure lifted off a bit, so thank you. I'm sure the nurse told me all of this but that feels like months ago and it's hard to remember when your in the middle of it.

    I will take your advise and move on from cycle days. What will be will be...I just have to deal with it.

    I'm actually going to print your response and put it in my diary - a reminder to bring myself back to logic if I freak out again.


    Thanks everyone. Good luck to all of you!

  8. #8
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    You sound a bit resigned:

    Quote Originally Posted by Renvind View Post
    I will take your advise and move on from cycle days. What will be will be...I just have to deal with it.
    It's not that cycle days are bad or wrong or anything like that. It's just that for a down-reg stim cycle like what you're currently doing they're simply not relevant. They're still appropriate for natural cycles.

    Also, as I said earlier your timing seems to be fine. You're heading for EPU after about 14 days of stims. In a natural cycle, when your ovaries start getting stimulation from CD1, the average person's eggs are ready after 14 days. So nothing wrong there, it's just that you should be counting CD6 as the start of your cycle (this one time), not CD1, because the Synarel was stopping your ovaries from getting any (or much) stimulation until you started the FSH injections.

    Changing the FSH dose is also not a problem. The initial dose is a guess based mostly on other women. After the first BT they get the first info about your personal response to the drugs and begin tailoring the meds to you personally. So if you need another stim cycle (but fingers crossed it works on this one) they'll start you at the higher dose from the get go.

    Your body won't start counting your luteal phase until after egg collection (just like for a natural cycle when luteal phase doesn't start until after ovulation), so you're not running headlong at a CD26 brick wall. And as I mentioned, the luteal phase will also be supported with progesterone anyway. The hormone manipulations of this cycle are adjusting the timing of events of your cycle, so if you get UTD it's probably best to tell your Ob that your LMP date was EPU minus 14 days rather than the actual date because they really, really like to think that ovulation happens on CD14 and it's completely ridiculous to count those first 6 days of your cycle when your body wasn't doing anything at all as part of their timing towards pregnancy progression.

    Do you know the lengths of your natural follicular and luteal phases. Obviously with a 26 day cycle at least one of them is going to be less than 14 days. If it's normally a short luteal phase you might want to request extra progesterone monitoring after embryo transfer, just to make sure you're on enough support to give the emby the maximum amount of time to implant before AF is due.


 

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