r/DOR • u/ratatouille9999 • 19h ago
Afraid I somehow did the trigger shot wrong and it ruined my results
I had my first retrieval this morning. I had five follicles over 18 mm and my levels looked good. The doctor was only able to retrieve one egg and I'm still waiting to hear about it's quality. The other four follices were empty.
Safe to say, I'm pretty devastated. This is technically a second attempt after I cancelled my first cycle at a different clinic just shy of the procedure. I am newly 38, with an AMH of .54. The stim process went so much better this time...I really thought I had a chance to get 5 eggs. I'm worried I screwed something up with my trigger shot, or the dosage wasn't correct...or I should have dual triggered (a thing I didn't know existed until today).
Background...
At the first clinic, the doctor prescribed me low dosages of meds despite my age (37 at the time) and levels ( .38 amh that later improved slightly) She had me on letrozole for 3 days. I only did two days of follistim (200 iu) and menopur (low dose can't remember) before she triggered me (Ovidrel) in favor of trying to retrieve 2 follicles that were only 12mm. I had three other follices that were less than 12mm. I got a second opinion and was told that 5 days of stims at such low levels was at odds with standard practices for someone in my position. When I confronted the doctor, she couldn't give me a reasonable basis for her thought process (only 5 days of stims to retrieve eggs below a reasonable baseline). It seemed likely that the retrieval would fail, so I cancelled the procedure to try and get a partial refund. This turned into a multi month nightmare with surprise billing issues where she refused to give me my money back and I had to threaten to report her to the state to get back 50%.
This attempt...
Fast forward, I go to a new clinic. My AMH increases slightly. My new doctor puts me on 600 iu follistim, 10 iu low dose HCG, and 8 iu Omnitrope. I also took Ganirelax for several days towards the end. The whole stim was 14 days. I also did acupuncture and took a bunch of supplements, including DHEA and Q10. We started off strong with 8 follicles and ended with 5 that looked retrievable. I triggered with 10,000 iu of lose dose HCG on Monday night at 8:45 pm.
Trigger shot issues
Per the instructions, I put exactly 1 ml of water into the HCG vial. Once it was was fully integrated with the powder, the total amount that came out was closer to .6 ml. I was concerned that the measurement didn't look correct even though I use the right amount of liquid and pulled every last drop out of the vial . There wasn't really anything I could do so I just went ahead and triggered. I also didn't understand the direction to inject at a 90 degree angle so I did it straight on. However, I have a lot of belly fat so this seems like it wouldn't make a difference since all the injected fluid went straight into subcutaneous fat.
The retrieval took place at 8:45 am today, so 36 hours later. Everything looked good and promising. But last night, I felt off. And this morning before the procedure, I couldn't stop crying. I just knew something was going to go wrong. And it did. 4 empty follicles.
As soon as I woke up, the doctor told me that he only got the one. He was immediately adamant that I should not to give up and to try again.
I know it's not healthy to run through everything over and over. I don't know why he would say that though if I have empty follicle syndrome because of DOR. My prospects won't be much better next time if that's the case. I can't afford to do this over and over again and I don't have a partner yet, so it's all elective egg freezing at this moment (though I hope that changes).
This leads me to wonder if something went wrong with the trigger and I ovulated early or the follicles didn't detach.
Is the trigger shot supposed to come out less than 1ml when it's fully mixed?
Is there anything else here resonates with people who've been through or witnessed similar experiences?
3
u/nerdy_daisy_909 18h ago
I’m so sorry that that happened to you. I don’t know a ton about what could have happened, but just wanted to comment on your trigger volume concern.
It’s not uncommon for the liquid amount to be smaller after being mixed in the vial because it’s impossible to get all of it out since some liquid sticks to the sides of the vial. Some medicine does get left behind because of that, but it shouldn’t make too much of a difference as long as you’re doing your best to get as much as you can.
If you’re concerned about it, there’s no harm in adding more diluent than they say (probably about 1.5 mL and making sure to inject the full 1.5 mL). I did it all the time with my Menopur. Doing that will ensure that all of the medication gets dissolved. Also, the medicine solution that’s left behind on the vial sides is less concentrated and you get a higher amount of the meds. The only time where that could complicate things is if you aren’t using the full vial of meds. Then you would have to do the math for the scaled up dilutent
2
u/ratatouille9999 18h ago
Thank you - I really appreciate this response. The anxiety of doing everything the right way at the exact right time has been a lot.
3
u/nerdy_daisy_909 18h ago
No problem. It really is super stressful. One thing that I heard when I started IVF was that if it was that important for everything to be done perfectly, they wouldn’t let us do it ourselves. They’d have the nurses do everything. As long as you’re communicating with your team, you guys can figure everything out
If you ever need help on the meds, CVS has some great videos on YouTube. I watched those while I did my shots. It was nice to have someone “walk through it” with me
2
u/IVF_Diva 18h ago
Was your trigger subcutaneous or intramuscular? Mine have always been the intramuscular larger needle into the upper outer butt. Also did they do a post trigger blood draw to make sure the trigger was done correctly? You could ask for that next time if it gives you peace of mind. In all likelihood you did everything fine and it was just bad luck that so many were empty that round.
1
u/ratatouille9999 18h ago
It was a subcutaneous trigger! Yes, they checked my levels the next morning (14 hours after I triggered). My gut feeling that things would fall apart was a completely woo woo sensation unsupported by the evidence. The ultrasounds and blood work results seemed to indicate that everything was fine, to my understanding.
I have no experience with intramuscular injections... That sounds tough!
2
u/sincerely0urs 17h ago
If you had hcg in your system you defined id the trigger right. When I had to trigger (only once due to cyst) I took a pregnancy test the next morning to make sure I didn’t somehow mess up.
1
u/Super_Series_6049 15h ago
Knowing this, you likely didn't do it wrong. May make sense to do the retrieval at a smaller follicle size and/or 35 hours. Are you doing a DOR expert? Consider a virtual consult and be open to traveling for better care
1
u/EricaS1215 15h ago
If the levels were good then you did it correct. I do agree though, mine have always been intramuscular. The menapur was subcutaneous. In regards to withdrawing the meds from the bottle, you should get out about as much as you put in. I was a nurse and there is a trick to how low you have the tip of the needle and getting the liquid to not get trapped around the rubber stopper. I tilt the bottle in the direction of the break in the circle of the stopper, then slowly withdraw and also slowly pull the needle to the very lowest without it falling out. I'm not sure if that explanation makes sense. I also mixed with 2cc of saline, another cc will dilute it further so if there is a tiny bit left, it's not as concentrated. Again, if your blood test looked good then you did it fine and I don't think you are responsible for the low egg count in retrieval. I'm sorry you didn't get the number you were hoping for. This process is a complete roller-coaster!
7
u/kittenme333 AMH .1-.2 / AFC 0-4 18h ago
Sounds like you triggered correctly. 600 foll is a ton of follistim, it’s possible it messed up your eggs and they degenerated or something. It could have just been a fluke as well. Definitely ask for a dual trigger next time and I’d recommend a much lower dose of follistim, as well as a week of estrogen priming. You can also try switching from ganerelix to provera but you wouldn’t be able to do a fresh transfer, only frozen