QuestionHx: TTC 4.5 yrs. (3.5 with RE) Many IUI's & IVF's. 3 chemical pregnancies - 2 with IUI 1 with IVF. AMA - 43ys. Hx of LUF without trigger shot.
This cycle I will be out of the country and would like to monitor with CBFM and OPK's and do an Ovidrel trigger shot just so I don't waste a cycle. So many times on natural cycles with timed BD - without a trigger shot - my progesterone rises - RE thinks I've ovulated - but then later it is confirmed that the follicle never ruptured. I was just going to take this month off since I'll be away - but after giving it much thought - I don't really have time to waste at my age.
I'd like to ask - When should I do trigger shot? - At positive OPK? Or wait until after the two days of the peak showing on the CBFM? Then how many days before I start progesterone suppositories. I am so used to being monitored so closely but since I cannot be monitored this month - I'm hoping to get lucky! I have heard of so many pregnancies of women over 42 on break cycles - I'm hoping to add to the statistics!
Many thanks for your input! It is very nice that you provide this service. Of course I understand your answer will be general information - but I just need some reassurance that my intuition is serving me. My RE will not give you a callback for two weeks to ask questions like this - then it will be too late.
My location is the east coast. Thanks so much for your input! It is much appreciated!
AnswerDear Addie,
Thank you for your question. I'll have to say, I'm not very texting literate so I had to think hard to figure them out. But I got it (eg TTC= trying to conceive).
You are certainly trying to beat the statistics in many ways. It is unfortunate that you have gone through so many cycles that resulted in miscarriages. Age is your main obstacle and only getting worst with time.
It will be hard to time your HCG injection on a natural cycle, but you could give it with the +OPK. The OPK is telling you that the LH is surging anyway (your body's natural HCG shot), so additional HCG will not hurt.
In terms of the progesterone, I generally start my patients on cycle day # 16 (an arbitrary day but close to the physiologic time).
IVF is certainly the best treatment method at this time for you, and you should be on an aggressive protocol to maximize the number of eggs retrieved. I also would not hold back on the number of embryos transferred. If these cycles don't work, then you would be an excellent candidate for donor eggs and probably would get pregnant quickly.
I hope that this answers your questions.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
