# Questions to be asked in follow up/investigation following complaint



## Bubbles12 (Aug 29, 2012)

Apologies for the long post.

Im 34. I have PCOS but have always been a good responder with good egg maturity and fertilization rate

To make a long story short, there was numerous occasions during this cycle of miscommunication. 
I responded quickly this time around and on day 7 of stims, the nurse measured my follicles and said i was ready for Egg collection, there was 5-6 follies measuring at 18mm, the rest were lower at 12-1mm, i was very shocked and my gut said it was too early
Subsequently, on coming round on wednesday, i was told that i only got 12 eggs. The doctor told me i have over 70 follicles and that she had never seen so many in her whole career and had they stimmed me for longer, they would have got too many eggs. Surely this is proof they over stimmed me and i over responded?

Anyway, i get the call the next day that only 2 out of my 12 eggs were mature and none fertilized. Game over.
This has NEVER happened to me. Ive always had good maturity and fertilization rate

The embryologist told me my husbands frozen sperm was good quality and it was definitely a problem with my eggs. She said that something had gone wrong here but wouldnt comment how, or what... but we both knew. She said how surprised they all were of the amount of eggs i got considering the amount of follicles i had.

The nurse confirmed a few days later that my estradiol level was at 11000 and for EC they like it to be below 18000

I think its pretty obvious they triggered me way too early and subsequently, ruined any chance of getting to tranfer, let alone getting a BFP. 
They should have either cancelled my cycle or let me continue stimming, coasted me then did a freeze all cycle to reduce the risk of OHSS. Im very certain of this. Im certain they should have done EC on the friday, rather than the weds.

I have my review on Weds and i want to go in prepared as i want my money back due to clinical error.

Here are the questions in brief..
1) why only 12 eggs collected when i had 40 follies on scan

2) why were only 2 mature, what does this suggest?

3) consultant said there was over 70 follies, all too small, why was EC considered in this case?

4) only 5-6 of follies were at 18mm, the rest smaller, why wasnt EC planned for friday to give the MAJORITY of the follies a chance to catch up. Considering you can still get a good quality egg at 22-24mm?

5) nurse said my bloods were at 11000, but for EC you like them to be 18000 or under, again, why couldnt you have continued to stim for another 2 days to allow catch up and maturity based on my bloods?

6) was i over responding? If so, why was this cycle not cancelled?

7) why wasnt EC not considered for friday, with a view of coasting if required?

 why wasnt a freeze all cycle considered to minimise OHSS?

9) why was my dose lowered on the day of the trigger shot?

Is there anything i havent covered or asked?

Ive researching the **** out of this but obviously, finding it hard to find anything that mimics my situation. But things are pointing towards early EC.

If there is anyone here that has time on their hands that is a dab hand at finding stuff out, could you have a look into this please..... im pretty desperate, we only had this one shot at this 😓 

Thanks for reading


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## bombsh3ll (Apr 19, 2012)

I too was badly overstimmed in my second cycle. I didn't have overt PCOS but was 31 and a high responder. My cycle was cancelled without proceeding to EC because by that time I was in so much pain & swollen up I couldn't walk, was short of breath & had completely lost faith in the clinic. 

We only got a refund of £500 out of £4500, but I believe from the consultant's words & a friend who cycled there a couple of years later that our formal complaint contributed towards changes in practice with a move towards more individualised dosing of stim drugs rather than whacking everyone onto the same perimenopausal dose irrespective of age or AMH and crossing their fingers. 

I think your questions are good, and the kind of thing I asked at the time. 

Some possible additions would be:

1/. How much refund do we get and when, or are they willing to let you repeat the cycle for free?
2/. How was my initial dose of gonadotropin decided on eg age, baseline ovarian scan, AMH, previous responses etc or are they just running a standard protocol for everyone. Do they still think this dose was appropriate for a 34 year old high responder with PCOS?
3/. Were there any missed opportunities earlier on to identify that you were overstimming and cut back the dose or coast you for a few days, eg did they scan you or take blood E2 levels? Who looked at the results? My clinic did, but the rocketing E2 levels were not acted on and I was continued on the same dose.
4/. Has your case been reviewed by a senior consultant and what are they going to do to try and reduce the risks for future patients? 
5/. What is the clinic's OHSS rate and were you made aware of it prior to entering into treatment with them? Clinics are meant to audit and provide this information. The clinic I ended up moving to (for DE by that stage as I couldn't face stimms again but wouldn't want to place my donor at risk) had zero OHSS because they used mild stimulation only. 
6/. If you did cycle with them again (and I personally wouldn't), but is there anything else they could do to reduce your risk such as use short protocol with cetrotide which is protective against OHSS compared to the use of buserelin or the like for down-regulation? I had actually asked for this having had previously milder but still painful OHSS on my first cycle where I used cetrotide, but was refused and forced to down-reg with buserelin against my better judgement which offers no OHSS protection for high risk women. We were NHS self-funding so paying all of the costs of private but having none of the say in treatment so worst of both worlds.  

I hope you leave with some answers and at least feeling validated and preferably with some form of recompense.

B x


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## Bubbles12 (Aug 29, 2012)

Thank you Bombshell

They are already aware that i wish for full refund or a free cycle as i stated this in my complaint letter.

I had OHSS with the clinic on cycle 4 after retrieving 38 eggs (and yes, they still went ahead with transfer).

On cycle 4, i didnt respond to stimming at all for the 1st 13 days then bang, it went crazy so i was put on a higher dose of menopur (225iu instead of 150iu) to avoid not responding to which i was fully aware about.

Missed opportunities, unfortunately, on day 4 of stims, they lowered my dose from 225 to 150 so im guessing they covered their **** there...

I will ask who has reviewed my case. I know that my consultant has already and apparently is ready to review my case with me, yep, this quick (it had only been 1 day at this point) this makes me worry its an open and shut case where no wrong doing was done by the clinic

Personally, i would cycle with them again, its local, cheap and really good success rates... plus, i know all the nurses and i feel comfortable. Yes, this is a setback and i utterly blame the clinic, but perhaps not enough to not use them again. I used cetrotide this cycle. But i will need to ask what changes they will make going forward to ensure that this doesnt happen again to me (well, avoid it as much as possible)

I think the way around this problem was not to do EC on wednesday, i think they should have done it on friday.

Im just scared as i think this is a battle that i am not going to win... they will pull rank, use a load of medical jargon and get them selves out of it.
They owe me £500 for non fertilized eggs, and they owe me £400 for the embyroscope so the least i will get is £900 but i think they should give me the full ICSI cost back plus the scratch that i had done.

If this was not an isolated case for me, where i was prone to small number of eggs or had issues with egg maturity, i could let it go but this isnt me, this has never happened. They have done this....


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