Changing Drug Protocols - Question for those who have done more than one round of IVF (PAIF welcome)

emmuffy

For those of you who have gone on to do a second (or third, or fourth) IVF, have you kept the same drug protocol or changed it? I was on the antagonist protocol (estrace/androgel, followed by Gonal 300/Menopur 75), and I responded relatively poorly, with disappointing egg/embryo quality (8R, 5M, 3F, 1 morula to transfer). I'm 31 with unexplained IF. I have heard of people changing protocols and experiencing better results on a subsequent round of IVF, and this is something I am interested in exploring. My current RE says that changing drug protocols makes no difference, and that if I did a subsequent IVF, my results would most likely be similar. I'm considering whether to attempt another round of IVF, and I'd be interested in trying a different protocol to see if it led to a better outcome. I'm getting a second opinion on my situation from another fertility clinic. I'd appreciate hearing from those of you who have done more than one round of IVF - did you change your drug protocol (or anything else)? Did your RE support making changes to your protocol, or did you switch clinics? Did you see much of a change from one IVF cycle to the next? If you have low AMH/DOR, or egg quality issues, did you find changing your drug protocol helped your situation?

Mrs.Ess

I hope you don't mind me responding as I'm only on my first round. If it were me and the RE was unwilling to try or suggest any changes, I would definitely get a second opinion.

Also, many of the ladies on here have mentioned low dose HCG in the place of Menopur and it seems several have seen an improvement with that adjustment. It seems lazy to me that the RE would just say you're doomed to have the same results and doesn't have any ideas on other options. You (or your insurance company) are paying him/her a LOT of money so that's unacceptable to me. I hope you get some good suggestions here!

alpCRNA

I have not started IVF #2 yet, but had poor embryo quality with my first IVF.  My RE wants us to change protocols (from antagonist to long-lupron) for IVF#2.  I was told there is no guarantee we will have better quality embryos, but some women do respond better to different medications.  So, it was worth a try.  I posted a similar post on this board and cross posted to PAIF a week or so ago.  It may be worth reading, as several people did post having better quality embryos on different protocols.

emmuffy

Thanks @alpCRNA. I will look for that. Do you happen to know what it is about Lupron that is thought to make a difference? I'm just curious about the theory/science behind the different approaches. GL with IVF#2

jessimi06

I was on the antagonist protocol for ivf #1 and responded so poorly (2 follies) that I was cancelled. We switched to a lupron protocol the next cycle and got much better results. The RE gave us the choice to go antagonist again but more aggressive (max dose of stims) or switch to lupron on a higher dose of stims than we were on for round 2, but not max. She did warn me that I could over respond (I have PCOS) and I might have to do a freeze all, but we ended up with 6 eggs (all mature) and weren't even close to overstimulation (even though I have PCOS and high antral follicle counts my body responds more like someone with DOR).

I would definitely ask your current and second option re about switching up your protocol or adding in more supplements? I'm mobile so can't see your siggy. GL!

Grateful&Thankful

PAIF*****

Sorry to be so blunt but I'd dump your RE & run as fast as you can. There are tons of women who have changed protocols and found success or improvement. My first RE was brilliant but also a pompous jerk who thought his way was the only way. Like your RE he told me changing protocols would not make a difference. I got a second & third opinion and left him. (((HUGS)))) I know it's not fun starting all over but sometimes it's necessary!

gsancho

My RE did a few tweaks after my first try was converted to an IUI due to poor response.  Is it bad I don't know the official protocol names?  My RE calls them odd names.  First time I did Lupron and Follistim only.  Second time I did what he calls a banking cycle, where they basically put me on a ton of meds and do a freeze all (to let my body calm down, I guess).  It was Lupron, Follistim, Menopur, Estradiol, and Ganirelix.  It was an expensive cocktail, but it worked.  I went from 3 mature eggs on the first try to 8 - technically they measured 10 mature before retreival.  

I think a second opinion will be great.  I understand some REs not wanted to do a 180 on the protocol, but I don't see why he has to be against making even minor changes.

saratrying

Definitely consult with another RE/clinic if you can. My first RE gave me that line. I tried the same protocol twice, and each time I was converted from IVF to IUI after stimming for more than 10 days (dominant follicle issues and poor response). Before our third try, I consulted with another RE who said adjustments should be made, even something as simple as dosing. I'm on my third RE (RE#2 was an ass), and he said the same thing. I feel like I wasted an entire year because my first RE was unwilling to make adjustments. 

I had a BFN on IVF#1 (which was IVF try #3), but it was the first time I made it to a retrieval and transfer, so I think that's a positive. This was an antagonist cycle (menopur, follistim, ganarelix) and I had the response I've ever had (18 eggs, 9 mature, 8 fertilized, transferred 3, nothing to freeze). For IVF#2 he's switching me to the microlupron flare protocol. 

Good luck to you!

ronniesgirl1981

I'm in a similar spot. I've tried antagonist twice and MDL once. I had no response to the MDL cycle. I only made it to ER once. I've scheduled two second opinion appts and am looking into cycling out of state. It sucks, but I agree with others that a second opinion is in order.

alpCRNA

@emmuffy  My RE said that they don't really know why I had poor embryo quality since we don't have any risk factors for poor egg quality.  She said some women produce poor quality eggs on some medications and produce better quality eggs on others.  She didn't really provide any science behind it.  She also didn't say we would definitely have a better response, but figured trying something different was better than doing the same thing that did not work.

blueeyes233

I'm doing my third fresh cycle in November.  Each cycle has changed a bit, I'm with a new RE this time around and she is moving me from LLP to antagonist so we will see how that goes.  

My first cycle I did LLP with Bravelle and Menopur.  I stimmed for 12 days.  I had issues with immature eggs. We retrieved 16 eggs, 6 were mature, and 5 fertilized with ICSI.  Since I still had five good quality embryos on day 3, we did a 5dt with two blasts and froze one.  

My second cycle I did LLP with Bravelle and micro dose hCG.  Better response, unsure about egg quality, possibly stimmed too quickly (8 days).  We retrieved 27 eggs, 17 were mature, and 7 fertilized with ICSI.  On day 3 we only had three good quality embryos so we did a 3dt with two embryos and froze one blast on day six.  

This next cycle I will be doing an antagonist protocol with Follistim and microdose hCG.  I requested to stay on the hCG since my maturity % was much improved last cycle.  

ChristieH917

I just finished my second attempt.  My first protocol was 150 iu of Follistim in the morning and evening, then added Ganerlix about halfway into stimming.  I had only 4 follicles and low estrogen, than cancelled my cycle.

My RE changed my protocol for the second attempt.  He increased my morning dose of Follistim to 300 iu and changed my evening medication to Menopur at 300 iu.  He kept the Ganerlix.  I only got 6 follicles, but that's better than 4.  

My RE also said that this was the max dose of meds, which clearly isn't the same as other RE's because I have seen many women on much higher doses.  I am not sure that increasing my dosages was the right choice for me, so we are going back for a consultation and seeking a second opinion.   It can't hurt to get a second opinion.  If the new RE agrees with the first then you know it's the best choice for your situation.

The definition of insanity: doing the same thing over and over again and expecting different results.

Edited because my brain had more to say.

pblge

***PAIF response***

Agree with PP--get thee to a new RE!! In my case, it wasn't even a new protocol that was needed, it was just a doctor more skilled with the dosing. IVF #2.0 was antagonist protocol with Gonal-F and dilute HCG. Cancelled and converted to an IUI, which was BFFN, of course. IVF #2.1 was also antagonist protocol with Gonal-F, but with Menopur and good dosing. 33 retrieved, 31 fertilized. An absurd difference that my first RE could never have gotten from me. I am definitely a proselytizer for second and third opinions.

You've been through too much to have your RE tell you to keep doing the same thing. I hope your next RE will have a good plan for you!

KM721

@Buttmonkey34--You are right about Lupron, it sort of calms down your ovaries to keep them from flipping out and ovulating on their own once you hit the stims. 

I am about to start IVF#3. I have done the long Lupron for 1 and 2. However, my RE did up my dosage of Follistim by 75 units. Even though we still didn't have many to freeze, we got two high grade blasts. And, I could feel the difference in the whole cycle. For me, the dosage made a difference. Next time he changing the Follistim dose again and adding low dose Hcg to try to get the response to ramp up faster in the first few days. So...even though I've been on the same protocol, it hasn't really been the same. 

I agree with some other comments--I'd really carefully consider working with an RE who isn't willing to adjust things and also sounds somewhat insensitive.

Twinkie0612

For IVF #1 I did a long lupron protocol and had terrible results. (6R, 5M, 3F, 0 made it to blast for transfer).

 For IVF #2 we did what SIRM calls a agonist/antagonist conversion protocol, basically a combination of LLP and an Antagonist. My stims were also increase considerably. We had a better cycle 8R, 7M, 5F, and 1 made it to blast to transfer. That cycle ended in a c/p.

For IVF #3 we did the same protocol, but increased stims again. We had a slightly better response 8R, 8M, 8F, and 2 made it to blast for transfer. Cycle was a BFN.

 I've now been diagnosed with some immune factor infertility and will be working with both a new RE and also a RI (immunologist) for this cycle (IVF #4). We will be doing the same conversion protocol, but also adding estrogen priming. My RE also mentioned increasing my stims again, but I will know for certain when I get my calendar on Wednesday).  I will also be doing immune treatments with the RI (prednisone, lovenox, baby aspirin, and probably IVIG).

Sha259

For IVF 1.1 and 1.2 the main difference was my method of suppression. With 1.1, we did BCPs and Ganerelix, and my ovaries took a holiday. Needless to say, I was cancelled. With 1.2 we did not do BCPs at all, but did 2 wks of Lupron prior to start of stims, and then continued throughout stims at a lower dose of Lupron. We also increased my stims doses. In the end, I did get more eggs, but not along the lines of the 20+ at ER that you may see around these parts.

trayle01

***ticker warning*** siggy warning*** loss mentioned***


We will start IVF #3 in about 2 weeks. IVF #1 was successful and we have a 2 yr old. IVF #2 failed, it was done without bc and we lost the baby at 8.5 weeks pregnant. We will attempt IVF #3 this time back on bc and adding hgh for the first time.

ddvj79

Definitely get a second opinion! I dumped my first RE because she wouldnt even make an effort during our IUIs.
I'm on my first IVF cycle & yet to stim but my RE took into account my response during IUIs & has still put me on the antagonist protocol but put me on Follistim + low dose HcG rather than Follistim + Menopur because with I responded poorly to Bravelle 75IUs for 5 days during IUI (like still made just one mature follicle). 

People do respond differently to different meds, I dont know if I will respond to Follistim this time but atleast trying something different makes more sense than just still doing Menopur and some how expecting a different result.

Good luck! 

Carol77B

*Loss mentioned*

My results are in my siggy, but I went from BCPs and antagonist with IVF#1 to BCPs and micro-dose Lupron for IVF#2 and finally, to EPP and antagonist and got a BFP with that last protocol. However, after two failures, we also presumed I had an implantation problem and I took prednisolone, baby aspirin and Lovenox (blood thinner) with IVF #3 and I had an endo scratch the month before.  

I don't think your RE's attitude is very helpful, and agree that you should consider finding a new one, even in the same practice, if there aren't other clinics in your area.  However, if that isn't possible for some reason, you should ask him why he doesn't think a protocol change would help and discuss with him the protocols that he does support and find out how responsive he would be to you trying different things.  

I have found with mine, that I do have to be an advocates for my own care and need to do as much research as possible and bring that to my RE. He's very responsive to my suggestions, but I feel like I need to push for changes and options; I don't feel like he is as progressive as I would like without some prompting on my part.

Good luck!  

emmuffy

Thanks everyone for the detailed responses. I really appreciate how people take the time to provide such meaningful answers. It's nice that we're all trying to help each other out during our respective journeys. There's so much great support here. I will be booking a second opinion with a different clinic soon. Hopefully, I will get some good advice about what protocol might work better for me.

kz's_girlygirl

Sig warning*****





I had a much better response after a change in med protocol for IVF #2.  The details as far as numbers go are in my sig, but I basically had 3x the total number retrieved and 4 times the number mature. 

For IVF #1 I started Gonal F (300iu, I'm a low responder) and Menopur (150) on CD3 and then added ganirelix.  We only ended up with 1 normally fertilized egg. 

For IVF #2, We combined an estrogen priming protocol with lupron flare and antagonist...lol.  I had a baseline check, then went back on CD 21 to confirm ovulation (no bcp for me) and started 10 units of lupron and 2 mg estrace for 7 days.  When I got my period,  I went back for another baseline, then started 375 Gonal F, 75 Menopur, .8 ml HGH, dexamethasone and doxyxycline (only 7 days of doxy).  I added in Ganirelix for the last 4 days of stims. After ET, I used PIO, estrace and lovenox. 

Like I said, the response to IVF#2 was way better.  GL as you move forward, and I hope you are able to find a protocol (and RE!) that will really work for you!