Your best tips and recommended protocols for DOR?
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Anonymous
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38 yo, endometriosis, DOR. Had surgery for endo,failed 3 IUI, don’t remember stats but doc said “numbers aren’t great but you are not completely out of the game”. Whatever that means...
10 days past ovulation: start estrogen patch (0.1 mg) -- replace every other day day 2-6 of cycle; 250 gonal-f & 75 menopur (doses changed over time though), continue patch day 7&8: cetrotide, gonal-f & menopur [remove patch) day 9: cetrotide, menopur day 10: 375 IU menopur, ovidrel at 7:30 PM day 11: no drug day 12: 7:30 AM retrieval - ICSI and assisted hatching -- 8 eggs, 6 mature, 6 fertilized, 6 blasts day 17: transfered the best looking 2 (one hatching) and froze the others Took doxycycline & a steroid at some point (around retrieval?) Result: twins (now 7) So the # of eggs wasn’t spectacular, but apparently quality was good. Younger friend at CCRM (CO) with DOR had a very similar protocol (she had failed IUI x 3 & IVF x2 at a local clinic & travelled). She had genetic testing of embryos (I didn’t- not standard back at the time)) & she had 2 successful FETs (1 embryo at a time - would recommend as twin pregnancy is rough even when it goes well). Best of luck & thinking good thoughts for you. |
Anonymous
This is amazingly helpful. Thank you for taking the time to write this all out. |
Anonymous
Poster from yesterday AM back. Since it’s helpful to you, OP, I looked in my email & found one to my friend (the one who ended up at CCRM.). The super-neurotically detailed email is copied/pasted below - maybe you will find all of these details helpful as my friend did  once again, all the best to you - this whole IF thing sucks.
“Hey! Here’s what I did.... ugh. Did NOT use BCPs to time start; use natural ovulation as start date (worried about oversuppression with a BCP start since my FSH was apparently high): 10 days past ovulation: estrogen patch (0.1 mg) -- replace every other day 12 days past ovulation: replace estrogen patch (0.1 mg) 14 days past ovulation: replace estrogen patch (0.1 mg) day 1 of period: replace estrogen patch (0.1 mg) day 2: ULTRASOUND & blood work; 250 IU gonal-f, 75 IU menopur, continue patch day 3: 250 IU gonal-f, 75 IU menopur, replace estrogen patch (0.1 mg) day 4: 250 IU gonal-f, 75 IU menopur, continue patch day 5: 250 IU gonal-f, 75 IU menopur, replace estrogen patch (0.1 mg) day 6: ULTRASOUND & blood work; 250 IU gonal-f, 75 IU menopur, continue patch day 7: 0.25 mg cetrotide, 250 IU gonal-f, 150 IU menopur [remove patch] day 8: ULTRASOUND & blood work; 0.25 mg cetrotide, 200 IU gonal-f, 225 IU menopur day 9: 0.25 mg cetrotide, 375 IU menopur day 10: ULTRASOUND & blood work; 375 IU menopur, 250 ug ovidrel at 7:30 PM day 11: no drug day 12: retrieval (propofol; miss 1/2 day of work; can't drive the whole day) -- used ICSI and assisted hatching -- got 8 eggs, 6 mature, 6 fertilized, 6 blasts day 17: transfered 2 and froze the other 4 (supposed to be on bed rest but had work & couldn't -- lied to Dr. about it, but obviously this didn't affect the outcome...) I also took doxycycline and a low dose of a steroid (I forget which one) around the egg retrieval. Started progesterone vaginal suppositories (endometrin) after the retrieval and continued until week 8 of pregnancy (She checked my progesterone levels at 7+ weeks and since it was high enough I could stop, but she forgot to tell me that). All drugs were subcu injections, here's the name of the patch and a list of the expensive stuff: Estrogen patch (Vivelle, I think): 6 patches (0.6 mg) gonal f: 1700 IU menopur: 1500 IU cetrotide: 0.75 mg ovidrel: 25 ug” |
Anonymous
How old were you through all of this? Did my first IFV cycle just after turning 41- and did the DE transfer just before turning 44. Between age and $ and knowing I wanted to do DE, I decided to stop. I realized there was always going to be one more thing to try and I wanted a baby more than I wanted to prove I could be successful. I knew there was a good chance DE would work, but was also planning that it could take a couple transfers and I really wanted to be done before 45. |
Anonymous
Do you happen to know/remember why you upped the Menopur at the end of your cycle? Btw, I am starting my third cycle with mini stim and estrogen priming (patch) and will also likely add in Femara/letrozole for the first 5 days of the cycle (CD2-6) to simulate some of the success I experienced with Clomid (during an IUI, got 5-6 follicles to grow vs my usual 3 on the two IVF medicated cycles) but without the thinning of the lining. |
Anonymous
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I'm sorry, I don't think I ever knew why the menopur was upped - I vaguely remember her telling me that the cetrotide was an "antagonist", and so to expect that the stims would be increased when I started the cetrotide. I do remember that the cetrotide was started when the follicles reached a certain diameter. Additionally, I remember her muttering about estrogen levels & trying to "make sure the estrogen matched" the number of follicles. I do vividly recall that the reason for all the menopur at the end was bc I took longer to stim than she expected & ran out of gonal-f. So last day of stims (day 10) she told me to just use up all of the menopur, which was all that I had left. I was kind of startled by that - didn't seem very scientific.
The whole time the doc seemed annoyed at me for not making enough follicles & then not responding well to stims. I didn't feel comfortable asking questions - just showed up & did what she told me to do & ran out of there as fast as I could. It was very strange and stressful & the whole thing passed in a haze. Though she got results, so I can't argue with that. I apologize for this long non-answer, and I hope that your new protocol works well. P.s. My friend from work picked me up at the surgery center the day of the egg retrieval (adding to the stress, my husband was out of the country for work- the lab used a previously frozen sperm sample). My friend then dragged me to mcdonalds (yuck!) for lunch, and made me eat an egg mcmuffin in honor of the egg retrieval. She is 100% convinced to this day that the egg mcmuffin did the trick. So I guess that an egg sandwich after the egg retrieval can't hurt either! |
Anonymous
Thank you! So helpful and interesting. And funny about the mcmuffin
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Anonymous
| I have DOR and just did clomid, tigger and natural cycle IVF. I took baby aspirin afterwards and estradial and progesterone. |
Anonymous
| It was either blind luck or DHEA that tipped the scales for me (conceived spontaneously after 3 failed IUIs and 3 failed IVFs). |
Anonymous
How much DHEA did you take a day and for how long? |
Anonymous
Great. What is your AFC normally and how many follicles did they retrieve with this protocol? What was the Estradiol for? |
Anonymous
One more question. I thought you were the one who initially said you did "Minimal stimulation starting with a few days of Clomid and leading into injections not to exceed 150 or 175 IUs of Follistim a day + no more than one vial of Menopur." But in looking at this protocol more closely it doesn't seem like you did Clomid at all (or at least it's not listed in your rackup) and took higher levels of Follistim (250IUs) vs the 150-175IUs you mentioned initially. Or did I misunderstand and you are two different posters? I just want to make sure I understand as this is very helpful in figuring what I should do. Thanks so much!! |
Anonymous
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To the poster on 3/9 at 16:13, you are looking at 2 different posters - it’s super confusing!
To clarify, I first posted on 2/16 at 9:15 (mentioned the endo & surgery for endo & being 38 at the time & resulting twins). that first post was the protocol as I remembered off the top of my head - honestly, It’s kind of scary that I remembered those numbers...I think that IF traumatized me! Someone said it was helpful to hear about the protocol, so then I checked my old emails & listed the full details of the protocol on 2:17 at 14:23. I then replied to a question on 3/05 asking why menopur went up (egg McMuffin post) I never did clomid as part of IVF (I had an undistinguished response of 1 follicle all 3 times I used clomid for IUIs). The IVF protocol I listed is probably really old-school since it’s from 8 years ago. I’m sure they have better ideas now. OTOH, my friend also had DOR said she did a similar protocol about 5 years ago at CCRM & had similarly good results (2 kids from two SETs). My doc did say that in retrospect I probably had “good quality eggs” - just not a whole lot of them. She hypothesized that the ICSI & AH may have been critically important bc old eggs have “thick shells.” There must be something about the transfer too - after the transfer the nurse tried to bet me $ that I’d have twins (I work in the facility where I had the procedure done - awkward! - so theoretically the nurse could have collected). I asked why & the nurse replied (roughly) “I see transfers every day! dr ___ is a jerk, but she’s GREAT at procedures! She got those embryos right in there - You’re going to have twins!” I remember rolling my eyes & thinking “yeah right lady, whatever”... but she wasn’t wrong. There are so many moving parts - the pt’s biology, stims, sperm, retrieval, the lab, the transfer... and luck - it’s so freaking frustrating and crazy-making! I really am thinking good thoughts for you!!! |
Anonymous
| Question. Which clinic (and doctor) did you ladies go to in order to utilize these DOR protocols? I'm at SGF and was told that since I have DOR that after 2 failed IVF cycles there was nothing more they could do and weren't willing to discuss using a EPP or natural cycle IVF. Thoughts? |
Anonymous
I did two rounds of NCIVF at Dominion with Dr Gordon (no longer at Dominion) with no success. I also did EPP at SGF, and that ended up being my worst cycle. Waiting for my first DEIVF transfer now. |