Too many follicles on baseline? Overstim 50 iu?

[angel535]

Hi all, This is my first time posting. I just don't know where to turn and have been googling like crazy the last day (which just scares me even more). A little background- I was diagnosed with hypothalamic amenorrhea after not getting my periods back after stopping BCP. I did ovulate once and got pregnant but sadly ended in MC. Clomid did nothing for me, which RE figured but we tried it anyway. Since the beginning, RE has been very positive about me doing injectables and having success with just timed intercourse. After what seemed like forever, we got the okay to start provera, bring on a period, and start Follistim. I got tested for AMH which was great (nice and high) and went for all the instruction on Follistim with the usual warnings of ovarian hyperstim and having to cancel a cycle (though the NP doing my training said that didn't happen very often and they'd be monitoring me closely).

So all is good and then I go for my baseline US a few days ago and I (I can't remember which), either 25-35 little follicles. So I go see the NP who reviews the US with me and she says that it's great that I have so many follicles (yay!) BUT (of course) it puts me at high risk for overstimulating and having to cancel the cycle. Then she just freaked me out (because I've never thought of it- the RE was so optimistic with us about just the meds and timed intercourse) and said I'd be the perfect candidate for IVF (because I have so many follicles) and it'd be something to consider at some point. So of course all I heard was "cancel cycle, IVF." She did say that they'd go very slow and low with dose with me and monitor me very closely and that everyone's body responds different to the meds so they'll just wait and see. Called me that night and said the RE wanted me to start 50 iu for next 3 days (I'm on night 2) and then US Monday.

Anyways I was hoping for some feedback and stories of experience (could use positive ones!) with having lots of follicles at baseline and not overstiming. Could I really overstim on 50 iu (though they may change it as we go...)?

Thank you so much!

[tumbleweed]

As long as you are being monitored, your RE probably knows what's best at this point.
First cycles are generally experiments -- often REs are just trying to sort out how you will respond before fine tuning on the next cycle.
Stick around to give/get support here.

[mrspotatohead91]

I had the same thing happen to me last month with the NP saying I looked like an IVF cycle but was doing TI. Thankfully two follicles took the lead and we were able to proceed. This cycle I again have a lot of follicles and another NP said we might have to cancel. I go back tomorrow for another monitoring appointment. Good luck. I think you are still early on in your cycle and that one or two follicles could take the lead.

[BunnyBerry]

Welcome. I'm sorry for your loss.

Sorry the Clomid didn't work, but I hope the injects do the job!

I just triggered ovulation for my 3rd injects cycle. The first he dosed me low because I have polycystic ovaries, and I ended up with just one follie (I O anyway but never get a BFP, so the purpose was to give me a couple more targets for the sperm).

The 2nd cycle, I overstimmed with 5 mature follies so we were cancelled due to risk of higher order multiples.

This cycle, although they were trying to keep it under control, I overstimmed again with at least 8 mature. They tried to switch me to IVF but in the end my meds hadn't been right for IVF and I was cancelled.

So, yes, the chance of overstim reduces the "pros" column for doing injects cycles, especially if you have high AMH and a very high antral follicle count. They kept telling me the same thing - "be thankful for your highly responsive ovaries, you have excellent chances for IVF" - and although it was scary (and frustrating) to hear, it is true.

Sounds like the have a good handle on your propensity to overstim and hopefully they can dose you just right so you have good chances! Good luck.

[lilyharper]

I concur with everything BunnyBerry said. Many of us pcos ladies tend to have that many at baseline. On the plus side, it gets you closer monitoring, unless the RE is an idiot.

[rainbowbridge14]

I agree with the PPs. I also wanted to add that I have high AMH and my AFC is over 80 total (yeah crazy I know) but I didn't overstim on low doses. In fact I needed higher doses to get my PCOS ovaries to respond at all. Basically, you may overstim or you may not, but try and trust that your RE will be watching closely and knows what they are doing.

[moto611]

My story is similar to @rainbrowbridge14... I always had 40ish little follicles at my baseline and my AMH is sky-high (it's 23 - doesn't that sound so high that maybe the lab made a typo or something??) but I never over-stimmed. I did 7 medicated cycles and the most mature follicles I ever ended up with was two. So... you never know. Hang in there, try to trust your doctor, and know that even if you do over-stim, they'll try a different protocol for next time.

[jellybean]

Hi, grad / lurker here. I'm sorry to hear about your loss. I wasn't sure if you're open to responses from grads since it's not in your siggy, but you mentioned you're looking for 'positive' experiences, so I thought maybe yes? Anyway, I have hypothalamic amenorrhea, and its fairly uncommon (I was the only one on here with it when I was on 3T. It definitely has some unique traits. I'd be more than happy to share my experience here if you're open to it- just let me know.

[nomnom]

*** PAIF ***

My AFC was 35-70ish, depending on cycle. My RE at the time had me do five days of femara followed by daily 75IU injects. I only ever got one follicle.(IUI didn't work for me because our main issue is MFI.)

My fresh IVF cycle the new RE supressed my ovaries using BCP for a couple of weeks, then put me on 200ish IUs of FSH and low-dose HCG. I ended up with 41 eggs retrieved.

Some with high AFC have produced more follicles with low doses, but not all. Kinda have to experiment, unfortunately.

[angel535]

Thank you guys so much for all your feedback. I guess I just wish I knew what was going to happen but will just have to wait and see (I'm not all that patient though... lol). Congrats to those of you who have made it to the other side and hopefully the rest of us will be joining you in the near future.

Did anyone actually use follistim and what doses were you on? Any side effects with it? We've done 2 doses so far and I've noticed some very mild cramping/muscle ache (from just from the actual injection).