# 43 follicles on day 8 of stims - advice please



## Livertypickle

Hi; I'm wondering whether anyone can offer advice.

I am in the middle of my first IVF - down reg was unremarkable, everything went fine.

I have been on gonal f for 8 days and went for my first scan today.  I had 43 follicles, about 10 or so of these being bigger than 10mm.
They were worried about OHSS so did a blood test which came back as low on oestrogen.  They have told me to continue stims on a lower dose and come back on Monday, either for EC on Tuesday or to abandon cycle, depending on the next scan and bloods.

I'm a little confused....  Can they not take the eggs that are big enough?  (1 x 16mm, 2x15mm and a handful of 11-13mm were there today) or are they likely to get smaller because my stims are decreasing.  Has this happened to anyone else?

Thanks

Juliet


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## karenanna

Hi Juliet

I have always had around this number of follicles when I have cycled and have luckily avoided OHSS. They usually look for a number of follicles over 18mm before triggering you to make sure there are enough mature eggs to collect. I always ended up with around 18-25 eggs collected that were mature enough to fertilise.

The key thing is that your oestrogen levels don't go too high - this is when you are at risk of OHSS and it can appear suddenly. My tips for avoiding it are to:

-  Drink lots of water - I had around 4/5 litres a day (make sure you have 2 large glasses of water before you go to bed at night, so that you are forced to wake up to go to the loo - each time you wake up drink 2 more)

-  Also have lots of protein - milk, eggs, cheese etc...

I would be surprised if your EC is on Tuesday as they would have to trigger you on Sunday night (needs to be 36 hours before egg collection and they normally like to collect eggs in the morning). I would think it would be much mroe likely to have an EC on Wednesday, but every clinic is different. It is just as important that you keep up the water and protein regime after EC to avoid developing OHSS.

Hope this helps and all the best for your cycle   

Karenanna xxx


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## Livertypickle

Thank you so much for your reply Karenanna - I really appreciate it.  And for the tips on the water, I will start that regime straight away.

You clearly had a fantastic outcome from your last ICSI - huge congratulations

Juliet x


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## Mistletoe (Holly)

It is important to drink plenty, but not to excess. If you stop peeing out all of what you are drinking, it will be accumulating in your abdomen and potentially the lungs which can be dangerous.

The Royal College of Gynaecologists guidelines on OHSS is to drink to thirst - not to excess.

You should monitor your body weight, abdominal girth and urine output - you should be peeing pale straw coloured urine regularly and your body weight and abdominal girth should not increase excessively.

If you stop peeing, if the urine is dark when you are drinking plenty, if you gain a few kilos in a short time, you have abdominal distension, severe pain, nausea or vomiting or any shortness of breath, you must contact the clinic, or go to A+E if severe, immediately.

OHSS you need to have the blood chemistry monitored and have anticoagulant drugs to stop clots, intravenous fluids and in severe cases fluid drained off the abdomen.

Lets hope it does not come to this. They are monitoring you correctly.

The follicles have to be 18mm to contain a mature egg. Sometimes the surgery on the ovaries can trigger the syndrome - so they will not go ahead at all if the risk is too high.


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## Livertypickle

Thanks for your replies.

Feeling really anxious and sad at the moment   My 2 friends that know about my IVF are both away on holiday so its hard to know where to turn.

I'm so fearful of my treatment being cancelled - I would be happy with an egg collection and no egg transfer until a later date; I just don't want to waste these precious little follicles (which I see as precious little chances of life)

If I have enough eggs over 18mm and my oestrogen is ok, would that mean I could go ahead?  On Friday, my oestrogen was fine (she said quite low) and I had around 10 follicles that were 13mm +  (including 1x 16mm and 2 x 15mm) - But 43 follicles is a bit high, right?

I know that no-one can really predict - I just wondered whether anyone can share their stories at this stage.

Thanks for the support

Juliet x


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## ma-me28

hi i had 37 follicles on day 10 and they were worried about ohss my bloods came back borderline and i am still going ahead with my e/c am just not sure what will be happening with embryo transfer but i was worried our cycle would get cancelled too, so stay positive. x


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## Mistletoe (Holly)

You will be monitored and they will assess your oestrogen level in relation to the follicles and see what the risk is likely to be.

They will not put you at excessive risk just for the sake of collecting the eggs or transferring the embryos. OHSS can happen straight away or it can happen if you get pregnant when the hormone levels are rising with the pregnancy.

If the oestrogen level gets to above 20,000, I have heard of clinics collecting but will freeze all on day 1-2 after collection and do a FERC at a later date thawing 7-10 embryos at a time and letting them develop on in the lab to get the best ones.

Sometimes clinics will stop the stim injections for a couple of days and see if the oestrogen level comes down a bit - this is known as coasting.

Obviously there is also the option of canceling all together - but this will only ever be done if the risk is too high. Please believe that they will do this in your best interests.

I work in ICU and I have treated a few women who have been quite ill. This is very rare indeed when you consider the number cycles carried out - I have only seen 2 or 3 cases in my unit in 10 years. But this is probably because the clinics are very careful to minimise the number of cases that get this bad.

Try to take each day as it comes. The clinic will make the right choice.

In my first cycle I was borderline for OHSS - I had 22 eggs and an oestrogen level of 17000. I was in severe pain post egg collection and they scanned me for free fluid pre ET as they were concerned - I was clear for that.
I was given the choice on the table about whether to go ahead with ET. They said it was my call as I was at risk if I got pregnant. They told me the risks and stats and let me choose. I went ahead. I did get pregnant and luckily I had no more trouble with OHSS.
I was advised to have salty food, isotonic drinks, plenty of water and protein.

I also know how disappointing it is to have treatment canceled - in my FERC, my lining would not thin down enough and they canceled me. I had to down regulate the next month after taking the pill for 21 days. I was so upset - I was psyched up for the treatment and I felt like it was the end of the world when they sent me away.


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## Livertypickle

Thanks very much ma-me28 and hopeful hazel for sharing your stories and advice.

... and for reminding me that this is ultimately about safety.  My head knows it, but my heart is struggling with that one   

Juliet xxx


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## Livertypickle

Today I have 44 follicles and borderline OHSS oestrogen result (14850) - up from 2000 on Friday (big jump!)

7 of my follies are above 18mm, another 15 are above 14mm.

They have decided to do an egg collection but freeze all.  There is a tinge of dissapointment but at least I have the chance of some FETs.

Thanks for your advice ladies

Juliet x


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