WTF Consult time - Gathering a list of questions

[lindseyp2012]

Hi everyone! I’m sorry I haven’t been really active on here yet, but I’ve been having a really difficult last few weeks. I just got the BFN confirmation call for cycle #3. I have a WTF consult scheduled for Thursday morning and am now obsessing over my list of questions. Can you all help me out with questions I may have missed?? Here is my summary and question list thus far:

Cycle#1 – 2.5mg Letrozole resulted in 2 follicles. Trigger CD15 & good timing (DPT1 & DPT2), progesterone sups= Neg.
Cycle #2 – 5mg Letrozole resulted in 5 follicles. Trigger CD12 & good timing (DPT1 & DPT2), progesterone sups = Neg.
Cycle #3 – 5mg Letrozole resulted in 4 follicles. Trigger CD12 & bad timing (DPT2 only), progesterone sups = Neg.

Possible options:
    - Continue with Letrozole/Trigger/TI/progesterone:
            o % chance of conception?
            o Do be we begin to worry about egg quality yet? (I am 28 years old with PCOS)
            o Would improving timing to DPT0, DPT1, DPT2, DPT3 increase chances?
    - Move to Letrozole/Trigger/IUI/progesterone:
            o Is there anything in the SA that indicates IUI would improve our chances? (RE originally gave the SA an A+, but didn’t go into details)
            o % chance of conception?
    - Move to Injects
            o % chance of conception?
            o Can we keep with TI? (This is really important to me! I want to keep TI!!)
            o Is there a concern of over-responding since Letrozole response was semi-high at 5mg?
            o What do we do if I overstimulate?
            o Is monitoring protocol same or different?
            o Subcutaneous or IM? (Maybe you ladies can already answer this one for me?)

Thanks for getting to the end of this long summary! Any input on extra questions to add is SOOOO appreciated! I'm totally overwhelmed and not really thinking too clearly.

[rainbowbridge14]

First (((hugs))) to you. It is hard to reach places where we need to have WTF consults.

In terms of your questions you seem to be right on with what you are asking. Some thoughts I had were that I would ask your egg quality issue in relation to your PCOS. I have done some reading about PCOS and egg quality and I would think that if there are egg quality or maturity issues it would be related to that. I also notice you have low vit D in your siggy, have you had it tested recently? Maybe you should look into a recheck to see where your levels are and if you need more supplements.

In regards to injects, all of mine have always beeb subq, no butt shots for my inject IUIs thankfully. I would make sure you ask about possible over response to injects as you respond so well to femara that injects for you seem rather dangerous. When I over responded to injects TI was NOT an option since I was in a lot of discomfort, but if you could get a controlled response than TI I think would work fine.

Finally, did your DHs SA have a strict kruger morph done? I ask since some REs see morph as less important but I know it has made a difference for us in terms of post wash counts during our IUIs.

[deelopi9]

I believe your RE will recommend you to do IUI since they like to try one protocol for 3 cycles and then if that is not working move on to another protocol. You are responding to Letrozole so I don't think it has to do with the medication. I know you mentioned keeping TI is important to you but if it were me I would try the IUI's before choosing the option of injections.

Edited: By the way, your questions for the WTF appointment are on point and valid.  :::Hugs::: Those appointments are always nerve wrecking but hopefully you'll come out with a plan that works for both you and your DH. GL

[Kushie77]

Hugs. BFNs suck

Your questions are all on point, have they checked your thyroid along with your Vit D as of late?

[sumbeach]

Aweeee Linds I am sorry
I guess this all depends on what your RE's protocol with TI is. What was your FSH? Can you get a copy of the SA?

[lindseyp2012]

rainbowbridge14 and Kushie77 - they did retest my thyroid after I had been on Levothyroxine for a month. It was responding perfectly. No retest on Vit D levels but I will add that to the list. I've been taking 2000IU daily since October.

deelopi9 - I know I'm being a baby about keeping TI. If it's necessary I'll put on my big girl pants and do it. If it won't increase our chances I don't think I want to do the extra procedure. I'm open to discussing it.

Thanks for the responses!!!

[bluejoan]

The questions sound on point. I had another woman tell me not to stress about questions initially. The best response she ever received was by asking her RE what they thought would be the next step based on her previous responses to meds and testing. It opened a dialogue where they worked together and most of her follow up questions were answered with out being asked. She had gone through 5 IVFs at that point and was starting with a new clinic.

Most injections are Sub-q but PIO and some triggers are IM (can't remember who had an IM trigger or the name of it right now though). I know TI is important but if IUI will give you better chances you can always add TI in if your DH's SA is good. We weren't able to do that due to MFI.

I'm also compiling questions and it's nerve wracking and a whole different level of stress. Good luck on Thursday!!

[BunnyBerry]

I know TI is important to you, but...my thought on IUI is that it could help you time everything perfectly, overcome any undiagnosed cervical factor, and if they do ultrasound just before as our office does, confirm that you have O'ed properly. If you were just getting 1 follie, I would think maybe just give it more time since PCOS might have been giving you little/no chances before. But with the superovulation, you've had the equivalent of up to 11 normal cycles of trying with good timing (2 dpt should be reasonably close).

You're already getting so many follies, I would ask about your risk of overstimming/cancelling if you are on injects. I had only 1 follie each time on Letrozole, but ended up with 5-8 mature follies on injects (and 2 wasted cycles) even when they tried to keep it under control. If insurance covers it though, it might be more worthwhile to give it a shot (no pun intended), since linings are better quality on injects (lots of E2!) than on Letrozole (blocks your E2!).

Edited for spelling

[deelopi9]

Jan 23, 2015 15:08:08 GMT -5 lindseyp2012 said:

rainbowbridge14 and Kushie77 - they did retest my thyroid after I had been on Levothyroxine for a month. It was responding perfectly. No retest on Vit D levels but I will add that to the list. I've been taking 2000IU daily since October.

deelopi9 - I know I'm being a baby about keeping TI. If it's necessary I'll put on my big girl pants and do it. If it won't increase our chances I don't think I want to do the extra procedure. I'm open to discussing it.

Thanks for the responses!!!

Girl I feel your pain and applaud you. DH and I held off from doing IUI's for a couple of months hoping and praying it would work as naturally as possible.

[lindseyp2012]

@buttmonkey – Thanks! Everyone’s saying IUI! Lol Thanks for the good info in the injects.

bluejoan – I approached my initial consult the same way. Most of my questions were answered by the RE to begin with so I took notes. I only had one or two of my questions unanswered by the end so I just went ahead and asked. Probably will do the same this time.

BunnyBerry – I should probably ask about the possibility of undiagnosed cervical factor since even with a trigger, I never seem to get much EWCM. Maybe that would make IUI an easier idea for me to wrap around if there was something that told me it was worth it. Thanks for the info about injects and E2!

[lindseyp2012]

Jan 23, 2015 15:47:57 GMT -5 deelopi9 said:

Jan 23, 2015 15:08:08 GMT -5 lindseyp2012 said:

rainbowbridge14 and Kushie77 - they did retest my thyroid after I had been on Levothyroxine for a month. It was responding perfectly. No retest on Vit D levels but I will add that to the list. I've been taking 2000IU daily since October.

deelopi9 - I know I'm being a baby about keeping TI. If it's necessary I'll put on my big girl pants and do it. If it won't increase our chances I don't think I want to do the extra procedure. I'm open to discussing it.

Thanks for the responses!!!

Girl I feel your pain and applaud you. DH and I held off from doing IUI's for a couple of months hoping and praying it would work as naturally as possible.

That's exactly what I'm hoping. Even after 16 months of trying, I'm still upset we even have to do any of this so I'm holding on to the things that make this the most natural process possible. Silly, but that's where I'm at.

[deelopi9]

Jan 23, 2015 15:56:53 GMT -5 lindseyp2012 said:

Jan 23, 2015 15:47:57 GMT -5 deelopi9 said:

Girl I feel your pain and applaud you. DH and I held off from doing IUI's for a couple of months hoping and praying it would work as naturally as possible.

That's exactly what I'm hoping. Even after 16 months of trying, I'm still upset we even have to do any of this so I'm holding on to the things that make this the most natural process possible. Silly, but that's where I'm at.

Not silly at all. IF is a bitch and you have to do what you feel in your heart is best at the moment.

[vballbaby]

Just wanted to say good luck! I can appreciate wanting to keep things natural, but I think you can still BD with IUI to increase your chances. May want to ask that though just to be sure. I know with my IUI there was a certain point where they didn't want you to during the process.

[remylove1011]

I think PP's gave some great advice. We're doing our first IUI this cycle and our RE said that we could TI after the IUI. He suggested that night and the next day. We're dealing with MFI but with good count and volume so the RE said it couldn't hurt anything. So that could also be an option for y'all to continue HIO.

[bluefairy5]

I'm so sorry, lindseyp2012. BFN after BFN is so disappointing.

From my perspective, you've got a great set of questions already, and PP have given some great additions. (And as @buttmonkey and bluejoan said, IUI injects would probably mostly be subQ; they might have you do an IM trigger, but maybe not.)

The one thing I'll add for your peace of mind (hopefully) isn't a question: Even with IUI, you get to keep the TI. Especially in cases w/o MFI, REs encourage TI the evening and morning after IUI. And if his counts are great, he probably only needs 2 days' abstinence beforehand, meaning you can still hit within the pre-O range with TI.

GL with the WTF!