Estrogen Priming Protocol

[Anonymous]

I'm DOR and currently researching about the estrogen priming protocol. Can you share your knowledge on this? What your protocol was like and your results? Thanks

[Anonymous]

I did it for DOR - my eggs were better quality and I had viable 5 day blasts (unlike antagonist protocol)

I was on DHEA for 12 weeks (so 6 weeks prior to meds). Estrogen patches every 2-3,days after ovulation. Then 3 days of Ganerellix. You get your period on the 3rd shot of Ganerellix.

Then you do normal protocal with menopur/gonal f/Ganerellix and trigger.

The cycle takes longer and no BCPs. Don't quote me but the theory is that BCPs and Lupron suppress, so instead of suppressing before cycle essentially you are getting a boost.

EPP worked for me.

Good luck!!

[Anonymous]

Anonymous wrote:I did it for DOR - my eggs were better quality and I had viable 5 day blasts (unlike antagonist protocol)

I was on DHEA for 12 weeks (so 6 weeks prior to meds). Estrogen patches every 2-3,days after ovulation. Then 3 days of Ganerellix. You get your period on the 3rd shot of Ganerellix.

Then you do normal protocal with menopur/gonal f/Ganerellix and trigger.

The cycle takes longer and no BCPs. Don't quote me but the theory is that BCPs and Lupron suppress, so instead of suppressing before cycle essentially you are getting a boost.

EPP worked for me.

Thank you. Anyone knows if this type of protocol works for people that don't ovulate on their own?
Good luck!!

[Anonymous]

My doctor has given me the option of trying EPP next cycle. I am not DOR (at least based on FSH and AMH blood work). I have one IVF cycle with a standard antagonist protocol with BCP and got 7 mature follicles but my second IVF attempt with a similar protocol only yielded 3 so it was cancelled before retrieval. Has anyone done EPP without an actual DOR diagnosis?

OP- I haven't done the protocol yet but what my doc suggests is very similar to what the PP posted for their protocol.

[Anonymous]

I've done EPP with antagonist and also with lower dose of injection (225/daily). This yield overall the highest number of high quality normal-fertilized embryo on Day 3 (freeze on Day3, so not sure if they would made it to Day5).
Started with estrogen oral pill immediately after detecting ovulation, once the period starts stop taking estrogen pill and starts injection, depending on your response inject longer days/shorter days, start antagonist on fixed day schedule (Day6 of injection) or variable start day (when 2 or more follicles with 14mm observed), did Lupron trigger for freeze all.

I did EPP-Antagonist with max dose before but the result was not as good as EPP-Antagonist-Low dose (less number of M2 eggs upon retrieval, less number of normal fertilized embryos).

[Anonymous]

OP here- I have found very little information on this. I have an appt at Shady Grove tomorrow so we shall see. I have done IVF on max meds so I am wondering if I'm a good candidate for this. I don't ovulate on my own so I wonder how they can time when to start either the pills or the patch.

[Anonymous]

Pp here - I actually have PCOS so generally don't ovulate on my own. But I also have DOR (it's a conundrum...too many or too few eggs...my ovaries are a mystery..)

My nurse and I kind of guesstimated on O but it still worked. I was on max meds before with little luck. I was still on a ton of Stims but my quality was better.

[Anonymous]

I've done EPP antagonist with SG. With me they would not do low dose stims since I had a "good response" to high doses. My doctor doesn't by the "high stims fry eggs" debate. I am moving to another local dr. who does the same protocol but with only 150-225 FSH.

[Anonymous]

i, too, am interested in this. DOR/AMA/poor responder here. My dr at SG has suggested a mini-IVF/low-dose protocol for my next cycle. He initially diagnosed me with an ovulatory disorder, and then after IVF said I was DOR. I'm wondering if he was just guessing after the ovulatory diagnosis? Starting to lose faith in my dr at SG.

[Anonymous]

OP here-
I have two consultations this week, one with Dr. Greenhouse at Shady Grove and one with Dr. Abbasi at Columbia Fertility Associates. I will update with whatever information I get from either REs about the estrogen priming protocol. Thank you for your responses so far. It helped me understand a little bit about this type of protocol.

[Anonymous]

22:12- who is your SG doctor? I asked mine about this several times and she won't do it.

[Anonymous]

NP. I am with Widra, he does do EPP, but you'd have to be a good candidate for it I guess.

[Anonymous]

This is 22:12- my dr is Levens at SG

[Anonymous]

13:23 - That's who I have. He refused to do low dose with me bc of my DOR and age.

[Anonymous]

I'm EPP-Antagonist-Lower dose poster. Initially, my RE wanted to repeat higher dose (Max 450/daily), but I insisted on trying the lower dose (225/daily) and my RE agreed. But before agreeing on this dosage, my RE warned me that I may not get as much M2 eggs as compared to the higher dose.
But, I'm at GW.