Re: questions from the new girl

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>

>Reply-To: MullerianAnomalies

>To: <MullerianAnomalies >

>Subject: Re: questions from the new girl

>Date: Tue, 15 Jul 2003 20:20:10 -0700

>

Traci,

During my first round of clomid (100mg), I produced 2 or 3 mature follicles

by cd 11 or 12 and then triggered with HCG. Timed intercourse was

unsuccessful.

During my second round of clomid (100mg), I remember going in on cd10, only

to find out that one of my follicles was 30mm. The ultrasound technician

called the doctor (it was a Saturday morning at 8 a.m.) and he said to go

ahead and trigger that night. So I did. But a few days later, I was

sitting on the toilet and I could feel that something was not right. Not to

mention that intercourse the night before had been extremely painful. So I

went in again (post trigger shot) for an ultrasound to see what was

happening in there and that's when they discovered between 9 and 10

follicles (or cysts) larger than 25mm. Needless to say, the timed

intercourse was also unsuccessful at that time. I took a month off to let

the cysts die down, which they did.

During my third round of clomid (now 50mg), I showed up on cd7 for the

ultrasound because of the incredibly quick growth last time around. And

sure enough, I had 1 follicle at 18.5mm and 1 at 14.5mm. So I triggered on

cd8 and received IUI on cd9 and cd10. Today is cd25. I got a BFN on the

HPT on cd22. I expect AF either today or tomorrow.

But here's the thing. Intercourse again has been painful on my right side

the last two nights in a row and I fear that the 18.5mm follicle never

released and now it's closer to 30mm. My RE would like me to come in for a

baseline ultrasound on cd2 or cd3. If I have a cyst or two, we

unfortunately have to take the month off, which makes sense. So now I

simply wait for AF. I can't help but think that I tested too soon, or that

implantation took place really late, and that I actually am preg, that the

soreness in my boobs is not just because AF is coming. But I think that's

just wishful thinking...

-Kathy, 28

ttc#1, m/c 7-02

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> I have Harvard Pilgrim insurance and have always gone to doctors at

Harvard

> Vanguard Medical Associates.

NO WAY! I work at HVMA Wellesley :-) What a riot!

> So if I end up liking what this woman has to say, I may

> have to find a new primary care physician. I would love to know of

any REs

> in the Boston area that people have been happy with, and maybe PCPs

as well!

To heck with job loyalty, if you need a new PCP, get one! My PCP is

non-HVMA (I have HPHC as well). Her name is Dr Cristina Holt in

Medford - probably waaaaay out of your way, but she's excellent at

letting me go wherever I want. She's not super available (M,W,F) but

I have so many specialists that I only see her for acute stuff. My OB

is very uterine anomaly-friendly - Dr Kobelin, at the Beth-

Israel Deaconnes Medical Care Center in Bedford (right on 95). My RE

is phenomenal ... Dr Reindollar at Boston IVF in Quincy.

Very, very uterine anomaly friendly - he's the one who made the

spectrum comment. Other REs that members have recommended are Dr.

& Dr Berger (also at Boston IVF). Jill has seen

another another doc ... if she doesn't chime in I'll message her.

Here is the contact information for those REs:

http://home.wi.rr.com/lflowers1/REPhysicians.html

> And I've obviously had many ultrasounds to see the growth of my

> follicles. I think that's it.

Might want to ask for a post-coital - will evaluate your cervical

mucous (quality etc) and make sure your stuff and his stuff aren't

killing each other :-)

Nice to " meet " you ... feel free to throw anything my way :-)

[Guest guest]

>

>Reply-To: MullerianAnomalies

>To: MullerianAnomalies

>Subject: Re: questions from the new girl

>Date: Wed, 16 Jul 2003 17:06:43 -0000

>

HVMA in Wellesley huh? That's where I had my HSG done! And that's also

where I had the ultrasound done that showed 9 to 10 ovarian cysts over 25mm.

So I definitely have memories, albeit not so fond, of Harvard Vanguard in

Wellesley.

Thank you for the names. I'm kind of kicking myself right now because two

of the REs you mentioned are part of Boston IVF. When I asked for a

referral for a second opinion regarding the PCOS, I had the choice to see

someone at the Fertility Center of New England or Boston IVF and I chose

FCNE because it's within walking distance from my house. I wish I had known

about this group before I made that appointment. Although who knows? I've

heard good things about the Fertility Center of New England, too. A friend

who used them is due in October.

I spoke with my husband and he agrees. We should definitely change our

Primary Care Physician, although he feels that Medford is a little far for

us. I'm going to need someone relatively close to Dedham/Newton who will be

open to me seeing other specialists and not force me to seek care " within

the group " . So, after my initial evaluation at FCNE on the 24th, I'll

switch my PCP and start from there.

Thanks again!

-Kathy, 28

ttc#1, m/c 7-02

awaiting AF tomorrow and IUI#2 w/cl

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Hi Kathy-

We have a lot of similarities... I produces 3 follicles my 1st cycle w/ clomid

(100mg cd3-cd7). I had an u/s on cd10 or 11? and had one follicle 33mm. I went

ahead and did a trigger shot and was checked again on cd3 of my next cycle to

check to see if it was still there. It was gone. I had no problems with it. The

next cycle, they gave me a combo of FSH (3 shots) and Clomid 100mg again for 5

days. I produced 6 follicles >16mm. None were >25mm. The criteria this clinic

used was anything greater than 16mm may respond to the trigger shot-so you count

those follicles. They prefer for the follicles to be 20mm or greater. I don't

know where the cut off point is for a cystic follicle- but I know anything >30mm

is. The 2nd cycle 2-3 other follicles that were just below the cut-off line

(14-15mm)- so they didn't count them. They cut back my dose and they next cycle

I had 3 follicles. The 4th cycle, I had 6 follicles again. Here is what happened

my fourth cycle... I had unusual abdominal pain too- hard to explain, but it

wasn't cramps. It felt more like pressure- it hurt to put pressure on my

abdomen. That started around cd3-cd5 and resolved on its own- started before I

started taking my clomid. Never knew why. I got it again after my IUI on cd14.

It went on for 4 days and then resolved. It worried me and I called my RE a

couple times but they blew me off. Probably one reason why I'm at another RE

now. I was concerned about OHSS - Ovarian Hyperstimulation Syndrome. From

everything I read, this can be very serious! (what you had). It sounds like we

both respond very easily- which is good and bad. Good that our bodies respond to

the meds. Bad if they respond too much. I guess 5% of women get OHSS and there

is a 1% chance of death if it is serious. That 1% scared me b/c I definately

respond so easily.

Anyway, I did get a lot of information at my previous RE about the follicle

criteria which I think is important for you to know. Basically, there policy is

they will not trigger you if you have more than 6 follicles- the chance for high

# of multiples is too great. If you have 4-6 follicles, you have to sign a sheet

that says you would consider embryo reduction . If you are ethically against

embryo reduction, than they would not trigger you if you had > 3 mature

follicles. They considered having multiples greater than triplets a failure on

their part b/c it is so dangerous, expensive & risky to the mother & babies.

Personally, I think this is a good policy to go by. I don't think it was a good

idea to trigger you if you had 9-10 follicles. On your 3rd cycle, it sounded

like you only had one follicle that was >16mm. But, again, 20mm is a lot better.

It may have been better if you waited an extra day. I hope your pg, but if not,

I would try another cycle- ask your RE if you can get u/s the day after IUI to

be sure you ovulated. You may not have even ovulated on the 2nd & 3rd cycles.

Are you using 10,000 IU of HCG?

Traci, 34, ttc#1, S/U

Re: questions from the new girl

>Date: Tue, 15 Jul 2003 20:20:10 -0700

>

Traci,

During my first round of clomid (100mg), I produced 2 or 3 mature follicles

by cd 11 or 12 and then triggered with HCG. Timed intercourse was

unsuccessful.

During my second round of clomid (100mg), I remember going in on cd10, only

to find out that one of my follicles was 30mm. The ultrasound technician

called the doctor (it was a Saturday morning at 8 a.m.) and he said to go

ahead and trigger that night. So I did. But a few days later, I was

sitting on the toilet and I could feel that something was not right. Not to

mention that intercourse the night before had been extremely painful. So I

went in again (post trigger shot) for an ultrasound to see what was

happening in there and that's when they discovered between 9 and 10

follicles (or cysts) larger than 25mm. Needless to say, the timed

intercourse was also unsuccessful at that time. I took a month off to let

the cysts die down, which they did.

During my third round of clomid (now 50mg), I showed up on cd7 for the

ultrasound because of the incredibly quick growth last time around. And

sure enough, I had 1 follicle at 18.5mm and 1 at 14.5mm. So I triggered on

cd8 and received IUI on cd9 and cd10. Today is cd25. I got a BFN on the

HPT on cd22. I expect AF either today or tomorrow.

But here's the thing. Intercourse again has been painful on my right side

the last two nights in a row and I fear that the 18.5mm follicle never

released and now it's closer to 30mm. My RE would like me to come in for a

baseline ultrasound on cd2 or cd3. If I have a cyst or two, we

unfortunately have to take the month off, which makes sense. So now I

simply wait for AF. I can't help but think that I tested too soon, or that

implantation took place really late, and that I actually am preg, that the

soreness in my boobs is not just because AF is coming. But I think that's

just wishful thinking...

-Kathy, 28

ttc#1, m/c 7-02

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>

>Reply-To: MullerianAnomalies

>To: <MullerianAnomalies >

>Subject: Re: questions from the new girl

>Date: Wed, 16 Jul 2003 20:03:34 -0700

>

Traci,

I am using 10,000 IU of HCG. Thanks for the info. There's a lot I don't

know. I didn't realize that I could ask to have an ultrasound immediately

after the IUI. That should have occurred to me, but it didn't. It would

have made sense to see if I had indeed ovulated or if those follicles just

continued to grow, as it seems they did in the past cycles. Is it possible

that I'm not responding to the trigger shot? I'll most likely see AF

tomorrow, and when I go in for my baseline ultrasound Friday morning, I'll

mention it, especially if I have large follicles on cd1 !!! I'm so glad I

found this group!!!

-Kathy, 28

ttc#1, m/c 7-02

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Kathy-

I also asked about having an u/s after the IUI. They told me they normally don't

do that. I asked why? They said women almost always respond to the HCG trigger

shot and b/c it was expensive & time consuming to do too many u/s per cycle for

the patients. I find it hard to believe EVERY women responds to the trigger

shot. I am a veterinarian that works at a reproductive facility for horses. We

use HCG all the time in horses. I would say the majority of the horses respond

to the shot. But, we do have some horses who do not for unknown reasons. We

always u/s the horse the day after IUI to check for ovulation. Not to compare

you to a horse!! Due to your history of multiple follicles after your

trigger shot, it sounds like you didn't respond. Therefore, I think it would be

a good idea to make a special request to have an u/s the day after your IUI. Let

me know what you find out on Friday.

Traci, 34,ttc#1, S/U

Re: questions from the new girl

>Date: Wed, 16 Jul 2003 20:03:34 -0700

>

Traci,

I am using 10,000 IU of HCG. Thanks for the info. There's a lot I don't

know. I didn't realize that I could ask to have an ultrasound immediately

after the IUI. That should have occurred to me, but it didn't. It would

have made sense to see if I had indeed ovulated or if those follicles just

continued to grow, as it seems they did in the past cycles. Is it possible

that I'm not responding to the trigger shot? I'll most likely see AF

tomorrow, and when I go in for my baseline ultrasound Friday morning, I'll

mention it, especially if I have large follicles on cd1 !!! I'm so glad I

found this group!!!

-Kathy, 28

ttc#1, m/c 7-02

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Hi Kathy,

Welcome to the group. I wish we had more T-shaped people here to

respond to you. I know that we had a few in the past, but none that

are active members now.

The things that you have read about surgery sound high risk. I would

imagine that cutting the uterus would just add to the possible risks

that an already small t-shape uterus may have (scars don't usually

stretch well). The best thing you can do now is have a dr with lots

of experience to give you advice. That can be hard to come by.

> He came to the conclusion (and noted in my records) that I have a

mild case

> of Poly Cystic Ovarian Syndrome. But my blood work fails to

support that

> diagnosis and I don't have any of the tell-tale signs. What

convinced him,

> I'm told, is how I responded to the clomid.

I am like you, in this regard. I did 3 rounds of clomid (all at 50

mg) and each time more follicles produced, but never had more than 4

mature follicles at the time of O. However, the next round I moved

up to injectables (gonal-f w/ hcg trigger) on the lowest dose that

they start new pts on. Well, on Friday I had 5 follicles in the race

and based on my estrogen levels I dropped down from 2 vials a nite to

only 1/2 a vial a night and by Monday I had 13 almost ripe

follicles. I had to cancel the cycle and my dr told me that I had

polycystic ovaries (he didn't do any other bloodwork). It meant that

getting the proper dose of meds to stim the follicles would be harder

to do. It meant that we would spend each month trying to figure out

what magical dose would work for me without producing too many

follicles. The next cycle they did one long, slow stim protocol

(only 1/2 to 1 vial a day) and it produced one follicle (which they

originally thought was a cyst) and I got pg.

I heard that if 50 mg clomid works, then increasing the dose will not

help more, in fact it will only cause probs like thining your lining

or decreasing CM. Also, the statistics show that if clomid does not

work in 3 or 4 cycles, it is not likely that more cycles would help.

It is best to move on to a new plan.

If you hyperstim on clomid, you are likely to hyperstim on

injectables. I ovulate regulary each month, so I felt like doing a

long, slow stim protocol on injectables was a waste of time and money

to get one follicle that I would otherwise get on my own. If you

hyperstim on inj, I would suggest skipping the IUI plan and moving

onto IVF. At least that way you can harvest all of those eggs and

only put back the best. You would not have to cancel a cycle like I

did.

Good luck with your appts and I'm glad that you found this group.

Sara

35, 1 m/c, SU resected x2, 28w6d

[Guest guest]

HI Kathy, We have very similar stories. I live in the northshore of

Boston. I am 33 years old. I also had a m/c last June at 11 1/2

weeks. I had another m/c at 5 weeks last Sept. My doc did an hsg

and diagnosed me with a T-shaped uterus in Oct and recommended that I

see an RE. My mother never took DES. She did take pre-natal vitamins

and I have heard that it is possible that DES was in vitamins at this

time (1969-70). I don't know if this is true or not. My older sister

has also been diagnosed with a T-shaped uterus. When I went to the

RE with my HSG films, he was not convinced that I really had a t-

shaped uterus. Although the films looked t-shaped, he said sometimes

if you have a tipped uterus and the doc may not get an accurate

view. He did a hysteroscopy and then an mri. He has diagnosed me

with a septum. I had lap/hyst surgery in February to remove the

septum. Last week, I had a follow up hsg. While my uterus still

looks somewhat T-shaped to me, it is definitely improved. My RE is

very pleased with the way it looks. You may want to see if you can

have further diagnostic tests to see if it is indeed a T-shaped

uterus.

I have been ttc since my surgery in Feb with no luck so far and will

begin clomid/IUI next month if I have not conceived this month. I

have also been prescribed natural progesterone suppositories 3 days

after I ovulate to help sustain a pregnacy. My RE has said we will

do 3 rounds of Clomid/IUI and then move on if need be. I guess

success rates are best in first 3 months.

I hope we both have success soon! Keep us posted.

-

> Hi. I'm new here. My name is Kathy. I'm 28 years old and live in

Boston.

> Almost exactly one year ago, I had a miscarriage, the cause

unknown. I was

> nearly 12 weeks along. I underwent a d & c twice. My OB sent me to

a

> fertility specialist and after an HSG, it was discovered that I

have a

> t-shaped uterus. My mother, however, was not exposed to DES. I

have been

> hard-pressed to find any information out there on the occurance of

a

> t-shaped uterus in women who are not DES daughters. Can anyone

shed light

> on this subject?

>

> I have undergone two rounds of clomid with timed intercourse and

one round

> with IUI, both unsuccessful. AF should be coming tomorrow and DH

and I plan

> on another round of clomid/IUI. After four rounds of clomid, have

I

> exhausted that option? Must I move on to other things?

>

> And finally, has anyone here heard of or undergone a hysteroscopic

> metroplasty to correct a t-shaped uterus? I don't think it has

come to this

> for me yet, but I want to know of my options should all else fail.

>

> Thanks!

> -Kathy

>

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>

>Reply-To: MullerianAnomalies

>To: MullerianAnomalies

>Subject: Re: questions from the new girl

>Date: Fri, 18 Jul 2003 19:20:37 -0000

>

,

That's GREAT information to know (that your t-shaped uterus was something

different entirely). I have an appointment for a second opinion on

Thursday, not just about the t-shaped uterus, but also about the possibility

of Poly Cystic Ovarian Syndrome, and about whether clomid is the right

choice for me, given that I have triggered with HCG, only to find my

follicles growing beyond 35mm AFTER the injection. I have a LOT of

questions for The Fertility Center of New England. Hopefully, I'll get some

answers. Keep me posted as to whether or not you indeed start clomid/IUI.

-Kathy D., 28

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> I've heard good things about the Fertility Center of New England,

too. A friend

> who used them is due in October.

Hi Kathy,

I've heard good things about them as well ... none first or second

hand, tho - that's why I don't usually mention FCNE specifically.

> I spoke with my husband and he agrees. We should definitely change

our

> Primary Care Physician, although he feels that Medford is a little

far for

> us.

Yup ... I figured that :-) But I'm glad you're switching. With our

funky needs, we really need more flexibilty than HVMA can afford

(guiltily looking over my shoulder for my supervisor).

Let me know if you need any help in the future!

[Guest guest]

>

>Reply-To: MullerianAnomalies

>To: MullerianAnomalies

>Subject: Re: questions from the new girl

>Date: Mon, 21 Jul 2003 14:46:54 -0000

>

,

What kinds of questions should I be asking at my " 2nd opinion " appointment

at the Fertility Center of New England? I have been given a one-time only

referral for a consultation, so I want to make sure I ask all the right

questions. After this, I will change my primary care physician. I know you

haven't memorized my situation, so here's the lowdown:

* m/c 7/02 at 11.5 weeks

* referred to RE 1/03

* HSG showed a t-shaped uterus

* dh checked out ok- gave two samples at two different times

* 1st round of clomid- 100mg days 3-7 triggered w/HCG on cd12- timed

intercourse

* 2nd round of clomid- 100mg days 3-7 triggered on cd11- timed intercourse-

BUT on cd16, an ultrasound revealed cysts that measured 38mm, 34.5mm, 24mm,

24mm, 21mm, 15mm, and 12mm (hence the hyperstimulation)

* diagnosed with Poly Cystic Ovarian Syndrome due to hyperstimulation of the

ovaries

* 3rd round of clomid- 50mg days 3-7 triggered on cd8- IUI on cd9 and cd10-

BUT on cd27, an ultrasound revealed 3 cysts over 35mm AND AF was a no-show

So, I don't know what to ask. I don't know where to start. I want to know

if I indeed have a t-shaped uterus and if this could be the cause of my

problems as opposed to my " PCOS " . I want to know why my follicles continue

to grow after the trigger shot. I want to know if I am indeed even

ovulating. What else should I ask?

-Kathy, 28

ttc#1

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Hi Kathy,

In theory, your T-shaped uterus should not effect ovulation - they

develop from totally different structures in the fetus. In reality

though, there's no real way of knowing whether they are connected.

My question now, is why are you taking clomid? Did they feel you

don't O, or were the docs simply giving it a try b/c you were unable

to concieve? Clomid doesn't solve all fertility issues. If you

legitimately don't O, then we start from the drawing board.

Right now your focus should be on your hyperstimulated ovaries (duh,

probably already is). But just having those doesn't mean you have

PCOS. As you've read here, many docs label pts with your issues as

PCOS as sort of a " well, we don't know what it is so we should at

least give it a name " diagnosis. That is completely inappropriate!

PCOS is a diagnosable, treatable condition - not some vague fancy

term for funky ovaries!

So, I would present everything to this new doc and hear what they

have to say. Early in the eval, I'd ask open-ended questions & hold

your BIG questions til the end ... the goal of this tactic isn't

necessarily to get answers - its for you to size up the doc. For

example: how would you approach managing my case, what do you think

our next step should be? As I said, don't look at their answers as a

concrete plan at this point ... you're still checking out whether

this doc is worth your time! I'd use this time to read between the

lines ... are they open-minded to non-cookie cutter situations? Do

they jump to the conclusion that hyperstim'ing ovaries mean PCOS?

If the doc appears closed minded that early on, by all means continue

to dig as many concrete answers out of them that you can - after all,

even biased info is info, but take it all with a grain of salt.

After you get a feel for the doc there are a few main areas to hit:

- What possible things could be causing the hyperstim'ing?

Looking at it realistically, it could be your body or the clomid.

- What can we do to identify the cause?

Testing to rule out PCOS and testing should be done to rule out any

hormonal issues.

- If no cause is identified, can we try an alternative drug?

Even though " all o' stim drugs do the same things " , their mechanism

might be slightly different from drug to drug (if I'm wrong folks,

correct me).

- If still no cause can be identified, what are the other options?

I know I mentioned this before, but I'd push for a post-coital test.

I know DH's semen are fine, but there are some situations where

cervical fluid can be too acidic, too thick or too sparse for the

sperm to swim through. Some RE's are clomid happy ... others are

willing to approach your issues w/IUI (thereby bypassing funky

cervical fluid).

I hope some of this helps. I would bring a notebook with all these

issues written down and take copious notes during the apt.

Take care!