# Bleeding before OTD - what should I ask for?



## jennyes2011

Hi there,

Just wondering if anyone can help me? I have had 2 failed ICSI cycles and each time, I bleed 2/3 days before OTD (1st cycle spotting at 8dp3d5 and AF day after, 2nd cycle spotting at 7dp3dt and AF day after).

What should I be asking my clinic to do - should I be asking for extra progesterone? Has anyone been treated for this? My clinic prescribed 1 400mg cyclogest every 24 hours on both cycles.

Thanks,
Jenny x


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## Ellie.st

Dear Jenny

So sorry about your BFN.     I'm not an expert but you could ask for more progesterone next time round.  Also, what fertilisation rate are you getting from the eggs which undergo ICSI?  If it is quite low, it might be worth asking about a protocol which might give you fewer eggs but a higher fertilisation rate.  It might also be worth getting some other tests done as well before your next cycle - there is a good list on the Starting Out board, some of which your GP could do.  I had them done after I had two BFNs - in my case they all came back OK but they could have shown up something which could be treated.  PS: if you look at my profile, you will see that I was third (and fourth) time lucky, so hang on in there.     

Ellie


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## emmy4

Hi jenny, i bleed before otd on my 4th ivf, when i went for follow up appointment my consultant said next time he would prescribe 2 x shots of hcg after et. My 5th ivf and thats what i did and got a bfp.x


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## jennyes2011

Thank you for your advice, and for the success stories  They give me hope.
My clinic told me that it didn't matter about the progesterone as it was an artificial cycle - which is just b***ks   
I am going to demand it this time lol. I will ask about the hcg shot - I really think the early bleeding is a problem.

I had an appointment with my GP just tonight, to ask for Level 1 immunes and a hysteroscopy. He said that the ultrasounds we have at the clinic are enough to spot any fibroids or polyps etc etc, and has offered to do the thyroid and diabetes tests only. At least its something though. I have 2 frosties so if they fail even after extra progesterone, I am going to get the level 2's done in London and switch clinics I think.

This is all becoming a lot harder than I imagined it would be!!!

Thanks again,
Jenny xxx


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## jennyes2011

Sorry - in answer to the question about fertilisation rates, it is quite low. On our 1st ICSI 12 our of 26 mature eggs were fertilised. On the second 6 out of 18 were fertilised.
I dont think the clinic are going to change much - unfortunately they seem to have a bit of a conveyor belt method going on! But we will see - I will ask about that. What is the protocol?

Thanks,
Jenny x


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## Wombly

Hi Jenny

I bled before otd on my first 2 ICSI's so I did some research and asked for gestone for my 3rd ICSI. The clinic I was with at the time said they don't prescribe 'experimental medicine'    but luckily they were associated with The Bridge in London who are a lot more forward thinking (I had EC at the other hospital then ET at The Bridge) anyway The Bridge had no problems giving me some gestone and I achieved my first ever BFP on that cycle. If I hadn't pushed for it I'm sure I wouldn't have got a bfp (but I'll never know I guess). I have then used gestone (or prontogest in my last 2 cycles as gestone is too hard to get hold of nowadays) for all of my further cycles. I have received bfp on 2 out of 3 of those cycles - the one I got a bfn in was a fet where the embies didn't defrost v well, lost a cell each & stopped developing so I wasn't expecting them to make it anyway. I know I have also mc'd on both of them but the first mc the clinic persuaded me it would be okay to switch to cyclogest after i'd got my bfp (I mc'd a week later) and the second one I'm just putting down to bad luck.

Anyway, I just wanted to tell you my story. Once you get the bfp though you need to do it until 12wks and you're bum is really really sore by then (but obviously soooo worth it). Also i find the prontogest less painful than the gestone....

Good luck!!! 

Wombly x


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## Holly82

Hi Jennyes- Im also at Newcastle, and have just had another BFN!! I have had one positive but a week later i started bleeding. I'm also now wondering what the clinic can maybe do differently as i am starting to think it may not work at all, and that scares me alot! This may sound like silly question but what is the progesterone, I thought this was the cyclogest? Im hopin to receive my follow up appointment soon and will also be askin some questions. 

We could be cycling around the same time as i'm also doing a FET cycle  

 to you x

Holly


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## jennyes2011

Hi Holly,
Sorry for you recent BFN . Its heartbreaking. Did you have good embryos transferred each time? Did you bleed before OTD? How many embryos? Here is a thread that I found very useful - it talks about the different tests you can have done: http://www.fertilityfriends.co.uk/forum/index.php?topic=242395.0

Yes, the cyclogest is progesterone. But even with the extra progesterone, I am bleeding too early, and I am not 100% sure but I think that indicates a low progesterone problem, or not enough progesterone to keep a pregnancy going. I'm going to ask them to double it up at least - but I am also going to suggest the injections either hcg or progesterone.

Jenny x


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## Ellie.st

Hello Jenny

I changed from Puregon to Menopur for stimming after my first cycle and my egg quality seemed to improve re fertilisation and embryo quality - I always had the long protocol.  I think there is research both pro and against Menopur but no harm discussing with clinic.

Good luck

Ellie


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## Holly82

Hi Jenny

The embryologist said one of my embryo's was perfect and the other was very good i had them both put back. I started to bleed on the morning of my OTD but i knew it was over before then as i did a poas test the day before and it was negative. Thanks for posting the thread on the different tests i can have, i'm going to look into them. 

How many cyclogest pessaries did you have per day? i was told to only take one at night. 

When is your follow up app? 

Holly   x


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## jennyes2011

Hi Holly, Yes I was the same - just one cyclogest pessary at night. I don't think that there's anything wrong with that as such, just in my case I bleed too early so I would like to try more of the cyclogest. It sounds to me that you are just fine, as bleeding on the day of the OTD means you have a 14 day luteal phase which is by the book! 
We have'nt had our letter yet for the follow up appointment, I imagine it will be in 6 weeks.
We have decided to switch clinics to QE - as I believe they will offer us a more bespoke service or at least it will allow some fresh eyes to look at our case and see if things can be improved. we found out that you can move frozen embryos between clinics, so we are going to do it!
Glad you found the link useful - somebody gave me the link just recently and I found it useful too. There are so many things to look into, it feels good to know that we are not at a dead end. 
Wishing you lots of luck  
Jenny xxx


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## Holly82

Hi Jenny

Have you received follow up appointment yet? Are you def switchig clinics? I am NHS funded and still have a cycle of IVF and FET cycles depending on my frozen embryo's hopefully i will be able to have two rounds. Are you private? 

Holly x


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## jennyes2011

Hi Holly,

No I haven't received any follow-up letter from CFL yet.
Yes we are definitely switching - we are also NHS and have our FET, and then another fresh cycle left to take. We went to a private urologist to see if there was anything they could do about our male factor problem but he said ICSI was the best thing for us (just what our GP said, but we wanted to make sure). We told him we had already done 2 failed cycles at CFL and would like to switch clinics after the FET. He said you can still switch clinics even with frozen embryos and referred us to the QE consultant Dr.Isaac. We are waiting for our appointment with him, which will most probably be a private appointment. But we are going to ask if we can use our remaining NHS funding - which I am sure he will be fine about.
To swap, we were originally going to see our GP - but we've done it this way now, so just going to go along with it.

Jenny x


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## Helenx

Hi Jenny,

I have had 2 ivf/Icsi cycles and I have bled early on each one. My dr has recommended taking 3 x 400mg cyclogest pessaries a day. I was previously on 2 a day. I've asked about the progesterone injections but apparently they don't use the as the injections are too hard to get hold of. There are also some tablets you can take. I am definitely going to up my progesterone for the next cycle.

I also had level 1 immunes done and I've been told to switch from short to long protocol for my next go as that can help with implantation.

Hope this helps


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## jennyes2011

Thanks Helenx  . 
For our last 2 I was only taking 1 pessary! When I asked about it at the clinic, they just said to do the same thing   Hopefully this new clinic will be better. I am going to demand 3 this time lol
I am already on the long protocol.  
Do you have a short luteal phase naturally? Did the clinic recommend any blood tests?
I asked my GP for Level 1's and he agreed only to the thyroid and insulin resistance tests, of which I get the results next week

Lots of luck to you xxx
Jenny x


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## Helenx

Hi Jenny,

Can't believe they gave you only 1 pessaries. The standard at my clinic is 2 a day. However when I got pregnant it was reduced to 2 x 200mg a day and then I had a m/c. Think so many clinics can seem to follow a one size fits all policy unless you start to take action and ask for things..test etc. I will take 3 a day now and I think the advice is to keep on them longer too. 

Don't know about my luteal phase I'm afraid.

I asked my consultant for level 1s and a vitamin D test. Which im very lucky they did as i know in some places you dont get that on the nhs. Think you should ask for the full level 1s when you start at your next clinic I asked for vit d test too as I'd read that might affect things like immunes.

How do you find the long protocol? I have only ever known short protocol so I am scared about moving onto something new.

I hope your results have good news for you next week. Xx


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## mazza10

Hi All,

Just thought I would share my experience.  

My 1st cycle, i tested early - 2 days before OTD and it was a BFP, but started bleeding the same day.  Even on OTD it was +ve.  I eventually lost it, but my consultant put me on progesterone injections the 2nd cycle which I think was better.  I did get another BFP on that cycle aswell but I had scaring on my uterus from the 1st chemical which led to the 2nd chemical.  I got my period 5 days later on the injections, i personally dont think my body absorbed the pessaries very well so the embryo wasnt getting enough support.  Even now with my 3rd cycle looming I will be asking for injections, they are sometimes painful, but if it's going to achieve a BFP in the end, then it's worth it.

Good luck to you all in whatever stage you're in xxxx


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## Helenx

Hi Mazza,

Sorry to hear you've had so much happen with your cycles. But third time lucky I am sure for you.

Can I just ask how they found out about the scarring? I have had an early m/c but no one has ever mentioned scarring? Would it come up on a normal ultrasound?

Many thanks

Helen xx


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## mazza10

Hi Helen,

After my 2nd chemical, my consultant wanted to do a HSG xray scan.  As he said I have achieved a pregnancy both times, but its not developing.  That's when they found the scarring.  So not sure if it was there before the 1st cycle or happened after.  This can prevent the embryo from attaching properly and developing.  Scans wont show up any problems with the uterus.  The xray also checks your tubes aswell.

Maybe ask your clinic if you can have one, just to make sure everything is still ok.  Depending on what your funding is like, you can maybe get it done on the nhs.  I just did that and saved myself £3,000.

Marian x


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## jennyes2011

Hi there,
Thank you for you help 
Will a HSG show polyps? What's the difference between a hysterscopy and a HSG?
Thank you!!!
Jenny x


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## mazza10

Hi Jenny,

A HSG is the xray scan that you do where they see if there is anything wrong inside with your uterus, tubes ovaries etc...I am sure it will show polpys.  A hysteroscopy is the minor op you need to remove scarring & adhesions on the uterus.  I have just been referred to get this done as my HSG showed scarring.

Hope this helps

Marian x


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## Holly82

Hi Jenny 

Hope you dont mind that i have been following you on the QE gateshead thread, i see you have your app with QE on the 20th!!   but you also have your app at CFL then too, will you attend your app at CFL? x  

I have my app on the 12th March, and i am going to go ahead with CFL for my FET cycle but cant help worrying that may be the wrong decision   it wont be. I have read that QE do things differently to CFL and i am thinking if my FET cycles do not work then i may ask to be referred to QE. How would i go about being referred to QE?  

I wish you all the best and   you get your BFP   x


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## jennyes2011

Hi Holly82,

QE have asked that I get my notes from CFL - so my plan is to call or email (prefer email!) to tell them I am switching clinics and that I need my notes.

I can't attend my appointment with CFL because I have no holidays and have to make up the time from the first appointment. I would prefer to do both, but since I have to choose, I have gone for QE of course. I dont think I will get anything out of the CFL appointment anyway - except the info that is in the notes. 

you'll be fine at CFL. I think they are brilliant at what they do - I just feel that I need a change and to be at a clinic that are willing to make changes. 

We got a referral by seeing a private urologist - who we wanted to help with our male factor, but he said ICSI is the best thing to do - asked us about our history of ICSIs, and advised that we switch clinics to the QE - and he made a referral. We were going to do our FET at CFL originallly because we didn't know you could transfer them.  I think you can get a referral through your GP and go from there.

Lots of luck for your FET x I hope it gets you your BFP 

Jenny xx


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## Poupeefee

Hi Jenny,

My OTD is Monday but I started bleeding today (exactly the same timescale as last BFN). So no hope left for Monday morning. I'll ask about the progestrone when I speak to the doctor. I never thought about that last time but the gel just never seemed to dissolve.

Please can I ask you a question? Did you end up having the same pattern as a normal month. The reason I ask is because my breasts were very sore from the time of the HCG until just two days before the bleed. This is my normal pattern - sore breasts, pain goes, headache and then bleeding. Sometime all in one day! Just wondered so I can ask the doctor about it.

We can both just keep breathing and try again.

Thanks
Fiona


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## jennyes2011

Hi Fiona,
 Hope your OK x
Yes - everything was pretty much the same as normal although my boobs were a little sorer than normal. I always have around an 11 day luteal phase so it was the same  there too. More reason to believe I need more progesterone. 

Lots of luck,

Jenny x


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