High dose stims

[Anonymous]

I am pretty sure I have DOR.

After 5 days of stims, my E2 is only 214 and I have 8 follicles, only 3 were measured. My RE is bumping my meds up to 300 Follistim and 225 Menopur. Does this seem really high for going into day 6 of stims?

I am worried that my eggs will be crap with this high dose and another 6 days of stims.

[Anonymous]

You are lucky to have a reading of 214 after 5days of injection. I had E2=167 after 7days of injection and E2=255 after 8days of injection, which RE only counted 3 measurable follicles.
I ended up with 5 eggs at the retrieval. You have 8 follicles after 5days. So, I believe you will probably end up with somewhere between 8 and 12 eggs. GL.

[Anonymous]

PP. I am AMA and also borderline DOR. I had 225/day all the way that resulted in 5 eggs. So with the increased medication, you may end up with whole lot more than 8 eggs.

[Anonymous]

Is this your first IVF? You either have DOR or don't - what is your AMH ? You may have slower growing follicles.

I have normal AMH but slow growing follicles. I just looked up my spreadsheet from 3 IVFs: on day 6 of stims I had Estrogen readings of 217, 342, and 259. All cycles went to retrieval with 12-14 retrieved and 7-8 mature/fertilized. At the beginning the follicle count was 4, 7, 8.

So it may be that you're a slow grower. Eggs can be crap even with low dose, but I would not sweat it too much. Under 600 total (Follistim+Menopur) you're ok I think.

[Anonymous]

OP here- No. this is my 5th fresh cycle. First two were 3 years ago and doses were much lower. I am definitely a slow grower, but I have never used this much Menopur this early.

My AMH was 2.7 a month ago. FSH is creeping up there and was close to 10.

[Anonymous]

OP, how was your estrogen progression in previous attempts? Does your RE have all the data from previous cycles?

Honestly, given the history, I would stick with lower doses and hold off on Menopur - try to talk to your RE. And, if he is uncooperative, and if you feel strongly about it, you can skip the Menopur and lower your dosages for a couple of days to see if estrogen will go up.

[Anonymous]

Anonymous wrote:OP, how was your estrogen progression in previous attempts? Does your RE have all the data from previous cycles?

Honestly, given the history, I would stick with lower doses and hold off on Menopur - try to talk to your RE. And, if he is uncooperative, and if you feel strongly about it, you can skip the Menopur and lower your dosages for a couple of days to see if estrogen will go up.

I do not advise switching to a low dose protocol in the middle of a cycle. It may lead to not retrieving any eggs.

OP, for my first IVF I was on 450 gonal-f and 225 menopur. Only one egg fertilized. For the second IVF I did the estrogen priming protocol and was on 450 gonal-f and 150 menopur. I got 3 fertilized eggs, one of which became a viable pregnancy.
Good luck!

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP, how was your estrogen progression in previous attempts? Does your RE have all the data from previous cycles?

Honestly, given the history, I would stick with lower doses and hold off on Menopur - try to talk to your RE. And, if he is uncooperative, and if you feel strongly about it, you can skip the Menopur and lower your dosages for a couple of days to see if estrogen will go up.

I do not advise switching to a low dose protocol in the middle of a cycle. It may lead to not retrieving any eggs.

OP, for my first IVF I was on 450 gonal-f and 225 menopur. Only one egg fertilized. For the second IVF I did the estrogen priming protocol and was on 450 gonal-f and 150 menopur. I got 3 fertilized eggs, one of which became a viable pregnancy.
Good luck!

I am the quoted PP. It's not switching to low dose, it's forgoing upping the dose - she won't be taking any less than previous days. I've done it twice and didn't have issues with the number of eggs retrieved.

[Anonymous]

OP here-

This cycle I am doing a different protocol (EPP) but compared to my last two fresh cycles (this year and both lupron stop) my Estrogen was comparable.

Cycle #1- After 5 days of stims- it was 222, but my RE bumped me up to 300 of Gonal F that night.

Cycle #2- After 5 days of stims- it was 217, stims stayed the same at 300 Gonal F & 150 Menopur

I guess that is why I am confused that he wanted to increase the Menopur to 225. Maybe to help recruit more follicles?

[Anonymous]

Anonymous wrote:OP here-

This cycle I am doing a different protocol (EPP) but compared to my last two fresh cycles (this year and both lupron stop) my Estrogen was comparable.

Cycle #1- After 5 days of stims- it was 222, but my RE bumped me up to 300 of Gonal F that night.

Cycle #2- After 5 days of stims- it was 217, stims stayed the same at 300 Gonal F & 150 Menopur

I guess that is why I am confused that he wanted to increase the Menopur to 225. Maybe to help recruit more follicles?

You need to ask him. An estrogen level of 200 after 5 days of stims is within normal.

[Anonymous]

Anonymous wrote:OP here-

This cycle I am doing a different protocol (EPP) but compared to my last two fresh cycles (this year and both lupron stop) my Estrogen was comparable.

Cycle #1- After 5 days of stims- it was 222, but my RE bumped me up to 300 of Gonal F that night.

Cycle #2- After 5 days of stims- it was 217, stims stayed the same at 300 Gonal F & 150 Menopur

I guess that is why I am confused that he wanted to increase the Menopur to 225. Maybe to help recruit more follicles?

On day 5 you're past recruitment. Even if you were to recruit more at this stage, they will never catch up to the ones that are already measurable. Are you at SG OP? If yes - I think it's a part of their cookie-cutter algorythm if below X on day Y, then up by Z. It happened to me even after explicitly discussing with the RE that I am a slow grower based on the records from 4 fresh cycles.

[Anonymous]

Anonymous wrote:

Anonymous wrote:OP here-

This cycle I am doing a different protocol (EPP) but compared to my last two fresh cycles (this year and both lupron stop) my Estrogen was comparable.

Cycle #1- After 5 days of stims- it was 222, but my RE bumped me up to 300 of Gonal F that night.

Cycle #2- After 5 days of stims- it was 217, stims stayed the same at 300 Gonal F & 150 Menopur

I guess that is why I am confused that he wanted to increase the Menopur to 225. Maybe to help recruit more follicles?

On day 5 you're past recruitment. Even if you were to recruit more at this stage, they will never catch up to the ones that are already measurable. Are you at SG OP? If yes - I think it's a part of their cookie-cutter algorythm if below X on day Y, then up by Z. It happened to me even after explicitly discussing with the RE that I am a slow grower based on the records from 4 fresh cycles.

OP here- yes I am at SG. Well that makes me sad, so basically I will only get a handful of eggs this time? Maybe 7-8 if I am lucky.

PP, did you stay at the same dose even though you are a slow responder?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP here-

This cycle I am doing a different protocol (EPP) but compared to my last two fresh cycles (this year and both lupron stop) my Estrogen was comparable.

Cycle #1- After 5 days of stims- it was 222, but my RE bumped me up to 300 of Gonal F that night.

Cycle #2- After 5 days of stims- it was 217, stims stayed the same at 300 Gonal F & 150 Menopur

I guess that is why I am confused that he wanted to increase the Menopur to 225. Maybe to help recruit more follicles?

On day 5 you're past recruitment. Even if you were to recruit more at this stage, they will never catch up to the ones that are already measurable. Are you at SG OP? If yes - I think it's a part of their cookie-cutter algorythm if below X on day Y, then up by Z. It happened to me even after explicitly discussing with the RE that I am a slow grower based on the records from 4 fresh cycles.

OP here- yes I am at SG. Well that makes me sad, so basically I will only get a handful of eggs this time? Maybe 7-8 if I am lucky.

PP, did you stay at the same dose even though you are a slow responder?

yes, I stayed on the same dose. My estrogen started rising within 48 hrs of day 5, so in retrospect I was happy to have stayed the course. However, based on several studies, when your lead follicle reached 14mm you're supposed to add 75 units to stims (I did it as a one time thing on stimulation day 9). Also if you need to go an extra day after at least 3 follicles are 17 mm (i.e. your RE doesn't trigger you) then you can coast a day - I did it at 200 units instead of 325.

Most likely you will have more follicles (given your good AMH), but some will be small/immature. I got consistently 7-8 mature out of 13-12 retreived.

[Anonymous]

PP- are you at SG?

This is probably our last attempt so I am trying to maximize what we get.

[Anonymous]

Anonymous wrote:PP- are you at SG?

This is probably our last attempt so I am trying to maximize what we get.

yes, I am at SG. I did 2 cycles with them, and 2 with Abbasi at CFA. Next one will be my last with own eggs simply due to my age - I am pushing 43...

There is nothing inherently wrong with your new higher dosages. For myself, it's pretty clear that the number of eggs does not go down with lower dose - it's very consistent. There are some studies showing lower dose protocols to be more sucessful for certain categories of patients. Not for everyone though. I felt strongly about not upping my doses largely because I had 3 2nd opinions during my infertility journey (at GW, Cornell and overseas) and all 3 advised to try lower doses after looking at my labs and protocols. The main thing for me though is that all protocols high and low dose were BFN. So, in the end, it didn't make any positive difference (other that saving a bit on the cost of meds).

I think it's important not to have any regrets and what ifs at the end of the journey. If it's your last round, do what you think you'll be able to live with even in the case of a negative outcome. Hug and baby dust to you.