Thursday, March 27, 2008

Monitoring

You know, when I first switched to NY Clinic, I was rather surprised that my RE kept droning on about how they monitored patients really closely and it was one of the things that differentiated them from other places. Because I couldn't really see what the eff they were doing differently. Local Clinic monitors patients pretty darn closely too. I mean, perhaps I had one more ultrasound at NY Clinic. Maybe. Perhaps not. But that was it. I couldn't see what the fuss was all about. There really was no discernable difference and arguably Local Clinic monitored me more closely, because at least they took their time to measure every follicle, whereas NY Clinic would often only look at the biggest two on each side and call it a day.

And here I am now, realizing that there can be a big difference in monitoring. I have done 3 days of stims, when I would normally have gone in for the first ultraound today at either NY Clinic or Local Clinic and yet I have no freakin' clue what is going on in the old ovaries and I still won't have an ultrasound for 4 more days. Yup, my first ultrasound is after 7 days of stims. Aaand I didn't have one right before I started stims either. I mean, I had one before starting estrogen priming but then hung around for a week doing that so I didn't start stims until a week after my ultrasound. It's already odd that NY Clinic did estrogen priming before AF, and LV Clinic does it after AF. But then not to even take a quick peek? Just seems odd, that's all. Especially as on my "dominant follicle" cycles I triggered after 6 and 7 days of stims, respectively. Oh well, I'm sure it'll work out OK. It's not as if anyone ever said "oh my god! We need to drastically reduce your dosage!" after any of my ultrasounds. Normally it's "well, we think we'll keep you on the same dosage for another day or two to see if any more develop." And it's in the plan to drop the dosage on the 7th night of stims anyway. I should be fine. I shall repeat this as my mantra. I should be fine.

I can feel some ovary action going on. I feel twingeing and growing and all of that. Of course, I hope this means that more follicles are popping up, given that I often don't feel my ovaries until closer to trigger, but I know that really it means nothing. After all, I still vividly remember my 3rd cycle where I was convinced, convinced I tell you, that I felt a gazillion follicles growing and that my abdomen was practically about to explode, only to go in for the ultrasound and have them discussing cancellation because of a poor response. I felt so disoriented having such a disconnect between how I was feeling and what was actually going on that it has stayed with me.

How does your clinic monitor during IVF? Are they standoffish or do they want you in every day after the first few days? I'm wondering if I have gone through the two extremes and if there's a happy medium somewhere, or if there is no happy medium and it's either one or the other depending on the RE's favorite school of thought.

7 comments:

Sarah said...

Being the vetran of one cycle, which was converted to IUI, I'm not sure what I can offer:
They did a baseline, next was 5 days after starting stims, next was 7, than 8, then 9, then 10. Yeah, crap response had them looking at me constantly. It got bad towards the end when I was so sore from the follicles that did come along that the dildo cam was not comfy. However, I am a tremedous bruiser, and I will hand it to the phlebotomists there, I never got a bruise, even though I made them use the same vein each time.

Almamay said...

After 4 IF clinics and way too many cycles I have to say that up to my first scan all the clinics were the same. My current clinic that I've now done 5 IVFs with monitors the most but they don't start monitoring until CD9. Hope that helps.

bleu said...

My doc feels really strongly that the u/s craze is completely a money making scheme. He does baseline or did before IVF #1 and did an u/s at day 7 of FET cycle and on day 9 of the IVF cycle and then no others. One check and that was it. He says checking for suppression is not necessary, the lupron works, and in all his years has never not except some random exception that would have cancelled no matter what.

He also says that after a day 9 check he can usually see when ER should be but sometimes he will have a slow grower and they will come back for one more u/s.

I personally always felt lucky with the lack of monitoring on this because there was much less obsessing.

orodemniades said...

I was on BCPs then Lupron, didn't get any monitoring until I began Follistim and Menopur, and then it was every other day u/s and bts.

katedaphne said...

My experience is that frequent monitoring helps. My first two IVFs at my Local Clinic did not monitor much at the end; I think they did the last u/s on a Friday and triggered me Sunday. If they had done an u/s on Sunday they would have seen my eggs were not as ready as they thought. Going an extra day or two may have really helped that cycle. They did the same thing for IVF #2. New Clinic for #3 didn't check enough and let me go too long. I'd rather see in there every dang day and KNOW rather than not look and wonder or be wrong.

sweetpeapod said...

I had an u/s on CD2 (the day before stim start); after 3 days of stim (CD6); after 6 days of stim (CD9); after 8 days of stim, which was the day I triggered (CD11). I felt good about that schedule. However, overall I feel like I went in for way too many visits, probably because they seem to have a consult for every single little thing that happens. If we weren't covered by insurance, I'd feel like there had to be a more efficient -and cheap- way of scheduling. I counted something like 20 visits from start to finish!

Aimee & Hannah said...

Let's see if I can remember....

Day2 - Baseline/Lupron Evaluation
Stim Day 5- E2 and follie
Stim Day 7- E2 and follie
Stim Day 9- E2 and follie
Stim Day 10-E2 and follie
Stim Day 11-E2 and follie
Stim Day 12-E2 and follie

I was ready to trigger on Day 12 and my ER was on day 14.

After my ER, I had to visit the clinic a half dozen times due to OHSS.