What different protocols are available at Cornell vs. DC area? Confused.

[Anonymous]

I keep reading about how some clinics are cookie-cutter and others have special "tools" for trickier cases. What constitues a tricky case.

For instance - I am over 40 with low FSH and I stim very well on low dosages. No male factor and no other issues on my part except age.

I am currently doing IUI since my insurance requires before moving to IVF. Do any of these state-of-the-art facilities have protocols for older women? Just curious as to what they do that is different?

[Anonymous]

I think Cornell uses protocols with estrogen patches more than SG or other DC clinics. I was on the estrogen priming protocol and they also use an estrogen protocol with a lupron flare. They also do co-culture (you can learn more about that via google) on some patients.

But the main thing is that b/c so many of their patients have failed elsewhere that they are just very familiar with difficult patients and how to best treat them (for example, I went from being one of my doctor's toughest patients at SG to being one of Dr Davis's easy patients at Cornell). Cornell also often starts poor responders on a high dose of drugs and then slowly lowers the dose when they are about half way through the stims. This helps keep the follicles about the same size so that you get more mature eggs. They also trigger much earlier than SG -- Dr Davis usually triggers when the largest follicle is size 18, SG let my follicles get a s big as 24.

Also, Cornell is super well-respected by RE's in general. I asked several local RE's about Cornell and no one questioned their stats (they all admitted that they have a great track record with a difficult patient population). After 3 cycles at SG, my doctor basically said that if anyone in the country could get me pregnant, it was Dr Davis at Cornell.

[Anonymous]

agree with pp.
as far who are tough cases? plenty! here's a sampling? someone who has everything normal, below 35, and still can't pregant; someone who is under 40 with all tests normal and stiill doesn't get pregnant; repeated implantatiopn failure; repeated pregnancy loss; immune issues (controversial topic); asherman's syndrome.
when shady grove was pushing me to try donor egg; cornell said there was a chance that i could still use my own eggs.
check out ivf connections and you'll see a lot of tough cases.

[Anonymous]

SG uses the same estrogen priming protocol as Cornell - the difference is that they don't go to is as quickly as Cornell, and they don't monitor patients as closely as Cornell.

I think what is at least as important as protocol is the lab, especially what culture is used for the embryos (differs lab by lab). I suspect Cornell's is better than SGs, and CCRMs is even better.

[Anonymous]

Cornell uses co-culture for some women's embryos (this is a process through which a culture medium is created using the patient's own endometrial cells and blood). I don't think that CCRM does this. There is some debate about whether co-culture does help patients and some REs at Cornell use it more often than others. Cornell has published some pretty compelling studies showing that when they randomized embryos to either go in co-culture or a traditional medium, the co-cultured embryos were more likely to lead to pregnancy.

[Anonymous]

Anonymous wrote:SG uses the same estrogen priming protocol as Cornell - the difference is that they don't go to is as quickly as Cornell, and they don't monitor patients as closely as Cornell.

I think what is at least as important as protocol is the lab, especially what culture is used for the embryos (differs lab by lab). I suspect Cornell's is better than SGs, and CCRMs is even better.

really? my RE at SG totally dismissed that protocol, and said she was not aware of it.