Deciding on a protocol

[Skittles11]

Hello everyone

I just wondered- has anyone else been told that their final protocol can be decided upon at their Day 2 scan?

I have had failed cycles in the past and am currently embryo banking. My last cycle was a disaster, several issues including likely early ovulation, 2 eggs and then abnormal development of both embryos.

In my debrief my doctor said they wanted to try the same protocol / drugs again (for the third time). The first time on this protcol I did get one pgt-a tested embryo but the second time (as above) was a no-go.

I objected to doing the exact same again and was told we will make a decision at the day 2 scan. But I'm worried about leaving it as late as this...this will be the day to start the meds. It assumes I will be able to get everything then and there. What are others thoughts? Am I worrying too much and should just go with the flow on this?

Thanks xx

[Hidden]

Hey lovely. I am by no means a medical expert but in my uneducated head I feel like day 2 seems a bit late to be deciding what protocol as I don’t see what difference it makes then? Like you would know your lining was thin but what else do they know? I don’t want to add to your angst and maybe loads of people can reassure you but sounds a bit odd to me (sorry!) xx

[Skittles11 in reply to Hidden]

Thanks Daisy. I just wasn't sure what to think and because I am a planner and I like to know what's happening, I find it all the more difficult just waiting to see especially as, like you, I am not sure what difference it will make. Xx

[JoyfulStar]

Hey hun, I completely relate to your fears about a round not going well. I also had several rounds of embryo banking. The first produced 2 blastocysts that were frozen, the second was a complete disaster but the third gave me my 5 month old miracle.

Like you, I was nervous about using the same protocol for the third round but the consultant reminded me that I had a good first round and blamed the sperm for my disastrous second round. We then agreed to have the same protocol but tweak the dosage of the injections if needed during the scans.

IVF can go rogue sometimes and it is hard to know w caused by the meds/protocol or something else

I agree with Daisy that it is a bit late to decide the protocol on day 2 but I guess this might be when you do your baseline scan if you are on a short protocol so it could work.

I would say that as you are paying lots of money, you have to be comfortable with whatever you decide with your consultant. So did the debrief leave you satisfied with the explanation of why that round failed? Do you have a plan b? As an example l, I opted for a day 3 transfer although my consultant was against the idea. We also used up 2 vials of DH’s sperm to get the best sperm as we were doing ICSI. It was our last round so we thought it was the best plan for us.

All the best with whatever you decide and hope you get that miracle 🙏🏾

[Skittles11 in reply to JoyfulStar]

Thank you for replying to me. I'm glad you finally got your little one after some mixed outcomes. I guess the difference for me is because the poor outcomes are likely to be due to poor egg quality rather than issues with the sperm. On my most recent round where I got no embryos, the clinic did tweak my meds but I was already on high stims. You are right in saying the day 2 is the baseline scan, I think the doctor was probably trying to stay flexible re the drug choice and liaise in person about it but another part of me thinks what will it actually achieve waiting until the last moment. And actually after agreeing we would wait until day 2, I did get a prescription sent to me for the drug regime that the doctor put forward which I had challenged. So some confusion there too. I probably need to phone and have a chat with someone there xx

[JoyfulStar in reply to Skittles11]

Being over 40, I was 43 when I commenced my last 2 IVF cycles of embryo banking I also had egg quality issues which was evident in the huge drop off in the numbers I had left on day 5. My consultant explained that the sperm was to blame for no blastocysts as previous rounds had resulted in 1 or 2 blasts.

I think what I was trying to say but said it badly is that as you have had a round with a PGT tested embryo, it is possible to be on the exact same protocol and have very different results. So, is your doctor’s recommendation this time based on the relative success of that round?

I really hope your next round is successful 🙏🏾

[Skittles11 in reply to JoyfulStar]

Hi

Thank you - you didn't say it badly but thank you for clarifying.

Yes I think that is the doctors rationale, that we have a pgt-a tested embryo from a round 2 cycles before the "disaster". And I guess this is what makes it so hard to know what to do. Because one round yielded a good embryo and the other yielded nothing. I'm very confused about what to do for the best.

I have phoned my clinic and explained my worries so hopefully will be able to address some of that in the coming days xx

[Twiglet2]

Whilst I don’t think my protocol was decided on day 2 scan it was defo communicated to me at that appointment in my last round -I wasn’t bothered and that’s when we are given meds to start anyway at our clinic. They do check in with you every few days as well in case the need to increase/decrease meds etc. but I can understand after your last round wanting to know in advance and prepare. Perhaps it’s worth asking them what they will know on day 2 scan that they don’t know now? So you can make a decision sooner rather than later xx

[Skittles11 in reply to Twiglet2]

Thank you Twiglet. Yes I think that is a good point to raise the question of what they'll know then that they don't know now. To be honest this has come about because I have said I didn't want want repeat the same thing but they don't seem able / willing to offer anything different. They did add in HGH last time so I guess that showed flexibility. Maybe it's me hoping there is something else to try when there just isn't xx

[Twiglet2 in reply to Skittles11]

🤔 yeah I can see what you mean….. whilst it is the definition of insanity doing the same thing over and over and expecting different results with IVF it defo can be the case that it gives different results!! But they should be open about why they are ruling out any other options for you at this stage. Good for you advocating for yourself, it’s hard to know when to go with the flow and when to challenge decisions isn’t it? Xx

[Skittles11 in reply to Twiglet2]

Thank you lovely. I think I just need them to confirm whether, in their view, this is the only option left open to me. It is really hard to know when to challenge the decisions, as if you think you know more than the medical professional! - but I don't want to go into a cycle with no confidence of it yielding embryos xx

[Twiglet2 in reply to Skittles11]

In my experience there is sometimes we do know best that’s for sure! I hope you get some clarity lovely 🤗 I will be routing for you xx 😘

[pink_lemon]

I had a protocol decided on day 2 once after day 1 blood results came back in the morning. My clinic has a specilised pharmacy in house and I live nearby, which made the last minute decision easy…Not sure if this is of any help…good luck 🍀

[Skittles11 in reply to pink_lemon]

Thank you Pink Lemon. That is reassuring, my clinic stocks some medicines but not all and I think this is what worries me that we'll wait and then won't be able to source everything xx

[Hidden]

Hi Skittles, I'm a planner, just to manage my expectations so I can imagine this is adding to the stress alright. I would imagine most of the drugs will be available but I would have a chat with your clinic if they plan to use Cetrotide or it's replacement Ganirelix on your protocol. There are lots of issues sourcing this at the moment and I had a panicked moment last week when my clinic advised me to ring around different chemists on the off chance they would have them left over! I'm in Ireland but I think multiple countries are affected so worth asking to avoid any future issues.

[Skittles11 in reply to Hidden]

Thank you Axel. It is definitely adding to the stress especially as time moves on. I didn't realise I'd be worried about it but now I am because the cycle start is getting closer!

Thanks for highlighting the struggles you've had with these medications. I am not down to have these however this draws attention to the exact type of thing I have concerns about. I don't want to be ready to start and told I can start but then not be able to obtain the meds in time.

Xx

[Hidden in reply to Skittles11]

It's such a stressful process but wishing you all the best for a smooth cycle this time xx