Why Do Some IVF Cycles Include BC Pills/Lupron and Others Don't?

[Anonymous]

I've met with 2 different RE's to discuss their prototcol for me and IVF...SG wanted to put me on BC pills/lupron however Dominion recommended that I don't due to the possibility of oversupression. I'm 32, healthy. We're doing IVF for male factor reasons.

What is the difference between a cycle with BC pills/lupron and a cycle that doesn't include these meds?

Thank you for your help! I'm such a dummy when it comes to understanding this stuff!

[Anonymous]

Oversuppression is the typical reason.

[Anonymous]

There are pros and cons of both methods and RE's pick protocols based on how they think your ovaries will respond. However, many clinics prefer BC/lupron cycles because they can be manipulated for their scheduling purposes. When you do a cycle that starts on day 2 of your cycle, it's your body that is determining the timeline. I'm biased on this issue because I was definitely oversupressed with BC/lupron and had my worst side effects from these meds. I was successful with my 3rd IVF attempt using a microdose flare protocol.

[Anonymous]

Anonymous wrote:There are pros and cons of both methods and RE's pick protocols based on how they think your ovaries will respond. However, many clinics prefer BC/lupron cycles because they can be manipulated for their scheduling purposes. When you do a cycle that starts on day 2 of your cycle, it's your body that is determining the timeline. I'm biased on this issue because I was definitely oversupressed with BC/lupron and had my worst side effects from these meds. I was successful with my 3rd IVF attempt using a microdose flare protocol.

I also had luck on round 2 when they switched me to the microdose flare protocol.

[Anonymous]

i don't ovulate (never have) so i don't need b/c or lupron.

[Anonymous]

OP here...thank you so much for your replies. So helpful.

Can someone tell me what a microdose flare protocol is. ??
Thank you!

[Anonymous]

http://www.ivfmd.net/Treatment/treatment2.htm

Found this link to the three most common protocols. Hope this answers your questions -Good luck!

[Anonymous]

Hi OP,

I've tried a number of different protocols myself because I'm a poor responder (and much older). I don't agree with the view that SG uses BC pills to schedule patients - they are open nearly 365 days a year, so when a women has to go in for monitoring and retrieval makes no difference to them. Plus, in the two cycles I did there they didn't change the number of days I was on the pill - I started whenever my period came, and was on them for the pre-determined length of time. If they wanted me to go to retrieval on a certain day, they would have changed in the number of days that I was on the pill, which they didn't do.

I do believe that REs just have different views on which protocols work best, but the fact is that for someone like you (who is young and dealing with male factor rather than ovarian reserve issues) it is most likely that any of the common protocols you've been offered would work well and would be a reasonable place to start. Statistically, the success rates aren't much different for the major protocols. I say most likely because there are a small number of women with good ovarian reserve who do seem to react differently to different protocols and who have to try different ones to have a good cycle, but that is rare and something you can't know until you try a cycle.

One thing you could do to help with your decision is do a narrow search of the SART statistics for both clinics (for your age group and a male factor diagnosis) to see if there is much of a difference between the clinics. But really, IVF isn't an exact science and all you can do in the end is go with a reasonable plan (which both clinics have offered you) and see what happens.

[Anonymous]

If you are young with male factor, then micro dose lupron probably isn't the protocol for you (it's typically used for women with poorer egg quality or who they suspect won't respond well to the drugs -- not when male factor is the only issue).

I did 3 cycles at SG. One with BCPs/lupron, one with BCPs and ganirelex (sp?) not lupron, and one without BCPs but with lupron (the lupron stop protocol). So any combo of BCPs and lupron is possible. Using BCPs can be for both medical reasons and scheduling reasons (it helps SG predict when you will start stims and they try to prevent too many women from starting stims the same day). the cycle when I did not use BCPs, day 2 of my cycle was later than expected and my nurse had to fight with the scheduling people to get my stim drugs start date changed since that date was already "filled". But it all worked out in the end.

[Anonymous]

OP here...THANK YOU ALL SO MUCH! Your posts are so incredibly helpful. I appreciate the link to the different protocols as well. Hopefully one of these protocols will work!

[Anonymous]

I disagree with the poster that said SG doesn't use these protocols for scheduling reasons, they are a huge clinic and they must limit how many patients start on any given day. Unfortunately, just bc your young doesn't mean you will respond well (I was 29 my first cycle) and Dominion makes that decision solely on your individual situation.

[Anonymous]

"I disagree with the poster that said SG doesn't use these protocols for scheduling reasons, they are a huge clinic and they must limit how many patients start on any given day."

So tell me just exactly how they do that?

If everyone is scheduled to be on birth control pills for three weeks, but some get their period 2 days early and some 2-3 days late, and others are on a 35 day cycle rather than a 28 day cycle - how does the use of birth control pills help with scheduling? It is not like they tell patients that they have to stay on birth control pills for a longer or shorter period of time just to be on their schedule - they don't. Plus, there are many other factors that change someone's retrieval schedule - you end up being on lupron for two weeks instead of one, or you end up stimming for just 9 days or 13 days rather than 11, for example.

Believe me, I'm not a huge fan of SG and I've criticized them for other things, but I just don't buy this one. I did two cycles with them. My nurse never filled out the dates of my protocol all the way through because there was just two much uncertainty as to what would happen when once I got started. I was never given any indication that I may not be able to start a cycle on a particular day because they were busy with other patients. And I certainly was never told, and have never heard of anyone else being told, that my time on birth control pills had to be changed to meet their schedule (beyond working around their annual lab closure). So I'm really curious as to how you think this occurs.