RP: DOR/high FSH/poor responders please come in - protocol question

kdussault

Briefly... I am currently at my third opinion RE.  The first one, in November 2009 was the first to check my FSH and found it to be high (20.3 in 11/09 and 14.3 in 12/09) and told me they would likely not even attempt IVF with my OE... second opinion because hearing that for the first time made me hate her... Second one looks at all the past test results and basically says the same thing "If we want to try IVF with your OE I would have to bring your case to the board of MDs and see what they have to say about it" - basically another, nope not using your OE.  So then a break happens and DH and I talk, decide we want the full pregnancy experience and decide DE is the way to go apparently... so without insurance, at the time, I call around to find the best clinic for financial and personality fitting.  I find my current RE who says "I need to look at you, 28, much differently than other women in their 40s with the same numbers"  He does more testing (FSH - 12.8, AMH 0.71 - i think - it was really low) and says he THINKS we might have a fighting chance and he would like to try a round of IVF with my OE before moving on... AWESOME!  So he puts me on high doses, apparently (this is where I need help) of 10units Lupron 2x/day and 300iu Follistim 2x/day following the Lupron Microdose protocol.  After about 10 days of Follistim I ended up with only one dominant follicle and a few unmeasurable (they don't measure under 10 at my clinic) and a couple cysts in the opposite ovary that appeared to be breaking down on their own.  It got converted to an IUI, a BFN and now RE says our next step is DE as he doesn't think he can get me to respond any better, already being on high doses, and he had said "we would try one IVF with my OE, after all, I went to him expecting to do DE"

So, my question is... in your experience, is this the best protocol?  Should I really move onto DE (not sure how much more disappointment I can take with cancelled/failed cycles)?

Part of me says move on because without this RE, I wouldn't have even had the option of doing IVF with my OE, but part of me isn't sure I want to "give up" just yet.   

Thanks for your input and reading this! 

GenRN45

MyFSH is normal, but my AMH is lower than yours. I don't know why you were put on lupron, at the highest possible dose (20/day). I was on lupron before they knew about my AMH and it MAJORLY suppressed me.

my BFP cycle I was on 300/day of gonal f and 2 vials of menopur from the start, adding ganirelix around day 9. We still only wound up with 3 embryos to transfer out of 13 eggs retrieved (only 7 were mature, only 4 fertilized - we also have MFI).

if this cycle hadn't worked, our next step would have been DE.

I would get another opinion about a different protocol.

GL

JM1977

(Jumping over from IF)

I'm wondering if you were on 20 units of dilluted Lupron per day.  That was what I was on at CCRM when I did the Microdose Lupron (Flare) protocol.  It sounds like a lot, but I think it was only like 20% strength or something like that.

I definitely think it's worth looknig into some other protocols.  When my Microdose Lupron cycle failed, my dr. at CCRM recommended estrogen priming.  I know a lot of people also find success with the antagonist protocol.

MarriedaSportsNut

I don't know what my AMH was/is, but my FSH was 9.2. I tried 3 cycles (2 MDL, 1 antagonist) and never got more than 2 follicles. Yeah we could've switched protocols or flown around the country for another try with a renowned clinic, but to me, having an OE baby wasn't that important. And I was sick and tired of the poor results. And we were OOP. The med prices alone were so outrageous that I declared myself done with my OE after 3 tries.

The DE process is much more sane. Maybe not cheaper, but the measure of hope you get from a young donor's eggs makes up for the cost.

Best of luck to you.

JM1977

I have to echo what the pp said in that I really was relieved to move on to DE in a way.  It is obviously an intensely personal process, but I just felt tired of pumping myself full of the max doses of everything to try to get my ovaries to work.  It's amazing how much more hope I feel now that we are doing DE (even though our first cycle was unsuccessful because of a problem on my DH's side).  I still have a lot of hope.

mbjmaybebaby

I was in the same situation as you...told I had to use DE if I wanted to carry a baby (ies).  My FSH was 9 and my AMH was 0.4.  After my 2nd failed cycle I started taking 75 mg of DHEA/day and 7 wheat grass pills/day to help with my egg quality.  I did this for 4 months prior to IVF #3.

I don't know why you were put on Lupron at all if you have had issues with getting follies. I did the antagonist Estrogen Priming Protocol (EPP) and did no Lupron, no BCP, nothing to suppress me. I stimmed with Gonal F & Menopur and then added in Ganirelex to make sure I didn't O on my own. 

EPP is not widely know/used.  My RE had never used it at they are at the University teaching hospital!!!  I pushed him to try it and thank goodness they were getting a new IVF nurse at the time who had experience.  

Look into this protocol, this is the ONLY protocol that I had any sort of success with (IVF 1 & 2 never even made it to an ER).

GL!!

Page me on this board if you have any questions.  If you're not ready to give up on your own eggs, then don't.  I wasn't either and look at me now.

kdussault

a couple things that have come up on the boards... first, my clinic will only go to ER if there are 3 follicles measuring 18mm or larger.  Second, it was diluted Lupron that I was taking.  It was my first injectable meds cycle, so that is another reason why I am not sure it is the right time to move on... if he thought he could do something, I'm not sure one try is enough... we'll see though, I have an appt on the 22nd and will definitely be bringing this information to the table!

Thank you ladies! 

juliannat

Although I agree with the other DE ladies that once you get there, it's actually a bit of a relief, in your shoes and at your age I would consider trying at least one more protocol. I found that I responded at least a LITTLE bit when I was not so suppressed at the beginning. Also, re: EPP - it works well for many but not so well for others - for me it wasn't any better - you might want to post your same question on SAIF if you haven't already, and ask for poor responder protocols there as you might get even more responses.

Good luck and keep us posted on what you decide!

 

CarrieB.

I was dx as DOR, because I failed the Clomid challenge, basically I did not respond at all and I was told my Ovarian Reserve was low. My RE told me that I should go right to DE and that I only had a 5% chance of getting pg with IVF with my own eggs. I'm only 32 so this was very upsetting. I went for a second opinion and the RE said I had a 15% chance, but we really wouldn't know unless we went for it and found out how I would respond.So I decided to give IVF a shot with him.

To prep for IVF, I did wheat grass shots and royal jelly daily, and for the 5 weeks leading up to ER, I did acupuncture 2x a week with electrostim. Then I did acu the day of ER, and before and after ET. My meds were BCP, then stimmed for 11 days with 250 follistim and 75 menupor. I also did daily meditation (highly recommend Anji) and weekly yoga until I was too stimmed for yoga. My DH and I both completely abstained from alcohol (he is borderline MFI) starting the week before my period. I really think that everything I did to try to make my body receptive to IVF made a difference in my cycle. 

good luck to you and do what is right for you. You can always go try to get another opinion.