# Moving on to Gonal f but given no explanation. Please help!



## JPSCoey (Jun 3, 2009)

I apologise in advance for the lengthly description but it helps to write it down.

To recap, after over 2 years of ttc our first and all the tests/laparoscopy etc, I have had two rounds of clomid (50mg).
1st round: ovulated but we didn't conceive
2nd round: follie's grew but I didn't ovulate (Failed clomid)

The screwed up last time and refered me to a different consultant (Dr V Hall) to the excellent one I have had many appointments with (Mr T).

I get there and Mrs Hall asked "What happened?" I tell her as above and she looks at my follicular scanning sheets. She then asked,
"What would you like to happen now?" I said, well I guess increase my clomid dosage or try something else... I am not a doctor so what do you suggest?"
She said "What was your plan with Dr Trew?" (My previous consultant).
I said he did the laparoscopy to see if clomid was viable or if I should move straight to ivf... and I've now tried clomid for 2 cycles.
She then said we will try Gonal F injections 75mg with monitoring. I asked if I could have the hsg trigger shot with that? (And fries please lol) and she said "Why not?"

She then didn't know what form to fill in so took me straight to the ivf unit, left me at the reception and asked someone what was the procedure for me now. She came back, gave me a follicle tracking form to fill in and said what I do is ring the ivf unit (They do the follicular monitoring with clomid/Gonal f) on the first day of my cycle.... and that's it.

She started to walk out and I said "What happens after that?" She said,
"If it doesn't work after trying it once, we move on to ivf, so you need to see me again then"
That was it........

I just feel like I was left with no information. I am frustrated that if the Gonal f doesn't work first cycle, I will be left in limbo with nothing to try in between being on the waiting list for ivf. 
My questions are: 

1. What is Gonal f and how is it different to clomid? Do they work in a similar way?

2. When will they give me the injections/explain how to use them?

3. What days do I take the injections?

4. 75mg of Gonal f, is that a valid presciption? My old clomid follicle tracking info sheet says it is prescribed as 300/450 or 900iu (Nothing about 75mg).

5. If I ovulate but don't fall pregnant on the first round of Gonal f,will the doctor's write me a prescription for another round of Gonal f or is that it (Like she said, one round)? What is the usual protocol? She didn't write "only one cycle of Gonal f" on the sheet but said if it doesn't work this cycle we move to ivf.

Sorry again for the long post. Hope my experience can help people in the future, but don't want anyone else to have to go through it or worse. I will be internet searching of course and update with answers for anyone who is interested.


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## kdb (Apr 9, 2009)

Hi JPS 

Got your PM and figured I would answer on your post in case anyone has similar Qs in the future 

Sorry to hear you had such an unsatisfying appt with Ms H. My last appt was a little similar in that Mr B asked me what I wanted to do, rather than look at my notes and make an advised recommendation! He's the one that spent years at med school, not me?!!

Anyway, I got what I wanted (no more Clomid) so I can't complain! And actually so far the experience with the clinic has been pretty good. Nice nurses and nice sonographers.

I'm on CD20 of my first Puregon cycle @ HH so can give you my experience...

*1. What is Gonal f and how is it different to clomid? Do they work in a similar way?*
Clomid blocks our oestrogen receptors so that our body thinks oestrogen is low, causing more gonadotropin (GnRH) to be released which in turn triggers our pit gland to produce FSH and LH. This encourages our ovaries to produce follies and ovulate. Unfortunately, because Clomid affects oestrogen it cause the lining not to thicken as it should, and also reduce CM.

Gonal-F is a synthetic version of FSH and directly stimulates our ovaries to produce follies. When you have 1-2 mature follies (17mm+ is the measurement HH calls 'mature') then you may be given an HCG trigger shot to take (eg, Pregnyl). I wasn't given one but I think pretty much all the girls on the OI thread have trigger shots.

*2. When will they give me the injections/explain how to use them?*
You don't need to make an appt for this. I went in on CD32 (a Friday) as I'd started spotting and wanted to get the meds before the weekend. I had to take a pg test and have a scan because when I had seen my cons two days earlier I couldn't prove that I wasn't pg. (!!!)

You can go into the clinic (the IVF unit), tell reception you're here to be shown how to do injections, and they will tell you to go through, turn right, and on the top of a bookcase are two clipboards. One is for scans, the other for bloods/injections. Write your name on the injection list and the time you arrived, tick in the 'injections' column and take a seat. Hopefully you won't have to wait too long before a nurse comes out and calls your name. They'll give you the needles, sharps bin, carry bag, etc and explain about the injections. Mine told me to do the injections between 7-9.30am but from what I've learned on FF it doesn't matter the time of day - just that you do it the same time each day.

On CD1 call the clinic (020 3313 4411) and pick the first option to book a scan/register the start of your treatment. I was told to book my first scan for CD7.

*3. What days do I take the injections?*
Generally speaking it's from CD2 through to whenever they tell you to stop (based on the follie tracking scans). I took my last dose on CD10 as my scan that day showed a 22mm follie. Based on EWCM and partly temps I ov'd on CD11 which was 4-5 days earlier than I did on Clomid. You could respond in the same way.

*4. 75mg of Gonal f, is that a valid presciption? My old clomid follicle tracking info sheet says it is prescribed as 300/450 or 900iu (Nothing about 75mg).*
Hmmm... is it definitely mg and not iu? 75mg does sound a bit strange - my prescription was for 2 x 300iu cartridges of Purgeon and my daily dose was 50iu, so enough for 12 days. FSH is a v powerful drug so they tend to err on the side of caution and start with a low dosage, esp if your ovaries responded to 50mg Clomid and produced follies. My prescription was done by the sonographer so, if you get scanned, you could ask about the mg/iu then. Or, when you see the nurse about the injections, check with them.

*5. If I ovulate but don't fall pregnant on the first round of Gonal f,will the doctor's write me a prescription for another round of Gonal f or is that it (Like she said, one round)? What is the usual protocol? She didn't write "only one cycle of Gonal f" on the sheet but said if it doesn't work this cycle we move to ivf.*
What I've done is make an appt with my cons for next Friday which will be the end of this cycle. I plan to discuss IUI with him for October. When Sister Rosie called me yesterday with my prog results she asked me if I had a treatment plan. I explained about my appt and she said ok, that's good. It sounds like you prefer Mr T so maybe call the clinic (not the IVF number, the appts number 020 8383 5125) and see when you can get an appt with Mr T that is around the time your current cycle will be finishing. Esp if you plan to move to IVF - it's impt you discuss it with a cons you're happy with! It may be possible to continue doing Gonal-F while you're waiting for IVF, I'm not 100% sure. Worth asking 

Depending on how you respond and feel using Gonal-F you might want to try it for more than one cycle.

Good luck JPS - let us know how you get on


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## Shellebell (Dec 31, 2004)

I think KD has pretty much covered it  
Why not join in the chatter on the ovulation induction thread
http://www.fertilityfriends.co.uk/forum/index.php?topic=170735.new;boardseen#new


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## JPSCoey (Jun 3, 2009)

kd74, thank you so very much for taking the time to reply   I so hope you get your bfp soon, you deserve it. Do you go to the ivf unit to get the injection 'equipment' between 730 and 9am. Could I go any day?


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## kdb (Apr 9, 2009)

Hi JPS - you're most welcome    Thank you for the kind wishes 

You can collect the injection kit and see the nurse for instructions anytime.  I got mine at 4pm-ish on a Friday.  M-F the clinic is open 7am-5pm.  (Also Sat/Sun 8-10am but I think this might be for IVF only?)  They do IVF scans between 7-9.30am and tend to be quite busy although having said that, I was there at 7.30am on Weds and only had to wait 15 mins to see a nurse for bloods.

So, you could rock up any day at any time that suits you!

xoxo

p.s. The on-street parking is free til 9am which is why I try and go in the mornings!


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