Suggestions for protocol for 39-year-old w/normal (not great) reserve?

[Anonymous]

I recently finished an IVF cycle with not great results and would love to get suggestions on a new protocol to try (I have consults set up with two new REs in the area in the next few weeks and would like to go armed with information). My current RE put me on a microdose lupron protocol, with about 10 days of BCP leading up to it. I was on fairly low doses of follistim (225 units) and menopur (2 vials) for 9 days and ended up four eggs retrieved and fertilized, three blasts sent off for PGS (awaiting results). I also added HGH the last five days of stims. Since it seems almost certain I will get 0 or 1 normal at my age, I'm planning for the next cycle with a new doctor. My AMH is 1.5, FSH 7.1 and AFC 17 (for the cycle that I just completed - had a CD2 u/s today and AFC is 15). I'm thinking about either natural start or estrogen priming protocol. Any other suggestions? Thanks in advance.

[Anonymous]

did estrogen priming and only got 3 eggs out of it but one of them took and became my daughter so it "worked" in that sense. not sure if it failed what would have been the next step, though

[Anonymous]

Anonymous wrote:I recently finished an IVF cycle with not great results and would love to get suggestions on a new protocol to try (I have consults set up with two new REs in the area in the next few weeks and would like to go armed with information). My current RE put me on a microdose lupron protocol, with about 10 days of BCP leading up to it. I was on fairly low doses of follistim (225 units) and menopur (2 vials) for 9 days and ended up four eggs retrieved and fertilized, three blasts sent off for PGS (awaiting results). I also added HGH the last five days of stims. Since it seems almost certain I will get 0 or 1 normal at my age, I'm planning for the next cycle with a new doctor. My AMH is 1.5, FSH 7.1 and AFC 17 (for the cycle that I just completed - had a CD2 u/s today and AFC is 15). I'm thinking about either natural start or estrogen priming protocol. Any other suggestions? Thanks in advance.

4 eggs retrieved doesn't seem "normal" reserve. Did you have a follow up appointment? Did your Dr offer any explanation why out of AFC 17 you got only 4 eggs retrieved? What happened to the rest? Knowing that is the key for your next cycle.
Your FSH is on the high side too. You could ask at your consults if estrogen priming without BCP is a good fit for you.

BTW, which clinic in this area uses HGH in protocols?

[Anonymous]

Anonymous wrote:

Anonymous wrote:I recently finished an IVF cycle with not great results and would love to get suggestions on a new protocol to try (I have consults set up with two new REs in the area in the next few weeks and would like to go armed with information). My current RE put me on a microdose lupron protocol, with about 10 days of BCP leading up to it. I was on fairly low doses of follistim (225 units) and menopur (2 vials) for 9 days and ended up four eggs retrieved and fertilized, three blasts sent off for PGS (awaiting results). I also added HGH the last five days of stims. Since it seems almost certain I will get 0 or 1 normal at my age, I'm planning for the next cycle with a new doctor. My AMH is 1.5, FSH 7.1 and AFC 17 (for the cycle that I just completed - had a CD2 u/s today and AFC is 15). I'm thinking about either natural start or estrogen priming protocol. Any other suggestions? Thanks in advance.

4 eggs retrieved doesn't seem "normal" reserve. Did you have a follow up appointment? Did your Dr offer any explanation why out of AFC 17 you got only 4 eggs retrieved? What happened to the rest? Knowing that is the key for your next cycle.
Your FSH is on the high side too. You could ask at your consults if estrogen priming without BCP is a good fit for you.

BTW, which clinic in this area uses HGH in protocols?

OP here. I agree, four eggs does not seem normal at all. I had nine follicles of varying sizes the day before retrieval, with about six over 18mm. my WTF appointment hasn't happened yet. I don't tend to think of 7.1 FSH as on the high side - if anything it's probably my AMH not being as high as some others my age, though I have seen many people with similar or worse numbers do much better than I did. Plus doesn't FSH reflect quality, not quantity? If anything, the few eggs that I did get seem to be of good quality since almost all reached Day 5. She said she drained all of the follicles and that was all they got. I'm not in DC - in California. I specifically asked for the HGH so she put it in and will continue to do so for next cycle(s). Even if it didn't help with quantity, I suspect it helped with getting as many embryos to blast as I got.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I recently finished an IVF cycle with not great results and would love to get suggestions on a new protocol to try (I have consults set up with two new REs in the area in the next few weeks and would like to go armed with information). My current RE put me on a microdose lupron protocol, with about 10 days of BCP leading up to it. I was on fairly low doses of follistim (225 units) and menopur (2 vials) for 9 days and ended up four eggs retrieved and fertilized, three blasts sent off for PGS (awaiting results). I also added HGH the last five days of stims. Since it seems almost certain I will get 0 or 1 normal at my age, I'm planning for the next cycle with a new doctor. My AMH is 1.5, FSH 7.1 and AFC 17 (for the cycle that I just completed - had a CD2 u/s today and AFC is 15). I'm thinking about either natural start or estrogen priming protocol. Any other suggestions? Thanks in advance.

4 eggs retrieved doesn't seem "normal" reserve. Did you have a follow up appointment? Did your Dr offer any explanation why out of AFC 17 you got only 4 eggs retrieved? What happened to the rest? Knowing that is the key for your next cycle.
Your FSH is on the high side too. You could ask at your consults if estrogen priming without BCP is a good fit for you.

BTW, which clinic in this area uses HGH in protocols?

FSH is not on the high side assuminf e2 is not masking it. four eggs is poor response but 3 blasts is decent response.

OP I had good FSH but low 39-40 and had poor response in terms of number of eggs. I had most eggs with natural start protocol but none of the three cycles actually work. I was eventually successful naturally.

[Anonymous]

If there were 15 follicles that they harvested, but only 4 eggs, it could have been an issue with the trigger timing or dose/type. I used a lupron trigger once and got a number of "empties." (they're not really empty, but they can't get the egg) You'll always lose some that will be too mature or immature, but 4 from 15 is low. I'd expect that to be more like 10ish mature eggs if you have the normal reduction in #s. However, to get 100% to fertilize and 3 blasts from only 4 fertilized eggs is fabulous. It's really about what you'd expect to get if you had 10 eggs mature eggs retrieved, so overall, I think you're in great shape.

I had the best response in terms of # of eggs from estrogen priming, using an estrogen patch and using a higher ratio of Gonal (Follistim) to Menopur. First round I got 8, but that was with estrace pills and equal ratio. Then I got 13 with the adjustments. I also did a lupron flare, but only got 5 eggs from that and early on it looked like it might only be 1. I had AFC of 9-10, FSH 6, but my AMH was 0.8. Nothing has worked yet, though.

I'm going to try a minimal stim - I was always on really high doses of stims (400 Gonal and 125-225 Menopur). Theoretically, this gets a low # of better quality eggs (kinda like it seems you did!)