WTF is tomorrow and need help!

armywife76

Ok ladies, going back tomorrow and apologizing in advance for the long post. I've detailed my cycle stats for comparison and need some advice. 

 

Obviously our problem is DOR, AMA (35 y/o) and poor embryo quality. No MFI or other issues. Of the 13 embryos we've produced only 3 have gone to blast (DS, the snowbaby, and our m/c). I need to figure out a different protocol or a change to this one. My RE has not changed the basic cocktail which is lupron and 187.5 gonal F in a MDL flare protocol.  I'm not happy with a few things about my current clinic, but only have one other option in driving distance (still at 5+ hour drive).

 

A few things I think might help:

 

1.  Adding menopur to improve quality

2.  Stimming longer to improve quality

3.  Maybe trying a true EPP protocol

4.  PGD (although my RE is convinced we won't have enough embies for this, but I think with the right protocol we might)

5.  Attempt a fresh cycle and grow as many to blast as make it (to limit potential abnormal day 3's) and transfer up to 3 (this would include the crap quality snowbaby if it survives the thaw) 

 6.  Donor eggs (not sure I'm ready just yet, though)

 7.  Cut my losses and cycle at a more reputable clinic (have a CCRM consult in July but with CCS, it would cost what two cycles here would)

 

We have met our 7.5% AGI for medical deductions, so basically anything from now on could be written off if it's done by the end of the year, hence the need to move on this. (We are 100% OOP)

 

What are your thoughts/suggestions? My appointment is at 10:30 so I'll be checking this post until then. Thank you so much!

 

IVF #1: 8/2009, MDL flare protocol

Baseline levels:

AFC: 11

FSH: 10.95

 

BCP's for 2-3 weeks prior to stims 

stim day 6--E2: 921

stim day 8--E2: 1,957 with 15 measurable follies,

stim day 9--E2: 3,357 (trigger)

Retreived 13 eggs, 11 mature, 8 fertilized with ICSI. 73% fertilization rate.

Transferred 2 grade 2 on day 3

None frozen

BFP! DS 4/19/10

IVF 2#: 5/2011, MDL flare again

Baseline levels:  

AFC: ?

FSH:  4.75

 

BCP's for 4 weeks prior to stims

stim day 4--E2: 866 with 7 measurable follies (12-18 mm)

stim day 6--E2: 1,357 with 8 follies (R: 17, 14, 21 mm and L: 21, 21, 19, 21, 21 mm)   (trigger)

Retreived 7 eggs, 5 mature. 100% fert. rate with ICSI. 

Transferred 2 gr. 2 on day 3

1 frozen CBB 6-day blast

m/c at 5 weeks+

cheekyali

All good questions. With Dr Davis at Cornell for this cycle I did EPP with 450 gonal f and 150 Memopur. I stepped down with the gonal. I stimmed for 12 days too. I got the same amount of eggs as I did 2 years ago and 4 embies instead of 2. I didnt have a quality issue first time though and this time I kinda did so it is hard to tell if the protocol affected the quality or just my age. I am 39. Good luck!

armywife76

cheekyali:

All good questions. With Dr Davis at Cornell for this cycle I did EPP with 450 gonal f and 150 Memopur. I stepped down with the gonal. I stimmed for 12 days too. I got the same amount of eggs as I did 2 years ago and 4 embies instead of 2. I didnt have a quality issue first time though and this time I kinda did so it is hard to tell if the protocol affected the quality or just my age. I am 39. Good luck!

Thanks so much, Cheeky. Last time I asked my RE about using an EPP, he said the protocol we are using is a type of EPP because he's using estrogen based BCP's? Not sure how receptive he will be to my suggestions. Did this look similar to your protocol?

Priming cycle:

?         Monitor for Ovulation Surge

?         Ovulation Surge is surge day 1 (SD1)

?         On SD8, start estrogen patches and change them every other day until period arrives. Once period arrives, leave the last patch on for four days or until it falls off.

?         On SD9, start Ganirelix injections, one per night for thee nights total until SD11.

Stimming cycle:

?         Baseline u/s is done on CD2. E2 will be slightly elevated from the estrogen patches. FSH will be lower than normal.

?         Start 450 Gonal-F and 150 Menopur on CD2. Continue for approximately 10 nights.

?         Add Ganirelix in nightly after lead follicle is at 13mm.

 

cheekyali

That is exactly what I did , except I stepped down on the gonal about halfway through and I stimmed for 12 days . So I reduced the amount of gonal after they did b/w. I was monitored almost every day though ( 11 times!) I know that isn't possible for you.

DavezWife

GL!!!!!

The only thing I'll toss in, (and keep in mind I'm old, but appear to make great embies?) is Sassy SLAMMED me this time with stims. 450 follistim + 150 meno right out the gate for 10 (?) days. I had the best cycle yet, by FAR! In the past, we'd gone slow and low, like everyone here says it "the" way to go. I can't recall my E2 at trigger, but it wasn't that high, and I didn't get OHSS like last time.