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Discussion Starter · #1 ·
Hi - I'm new to the forum/bulletin thing so here is my background... TTC since 3/08, assumed infertility due to hypothyroidism causing anovulation (although my period has always been super regular!). I live in Costa Rica and although my doctor is supposed to be somewhat of a fertility specialist, she doesn't know too much because she says the treatments are not too common here because of the price. So I'm not really getting all the answers I need... I have 3 different main concerns...<br><br>
The whole country has been out of Clomid for 2 months so I started out right away with Gonal-F injections, 75IU, starting day 3. My Dr. had me do 5 days of injections and the results were good so she told me to skip one day then take another injection and 2 days later I should be ready for my Hcg shot. Well I went in and I wasn't ready so she said do one more injection then come in 2 days. I did that and because I had skipped the 2 days of injections she told me to my follicles never reached an adequate size so she said seemed like my follicles reacted well to the Gonal-F but did not grow at all on their own on the days I didn't do an injection. So she told me this month I would not ovulate since there was no point to the Hcg shot when the follicles were too small so just wait for my period. I'm now on day 16 of my cycle and started to have menstrual bleeding/spotting. I've never had any type of spotting mid cycle before - my Dr says its probably due to my hormones regulating and being confused over the injections. How do I know this is just spotting and not my period? It isn't as heavy as my period but has been non-stop for 2 days now.<br><br>
How common are the side effects of Gonal-F? I feel like I got every single one so I am really not looking forward to more months of injections but they really work. Should I go see a regular doctor and not my fertility doctor if I am experiencing the respiratory side effects? I haven't had an injection now for 5 days and am still feeling like crap. I had all of the following side effects, some on different days some all at the same time: upset stomach, nausea, headache, flu symptoms (body aches, fever), fatigue, loss of appetite, bloating, and respiratory probs. Do the symptoms usually come every cycle of Gonal-F or is the first round the worst cuz I was miserable for so long?<br><br>
My doctor wants me to combine Clomid and Gonal-F next cycle. Clomid starting day 3 and Gonal-F starting day 5. Has anyone else done this before? Any more side effects by doing this? Is it that much more effective or a high risk over overstim?<br><br>
Thanks for any help you can give me! Although it was kind of a blessing to be living in Costa Rica when I found out I had infertility problems (much cheaper for treatments and meds here!) medical care is just not the same and its so hard to find out anything!
 

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It sounds like you were poorly monitered for the injectible cycle. I have never heard of skipping ANY days of gonal-f, and I have had 4 cycles of them. See, the injections override your natural FSH production. So you were giving the dose; your body quit making it. Then you withdrew the FSH, your body was used to NOT making it, then bam, your cycle fell apart. If you are responding super well to the FSH, you should lower the dose, not quit, because your body is not producing its own.<br>
The midcycle bleeding sounds like withdrawl bleeding because your body never ovulated. Its considered a period, (even though you never ovulated) and the first day of full on bleeding is Cycle Day 1.<br>
All of your symptoms seem to add up to overstimmulation. You should see a doc for difficulty breathing, poor urinary output, or severe pain. I would be wary of seeing that fertility doc. It sounds like she isn't practicing common practice.<br>
Not sure about combining Clomid and Gonal-f in your situation. Just please never skip injections, even though she told you to.<br>
Best of luck to you. Keep us posted!
 

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By-the-Lake gives you great advice. I have done 4 rounds of Clomid and 3 cycles of injectables and had 2 different REs over the yrs. What you describe is not common practice. NEVER skip any days with fert. meds. If you are responding well, the dose can be lowered but not skipped. I also would not take 2 fert. drugs at the same time. I would just do a basic inject. cycle. Start meds cd 3, 75 iu for 4-5 days, get an u/s and an estradiol read. You'll probably want to have a baseline u/s after this cycle though to make sure you didn't get cysts from stimming and not releasing. Sorry. I think you can get by if you become your own advocate, go in to the doctor knowing A LOT and being v. proactive. Ask us anything over here. We'll try to help.
 

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Discussion Starter · #4 ·
Thanks for the advice and info! I wish there were actual infertility experts around! There just isn't though - IVF isn't even legal here! Most people have to go to Columbia or Panama to get it done. What is the difference between a baseline u/s and a regular u/s? Also how do they do an estradiol read? Is it a blood test? Also what does the estradiol read tell you? I think you are right that as long as I find out a lot of information before going to the doctor I can have better control.<br>
I did read about people combining Clomid and Gonal-F on some other sites, but I think I'll just stick to the Gonal-F - when I had gone in on day 9 I had 4 follicles between 14-16 so I think my body responded well to just the Gonal-F. I also think that it was just spotting that I had - it only lasted 2 days, guess it doesn't matter, I will have to wait for next period to start either way.<br>
On my next cycle, what size folllicles by what day would you start to reduce the injection amount? Or would you just do if showing symptoms of overstim? Or is that what the estradiol reading shows? I thought 75 IU was already the lowest - the pen does do a 37.5 IU though
 

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Hello, a baseline u/s shows how your ovaries look before you are in the follicular stage (where the follies are growing because of the FSH). This tells you if there are cysts that will interfere with follicle development and ovulation. On the baseline u/s they should also drawn an estrodial, which is a blood test. If your estrodial is too high, it will interfere with ovulation. Most docs want it less than 80. A 'regular' u/s in a follicle study to see how things are progressing. When a follicle is to the right size (this varies doc to doc, but most want it at least 18mm.) they will look at the uterine lining to see if its the right size for possible implantation. It should be at least 8 mm. Clomid is notorious for thinning it out. They will also drawn an estrodial. The rule is generally 200 per good egg; again varies doc to doc. They will then decide based on these things to a) lower the dose b) increase the dose c) continue the dose for a few more days d) trigger ovulation with a HCG shot. Ovulations should occur 36 hours after.<br>
There is no exact time as to when your follies should be a certian size. It depends on your response to the meds.<br>
Examples- if your follies are too big for what your estrodial reads, you would reduce the dose. If your follies aren't progressing, they might increase the dose.<br>
Goodl luck with next cycle.
 
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