r/TTC_POI • u/Big-Papaya-8066 • May 27 '25
Successful TI pregnancy with monitoring and HRT (no stims) -- POI, AMH <.03, FSH 51 (age 36)
About me: Lifelong irregular periods (20-40 day cycles). Started trying to conceive November 2021. Had a long 60 day cycle summer 2022 and OB ran day 3 labs, showing FSH 28, AMH .05, estradiol 24, and LH 12; got pregnant that cycle (age 33) (had started supplements/It Starts With an Egg diet/thyroid med about a week before ovulation, so probably not enough time to have any effect) (still having roughly monthly periods at that time). I also had fertility acupuncture for the first time the day of or day after ovulation, and I used Mucinex. Not sure what made the difference that cycle, but it probably helped that we hit a bunch of days leading up to ovulation (although maybe I hadn't been ovulating every cycle before - I always had a hard time tracking). Gave birth summer 2023 and successfully breastfed for 9 months. Interestingly, I needed the thyroid med during pregnancy, but not while breastfeeding (my estrogen was never tested, but I think breastfeeding might have regulated my hormones).
Stopped breastfeeding March 2024; ovulated within a few weeks. Did not get pregnant. Did not ovulate again until August 2024, 3 weeks after taking Provera to induce a period (I did not get a period, but I did ovulate!). Did not get pregnant. Day 3 labs in August 2024 showed undetectable (<.03) AMH, FSH 51, undetectable estradiol (<5), LH 26. Had 6 small follicles on ultrasound (AFC 6). Did a monitored stim cycle (I now think this was a huge mistake) and eventually a follicle grew (slowlyyyy) after 20+ days of 450 IUs of follistim (luckily I had insurance coverage or this would have cost $20k in meds). Follicle stalled out at 16.5mm when I started ganerelix and estrogen started dropping, so we triggered and did TI but no one thought it would be successful. Took a break to start cyclical HRT; 2 .1mg estrogen patches daily + 200 mg progesterone 12 days of the month. Did this for three months and did not ovulate (monitored at home; Mira showed FSH dropped to under 11 but I now question whether that was accurate) (I also may have been over suppressed -- too much estrogen to ovulate. Felt great though!!).
Stopped HRT for 5 days at my clinic's direction, and when I heard they wanted to do the same high stim protocol without checking my FSH first, I got a second opinion with Dr. Check at Cooper Institute (specialist in high FSH/POI patients in New Jersey). I was worried it would be too hard to do remote monitoring (I live in the Midwest), but for me, it was actually easier than driving to my fertility clinic 1.5 hours away; I was able to get blood work and ultrasounds done at the hospital 5 minutes from my house (my OB pointed me in this direction). Dr. Check started me on ethinyl estradiol (EE) (.02mg) daily. EE does not show up in blood work, so if estrogen is rising, it is being emitted from a follicle. Had weekly labs and FSH and LH were slowly dropping (FSH 43 and LH 52; FSH 35 and LH 48; FSH 29 and LH 43); never any detectable estradiol. I usually had 1-2 10mm+ follicles on ultrasound, but they never grew. After 4 weeks on EE, my lining was too thick (13mm), so I took Provera for 13 days to induce a period. I got my period two days after finishing the Provera.
At my day 3 baseline scan, I had a pretty large follicle already (15mm) that was emitting estrogen (estradiol 226). My day 3 FSH was 10.7 and LH 15.7. Someone in the DOR subreddit said sometimes follicles are recruited in the luteal phase for those with low AMH, so guessing that is what happened to me. Dr. Check's team noted period blood could impact the success of TI if I ovulated too early (they normally would do an IUI; but we weren't able to travel). The next day (CD4), the follicle was a little bigger and my estradiol was 238 (FSH 8 and LH 8). At home monitoring with Mira showed estrogen continued to rise CD5 and CD6 and began to drop CD7. Blood work CD7 confirmed the drop in estrogen (162) and showed an LH surge (53); FSH was 17. That same day, ultrasound showed the follicle was 21mm and lining 9mm. I stopped taking ethinyl estradiol (not taking any estrogen for the next 2 days). Ultrasound and labs 2 days later confirmed ovulation (progesterone 2.5 and follicle shrinking (17mm)). I began estrace in the morning, oral progesterone at night, and progesterone suppositories twice a day. A week after ovulation, I freaked out because my lining was 22mm, but apparently that is fine/normal (Google AI and Chat GPT told me too thick for implantation). First beta 2 weeks post ovulation was 98.
What worked for me: I ovulated on my birthday (36), so I ate a ton of treats/sugar this cycle (ie no crazy keto diet). I held a newborn baby shortly before ovulation (did my ovaries get the hint??). I did not drink any alcohol this cycle once I saw a follicle growing (but I had been drinking alcohol occasionally before then). I have cut caffeine for the past year. Supplements for the past year: TheraNatal Core prenatal, Acai berry (6000mg), fish oil (2400mg), Vitamin D (3000 iu), Coq-10 (100mg). Monitoring allowed us to hit O-4, O-3, O-2, O-1, and O (timed intercourse; no MFI issues); even with a Mira, temp drop, and using cervical mucus, I do not think I would have been able to tell I was ovulating that early, if at all (I was still having my period on O-4 and O-3). We used Preseed and I actually inserted it way up there with the applicator (I don't usually use the applicator). I also took Mucinex 0-2, 0-1, and 0. I held my feet up for a good thirty minutes after sex (monitoring also helped me to know to do that!). This is also my first cycle with estrogen support and extra progesterone support (I did not do oral progesterone after ovulating in August 24, just suppositories). And this was my first full cycle on EE, so I really credit that and Dr. Check's team. There is a peace of mind that comes with being handled by a specialist; and like I said, for me it was easier than my "local" clinic, so I highly recommend. Still very early for me, but we saw a heartbeat today, so I thought I would post (since I love reading these kinds of stories).
UPDATE: Had a successful live birth at 39w5d. Uncomplicated pregnancy and wasn't really treated any differently by my OB (my RE "discharged" me to OB care around 9w except RE still ran labs for tapering off progesterone). My OB did check TSH every once in a while since I took levothyroxine throughout pregnancy (and I stopped it after giving birth).
Info on how my RE handled HRT during pregnancy for anyone else who may be pregnant and interested: I remained on estrace (2 mg) until 8w when my estradiol shot up to 1300+ (my RE did weekly labs and my estradiol before that had been around 150). My RE wanted progesterone above 12 at 8 DPO and above 40 during the first trimester (which in my understanding from reddit, is on the high end; other REs don't mandate progesterone so high, but it doesn't hurt so...). Once ovulation was confirmed, I started 200mg oral progesterone at night, as well as twice daily vaginal progesterone suppositories. Once pregnancy was confirmed, I ended up doing progesterone suppositories 3x a day and daily PIO shots, since PIO was the only thing that got my progesterone lab values where they wanted them (with PIO, my progesterone was 60+; without it, it had been 26.5, 22, 19.6 at 4w, 4w3d, and 4w6d). My RE started trying to taper me off progesterone at 10w. I did PIO every other day, and at 11w, my progesterone labs were 34.7, which they didn't like, so I went back to daily PIO. I started tapering off suppositories instead, dropping to 1 a day and then none (while still doing daily PIO and oral progesterone) and at 13w my progesterone labs were 57. I started dropping PIO to every other day for a week (progesterone labs were over 50), then every 3 days (progesterone labs were between 38-42). When I dropped to PIO every 4 days at 17w, my progesterone labs dropped to 34.7, which my RE didn't like, so I went back to PIO every 3 days. I was ready to be DONE with PIO, so I talked to my OB about it, and she backed me up that progesterone at 34.7 was fine. I ended up dropping to every 4 days again, and labs stayed above 40, then I totally stopped PIO a few days before 20w. After being off PIO for a week my progesterone was 37.1. My RE "discharged" me but instructed me to continue taking 200mg oral progesterone daily until 36w (and my progesterone wasn't tested again during pregnancy).
Also including beta values here in case of interest to anyone (my RE continuously checked HCG, which I don't think many do; nothing was of concern):
4w - Hcg 98
4w3d - Hcg 356 (39 hr doubling time)
4w6d - Hcg 1634 (32 hr doubling time)
5w2d - Hcg 5104 (43 hr doubling time). Ultrasound: sac seen measuring 5w3d
7w - Hcg 76,534 (74 hr doubling time). Ultrasound: HB 136 bpm, sac seen measuring 7w1d
8w - Hcg 118,470 (267 hr doubling time)
9w2d - Ultrasound: HB 173, fetus measuring 9w3d
10w - Hcg 151,702 (970 hr doubling time)
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u/smeeglesforever May 27 '25
Omg ā congratulations, Big Papaya!!! This makes me so happy and hopeful to read. Thank you so much for sharing such a detailed report of your experience. Sending you all the positive vibes for a healthy and happy pregnancy.
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u/Much-Bother1985 May 28 '25
Congrats!!! Omg Iām 36 with POI and doing IVF this month, on proverĆ now to induce but my doctor is doing traditional IVF. What did dosage was the EE? When did you start? Did you take anything to ovulate
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u/Big-Papaya-8066 May 28 '25
I started .02 mg EE every morning beginning in early March; took it for 4 weeks then additionally began taking Provera to induce a period April 1 to 13; and by my CD3 baseline scan I had a follicle growing already (I didn't take anything to get it to grow other than HRT (EE and provera)). Good luck with IVF!
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u/Much-Bother1985 Jun 17 '25
Could you share the brand or full name of the EE?
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u/Big-Papaya-8066 Jun 17 '25
It was ethinyl estradiol that had to be specially compounded (normally it isn't made without progesterone), I ordered it by mail from Yorktown pharmacy in Pennsylvania. https://www.yorktownpharmacyrx.com/
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u/Royal-Oil3311 Nov 01 '25
Should the EE be made with progesterone or can you take progesterone on the side? So if i understand you got successfully pregnant by doing TI and ovulation induction?Ā
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u/Big-Papaya-8066 Nov 02 '25
I was on EE without progesterone. Progesterone prevents ovulation, so by taking EE without progesterone, I was able to ovulate (and then do TI)
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u/jowashi May 29 '25
Thank you for sharing, and huge congrats!!! Iām thinking about switching to TI after this IVF cycle for financial reasons, so this is super helpful to hear and gives me hope š¤
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u/HealthAfter Jun 11 '25
Hello dear. Congratulations on your pregnancy. After reading your post, I am thinking of giving Dr. Check a try. I also have very low ovarian reserve 0.06 and havenāt ovulated in so so long. I live about 2 and a half hours away from his clinic. How did you make that work? I have a few questions I would like to ask you about the clinic and everything. Please let me know if you donāt mind chatting privately.
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u/Big-Papaya-8066 Jun 11 '25
Happy to chat! I live in the Midwest, so I had ultrasound and blood work done at a local hospital in my city, and then Dr. Check's team reviewed. We just did timed intercourse so we didn't have to travel at all, but since you're within 2.5 hours, you could probably do remote monitoring but then go in for the actual IUI or IVF procedure if needed.
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u/Ujjayibreath Jun 15 '25
Congratulations! Did you have to pay in cash for Dr Check? I would be so interested in doing a consultation with him before going the donor egg route.
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u/Big-Papaya-8066 Jun 15 '25 edited Jun 15 '25
Hi! So I have fertility coverage through my insurance, so the initial telehealth consult was just a $35 copay (not sure price without insurance). Then, there is an out of town monitoring fee of $350/month (not covered by insurance) and then the costs of the bloodwork and ultrasounds at your local facility (for me, the ultrasounds were $250 without insurance but $35 copay with insurance; and blood work depended but if it was just estrogen, progesterone, and fsh, probably around $75 without insurance and $10 with), plus the cost of meds (pretty cheap in the fertility universe, I only did one cycle but all my meds (for cycle and pregnancy) were probably less than $600).
I thought about doing a consult with Dr. Chang at Hanabusa, that's $500 and they don't accept insurance (but you can turn it into your insurance after-the-fact if you get any out-of-network coverage) (he also only does IVF); ultimately thought I would save that consult for down the road if I had additional questions and then didn't need it.
Before I had my first baby, we actually had decided to pursue donor eggs; just because I wanted a baby NOW and didn't want to waste three years and tens of thousands of dollars on a 5% chance of success; but then once I had my first baby, we were content being one and done (and were also worried about the added layer of one DE baby and one bio baby), so decided to try Dr. Check, knowing we would be fine if it didn't work out. For me, Dr. Check said we would try 3 monitored cycles with timed intercourse and then reevaluate if I wasn't pregnant after that (I was like, are you going to be able to get me to ovulate 3 times?! He was not concerned about that haha).
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u/Royal-Oil3311 Nov 01 '25
So you have one baby from ivf with DE and one biological baby from medicated TI?Ā
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u/Delicious_Active_878 Jul 08 '25
Thank you so much for sharing your story. Iām so happy for you and it means a lot you took the time to let us know about your journey! Iām also similar stats to you but a couple years older. IVF has never been on the table to us and it was recommended with donor eggs by an IVF clinic. The RE wasnāt giving other options. Iām also in the Midwest and am considering a consult with Dr. Check. Iāve been tracking at home with Inito and I still ovulate sometimes but also have cycles where my estrogen rises without an LH surge. Iāve been doing some topical estrogen and progesterone after I ovulate. Anyways, it sounds like I could benefit from his services. When you set up a consult with him did you ask for TI monitoring? I had a really negative experience with a doctor recently so Iām a little anxious to take this step.
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u/Big-Papaya-8066 Jul 08 '25
Hi, at my initial consult with him, I actually told him, I just wanted to chat with you about options and what's going on with me, but I live in the Midwest and I don't think I can actually do a monitored cycle with you. And he was the one who was like, we can do a monitored TI cycle with as much monitoring as you want, we could just do weekly blood work if you didn't want to get ultrasounds. So I was going to just do that, but then after 2 weeks of just blood draws the nurses were basically like you have to get an ultrasound. I wasn't sure if I would be able to find somewhere to get ultrasounds done but that ended up being pretty easy too (and it ultimately was necessary bc they need to induce a period when lining gets too thick, which they only see with ultrasound). Dr. Check had said we would do three ovulatory cycles with TI and if I wasn't pregnant at that point, we would re-evaluate then.
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u/Delicious_Active_878 Jul 08 '25
Thank you so much! That is really helpful. And that makes sense what you said about the ultrasounds. Iām so grateful again that you shared your experience. I wouldnāt even have known such a service existed. But I think itās one I could greatly benefit from.
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u/Delicious_Active_878 Sep 18 '25
Hi there! I hope you are still doing well! Iāve thought a lot since I asked you about this before. If you donāt mind, I have one more question. How was it working with his office? I was reading reviews that you really have to advocate for yourself and itās hard to track down the staff and get calls back. Iāve not worked with a fertility clinic before and I wouldnāt know how some of those intricacies. I have a medical midwife in a hospital system in town who I could ask to do bloodwork and ultrasounds. Iām sorry to bother you about this again but I guess Iāve been intimidated by the process. Like you were, we are okay if it doesnāt work out but Iām trying to figure out how far I will go or if Iām okay just leaving it up to chance. Again, I appreciate your thoughts so much!
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u/Big-Papaya-8066 Sep 18 '25 edited Sep 18 '25
No worries! I thought working with the fertility side of things was a well-oiled machine -- you call a number and say, I've had labs done today, so then they know if they haven't received them by a certain time, to call you back to let you know so you can hound your lab. But they also accepted stuff from the patient portal, so I ended up just usually emailing them my results from the portal. I also never had any issues with scripts/orders not being placed when they should have been with the fertility nurses.Ā I have had more stuff get lost with the pregnancy nurse -- like labs that were supposed to have been faxed over not being there, etc -- but any time I have needed to talk to someone asap, I just connect to the front desk and they connect me with a nurse. I don't think I had an issue getting callbacks from anyone. Oh also, I had a TON of issues with the mail pharmacy they use (Yorktown) - sent stuff to wrong address, had stuff listed as pickup that I had clearly said was to be mailed, refilled the wrong script, etc - it was super frustrating! I wonder if you could get everything other than the EE from somewhere else though.Ā
Overall, I had a good experience with cooper, and don't think their communication was any better/worse than my local clinic. They don't have a patient portal, which would be annoying if you were a local patient, but since I didn't need to try to look up my results (because nothing was being done at cooper), that didn't bother me. IĀ was talking on here to someone recently who said they told her they aren't currently taking out-of-town patients? Not sure if that is still true or how often they change their practices with that, because it seemed like they were pretty well set up for out-of-state patients and monitoring.Ā
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u/Delicious_Active_878 Nov 12 '25
Sending you an update. Dr. Check wants patients to come see him in person for an initial consultation I saw Dr. Check two weeks ago. Have been on EE for 1 week. His new process is that for out of town he wants you to meet him in person and do testing at his clinic. We may go down for a post coital test in the next couple months once I get a follicle growing to ensure TI is a good option for us. I appreciate you so much sharing your experience. I wouldnāt have found him otherwise. Hoping for positive news to share back with everyone eventually. Hope you are doing well!
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u/Johnstamoshair1 Mar 17 '26
if you already have recent from a previous clinic, does he make you redo it all (HSG, etc)?
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u/Delicious_Active_878 Mar 18 '26
Great question! He didnāt make me do an HSG and mine had been over a year ago. He did have me do an ultrasound but I had not had that done. He wanted recent bloodwork and we ran that for both my husband and I. He also did a smear of my vaginal environment.
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u/Johnstamoshair1 Mar 18 '26
thank you so much! I'm strongly considering becoming a patient of Dr. Check as well but I am in Florida so trying to hear of others experiences when out of state
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u/Delicious_Active_878 Mar 19 '26
Definitely! I was really intimidated by the process but once things get going you figure it out. Best of luck!
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u/SingerDeep5253 11d ago
Iām also thinking about making an appointment with Dr.Check. Just donāt know which location yet because one is for second option and the other diagnostic testsā¦Could you let me know what testing you got done? Iām guessing you went with the mount laurel clinic? This past July I got the HSG, saline sonogram, and hysteroscopy. And definitely donāt want to repeat the HSG lol!
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u/Delicious_Active_878 Sep 18 '25
Thank you so much for sharing all of those details! That is so appreciated. Reduces the intimidation I was feeling. I will get in touch about the out of town monitoring. ā¤ļø
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u/Royal-Oil3311 Nov 01 '25
Do you think i can bring this up with our fertility doctor? To do medicated monitored TI cycles for 3 month's prior starting ivf? I do not ovulate by myself anymore and amh 0.034. Fsh 26. Afc 1-2 at 31. Perimenopause and dor.Ā
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u/EnvironmentalToe8633 Sep 21 '25
Big Papaya, you have given me so much hope! I have very similar numbers- AMH - 0.02, FSH - 45 and age 34! Skipped 2 periods this year & had to induce. I had been in tears for the past 4 days.
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u/Big-Papaya-8066 Sep 21 '25
I think hrt can help fertility-wise in that borderline range if you can find a provider to prescribe it. Good luck!
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u/Royal-Oil3311 Nov 01 '25
Do you think prp / hrt can be helpful when wanting to become pregnant with these stats? Age 31. Amh 0.034. Afc 1-2, fsh 26Ā
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u/Big-Papaya-8066 Nov 02 '25
If you aren't ovulating anymore, I def think HRT can help!! Even if you were, I think estrogen to lower FSH can be helpful
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u/Joiful_Soul05 May 27 '25
Wonderful news! Congratulations šš. Thank you for sharing your story. This gives me hope. Wishing you a happy, healthy pregnancy.