Advice on next steps please!
I’m 36, currently in Australia with my husband (40M) relocating Virginia in early August.
It’s a lot so I really appreciate anyone who reads it all and has advice!
I have endo… laparoscopy four months ago to remove it from my uterosacral ligament. I believe it was stage 3. Also my right tube is blocked. AMH is 15 pmol/L (2.1 ng/mL). I we had been TTC naturally for a year or so before the lap confirmed endo. We only got one cycle post lap to try before moving onto IVF.
IVF is funded through my employer until I leave Australia. Once I go, funding stops completely and IVF in the US would be out of pocket.
I have had problems with my doctor since I started with him but due to the funding I don’t really think I have the ability to switch. He made a shitty comment about “being lucky I found a man” at my age when I first saw him to have my IUD (which was improperly inserted apparently) removed. I’m grateful he scheduled me in for a lap and found endo so quickly though, I know I’m lucky for that. He is a general OB/GYN not a dedicated REI and communication has been really poor throughout. I think that he/the clinic sticks to a one size fits all regimen because they do batch retrievals and can’t / won’t adjust any timings.
What happened in my first cycle:
PPOS/random start protocol — Ralovera 10mg, Gonal-F 300 IU, Decapeptyl trigger. No blood tests at any point. First monitoring scan wasn’t until day 10, second on day 12, both very brief with no dose adjustments made. I had to beg for the day 10 ultrasound.
I strongly suspect I had a premature LH surge before my trigger. I had breast soreness before the trigger shot, I had sustained abdominal pain the morning of retrieval, and severe rectal pain afterwards from what was likely fluid in my pouch of Douglas. Despite 12 follicles going in, only 2 eggs were collected. My doc acknowledged blood tests would have detected a premature surge but had no alternative explanation for why we only got 2 eggs from 12 follicles with about 9 measuring correctly. He said if I had ovulated prematurely we wouldn’t have gotten any eggs which I now understand to be false.
The retrieval was under gas and local anaesthetic only. very painful and lowkey traumatic. One egg fertilised and made it to a day 5 AA blastocyst. PGT came back as a low level mosaic — missing copy of a 57.1Mb region of chromosome 5q23.2-35.3, mosaicism below 50%. We have decided not to transfer it.
Where things stand:
Currently in a mock FET cycle doing ERA/ALICE/EMMA with biopsy on May 18th. I had to beg for this. On Progynova 8mg and really struggling with mood — I’m quite oestrogen sensitive and finding the hormonal load difficult.
My doc has proposed a second retrieval using Ralovera again alongside Pergoveris 375 IU and Decapeptyl trigger, with scans on days 10, 11 and 12 only and no blood tests. My concerns are significant — the same suppression that failed last cycle, Pergoveris adds LH making LH monitoring uninterpretable, and Ralovera masks progesterone monitoring.
The decision:
June 24th retrieval is available. Given the financial stakes I feel I should use the funded cycle but I’m uncertain how. A fresh transfer without PGT would mean retrieval June 24th, transfer around June 29-30th and beta around July 9-10th — nearly a month of buffer before my August move.
A frozen transfer with PGT would mean results around July 6-7th (our lab returned them in 7 days last time), transfer around July 16-17th and beta July 26-28th. Only 1-2 weeks buffer before the move and another Progynova cycle which I’m really struggling with.
I’ve also considered IUI but with one blocked tube and endometriosis history it doesn’t seem like a good use of time. And I’ve thought about just doing the ERA diagnostics and trying naturally given I’m only one cycle post laparoscopy — but that means Virginia IVF at full cost.
I am really stuck on the best course of action going forward. I don’t think I can switch doctors but I really do not trust who I have now. I also know I’m so lucky to have any funding and I should take advantage of it while I can.
Thanks for reading!