New here - need protocol advice

marioana99

Hi everyone! I am in the same boat as everyone else here I guess, 36 going on 37, TTC since I was 34, started IVF at 35 with a DOR diagnostic. Last AMH was 0.48, FSH was 13 at his highest , AFC 7 to 10.
First IVF  was antagonist protocol, second micro-flare lupron, third estrogen priming (slow response and got triggered when progesterone started rising), fourth testosterone priming and only got 2 folicles, and 5th was A/ACP with estrogen priming. The A/ACP seemed promising(7 follicles, 4 leading), but with the 7 days of estrogen priming and slow response we got with stims at day 19 when LH started rising and I ovulated on my own, so we converted to an IUI that didn't succeed. I kind of like the idea of the A/ACP with ganirelix from the first day of cyle to suppress LH, but I was wondering if anyone did it without the estrogen priming. Or if anyone has any other suggestions forprotocols the work for DOR...

JamieH2000

I have DOR as well, and my best response by far was what my clinic called the Schoyer protocol and then antagonist. I did estrogen priming during my luteal phase with 3 shots of ganirelax (usually around days 20-22). Then we did max stims (450 follistim, 150 of menopur) and then added in ganirelax as we got closer to trigger. Perhaps you tried something similar already, but thought I would throw it out there. I only had an AFC of 13 that cycle and was able to get 12 eggs (8 mature), which I really didn't think would be possible for me. It didn't work, so now we are moving on to donor since it appears to be more of a quality issue for me. Best wishes on finding the right protocol!

marioana99

yeah, I did the same protocol on my 3rd cycle. I got the most follicles, 9 but only got 3 eggs and none fertilized. It might have to do with the DHEA that I was on for more than 6 months, but not sure. It's clear that I have quality issues, but to me it looked like quality was getting worse with every cycle, the more I was on DHEA the worse it got. So I stopped DHEA after cycle 4, but this cycle I didn't retrieve anything so I am not sure if my theory is ok or not...

[Deleted User]

Hey welcome!  I have not cycled yet so I know less than zero about the all the meds, but I am lurking hard and super curious to learn.

My doctor gave me an idea of the protocol she wants to try for me, but it will ultimately depend on test results, too. Maybe someone who has more experience or knows what its called?  I think it's *"antagonist" maybe?  But I don't know what that means bc I have seen so many different protocols all called that... Or what the deal is with the hcg?
<img alt="" src="https://us.v-cdn.net/5020794/uploads/editor/tw/jore1z2xkufa.jpg">
Not to hijack your thread OP, but maybe just help keep the conversation going???  o:) I hope?? 

~~~~~~~~~~
<div class="Quote">@JamieH2000 said:Then we did max stims (450 follistim, 150 of menopur) and then added in ganirelax as we got closer to trigger. </div>My bff has dor and just did this exact protocol! She got two 3-day blasts to transfer and ***TW*** and she's now 7+3 with a singleton. **/TW**

marioana99

HCG is for maturing the eggs at the final stage, not sure about the low dose HCG during stims. Ganirelix is to stop ovulation and folistim is to grow the eggs. It looks like an antagonist protocol, low dose. Depending on how you are going to respond your RE might increase the dose of folistim. I remember on my first cycle I started with 225 folistim and 75 menopur for the first 3 days, and after the us on the 4th day they increased it to 350, then to 400. 
Any reason you are doing FET instead of fresh?

[Deleted User]

Hey thanks for the input @marioana99 :)

I asked my nurse about it bc I wasn't sure, but turns out, they <i>only</i> to fet at this clinic, bc their research shows better outcomes when the estrogen is not so high as it can get during stimming?  We are also having PGS because 1. Azoo (make sure they each got a healthy sperm+egg combo) and 2. We would eventually hope to transfer all, so my doctor doesn't want to waste that time, energy and pain transferring anything we know is non-viable. :/

I guess she said the low-dose hcg helps produce more mature follicles?  I think???

SP128

@BusinessWife this is my first ivf and I had low dose hcg in my protocol too. Are you going to be using Caremark- cvs specialty pharmacy by any chance ? I was lurking over at ttgp earlier and thought I saw an older post of yours. If so, they are a pain and would love to share my experience!

[Deleted User]

@SP128. Yes!!!  I will be!  What happened??

SP128

@BusinessWife ok. My insurance (tufts) made me use them. Cvs specialty and Caremark are the same but different in a way. I had my own health insurance before I got married and their systems didn't link so drug wise, it showed my insurance expired. It was a cluster to fix. 

Cvs specialty is in Illinois. They are not open on weekends, meaning if you need something for Monday you best have them deliver it on Friday so you can get it Saturday. 

Keep in mind how early you order mess bc the low dose hcg has a shelf life of 14 days from when it is mixed. 

I I just got delivered hcg and certitide just in case I didn't trigger last night. Now the hcg will go to waste. Will prob use the other meds another cycor if this one doesn't work. 

I had had two shipments, one I requested that I have to sign for it. The second I instructrd to leave at door since I was going to be at work. Well, they screwed that up. It all ended up working out but it was stressful bc I needed the hcg that night. I called and asked what the problem was and they said the instructions never switched in their system. 

However, they did a good job with getting me an override to a local cvs last week when I was going to run out of gOnal f. Score for them. 

I made the mistake of assuming that my shipment contained all the meds I needed. Wrong. 

SP128

@BusinessWife one more thing. I got my estradiol from Walmart. It's part of some kind of drug program. It only cost $4 cash, didn't go through Insurance. My dh asked the pharmacist how much it would cost using insurance and he pretty much said it's not going to beat $4!

Cowboycorgi

@BusinessWife, I did the follistim/menopur Antagonist protocol as well. 

*TW* I now have a 15 month old from my fresh round, and I am *barely* pregnant from June FET.
*End TW*

That protocol worked very well for quality eggs for me. I also used Walmart for my drugs and ended up saving almost $2000, and had no hassles. 

[Deleted User]

@SP128 wow, what a fiasco!  I will remember that about ordering the low dose hcg.  For me its only the low dose (compounded) and the 10,000 trigger that will go through Specialty.  I will definitely check the estradiol!  IKWYM about those walmart prices - amazing deal for some things!  Caremark quoted me $2.11 copay, but IDK what quantity, so that obv makes a difference.  GL with your retrieval!!!  When is it scheduled?

@Cowboycorgi. Congratulations!!!  That is awesome news!  How many frosties did you get?  We are hoping for the same - since we always wanted a bigger family, I will be sure to talk to our doctor about what point we would consider repeating the cycle before moving onto transfers, since I'm 34... I don't know how our insurance works, but we won't have a package or anything, so fx we can kind of do what we want. wishing you a H+H9mos!!!  So exciting. :)
*typos

Cowboycorgi

@BusinessWife, Thank you! We ended up with 6 frosties, and now have 4 left. We are completely OOP, so that was our last shot at getting quality embryos. I do work with a very low cost clinic though, so IVF with ICSI was only 6k (minus meds). I'm grateful to be so close to a more affordable clinic. My first clinic quoted me 13k per round with no insurances. 

FX That a new protocol works for you! We are 35, and having more than 1 was important to us, but (like most infertile couples) even having 1 was a miracle of science for us! 

SP128

@BusinessWife  Today!!!  It's scheduled for 1:30 pm.  Eeek

[Deleted User]

@SP128. Aahh!!!! GL!!! You totally got this!

@Cowboycorgi. This will be our first cycle!  We had to wait long enoigh for DHs clomid to hopefully increase our chances of getting sperm to freeze first.  Plus then once we saw our oop bill, I did a litle research and went out and found a job with anazing IF covrrage and no lifetime cap.  DHs procedure was goong to be about $7500 alone.  Then my cycle, plus meds, plus icsi, plus pgs.... then another 5-6k per FET... Like we were looking at 40k just to get us to our first kid.  :o. That is so great that you live close to a more affordable clinic!  We are in NJ so maybe here notsomuch.  So DH has a $500 deductible, then 80/20 up to $2000, then 100% covered.  So he will use his oop max up, or close to it anyway, with his retrieval.  And then he's done lol (not sure if sperm cryo if we were to keep it longer than the year would stay under his or what)  then there's me and my $2000 oop max (for the year) so I am incredibly relieved to be going from 40k to 4k!!!

Obv each year would bring new things like embryo cryo, transfer cycles, L&D, but nothing like that first retrieval.  I had no idea till I saw it on paper just how costly that can be.  And omg!!!  If only DH could just give a sample the old fashioned way!!! Lol

So glad that you were able to get so many!!!!  It is truly amazing.

Cowboycorgi

@BusinessWife, I can't imagine how you felt when you added it all up and saw the cost of getting a chance to have a child. When we were first going through IVF, so many people talked cost with us and said ' but it will be worth it to hold your future children'. They really didn't understand that infertile couples are spending tens of thousands for only a chance at having kids. It's all a potentially heartbreaking gamble.

marioana99

So I just met with my RE, she was leaning between sher and antagonist, and she didn't want to shorten the sher protocol (skip the estrogen priming step) so we will do sher again, but this time adding full dose of ganirelix on day 6, hopefully I won't ovulate again...