FIrst IVF cycle...Ovulated on my own!?!

[Squirl1003]

I just started my first IVF cycle. I am 28 years old and my husband is 28 also. Up until this cycle we were unexplained (normal FSH and immunology testing)infertility. We got pregnant naturally last year but later miscarried at 7 weeks.  After 4 months of failed back to back IUI's our dr suggested we try IVF.
I was started on Lupron 10 units for a few days and eventually it was decreased to 5 units per day. I was on Follistim 450 for 3 days and then decreased to 300. LUveris 0.5 was added. The whole time I was stimming I was on Lupron 5 units. When I went for my ultrasound after 5 days of stims:
Right ovary: 19, 15, 14, and three follicles less than 10
Left ovary: 15, 11, 11, and four follicles less than 10
Endometrium was 9.9 and three layered
Estradiol was 1,388
Progesterone 1.1

After 7 days of stims:
Right ovary: 22, 18, 18, 11, 11, 11
Left ovary: 18, 15, 15, 12, 15, 12, 12
Endometrium was 10.3 and three layered
Estradiol was 1294 (decreased)
Progesterone 2.1

I continued to stim for one more day (Follistim 300 and Luveris 0.5) continued Lupron 5 units also.
The following day I returned for another ultrasound and blood work.

Right ovary: 30, 20, 20
Left ovary: 17, 16, 15, 14

Estradiol was 1600 (marginal increase)
Progesterone 4.4

My dr said that it appears that my body is ovulating on its own despite being on Lupron.  I am confused how this could have happened.
Could this have been prevented with closer monitoring?

He also said that it appears that I have an egg quality issue judging from the erratic shapes sizes of my follicles.
Can this be judged based on how the follicles are growing during an IVF cycle?

My cycle was cancelled and I am devastated...what are your thoughts on all of this?

[Shayne Plosker, MD]

Dear Squirl1003 - it is possible to ovulate while on lupron; this occurs 1%-1.5% of the time. A progesterone of 4.4 suggests that this may have happened. I don't think anything could have been done to avoid this. Perhaps testing your blood for LH would have been helpful. It is pretty standard to start at lupron 10 units and drop to 5 units when fertility drugs were started. This is one of the most common protocols that we use. You were on high doses of fertility drugs and judging by your response, which was not too much and not too little, it seems to me that your MD picked the correct dose of medication. Canceling a cycle is always upsetting, but I believe was the right thing to do for you; it was not a perfect cycle and you saved thousands of dollars in retrieval, embryo transfer, and lab fees. To give HCG after seven days of stim, when your estradiol plateaued, would not have been a good idea because your uterine lining needs at least 8 days of stimulation to be optimally prepared. Next cycle, your MD might consider using a GnRH antagonist rather than lupron. This response was not expected and could not have been predicted. I hope your next cycle goes better.

[scrambler4201]

I had my cycle cancelled three hours prior to my first injection because my FSH had gone from 5.8 to 20.  I was dropped from the program and was devastated, although I hadn't gotten as far as you did.  I found another Dr. and after an agonizing month of waiting for my next period, got an FSH of 6.0.  There had been problems with my first center from the start so despite how painful it was to be delayed, I have to believe it was for the best. Maybe your baby just wasn't ready to come down from Heaven yet and he's still up there playing with mine.  Can you try again soon?  Sounds like your body is just working too well.  Are you able to change meds or doctors?  Good luck :)    

[scrambler4201]

I had my cycle cancelled three hours prior to my first injection because my FSH had gone from 5.8 to 20.  I was dropped from the program and was devastated, although I hadn't gotten as far as you did.  I found another Dr. and after an agonizing month of waiting for my next period, got an FSH of 6.0.  There had been problems with my first center from the start so despite how painful it was to be delayed, I have to believe it was for the best. Maybe your baby just wasn't ready to come down from Heaven yet and he's still up there playing with mine.  Can you try again soon?  Sounds like your body is just working too well.  Are you able to change meds or doctors?  Good luck :)    

[Hope4Baby24]

Yes, I would definitely get a second opinion, it dousn't sound like that doctor knows what he/she is doing.  How can you ovulate on your own if your body was supressed before the cycle started? and how did they let your follicles reach 30 mm? you need to have a lead follicle between 16-20 mm and you'd be ready to go.  They should have given you ganirelix, it stops ovulation and allows the follicles to mature into the right size before they take them out.  But hey, the first cycle is a test for most people.  I wasn't given enough follistim during my first cycle.  They doubled the dosage in my second cycle and i produced much better follicles.  And honestly, they can't tell egg quality by looking at your follicles in an ultrasound, that's bs.  They can detect quality by testing your FSH levels and even then, it's not enough.  They can not test egg quality until after they've retrieved the eggs, fertilized them, and tested the embryo quality.  This is where IVF is best, you can test the quality of your eggs and adjust any changes for the next cycle.
Again, I would see another doctor...and don't go to just anyone.  Do some research, visit someone who is established, has great reviews, and look at his/her success rates.  My doctor had a 91% success rate when I went to see him with a state of the art lab and clinic all in one place, so I knew I was in good hands.
Good luck, keep trying, and stay positive!

[FamilyDesire]

Hi. I saw your post and noticed you haven't had any responses yet. I can tell you that early ovulation could have been prevented with Ganirelix and antagon shot taken about 4 days prior to triggering with HCG to prevent ovulation.  I was monitored every day on my 2nd IVF cycle and when the lead follicle reached 19mm, they put me on Ganirelix for 4 days. This did impact my estrogen levels so they upped my FSH dosage of Gonal F from 450 to 600 units. As for your other question, I had not heard before that egg quality can be determined by follicle size disparity. My opinion, get the advice of another RE or two before attempting your next IVF cycle.