Your best tips and recommended protocols for DOR?

[Anonymous]

I will be going into my third IVF cycle shortly and have an appointment next week to talk to my doctor about the protocol. I'd love to hear your tips and protocols that worked for those of us with DOR (I am 39), thanks.

[Anonymous]

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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

[Anonymous]

Apologies if this is not relevant to your question (this is more about egg quality than specific protocols), but in case you haven't already, I read It Starts with the Egg and basically followed those recommendations, which involved taking supplements like Co Q10 (specifically ubiquinol) and DHEA (with my RE's blessing, after she saw how low my testosterone levels are), and some extra antioxidants. I also tried my best to avoid pthalates and BPA, which basically meant buying glass containers for my lunch and buying fragrance free products where possible (but did not go crazy with this). The book is evidence based and was a good way to weed out all of the non evidence based stuff you see online about improving egg quality. I did not do IVF as I got pregnant on my second IUI cycle (just about 3 months after I started DHEA).

[Anonymous]

may i ask what clinic you're going to? i have DOR but my doctor thinks he is fresh out of ideas.

[Anonymous]

I am the OP and at GW if you are asking where I am vs the 11:09 poster.

PP, thanks for the It Starts with the Egg tip. I've read it closely and follow a lot of its advice. It is so hard to avoid all plastics!

[Anonymous]

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

I just emailed with my doc and she recommends doing estrogen priming along with a mini stim of max 225 IUs. What do you base the "not to exceed 150-175 IUs of Follistim" on? And what is the difference between Clomid priming, if you will, and estrogen priming?

Also, why did you have to go out state? No one in the area would do this protocol? Thanks.

[Anonymous]

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

What is your AFC and how many more eggs did you end up producing on this particular protocol vs others?

[Anonymous]

Anonymous wrote:I am the OP and at GW if you are asking where I am vs the 11:09 poster.

PP, thanks for the It Starts with the Egg tip. I've read it closely and follow a lot of its advice. It is so hard to avoid all plastics!

I see. I am also at GW with DOR and on my 2nd cycle. My doc doesn't seem to think there's much more to do for me. We've done estrogen prime and high and low stim on gonal f and menopur. Guessing you've already done that?

[Anonymous]

Anonymous wrote:

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

I just emailed with my doc and she recommends doing estrogen priming along with a mini stim of max 225 IUs. What do you base the "not to exceed 150-175 IUs of Follistim" on? And what is the difference between Clomid priming, if you will, and estrogen priming?

Also, why did you have to go out state? No one in the area would do this protocol? Thanks.

Hi PP. I suggested that particular number because that was basically my protocol at Cornell. I did I think 4 retrievals with them. They are widely lauded on this board to be a great clinic for those with DOR. Of course, our bodies are all different so what worked well for me might not work for you, and I think starting out with your doctor's suggested protocol is fine, and then if that doesn't work, maybe go down from there. I am not sure I can explain the scientific differences between estrogen priming and Clomid... only that EPP by itself never worked well for me. With Clomid added, I saw a marked increase in my follicle count. What I forgot to mention in my first post is that Cornell actually DID start me on estrogen patches (as opposed to BCP). If you are interested, I have everything in a Google calendar. So yes, I began with a patch, then started stimming with Clomid, then added in the injections.

I always start out with a decent AFC (10-20) and then, when I was on high stims, by the time I got to retrieval, we'd get 4-6 eggs. I would always go for monitoring at Cornell after taking the first few doses of Clomid and marvel at the screen. The doctors doing the monitoring would always attribute things to the Clomid. Upon my first retrieval there, they got 25 eggs. I was shocked, since I came from a Dr at SG who said I had DOR. That said, it does have a tendency to thin your lining... though it rarely inhibited implantation for me.

I went out of state because my doctor at SG was not very receptive to me changing up my protocol and I was just over it. By the time I was done at Shady Grove I was just so down and fed up that I wanted to find "the best" clinic (and I did meet with one of the CFA doctors before I chose to go out of state but she was very pessimistic about my case). I was in between CCRM and Cornell and chose Cornell.

[Anonymous]

Anonymous wrote:

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

What is your AFC and how many more eggs did you end up producing on this particular protocol vs others?

My AFC at Shady Grove hovered around 10-12, and at Cornell it was usually between 16-20, sometimes more. I attribute that to suppressing with estrogen patches as opposed to BCP which had the tendency to shut my body down.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I am the OP and at GW if you are asking where I am vs the 11:09 poster.

PP, thanks for the It Starts with the Egg tip. I've read it closely and follow a lot of its advice. It is so hard to avoid all plastics!

I see. I am also at GW with DOR and on my 2nd cycle. My doc doesn't seem to think there's much more to do for me. We've done estrogen prime and high and low stim on gonal f and menopur. Guessing you've already done that?

Hi, OP here, yes, I did an initial cycle with estrogen priming and then combo of Gonal and Menopur. 3 follicles, 2 eggs, 2 fertilized, 2 transferred on day 3, BFN. The second cycle we did a Lupron flare protocol with 450IUs of Gonal. 3 follicles, 2 eggs, 1 fertilized, day 2 transfer, still awaiting outcome but it's not looking good. My doc is now proposing the mini stim, see more details above. AFC is 7-8 by the way, what's yours? Who are you seeing at GW?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

I just emailed with my doc and she recommends doing estrogen priming along with a mini stim of max 225 IUs. What do you base the "not to exceed 150-175 IUs of Follistim" on? And what is the difference between Clomid priming, if you will, and estrogen priming?

Also, why did you have to go out state? No one in the area would do this protocol? Thanks.

Hi PP. I suggested that particular number because that was basically my protocol at Cornell. I did I think 4 retrievals with them. They are widely lauded on this board to be a great clinic for those with DOR. Of course, our bodies are all different so what worked well for me might not work for you, and I think starting out with your doctor's suggested protocol is fine, and then if that doesn't work, maybe go down from there. I am not sure I can explain the scientific differences between estrogen priming and Clomid... only that EPP by itself never worked well for me. With Clomid added, I saw a marked increase in my follicle count. What I forgot to mention in my first post is that Cornell actually DID start me on estrogen patches (as opposed to BCP). If you are interested, I have everything in a Google calendar. So yes, I began with a patch, then started stimming with Clomid, then added in the injections.

I always start out with a decent AFC (10-20) and then, when I was on high stims, by the time I got to retrieval, we'd get 4-6 eggs. I would always go for monitoring at Cornell after taking the first few doses of Clomid and marvel at the screen. The doctors doing the monitoring would always attribute things to the Clomid. Upon my first retrieval there, they got 25 eggs. I was shocked, since I came from a Dr at SG who said I had DOR. That said, it does have a tendency to thin your lining... though it rarely inhibited implantation for me.

I went out of state because my doctor at SG was not very receptive to me changing up my protocol and I was just over it. By the time I was done at Shady Grove I was just so down and fed up that I wanted to find "the best" clinic (and I did meet with one of the CFA doctors before I chose to go out of state but she was very pessimistic about my case). I was in between CCRM and Cornell and chose Cornell.

I'd love to see the calendar if you could post a link. Also, do you mind sharing your age and AMH/LH? Thanks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am the OP and at GW if you are asking where I am vs the 11:09 poster.

PP, thanks for the It Starts with the Egg tip. I've read it closely and follow a lot of its advice. It is so hard to avoid all plastics!

I see. I am also at GW with DOR and on my 2nd cycle. My doc doesn't seem to think there's much more to do for me. We've done estrogen prime and high and low stim on gonal f and menopur. Guessing you've already done that?

Hi, OP here, yes, I did an initial cycle with estrogen priming and then combo of Gonal and Menopur. 3 follicles, 2 eggs, 2 fertilized, 2 transferred on day 3, BFN. The second cycle we did a Lupron flare protocol with 450IUs of Gonal. 3 follicles, 2 eggs, 1 fertilized, day 2 transfer, still awaiting outcome but it's not looking good. My doc is now proposing the mini stim, see more details above. AFC is 7-8 by the way, what's yours? Who are you seeing at GW?

My AFC is typically 3-5. I see Dr. Humm. I was successful once with them but that was when I was 31 (same AFC, same AMH --0.3).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

I just emailed with my doc and she recommends doing estrogen priming along with a mini stim of max 225 IUs. What do you base the "not to exceed 150-175 IUs of Follistim" on? And what is the difference between Clomid priming, if you will, and estrogen priming?

To clarify, you can do EPP and clomid in the same cycle. Clomid is used as part of a low dose/mini stim cycle and as part of the stim meds. EPP or BCP are the ways to prep the ovaries so that you start the cycle with all the eggs at the same stage, so as many as possible are ready at the same time. BCP can be overly suppressive, so the EPP method is often used for DOR or older people. Both BCP and EPP involve estrogen taken prior to the start of a cycle, just in different ways/amounts.

I did this type of cycle at Dominion, but the idea came from a Cornell consult and a lot of research on my part b/c I didn't have DOR, but am older. This cycle was much better for my egg quality (I did also take ubiquinol and fish oil and later a lower dose of DHEA, of those I can only say that ubiquinol was clearly helpful). When I talked to Cornell, they basically said it was a good option if you knew you'd only get a few eggs anyway, and they focused on doing a day 3 transfer and other lab differences they thought were important. So initially I didn't go with them b/c I was thinking that its all a #s game (which is not entirely true), and I did go on to SG and do cycles with plenty of eggs, but no blasts. We had MF issues, too, so I chased down whether that was the issue as some docs say it is when you don't get blasts, but it most certainly wasn't (DH had normal DNA frag test and DE cycle results were perfect with very high fertilization rate). As I looked into it further, I found info that suggested that high stims can be bad for quality, esp menopur, so I tried the mini, and while I had much better results (higher fert rate and more blasts), it wasn't successful (chemical) and I had already been going for a couple years and had gotten even older, so I decided to stop there. I do wish I'd gotten there much sooner and would have been able to try that protocol several times and a couple years younger, but I did what I thought best based on the info I had at the time, so no regrets - just frustration at the lack of reliable info in the process. I did DE and it worked, but feel like I should share info since I got ideas for things to look into from this and other boards.

Unfortunately, the research in this area isn't great and lots of docs have their go-to thing that's often based on their own limited experiences rather than good data. Anyway - I know it's tough to sort through the info, but I hope you're successful!

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote: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. This did wonders for my cycles. I produced more eggs of higher quality. Good luck, OP. I also had to go out of state.

I just emailed with my doc and she recommends doing estrogen priming along with a mini stim of max 225 IUs. What do you base the "not to exceed 150-175 IUs of Follistim" on? And what is the difference between Clomid priming, if you will, and estrogen priming?

To clarify, you can do EPP and clomid in the same cycle. Clomid is used as part of a low dose/mini stim cycle and as part of the stim meds. EPP or BCP are the ways to prep the ovaries so that you start the cycle with all the eggs at the same stage, so as many as possible are ready at the same time. BCP can be overly suppressive, so the EPP method is often used for DOR or older people. Both BCP and EPP involve estrogen taken prior to the start of a cycle, just in different ways/amounts.

I did this type of cycle at Dominion, but the idea came from a Cornell consult and a lot of research on my part b/c I didn't have DOR, but am older. This cycle was much better for my egg quality (I did also take ubiquinol and fish oil and later a lower dose of DHEA, of those I can only say that ubiquinol was clearly helpful). When I talked to Cornell, they basically said it was a good option if you knew you'd only get a few eggs anyway, and they focused on doing a day 3 transfer and other lab differences they thought were important. So initially I didn't go with them b/c I was thinking that its all a #s game (which is not entirely true), and I did go on to SG and do cycles with plenty of eggs, but no blasts. We had MF issues, too, so I chased down whether that was the issue as some docs say it is when you don't get blasts, but it most certainly wasn't (DH had normal DNA frag test and DE cycle results were perfect with very high fertilization rate). As I looked into it further, I found info that suggested that high stims can be bad for quality, esp menopur, so I tried the mini, and while I had much better results (higher fert rate and more blasts), it wasn't successful (chemical) and I had already been going for a couple years and had gotten even older, so I decided to stop there. I do wish I'd gotten there much sooner and would have been able to try that protocol several times and a couple years younger, but I did what I thought best based on the info I had at the time, so no regrets - just frustration at the lack of reliable info in the process. I did DE and it worked, but feel like I should share info since I got ideas for things to look into from this and other boards.

Unfortunately, the research in this area isn't great and lots of docs have their go-to thing that's often based on their own limited experiences rather than good data. Anyway - I know it's tough to sort through the info, but I hope you're successful!

How old were you through all of this?