[angie056]

Hi All,

I am hoping someone will have some insight on how the HCG trigger shot dosage is determined. I am triggering tomorrow but they want me to only take 5000HCG instead of the 10000 originally planned because my E2 was over 4500 today after 8 days of stims. Has anyone run into this?

Any input would be great!!

[amybeth]

That's what happened to me! My E2 after 8 days of stimming was 3900 and they dropped me to 1/2 vial of Menopur for one more day. On day 9 my E2 was 4240 so they had me trigger that night. I used 5000 units instead of the originally prescribed 10,000. It resulted in a smaller amount of mature eggs as my follies grew but there were not a lot that produced eggs. But remember, it only takes one!

As you can see from my signature, they knew what they were doing as the cycle resulted in a BFP and I now have a darling little 10 week old son!

Good luck and sending you lots of baby dust!!!

[Vickie]

Angie056:

I also had to take 5000 dosage instead of 10,000 before my ER. When nurse called with instructions and told me to "waste half the liquid", I asked her twice to repeat what she said to make sure I got it right. The reason for this was the same as Amybeth describes in her post - E2 was very high.

[angie056]

Thank you, thank you, thank you! I feel soooooo much better.

Amybeth - thanks for the baby dust and congratulations on your beautiful little boy!

Vickie - congrats on your BFP and I wish you a perfect pregnancy and delivery of your little sweetie!

[Ghost]

Triggering with 5,000 instead of 10,000 hCG results in a modest decrease in the chance of OHSS.

Triggering early (e.g. 8 days) or coasting (using little or no FSH for the last few days before trigger) compromise the embryo cohort (many small follicles with typically yield lousy eggs). It is claimed that these approaches reduce OHSS incidence, but properly designed studies have not been performed to prove it.

A much better solution is to trigger with a GnRH agonist (like Lupron) instead of hCG. This induces an LH surge that matures the eggs much like it does in natural cycles. But the LH is short-lived (half life is around 1 hour, as opposed to 36 hours for hCG), so it does not keep stimulating the follicles for days afterward, like hCG does. With this approach, clinically significant OHSS is impossible or nearly so, so there is no need to play games with the stimulation and compromise the oocyte cohort.

Of course, you can use the GnRH agonist to trigger only if you are using an antagonist for pituitary suppression (basically, you would need to be in a ganirelix cycle). It won't do anything if you are already using Luporon for down regulation.

We have used this trigger hundreds of times, even on several patients with E2 well above 10,000. No OHSS yet.

The luteal support must start earlier and be more aggressive than with hCG cycles, if you are going to transfer fresh embryos in non-donor cycles following a Lupron trigger.

The current best study of this method is by Engmann et al (2008). Note the luteal support protocol.

[kts]

I also trigger w/ 5000. My E2 was high and I was over stimulating. I ended up with 26 eggs, 15 of which fertilized! I also ended up with OHSS, not so much fun, so I am really glad they had me use the low dose because I don't even want to know what the 10000 dose would've done.

Good luck!

[tygerlilly]

So, I have a TON of follie's, 20 that they are going to go after... how will I know if I have OHSS? Would I be able to tell now?

[Bothsidesnow]

My clinic told me that they base the hCG dose on the E2 levels:
E2 < 3500 -> trigger with 10,000 U
E2 > 3500 -> trigger with 5,000 U

My E2 was 3418, so I was instructed to trigger tonight with the full 10,000 U dose. It seems that my number is borderline, so I hope that I will not overstimulate! Did anyone else with a borderline value trigger with the full dose?

I was also instructed to take my last dose of Lupron 5U between 6 - 7 p.m. Wish me luck!

[eco-friendly]

bothsidesnow, congrats on your last lupron shot.

I am glad I didn't read this thread when I triggered or I would have been freaked out! My E2 was nearly 6000 after stimming for 10 days and I was instructed to use the full 10,000 units of hcg. I had 13 eggs retrieved; 12 of them were mature.

I felt like I had mild OHSS but I wasn't diagnosed with OHSS. My ovaries were enlarged for 3-4 months, but I'm not complaining because I am happy with the outcome.

Good luck everyone!

[Bothsidesnow]

Originally Posted by eco-friendly

bothsidesnow, congrats on your last lupron shot.

I am glad I didn't read this thread when I triggered or I would have been freaked out! My E2 was nearly 6000 after stimming for 10 days and I was instructed to use the full 10,000 units of hcg. I had 13 eggs retrieved; 12 of them were mature.

I felt like I had mild OHSS but I wasn't diagnosed with OHSS. My ovaries were enlarged for 3-4 months, but I'm not complaining because I am happy with the outcome.

Good luck everyone!

eco-friendly - Thanks so much for sharing your experience. I feel much better about triggering with the full 10,000U after hearing your story. As of this morning, I only had 7 follicles that were in the desired size range (out of 19 total). I'm hoping that some of the other stragglers will catch up by my ER on Thursday. Congratulations to you on your success! You must be so excited. Hearing stories like yours give me hope.