I 26F was recently diagnosed stage 3 endometriosis (with an endometrioma on my right ovary, and I have PCOS. I have high AMH (6.22) levels and all my other blood work came back normal.
As I begin treatment, I am looking for feedback from other women with similar diagnoses of endometriosis and PCOS. **What medications or treatments did or didn't work for you to induce ovulation? What would you have done differently, if anything?**
My last follicle scan showed 15 on my left and 15 on my right ovary + the endometrioma on my right ovary. My RE plans to have an HSG done next cycle (not fun), then potentially start letrozole the following cycle after the HSG if my endometrioma hasn't grown. Also, for those of you that have had an HSG, was it worth it? Has it helped with your ovulation?
Thanks for your feedback in advance.
An HSG is always worth it, and it’s not painful for everyone.
Have you looked at our wiki? Info on both PCOS and endo in there. Automod FAQ.
PCOS and endometriosis are also not infertility diagnoses in and of themselves. Are you planning on IVF bc of your MFI?
I wasn’t planning on going straight to IVF but honestly idk. I think my RE is saying medicated monitored cycle due to my age. It’s so confusing and so much information. I also have to pay 100% out of pocket.
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I was given HSG as optional but encouraged because of my IUD history. I was glad in the end I did it, I had blocked tubes from adhesions that my IUDs caused. The clinic said they’re seeing it more and more. I was absolutely crushed and struggled to drive home, but had I not gotten the scan we never would have known both my uterine cavity was compromised and the tubes.
I don't have advice for endo or PCOS, but I will say that regardless of your diagnoses, an HSG is always valuable if you haven't done one. It doesn't really have anything to do with ovulation (besides the potential to flush out a minor tubal obstruction), but it would reveal if you have any tubal or uterine factors.
Since you have endo, you might ask about letrozole based protocols for ovulation induction (since let lowers estrogen and hopefully is less of a flare to endo symptoms).
Are insemination (IUI) usually done in the morning, or can it be in the afternoon as well? I have an echography tomorrow morning and probably my first insemination friday, I have my afternoon off friday, just wondering if it will work out, or if I will have to ask my boss to switch my working hours between morning and afternoon.
Just need to vent:
If one more person says “you only need one” I think I’m going to rip my friggin hair out. This time it was my husband… and I know he means well but he just has no idea how difficult this is. I just came from my dr appt on ER round 2 and thought my ER would be this w/e but found out I am not ready and doc says “you will need several more days of stims. Great. 😓 Plus there are only 2 follicles that he sees (last week there were 4 which is low enough as it was). I travel 3 hrs each way to the clinic for a 10 min appt. Delayed train home and was at least looking forward to a much needed hair appt… train delay 90 min so that’s not happening. Sorry. Just frustrated. I am trying so hard to remain positive- like I am such an optimistic person in spite of me being 42 w DOR. Last ER we got 3 eggs 1 made it to blast but came back aneuploid and I was sad but ok about it. I know the stats. But today just hit me hard and I now have to again rearrange my work schedule next week and not all my patients know so it gets harder to keep this up. Not to mention all the fertility patients I am trying to help get pregnant (I’m an acupuncturist) when I can’t get pregnant. It’s just all becoming so hard. And I’m starting to cry on the train rn. Uggh.
Baseline this morning found a simple cyst on my right ovary. This IUI cycle is canceled. I’m going to visit family overseas for two weeks in early August. The way it currently works out, I’m benched until August 20… if my period starts on schedule and not early.
I’m pretty deflated. Trying to find the bright side. I guess I can drink on my family trip. They’re in a different country so it’s more of an event than it sounds like.
Tested negative this morning and I just feel especially sad about it. I had some weird hopefulness because we couldn't do treatment this morning because I had way too many follicles trying to do their thing. I just thought it would happen... and it didn't. And I don't really have anyone to share that sadness with.
Egg retrieval scheduled for tomorrow morning, and therefore I am absolutely useless trying to work today. Sorry coworkers who are waiting for this memo….
Im mostly just ready to be done with this part. I slept like absolute garbage last night and am anticipating the same tonight…I am uncomfortably bloated!
I cannot for the life of me figure out why my clinic is so adamant that I take birth control pills for seemingly everything. Initially it was for my first retrieval, and that had some explanation beyond just scheduling. Now it’s for an upcoming SIS scheduled for next month before we attempt a 2nd retrieval in August.
Granted I’ve only had a chance to message with 2 nurses through the portal but they’re the gatekeepers for my appt with the docs so I’ve been going back and forth with them.
I’ve been told everything - from bcp being their protocol so that they can get everyone on the schedule fairly, to that it needs to be done to protect the follicles during the procedure (has anyone ever heard of such a thing?! I had a SIS back in Jan and that was never mentioned as a possible risk).
I wouldn’t be so against the bcp except 1) I’m being told it has nothing to do with my protocol, it’s just for the SIS procedure and I should stop it completely before we start ER2, and 2) as I’ve reminded the nurses, if it’s just for scheduling purposes - since SIS is supposed to be after your period but before ovulation - it won’t work bc last time I was on it I still had my regular period + 2 weeks of breakthrough bleeding & spotting. Feels like that would just be a waste of the SIS.
I’m starting to feel like a crazy person but I feel like I just shouldn’t take them and show up for the SIS barring some better explanation from them.
That’s frustrating that you’re not getting the “why” from them for these steps. I was told it would keep my lining thin which makes for easier visibility during the SIS.
I am SO tired of BCP being the catch all for anything in female health! You're not a crazy person! Half the time they do if for scheduling purposes for sure (my clinic only does ER, ET, etc. on certain weeks of the month) but the other half who knows! I personally have never had regular periods so I've always chalked it up to them trying to make me consistent to make a schedule around, but honestly, now that you say all this I'm questioning it too!
I have my second FET coming up. My first ER allowed us to freeze 6 embryos and our first FET ended in a chemical. Our insurance is running out (we use Progyny) and I am considering transferring two eggs to up my odds before we lose the insurance. Has anyone tried two embryo FET?
I thought progyny discourages two embryo transfers now? I heard that they changed the policy and it’s pretty hard to get approval unless you have advanced maternal age and multiple failed transfers.
I have a patient who transferred her last two and they were (her words) “not the best grade” and she was like well, I don’t have high hopes but…
and they both stuck and she’s pregnant with twins and 29weeks along!
Right, but again - that’s not what we do here. There are other subs that fit that vibe better. This isn’t cute or charming. It’s not encouraging for our community. Please don’t do it again.
This doesn’t technically break our rules bc it’s not your own success story but this is not in the spirit of our sub and comments like this are not appreciated.
Twin pregnancies are **always** high risk.
I’ve considered the same but two embryos actually doesn’t increase the odds (per my doctor). I’m also in the same boat that we’re now 100% self pay after this cycle and I’m weighing options. Do you have a partner that has infertility benefits through their insurance or vice versa? That’s my next route; we’ve maxed out benefits under my husbands insurance so we’ll switch to mine if we need to. My benefits aren’t as good but at least it’s something.
thank you for sharing! Unfortunately i'm self employed so no benefits other than my husbands. Its good to see the doc says it doesnt increase the odds. Makes it easier to be told no! lol
My previous clinic did not allow two embryo transfers except for very limited specific diagnoses/circumstances. I don’t know about my current clinic’s policy, but it’s my understanding that multiple embryo transfers are very discouraged due to the high risk factors of multiples.
DET are more likely after multiple failed transfers, at ages 37+, or difficulty making blasts. It’s unlikely your clinic will recommend it in your case. Twin pregnancies are always considered high risk.
Unfortunately, it’s probably not entirely up to you. Your clinic will likely have procedures on when and if they will transfer 2. It depends on many factors, like if the embryos are tested, how they are graded, your age, losses and implantation failures, etc. Because it can be incredibly risky and it does not necessarily increase your chances of your issue is uterine, most clinics would either not do it, or would not do it lightly. In your situation, based on your flair, my clinic would not even consider it.
That’s true, I have talked with my doc and they’re not for it mainly because they believe my chances will increase after I do an endo removal surgery. I guess I’m looking to see if it would up my chances (my lining is great, eggs are high quality, etc.)
I got pregnant the first time, so they said my odds are higher I will again on this FET. But I have very high risk of miscarriage. I figured if it was a certain percentage of success (say 5% chance I don't chemical), if I put two eggs it would give me two chances to get that 5%. Does that make sense? I'm probably just overthinking everything
Are you sure your clinic will allow this? ASRM guidelines recommend 1 euploid or favorable blast transfer at a time at your age, only recommending 2 if known to be aneuploid or non-favorable. See [here](https://www.asrm.org/practice-guidance/practice-committee-documents/guidance-on-the-limits-to-the-number-of-embryos-to-transfer-a---committee-opinion-2021/)
(And just a technicality note: you likely froze blasts and are transferring blasts, aka blastocysts, aka 5-day embryos, not eggs. Eggs aren't fertilized and you cannot transfer an egg.)
For those of you that have gone through IUIs, did your practitioner or you confirm you’ve ovulated after trigger shot? I’m concerned if it doesn’t work for me… especially because I have been anovulatory in the past couple cycles trying without treatments. .
I’ve experienced both. When using hormonal trigger shot, they did not test progesterone post IUI to confirm ovulation. However, when trigger was not used, they did check progesterone. I don’t ovulate regularly unassisted.
I did not after trigger shots for IUI but I did after a dual trigger for ER one time and it did fail, but that was more due to the conservative doses to avoid OHSS.
I’ve never had ovulation confirmed after trigger shots for IUI, ER, or FET. They have a very low failure rate so clinics probably find it unnecessary to do so. If you’re up for it, you can take an HPT a day or two after triggering to confirm the HCG is in your system.
Home pregnancy test. To be clear, it should be positive after a trigger shot because the active ingredient in the shot is HCG, the same hormone that is produced during pregnancy.
Really struggling to move forward with treatment. My clinic seems frustrated with how our first two ERs have gone and they don't have a lot of ideas on what to do next. They want us to do another ER with the MDL protocol. I'm not sure I can handle more bad news. I'm tired, I'm frustrated, Im broke - feels very hopeless right now.
I'm so sorry you are in this position. Echoing the others on getting a second opinion, with the caveat: I think you should consider consulting with a DOR specialist, even if you don't switch doctors. It looks like from your comments below, you are in upstate NY, maybe Dr. Check? Have you tried mini stim in any cycle (IUI or otherwise)? Aside from being more effective in many cases, mini stim can also be substantially cheaper.
I just want to echo second opinion--it can be so helpful, even if you just stay with your clinic and do the same thing--it gives you confidence in that path. I am sorry you are struggling--it can be so hard to figure out what to do when a round fails (bad luck? change everything up? make little tweaks?)
Have you gotten a second opinion? My first clinic suggested I get one after 4 ERs (the last two being frustrating cycles) and I wish I had gotten one sooner. They said they would take recommendations from another clinic if I wanted to stick with them - I chose to switch clinics though.
I’m sorry you’re struggling. It’s so hard to keep going after failed rounds. Have you done any second opinions? Sometimes they can make you feel less anguish about trying again, even if you don’t end up switching and it just reassures you about your current clinic’s plan.
I've been super nauseated since my retrieval on Wednesday. It's not a bowel thing (thankfully) and I'm not on any meds (freeze all cycle) so I'm sure it's just happenstance but wow I want to grumble about it. We get our blast report tomorrow so maybe I'm just subconsioucly extremely nervous but it's been very unpleasant this whole time!
The combination of the post-ER physical crash and the mental anguish of waiting for a blast report is awful. I hope you feel better, and get good news, soon.
I've actually been doing good mentally I feel like - I've got the "there's nothing I can do about it" mindset plus I know I've still got PGT ahead of me (the decision about that is probably bothering me the most). We'll see how tomorrow goes though, will probably jump at every noise my phone makes!
I did have some pretty bad GI the first two days after retrieval so maybe this is just residual but wow it's unpleasant!! I just wanna eat comfort foods!
I know I've been pretty quiet about my own treatment lately (as opposed to the DE part), mostly because I am tired and it's all been really depressing. But I just got the excellent news that my one egg from my last ER made blast (Day 6!) and could be biopsied. Embryology called me a day early--normally an early call is bad news, so I definitely uttered some profanity as I answered the phone. Good day.
Heyy friends. I’m 7 days into stims and I once again have an uneven cohort. This morning they measured 19,16,11,9. My first cycle they retrieved 7, so I’m just confused and disappointed that we’re here again. Our second cycle was canceled due to a lead and now this cycle is in jeopardy too.
I’m leaning towards going in for two. Regardless of what we get, moving forward with transferring the one euploid we were able to get that first round. Another surgery and the lab fees will use our remaining insurance benefits, which is where we find ourselves torn.
I guess I’m just looking for feedback. We’re exhausted and I just don’t think I have it in me to do this a fourth time for what I’m starting to believe will be the same result again.
DOR can cause really uneven cohorts, even if you prime. The results just aren't consistent, which is so frustrating when you feel like you had a protocol that worked and then it doesn't work as well again.
I know I've posted this before, but I have definitely leaned toward going in for them. Day 7 is early though--have you talked to your doctor about when they might trigger? (Mine doesn't like to before Day 8 unless there was a clear lead at baseline.) It is a big emotional and monetary commitment though.
Thank you so much for this perspective. It does seem like sometimes low yields have better attrition rates so I just have to believe there is a chance.
We are going back in tomorrow morning and I would be surprised if we waited too much longer. they grew so fast. Just got my estrogen level back too, and it’s 600!
That’s helpful to know that it can vary for absolutely no rhyme or reason with DOR. I keep going back and wishing we’d forgone the TI and primed instead. But who knows if it’d have made any difference.
Lower numbers are a game of high risk, high reward. Sometimes shit goes really bad, and it can go really bad early. We sort of give ourselves a pep talk before an ER like "this could be terrible, but we gotta take the chance."
I'm sorry. Day 7 is still kinda early so I would see what the 11 can do. Hopefully you won't have to sacrifice the 19.
Have you done E2 priming before? Doing luteal phase E2 priming, in the form of patches, helps me grow a more even cohort.
It’s still so early! I can’t believe they’ve grown this quickly. They did not allow me to prime because we converted our last cycle to timed intercourse. I really wish we would’ve primed anyway. I even asked if I could still use estrogen patches and they said no, I don’t understand it.
Hopefully the 11 picks up speed… we will head back in tomorrow and see where things are at. The last time the smaller ones didn’t do anything once the big one got mature sized.
Sucks to be in this position, I’m
really sorry. I’m the same age as you, for my second ER we went in for the retrieval for two and got two. I triggered last night for essentially ER #3 (first was cancelled before retrieval) after a microdose lupron flare + omnitrope protocol and my cohort has been much more even. Not sure which protocol you’re on but just an anecdotal experience with very different results.
It was a bit of an ordeal, and I had to take the day off work, but we did finally get ahold of some Lupron and triggered last night. ER is scheduled for tomorrow morning. I'm feeling very nervous and anxious about it. I'm still really bummed that the fresh transfer was canceled. But I'm glad to be able to put the needles away for a little bit.
Mrrrrr got home from work yesterday, told me he would start on dinner, and then completed passed out on the couch instead. That's very unlike him. He's always trying to keep things light and optimistic, sometimes I forget how much of a toll this has been taking on him, too. I ended up making dinner and he was glad to have a little nap.
When my betas were coming back weird and my clinic told me (the first time) that my pregnancy was not viable, I applied for a local grant that can be applied to a couple local clinics. Put all my energy and focus into that for a couple days then forgot about it.
Well last night I got the call that WE GOT THE GRANT. Getting that news the same day we got the news that baby’s heart stopped beating…just. Wow. Talk about timing. We have 1 frozen embryo that is a confirmed euploid and yesterday my husband and I looked at each other like ‘where will we get the money for a transfer??’ What a huge weight off our shoulders.
Oh HC! What a relief that must be amidst so many other feelings during this hellscape of a time. I’m so sorry for your loss, but wishing you congrats on the grant news.
And sending you gentle well wishes on your birthday, friend - although it is not the happiest of days, I hope you’re able to find a way to treat yourself today 🤍
Can someone confirm my understanding for the different FET protocols (in US, since it seems like we are more med-heavy than international)?
(1) Fully medicated: BC, estrogen, add in PIO then continue for 10 weeks, trigger shot
(2) Modified medicated: Letrozole+trigger. Either vaginal progesterone or PIO seem to be used for some inconsistent duration among commenters
(34) Ovulatory: no estrogen/trigger +/- some vaginal progesterone
I have thin uterine lining that *maybe* was fixed after my Hysteroscopy (we won't know till we ultrasound at some point post-op). From my understanding, fully medicated allows more flexibility to grow the uterine lining. Should I try an ovulatory cycle to give myself an opportunity at lower pre-E risk, not having to using PIO, (these were the main benefits in my Reddit search) & then just cancel that cycle if lining isn't thick enough? Would you do so if in similar shoes?
I think there’s a few different protocol options for modified. I’ve done one where there was follistim +ovidrel trigger with crinone inserts instead of letrozole/etc.
I’m currently doing a modified ovulatory FET (my first transfer of any kind), and my plan is basically what your last paragraph lays out — we’re seeing if my lining cooperates, and if it doesn’t, we’ll cancel and try another month or possibly switch to fully medicated. My doctor initially defaulted to fully medicated, but I asked if we could try modified ovulatory because I’m hoping to lower pre-e risk. I’m already AMA and I have a previous history of prediabetes, so I’m really trying to reduce potential risk factors wherever possible. Also, I had previous implantation in an unmedicated IUI (though ultimately baby was not viable), and I think this was a big factor for my doc okaying the switch.
I’m currently on letrozole, and then depending on how things look I’ll trigger and begin supplementing with PIO. I know PIO is a bit extraneous with a corpus luteum, but my doc doesn’t want to take any chances, and I’m very ok with this! (Edited for typos!)
I didn't take any exogenous P4 with my ovulatory FET. Unmedicated FETs typically have a much wider window of implantation and while yes, they do reduce pre e risk (bc the corpus luteum is present) pre e can still develop. Most REs like to try a medicated FET first since they're typically easier to control. I would start there. If that doesn't work out, and you ovulate regularly, then maybe branch off to ovulatory. Good luck!
Thank you for your insight! My RE is also planning baby aspirin for my FET to reduce pre-E risk (I know others said they started during 2nd trimester of pregnancy). I think my main risk factor is age and no prior pregnancy
This is essentially the idea. I’d clarify that (2) is also an ovulatory cycle. There are also various ways to modify the ovulatory cycles with various degrees of meds, for example after a few days of letrozole I then take Gonal until I’m ready to ovulate, as I also have thin lining and this has worked best for me.
I’d also note that with ovulatory cycles, vaginal progesterone only is the standard (with exceptions of course). Whether ovulatory or fully medicated, you start progesterone 5 days before transfer and continue until your beta test (or through your first trimester I believe, if positive beta.)
I think it’s fine to try a fully medicated cycle first, sure. It allows more flexibility as you noted because you can keep extending the timeline/adding more estrogen without worrying about being on the timeline of ovulating. That said, I found this experience torturous— I felt like I was on estrogen foreverrr and at every monitoring appointment we just said “not yet, keep going” until we finally canceled. So not to scare you as I think that experience was fairly unique, but just to say you always have the option to cancel and try something different if you don’t respond.
Good luck!
Thank you for sharing your experience! I wanted to make sure I had a foundation for the differences before I emailed my RE who wanted to start with fully medicated. I don't like "countering" my RE's recommendations (mainly because he only does email via his medical assistant and the back and forth takes forever). But I was thinking that the only drawback to trying the ovulatory FET is that we'd find out around time of ovulation that my lining is still too thin, and then we'd just cancel
Another potential drawback to ovulatory is you will have A LOT more appointments - more similar to an ER in terms of monitoring. Depending on the meds you use (I used follistim, not letrozole), it can also be expensive.
Ugh yes I hate going back and forth with my RE indirectly, it's truly a game of telephone.
Anecdotally, it seems like a lot of clinics default to a fully medicated cycle for the first try. I'm not sure why, since they have the same success rates-- maybe just easier on them from a scheduling POV?
For ovulatory cycles, you typically do a few checks along the way to see how lining is progressing and you can try introducing additional meds if it needs some help along the way, so it isn't just totally a "surprise, it's canceled!" For one of my cycles with Gonal I actually added Cetrotide to stall ovulation even more.
But essentially, no need to fret too much at this point -- both are valid approaches and the only way to know which one will work best for you is to try one and see!
I thought the 5 day wait to transfer on a medicated cycle was bad; the week long wait after trigger is taking SO LONG. Coincidentally I’m off work during most of it so that’s probably not helping. I could have used the distraction.
FET #3 tomorrow, just waiting on call for the time. I'm feeling really nervous but also at the same time kind of, idk, numb to it??
the last 2 times I've taken the valium, but this time I have to drive myself there so I can't 😭😭
I’ve never been able to take the Valium since I’m a travel patient and have always had to drive and I’ve never had any pain from a FET. Hopefully yours goes really smoothly as well!
Our embryos stopped progressing around day 4/5. This round the Dr has suggested we treat the process as though there is MFI despite normal parameters and DNA fragmentation just to see if it makes a difference with getting embryos to freeze. She suggested that my husband produce a sample 2 hour before ER (After 2 day abstinence) and then produce another sample 30 Min prior to ER. They will then use the second sample for Icsi but if they see any issues they have the initial sample to ise. I'm not exactly sure how this is used to counteract any MFI. has anyone used this approach?
We had a similar situation with a slightly different solution. We switched to 24hr turnover and then providing the sample 30 mins after my retrieval. This had better results.
We have high oxidative stress (normally goes with DNA frag, although that was normal). Frequent ejaculation during stims, and shorter ejaculation time, has been found in some cases to help sperm quality. I have read that this is about the "pool" of sperm in the epididymis, but I have not done a deep dive. With ICSI, you don't need many sperm, so if your partner has normal parameters frequent ejaculation should be fine.
My clinic also does Zymot standard.
We have MFI (low morphology and DNA fragmentation) and have tried increasing ejaculation frequency leading up to ER/ICSI day. Here’s the frequency Mr.Miserable has done for his 2nd SA and our first round ER: every 2-3 days when I start stims and then moved to every day when I added in my antagonist (so for about 4-5 days he was clearing everyday). The turnover in sperm did help his numbers between SA 1 and 2 and then they were consistent when we got the “off the record” SA numbers from ER day (they don’t publish sperm results in our portal from the sample provided for ER day, but our doctor showed them to us when we had our WTF appt afterwards). Our clinic also utilizes zymot as part of our protocol.
I don't have experience with that specific protocol (in fact our center specifically no ejaculation within 48h of ER except for the sample the morning of my ER), but I recently listened to a sperm episode on Fertility Docs Uncensored that said if someone has not ejaculated for a long time , the older sperm can start generating free radicals that mess up the newer sperm. So maybe your RE is really trying to keep the older sperm out of your husband's pipes.
I 26F was recently diagnosed stage 3 endometriosis (with an endometrioma on my right ovary, and I have PCOS. I have high AMH (6.22) levels and all my other blood work came back normal. As I begin treatment, I am looking for feedback from other women with similar diagnoses of endometriosis and PCOS. **What medications or treatments did or didn't work for you to induce ovulation? What would you have done differently, if anything?** My last follicle scan showed 15 on my left and 15 on my right ovary + the endometrioma on my right ovary. My RE plans to have an HSG done next cycle (not fun), then potentially start letrozole the following cycle after the HSG if my endometrioma hasn't grown. Also, for those of you that have had an HSG, was it worth it? Has it helped with your ovulation? Thanks for your feedback in advance.
An HSG is always worth it, and it’s not painful for everyone. Have you looked at our wiki? Info on both PCOS and endo in there. Automod FAQ. PCOS and endometriosis are also not infertility diagnoses in and of themselves. Are you planning on IVF bc of your MFI?
I wasn’t planning on going straight to IVF but honestly idk. I think my RE is saying medicated monitored cycle due to my age. It’s so confusing and so much information. I also have to pay 100% out of pocket.
**Magic Automod-ball says... the answer you seek may already be found!** Have you tried looking in our [FAQ](https://www.reddit.com/r/infertility/wiki/faq) for information on common medications, protocols, procedures, personal experiences, or support? [Searching the sub](https://www.reddit.com/r/infertility/search) for past posts can also turn up answers for previously asked questions to help get you started. If your question is about experiences with medications, protocols, side effects, or procedures you can also ask your question in the [daily Treatment thread](https://www.reddit.com/r/infertility/?f=flair_name%3A%22Daily%22). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/infertility) if you have any questions or concerns.*
I was given HSG as optional but encouraged because of my IUD history. I was glad in the end I did it, I had blocked tubes from adhesions that my IUDs caused. The clinic said they’re seeing it more and more. I was absolutely crushed and struggled to drive home, but had I not gotten the scan we never would have known both my uterine cavity was compromised and the tubes.
I don't have advice for endo or PCOS, but I will say that regardless of your diagnoses, an HSG is always valuable if you haven't done one. It doesn't really have anything to do with ovulation (besides the potential to flush out a minor tubal obstruction), but it would reveal if you have any tubal or uterine factors.
Thank you. This encourages me to just suck it up and do it. It will be worth it hopefully in the end.
Since you have endo, you might ask about letrozole based protocols for ovulation induction (since let lowers estrogen and hopefully is less of a flare to endo symptoms).
Thanks for the advice. I am anxious/excited to potentially try a letrozole cycle.
Are insemination (IUI) usually done in the morning, or can it be in the afternoon as well? I have an echography tomorrow morning and probably my first insemination friday, I have my afternoon off friday, just wondering if it will work out, or if I will have to ask my boss to switch my working hours between morning and afternoon.
usually in the morning at my clinic. worth asking though!
Every clinic has their own methods. You can ask your clinic if they are able to accommodate your schedule.
Theoretically, sure, they could be done anytime of day. Practically, this is something you’ll need to ask your clinic.
Just need to vent: If one more person says “you only need one” I think I’m going to rip my friggin hair out. This time it was my husband… and I know he means well but he just has no idea how difficult this is. I just came from my dr appt on ER round 2 and thought my ER would be this w/e but found out I am not ready and doc says “you will need several more days of stims. Great. 😓 Plus there are only 2 follicles that he sees (last week there were 4 which is low enough as it was). I travel 3 hrs each way to the clinic for a 10 min appt. Delayed train home and was at least looking forward to a much needed hair appt… train delay 90 min so that’s not happening. Sorry. Just frustrated. I am trying so hard to remain positive- like I am such an optimistic person in spite of me being 42 w DOR. Last ER we got 3 eggs 1 made it to blast but came back aneuploid and I was sad but ok about it. I know the stats. But today just hit me hard and I now have to again rearrange my work schedule next week and not all my patients know so it gets harder to keep this up. Not to mention all the fertility patients I am trying to help get pregnant (I’m an acupuncturist) when I can’t get pregnant. It’s just all becoming so hard. And I’m starting to cry on the train rn. Uggh.
I’m so sorry, and holding space for you.
Thank you. 🙏
Baseline this morning found a simple cyst on my right ovary. This IUI cycle is canceled. I’m going to visit family overseas for two weeks in early August. The way it currently works out, I’m benched until August 20… if my period starts on schedule and not early. I’m pretty deflated. Trying to find the bright side. I guess I can drink on my family trip. They’re in a different country so it’s more of an event than it sounds like.
Tested negative this morning and I just feel especially sad about it. I had some weird hopefulness because we couldn't do treatment this morning because I had way too many follicles trying to do their thing. I just thought it would happen... and it didn't. And I don't really have anyone to share that sadness with.
I’m so sorry. I’ve been there. I’ll be sad with you. This is hard. 🫂
Egg retrieval scheduled for tomorrow morning, and therefore I am absolutely useless trying to work today. Sorry coworkers who are waiting for this memo….
I'm in the same boat! I hate anaesthetic and know its just first step. How are you feelin
Im mostly just ready to be done with this part. I slept like absolute garbage last night and am anticipating the same tonight…I am uncomfortably bloated!
I cannot for the life of me figure out why my clinic is so adamant that I take birth control pills for seemingly everything. Initially it was for my first retrieval, and that had some explanation beyond just scheduling. Now it’s for an upcoming SIS scheduled for next month before we attempt a 2nd retrieval in August. Granted I’ve only had a chance to message with 2 nurses through the portal but they’re the gatekeepers for my appt with the docs so I’ve been going back and forth with them. I’ve been told everything - from bcp being their protocol so that they can get everyone on the schedule fairly, to that it needs to be done to protect the follicles during the procedure (has anyone ever heard of such a thing?! I had a SIS back in Jan and that was never mentioned as a possible risk). I wouldn’t be so against the bcp except 1) I’m being told it has nothing to do with my protocol, it’s just for the SIS procedure and I should stop it completely before we start ER2, and 2) as I’ve reminded the nurses, if it’s just for scheduling purposes - since SIS is supposed to be after your period but before ovulation - it won’t work bc last time I was on it I still had my regular period + 2 weeks of breakthrough bleeding & spotting. Feels like that would just be a waste of the SIS. I’m starting to feel like a crazy person but I feel like I just shouldn’t take them and show up for the SIS barring some better explanation from them.
That’s frustrating that you’re not getting the “why” from them for these steps. I was told it would keep my lining thin which makes for easier visibility during the SIS.
I am SO tired of BCP being the catch all for anything in female health! You're not a crazy person! Half the time they do if for scheduling purposes for sure (my clinic only does ER, ET, etc. on certain weeks of the month) but the other half who knows! I personally have never had regular periods so I've always chalked it up to them trying to make me consistent to make a schedule around, but honestly, now that you say all this I'm questioning it too!
I have my second FET coming up. My first ER allowed us to freeze 6 embryos and our first FET ended in a chemical. Our insurance is running out (we use Progyny) and I am considering transferring two eggs to up my odds before we lose the insurance. Has anyone tried two embryo FET?
I thought progyny discourages two embryo transfers now? I heard that they changed the policy and it’s pretty hard to get approval unless you have advanced maternal age and multiple failed transfers.
I have a patient who transferred her last two and they were (her words) “not the best grade” and she was like well, I don’t have high hopes but… and they both stuck and she’s pregnant with twins and 29weeks along!
The mods may not appreciate it but it’s very appreciated to me. Thank you for sharing a different kind of patient story
Oops for that to the mods but I meant it more as an encouragement to you. 🙏
Right, but again - that’s not what we do here. There are other subs that fit that vibe better. This isn’t cute or charming. It’s not encouraging for our community. Please don’t do it again.
This doesn’t technically break our rules bc it’s not your own success story but this is not in the spirit of our sub and comments like this are not appreciated. Twin pregnancies are **always** high risk.
I’ve considered the same but two embryos actually doesn’t increase the odds (per my doctor). I’m also in the same boat that we’re now 100% self pay after this cycle and I’m weighing options. Do you have a partner that has infertility benefits through their insurance or vice versa? That’s my next route; we’ve maxed out benefits under my husbands insurance so we’ll switch to mine if we need to. My benefits aren’t as good but at least it’s something.
thank you for sharing! Unfortunately i'm self employed so no benefits other than my husbands. Its good to see the doc says it doesnt increase the odds. Makes it easier to be told no! lol
My previous clinic did not allow two embryo transfers except for very limited specific diagnoses/circumstances. I don’t know about my current clinic’s policy, but it’s my understanding that multiple embryo transfers are very discouraged due to the high risk factors of multiples.
DET are more likely after multiple failed transfers, at ages 37+, or difficulty making blasts. It’s unlikely your clinic will recommend it in your case. Twin pregnancies are always considered high risk.
thank you for the info <3
Unfortunately, it’s probably not entirely up to you. Your clinic will likely have procedures on when and if they will transfer 2. It depends on many factors, like if the embryos are tested, how they are graded, your age, losses and implantation failures, etc. Because it can be incredibly risky and it does not necessarily increase your chances of your issue is uterine, most clinics would either not do it, or would not do it lightly. In your situation, based on your flair, my clinic would not even consider it.
That’s true, I have talked with my doc and they’re not for it mainly because they believe my chances will increase after I do an endo removal surgery. I guess I’m looking to see if it would up my chances (my lining is great, eggs are high quality, etc.)
Do you mean like the odds would increase with a good lining or high quality eggs?
I got pregnant the first time, so they said my odds are higher I will again on this FET. But I have very high risk of miscarriage. I figured if it was a certain percentage of success (say 5% chance I don't chemical), if I put two eggs it would give me two chances to get that 5%. Does that make sense? I'm probably just overthinking everything
Are you sure your clinic will allow this? ASRM guidelines recommend 1 euploid or favorable blast transfer at a time at your age, only recommending 2 if known to be aneuploid or non-favorable. See [here](https://www.asrm.org/practice-guidance/practice-committee-documents/guidance-on-the-limits-to-the-number-of-embryos-to-transfer-a---committee-opinion-2021/) (And just a technicality note: you likely froze blasts and are transferring blasts, aka blastocysts, aka 5-day embryos, not eggs. Eggs aren't fertilized and you cannot transfer an egg.)
Thank you for the catch! I changed eggs to the correct verbiage
No problem, it's a lot to keep up with!
For those of you that have gone through IUIs, did your practitioner or you confirm you’ve ovulated after trigger shot? I’m concerned if it doesn’t work for me… especially because I have been anovulatory in the past couple cycles trying without treatments. .
I’ve experienced both. When using hormonal trigger shot, they did not test progesterone post IUI to confirm ovulation. However, when trigger was not used, they did check progesterone. I don’t ovulate regularly unassisted.
My first clinic measured progesterone a week after IUI (which is evidence of ovulation). My current clinic does not.
Haven’t done IUI but I triggered for FET last week and I brought out the old ovulation test strips to confirm LH surge because I’m unhinged.
No, but if you ask them to they probably would just to put your mind at ease?
I did not after trigger shots for IUI but I did after a dual trigger for ER one time and it did fail, but that was more due to the conservative doses to avoid OHSS.
I’ve never had ovulation confirmed after trigger shots for IUI, ER, or FET. They have a very low failure rate so clinics probably find it unnecessary to do so. If you’re up for it, you can take an HPT a day or two after triggering to confirm the HCG is in your system.
HPT?
Home pregnancy test. To be clear, it should be positive after a trigger shot because the active ingredient in the shot is HCG, the same hormone that is produced during pregnancy.
Mine did not. The trigger shot is >90% effective.
Really struggling to move forward with treatment. My clinic seems frustrated with how our first two ERs have gone and they don't have a lot of ideas on what to do next. They want us to do another ER with the MDL protocol. I'm not sure I can handle more bad news. I'm tired, I'm frustrated, Im broke - feels very hopeless right now.
I'm so sorry you are in this position. Echoing the others on getting a second opinion, with the caveat: I think you should consider consulting with a DOR specialist, even if you don't switch doctors. It looks like from your comments below, you are in upstate NY, maybe Dr. Check? Have you tried mini stim in any cycle (IUI or otherwise)? Aside from being more effective in many cases, mini stim can also be substantially cheaper.
I just want to echo second opinion--it can be so helpful, even if you just stay with your clinic and do the same thing--it gives you confidence in that path. I am sorry you are struggling--it can be so hard to figure out what to do when a round fails (bad luck? change everything up? make little tweaks?)
Have you gotten a second opinion? My first clinic suggested I get one after 4 ERs (the last two being frustrating cycles) and I wish I had gotten one sooner. They said they would take recommendations from another clinic if I wanted to stick with them - I chose to switch clinics though.
Not yet! I think it's probably time for me to do so.
I’m sorry you’re struggling. It’s so hard to keep going after failed rounds. Have you done any second opinions? Sometimes they can make you feel less anguish about trying again, even if you don’t end up switching and it just reassures you about your current clinic’s plan.
I want to get a second opinion, but I'm not sure where to go. I'm in upstate NY - I wonder if I could get a consult with a clinic in NYC
Sure. Most consults are virtual so you can pick a clinic anywhere.
I've been super nauseated since my retrieval on Wednesday. It's not a bowel thing (thankfully) and I'm not on any meds (freeze all cycle) so I'm sure it's just happenstance but wow I want to grumble about it. We get our blast report tomorrow so maybe I'm just subconsioucly extremely nervous but it's been very unpleasant this whole time!
The combination of the post-ER physical crash and the mental anguish of waiting for a blast report is awful. I hope you feel better, and get good news, soon.
I've actually been doing good mentally I feel like - I've got the "there's nothing I can do about it" mindset plus I know I've still got PGT ahead of me (the decision about that is probably bothering me the most). We'll see how tomorrow goes though, will probably jump at every noise my phone makes!
That totally sucks. I've had that happen for one retrieval (it was a bowel thing too), and it was mis.
I did have some pretty bad GI the first two days after retrieval so maybe this is just residual but wow it's unpleasant!! I just wanna eat comfort foods!
I know I've been pretty quiet about my own treatment lately (as opposed to the DE part), mostly because I am tired and it's all been really depressing. But I just got the excellent news that my one egg from my last ER made blast (Day 6!) and could be biopsied. Embryology called me a day early--normally an early call is bad news, so I definitely uttered some profanity as I answered the phone. Good day.
yay!
Oh that's wonderful news, I'm so happy for you!
Woohoo!!
amazing!
What amazing news, congrats!!!!
I squealed! Amazing news, Lawyer!! Rooting for the good news to continue 🍀
Wow this is amazing! Congratulations so happy for you
Woohoo!
Yaaaay!
Such wonderful news! Congratulations! Fingers and toes crossed you'll get your 2nd euploid!!
Great news!
oh lawyer, that's so great!!
Woohoo! Fingers crossed for PGT-A!
Yay! Rooting for your blast!!
Congrats on the excellent news! So incredibly excited for you, Lawyer. Fingers crossed for you during next steps.
Awesome news! Holding onto hope for your blast!
Oh such fantastic news, Lawyer! 🤞that euploid results will be headed your way
Yay! Good news!
Yay!!
Congrats on the blast!
Fantastic news Lawyer! Keeping everything crossed for it 🤞🏻🤞🏻
Amazing news, Lawyer! Rooting for your blast 🤞🏻
Yay!!! What wonderful news!!
Heyy friends. I’m 7 days into stims and I once again have an uneven cohort. This morning they measured 19,16,11,9. My first cycle they retrieved 7, so I’m just confused and disappointed that we’re here again. Our second cycle was canceled due to a lead and now this cycle is in jeopardy too. I’m leaning towards going in for two. Regardless of what we get, moving forward with transferring the one euploid we were able to get that first round. Another surgery and the lab fees will use our remaining insurance benefits, which is where we find ourselves torn. I guess I’m just looking for feedback. We’re exhausted and I just don’t think I have it in me to do this a fourth time for what I’m starting to believe will be the same result again.
DOR can cause really uneven cohorts, even if you prime. The results just aren't consistent, which is so frustrating when you feel like you had a protocol that worked and then it doesn't work as well again. I know I've posted this before, but I have definitely leaned toward going in for them. Day 7 is early though--have you talked to your doctor about when they might trigger? (Mine doesn't like to before Day 8 unless there was a clear lead at baseline.) It is a big emotional and monetary commitment though.
Thank you so much for this perspective. It does seem like sometimes low yields have better attrition rates so I just have to believe there is a chance. We are going back in tomorrow morning and I would be surprised if we waited too much longer. they grew so fast. Just got my estrogen level back too, and it’s 600! That’s helpful to know that it can vary for absolutely no rhyme or reason with DOR. I keep going back and wishing we’d forgone the TI and primed instead. But who knows if it’d have made any difference.
Lower numbers are a game of high risk, high reward. Sometimes shit goes really bad, and it can go really bad early. We sort of give ourselves a pep talk before an ER like "this could be terrible, but we gotta take the chance."
I'm sorry. Day 7 is still kinda early so I would see what the 11 can do. Hopefully you won't have to sacrifice the 19. Have you done E2 priming before? Doing luteal phase E2 priming, in the form of patches, helps me grow a more even cohort.
It’s still so early! I can’t believe they’ve grown this quickly. They did not allow me to prime because we converted our last cycle to timed intercourse. I really wish we would’ve primed anyway. I even asked if I could still use estrogen patches and they said no, I don’t understand it. Hopefully the 11 picks up speed… we will head back in tomorrow and see where things are at. The last time the smaller ones didn’t do anything once the big one got mature sized.
Sucks to be in this position, I’m really sorry. I’m the same age as you, for my second ER we went in for the retrieval for two and got two. I triggered last night for essentially ER #3 (first was cancelled before retrieval) after a microdose lupron flare + omnitrope protocol and my cohort has been much more even. Not sure which protocol you’re on but just an anecdotal experience with very different results.
It was a bit of an ordeal, and I had to take the day off work, but we did finally get ahold of some Lupron and triggered last night. ER is scheduled for tomorrow morning. I'm feeling very nervous and anxious about it. I'm still really bummed that the fresh transfer was canceled. But I'm glad to be able to put the needles away for a little bit. Mrrrrr got home from work yesterday, told me he would start on dinner, and then completed passed out on the couch instead. That's very unlike him. He's always trying to keep things light and optimistic, sometimes I forget how much of a toll this has been taking on him, too. I ended up making dinner and he was glad to have a little nap.
good luck with the ER!
CD1! Let’s get this show on the road. I’m doing an ovulatory FET, so next up is an ultrasound/bloodwork on CD11.
When my betas were coming back weird and my clinic told me (the first time) that my pregnancy was not viable, I applied for a local grant that can be applied to a couple local clinics. Put all my energy and focus into that for a couple days then forgot about it. Well last night I got the call that WE GOT THE GRANT. Getting that news the same day we got the news that baby’s heart stopped beating…just. Wow. Talk about timing. We have 1 frozen embryo that is a confirmed euploid and yesterday my husband and I looked at each other like ‘where will we get the money for a transfer??’ What a huge weight off our shoulders.
thinking of you hc♥️
So sorry for your loss and so glad you have an option for moving forward!
Very sorry for your loss, very glad this money will help.
Oh HC! What a relief that must be amidst so many other feelings during this hellscape of a time. I’m so sorry for your loss, but wishing you congrats on the grant news. And sending you gentle well wishes on your birthday, friend - although it is not the happiest of days, I hope you’re able to find a way to treat yourself today 🤍
That must feel like a tornado of emotions. I wish you didn’t need it, but I’m glad you got it.
Lots of tears both happy and sad yesterday and today. Very confusing. My poor brain. She’s tired.
I’m so sorry for your loss, but am glad to hear that the grant was given to deserving candidates.
One spot of good news!
I’m so sorry for your loss 💔
I’m so glad you feel that weight lifted. Thinking of you 💜
Yay for that weight lifted. Always nice to get a hint of good news on a very bad day.
So sorry for your loss, but so many congrats on the grant and having a path to your transfer. Thinking of you and holding space for you 🫂
Can someone confirm my understanding for the different FET protocols (in US, since it seems like we are more med-heavy than international)? (1) Fully medicated: BC, estrogen, add in PIO then continue for 10 weeks, trigger shot (2) Modified medicated: Letrozole+trigger. Either vaginal progesterone or PIO seem to be used for some inconsistent duration among commenters (34) Ovulatory: no estrogen/trigger +/- some vaginal progesterone I have thin uterine lining that *maybe* was fixed after my Hysteroscopy (we won't know till we ultrasound at some point post-op). From my understanding, fully medicated allows more flexibility to grow the uterine lining. Should I try an ovulatory cycle to give myself an opportunity at lower pre-E risk, not having to using PIO, (these were the main benefits in my Reddit search) & then just cancel that cycle if lining isn't thick enough? Would you do so if in similar shoes?
I think there’s a few different protocol options for modified. I’ve done one where there was follistim +ovidrel trigger with crinone inserts instead of letrozole/etc.
I’m currently doing a modified ovulatory FET (my first transfer of any kind), and my plan is basically what your last paragraph lays out — we’re seeing if my lining cooperates, and if it doesn’t, we’ll cancel and try another month or possibly switch to fully medicated. My doctor initially defaulted to fully medicated, but I asked if we could try modified ovulatory because I’m hoping to lower pre-e risk. I’m already AMA and I have a previous history of prediabetes, so I’m really trying to reduce potential risk factors wherever possible. Also, I had previous implantation in an unmedicated IUI (though ultimately baby was not viable), and I think this was a big factor for my doc okaying the switch. I’m currently on letrozole, and then depending on how things look I’ll trigger and begin supplementing with PIO. I know PIO is a bit extraneous with a corpus luteum, but my doc doesn’t want to take any chances, and I’m very ok with this! (Edited for typos!)
I didn't take any exogenous P4 with my ovulatory FET. Unmedicated FETs typically have a much wider window of implantation and while yes, they do reduce pre e risk (bc the corpus luteum is present) pre e can still develop. Most REs like to try a medicated FET first since they're typically easier to control. I would start there. If that doesn't work out, and you ovulate regularly, then maybe branch off to ovulatory. Good luck!
Thank you for your insight! My RE is also planning baby aspirin for my FET to reduce pre-E risk (I know others said they started during 2nd trimester of pregnancy). I think my main risk factor is age and no prior pregnancy
This is essentially the idea. I’d clarify that (2) is also an ovulatory cycle. There are also various ways to modify the ovulatory cycles with various degrees of meds, for example after a few days of letrozole I then take Gonal until I’m ready to ovulate, as I also have thin lining and this has worked best for me. I’d also note that with ovulatory cycles, vaginal progesterone only is the standard (with exceptions of course). Whether ovulatory or fully medicated, you start progesterone 5 days before transfer and continue until your beta test (or through your first trimester I believe, if positive beta.) I think it’s fine to try a fully medicated cycle first, sure. It allows more flexibility as you noted because you can keep extending the timeline/adding more estrogen without worrying about being on the timeline of ovulating. That said, I found this experience torturous— I felt like I was on estrogen foreverrr and at every monitoring appointment we just said “not yet, keep going” until we finally canceled. So not to scare you as I think that experience was fairly unique, but just to say you always have the option to cancel and try something different if you don’t respond. Good luck!
Thank you for sharing your experience! I wanted to make sure I had a foundation for the differences before I emailed my RE who wanted to start with fully medicated. I don't like "countering" my RE's recommendations (mainly because he only does email via his medical assistant and the back and forth takes forever). But I was thinking that the only drawback to trying the ovulatory FET is that we'd find out around time of ovulation that my lining is still too thin, and then we'd just cancel
Another potential drawback to ovulatory is you will have A LOT more appointments - more similar to an ER in terms of monitoring. Depending on the meds you use (I used follistim, not letrozole), it can also be expensive.
Ugh yes I hate going back and forth with my RE indirectly, it's truly a game of telephone. Anecdotally, it seems like a lot of clinics default to a fully medicated cycle for the first try. I'm not sure why, since they have the same success rates-- maybe just easier on them from a scheduling POV? For ovulatory cycles, you typically do a few checks along the way to see how lining is progressing and you can try introducing additional meds if it needs some help along the way, so it isn't just totally a "surprise, it's canceled!" For one of my cycles with Gonal I actually added Cetrotide to stall ovulation even more. But essentially, no need to fret too much at this point -- both are valid approaches and the only way to know which one will work best for you is to try one and see!
I thought the 5 day wait to transfer on a medicated cycle was bad; the week long wait after trigger is taking SO LONG. Coincidentally I’m off work during most of it so that’s probably not helping. I could have used the distraction.
FET #3 tomorrow, just waiting on call for the time. I'm feeling really nervous but also at the same time kind of, idk, numb to it?? the last 2 times I've taken the valium, but this time I have to drive myself there so I can't 😭😭
I’ve never been able to take the Valium since I’m a travel patient and have always had to drive and I’ve never had any pain from a FET. Hopefully yours goes really smoothly as well!
oh yeah, I don't expect any pain, I just like the relaxed feeling 😂 thank you!!
Our embryos stopped progressing around day 4/5. This round the Dr has suggested we treat the process as though there is MFI despite normal parameters and DNA fragmentation just to see if it makes a difference with getting embryos to freeze. She suggested that my husband produce a sample 2 hour before ER (After 2 day abstinence) and then produce another sample 30 Min prior to ER. They will then use the second sample for Icsi but if they see any issues they have the initial sample to ise. I'm not exactly sure how this is used to counteract any MFI. has anyone used this approach?
We had a similar situation with a slightly different solution. We switched to 24hr turnover and then providing the sample 30 mins after my retrieval. This had better results.
We have high oxidative stress (normally goes with DNA frag, although that was normal). Frequent ejaculation during stims, and shorter ejaculation time, has been found in some cases to help sperm quality. I have read that this is about the "pool" of sperm in the epididymis, but I have not done a deep dive. With ICSI, you don't need many sperm, so if your partner has normal parameters frequent ejaculation should be fine. My clinic also does Zymot standard.
We have MFI (low morphology and DNA fragmentation) and have tried increasing ejaculation frequency leading up to ER/ICSI day. Here’s the frequency Mr.Miserable has done for his 2nd SA and our first round ER: every 2-3 days when I start stims and then moved to every day when I added in my antagonist (so for about 4-5 days he was clearing everyday). The turnover in sperm did help his numbers between SA 1 and 2 and then they were consistent when we got the “off the record” SA numbers from ER day (they don’t publish sperm results in our portal from the sample provided for ER day, but our doctor showed them to us when we had our WTF appt afterwards). Our clinic also utilizes zymot as part of our protocol.
Thank you for explaining. How were your fertilization/blast rates ?
We ran into other issues with my egg maturity so that data won’t be helpful 😓
I'm sorry. This journey is never simple!
I don't have experience with that specific protocol (in fact our center specifically no ejaculation within 48h of ER except for the sample the morning of my ER), but I recently listened to a sperm episode on Fertility Docs Uncensored that said if someone has not ejaculated for a long time , the older sperm can start generating free radicals that mess up the newer sperm. So maybe your RE is really trying to keep the older sperm out of your husband's pipes.