I really would recommend you at least get a consult from Dr. Davis at Cornell. I got the exact same words from Widra, and ended up pregnant with my own eggs at Cornell although Widra gave me less than a 5% chance. I also had problems with a dominant follicle, was on the EPP at Cornell with lower stim doses and stimed for less days and got more eggs.

Oh man. OP, all I can say is that you're asking yourself the right questions, even though they have no easy answers. I guess one good thing about donor egg is that you don't have to make the decision right away, like you'd have to if you went through another IVF cycle.

What do you think about the suggestion of a natural IVF cycle that a previous poster made? From my understanding, they're less expensive (I don't know if the cost difference all that substantial, though). But maybe going that route would help you feel like you gave having another bio kid your last, best, try. Or maybe you're at that point already, which is okay, too.

I wish I had an answer. Good luck to you.

OP here: Oh to have the fortitude/money (think Alexa Stewart) to persevere over and over and over every month, years on end, nevermind the $$ . . . but, for those of us in the real world . . . ! Dr. Widra says next try Lupron stop (that is what worked for me three years ago, at 39) . . . but he doesn't hold out high hopes. Based on my FSH/AFC/Age 15-20% chance of a take home baby IF we make it to egg retrieval - and obviously, a dominant follicle is making that modest goal difficult.

Honestly, if I had endless $$, what the heck . . . keep trying. But, I don't.

So, the next option is donor egg. Dr. Widra said - "if you want a baby, do donor egg, you'll get a baby." (perhaps not those exact words, but definitely his point) Of course, there is no guarantee on that (other than $$ back - whoa - how can you resist?!) - but I have NO uterine/lining/blah blah problems/ I carried my DD to term with ZERO problems, so no reason to think donor egg would not be successful.

So - next existential crisis - do I REALLY want another baby?? In some odd, silly way, my thought process was - "well, odds are against us, so if I do IVF and it works, another baby was meant to be." That is, out of my hands, other than the odd grand or six. The fact that (Dr. Widra opines) I will have another baby if I want one (albeit through donor egg - and I'm fine with that) - makes me stop and think much more. So - I can have another. Do I really want one? What does it mean to parent a baby at 43??

OP - this is probably not what you want to hear, but I think the best person for you is probably Dr Davis at Cornell. From what I understand, EPP is usually a good protocol for dealing with the lead follicle problem. Davis is the best person for gradually tweaking your dose of stims each day to prevent a dominant follicle.

Anonymous wrote:Hi OP, what were your daily stim doses? I suspect that the issue of dominants may have more to do with dose level than with protocol. I had dominants ruin my first two attempts at IVF. I was on antagon and microdose flare protocols at SG when it happened. My RE started dosing me at 250-300 and never dosed me at higher than 450 stims. Subsequently I went to another center that put me on higher dose stims (600/d) and I never saw another dominant. Based on my personal experience, I have my own crazy theory that there are greedy dominant follies that want to hoard all of the available FSH, but if you have an excess FSH available at the very start of a cycle, this can be prevented. I also suspect it may be a waste of time if you start with a low dose and ramp up the dose during the cycle (the way my RE at SG did) because the dominant follicle has already started to take it's lead in the first couple of days, and once it does there's no going back. Like I say, this is just my personal theory on why dominants may happen and how to prevent them. I never had another dominant follie appear in any of the high dose cycles (there were quite a few...and yes, I did finally have success). I'm curious to get your thoughts!

new poster here.
I'm pretty young (34 at the time of IVF) and had normal FSH but was a poor responder and had dominant follicle issues (which is usually a sign of poor ovarian reserve/poor response, right?--i was never quite clear on this). In any case, I get WAY over suppressed on the long lupron protocol.
What ended up working was a Lupron stop protocol and then very quickly ramping up to super high doses of stims (I was on 450 of gonal f plus 150 of menopur so 600 total). I think I was on 600 by day 3 of stims (started at 450). I still ended up with a dominant follicle that was over mature at the time of retrieval but we also got 4 other eggs. I had one blast left by day 6 and now have a one year old.

This was at Shady Grove.

Hi OP, what were your daily stim doses? I suspect that the issue of dominants may have more to do with dose level than with protocol. I had dominants ruin my first two attempts at IVF. I was on antagon and microdose flare protocols at SG when it happened. My RE started dosing me at 250-300 and never dosed me at higher than 450 stims. Subsequently I went to another center that put me on higher dose stims (600/d) and I never saw another dominant. Based on my personal experience, I have my own crazy theory that there are greedy dominant follies that want to hoard all of the available FSH, but if you have an excess FSH available at the very start of a cycle, this can be prevented. I also suspect it may be a waste of time if you start with a low dose and ramp up the dose during the cycle (the way my RE at SG did) because the dominant follicle has already started to take it's lead in the first couple of days, and once it does there's no going back. Like I say, this is just my personal theory on why dominants may happen and how to prevent them. I never had another dominant follie appear in any of the high dose cycles (there were quite a few...and yes, I did finally have success). I'm curious to get your thoughts!

I would not use Widra or SG if you have a dominant follicle problem - I wasted three cycles w/ them as it is not their area of expertise. I would either do natural cycle w/ Dominion; try GW if your FSH is under 15; or go to Check's clinic in NJ or SHER in NYC for mini-stim.

OP, I would get a second opinion with Dr Gordon at DF, he may agree with your current RE on protocol but another set of eyes on your issue may be helpful.

OP, don't be discouraged yet. I would seek a different opinion at a different clinic if I were you. Unless you are too worn out emotionally to keep trying. I personally feel so tired from the whole TTC process after 5 years, I am attempting one last IVF and throwing in the towel after that and living my life child free. I put so many things on hold while TTC, I feel it's time to get my life back.

OP here - I think I would be oversuppressed on long lupron . .. I did lupron stop for my first (successful) IVF three years ago, and was a bit oversuppressed on that one - and my FSH/AFC has gone up/down since then. . . .

Sigh.

I would guess my RE (Widra at SG) will either (1) fire me; (2) want to try EPP again; or (3) suggest trying lupron flare.

We (my husband and I) are leaning towards throwing in the towel . .. odds of success of only 15-20% - and that only IF we make it to egg retrieval - are just so darn low . .. and every time we get cancelled its another grand out the door (meds and office visits).

Depressing.

Definitely change protocols - how about long Lupron protocol? What clinic do you go to?

OP here - first protocol was antagonist - suppression was 17 days of BCP prior to start of cycle. Second protocol was EPP (vivelle patch starting ten days after ovulation of preceding cycle plus three ganirelix shots just before period started). Not good that I still got a dominant follicle both times, eh? Freakin unbelievable/disappointing/annoying to go (both times) from perfectly low ET and all AFC < 10 on CD 2/3 to a 20 mm/E2 of 300 on CD 5/6 . . . .

Sounds like you need a different protocol.

What protocol were you on? This should not have happened if you were sufficiently suppressed.

I just had my second IVF cancelled after a dominant follicle magically appeared on the first stim check - nothing seen on CD 2/3, then one big 20 mm on CD 5/6 . . . . I'm feeling pretty discouraged and ready to give up on IVF. Anyone else have this problem? Were you able to deal with it/successful with IVF?