IVF protocol for poor responder.. Advice needed.

crpate · March 2013

Ok. The run down is that my AMH and FSH, plus every other thing they have ever pricked me for has come back "normal". Antral count was 11. I'm 29.

We went straight to IVF due to MFI. We did the long lupron protocol with birth control. We only retrieved 6 eggs, 3 fertlized, none made it to transfer (they said poor egg quality).

My RE basically gave us no hope for doing future IVF cycles, and we've been trying to get enough sperm to do IUIs. This is process is not going well. We did IVF in November and haven't been able to do anything since. At this rate we will still be about a year before we get enough sperm for IUI.

I feel like i was simply over suppressed and theres no reason why we shouldn't try different protocols. We have a meeting Monday to try and get a plan vs being stagnant for so long. Since RE just doesn't think i'll respond well regardless i need to go in with some info.

What protocol worked better for you? Hoping to get as much details and dosages, so i can advocate for us. What are some of the most aggressive methods for under responders?

PurpleIris30 · March 2013

Do you have a different RE you could see for a second opinion? If all of your testing has been normal, I'd agree that you're not a lost cause.

However, I'd be suspicious of your current RE's attitude and continuing to work with him/her.

hmz819 · March 2013

I think you need to see another re. Sounds like your re thinks you are a lost cause.

As for protocols you could try long Lupron without bcp and higher stims, micro dose Lupron, antangonist.

CousinVicki · March 2013

ticker warning!!

I also have normal bloodwork but am not a great responder either. my last 2 ivf's i did bcp's leading up to cycling, then did super high stims (450 gonal f , 150 menopur) and ganirelex. IVF #1 i had 7 retrieved, 3 fertilized and 2 great looking ones to transfer, but nothing to freeze.

second cycle we did same dose of stims, but added in 5 days of Femara. ended up with 10 retrieved, 5 fertilized with 2 great ones to transfer, and one to freeze. So , an improvement , and all were top notch looking embryos. I know there are SO many diff. protocols, i would urge you to get a 2nd opinion if your RE is giving up on you (which seems super premature to me!!)

AmCheri · March 2013

I hope it's ok that I respond.

I'm a very poor responder. I learned through experience and education that poor response is often correlated with quality problems. Our first cycle was long Lupron without birth control and it was a disaster. After the first cycle, my RE continued to keep me off birth control and did not use Lupron again because he thought they would oversuppress me.

Estrogen priming antagonist is one of the more aggressive protocols used with poor responders. (Of my three cycles, we got the best results with EPP.) Micro dose Lupron flare is another option. Testosterone priming could be considered also, but I'm not sure how many clinics have real experience with it. Finally, consider adding human growth hormone to whatever protocol you try next.

I think it's extremely premature for your RE to suggest that you won't respond better to a different protocol. He may just not be experienced in treating low responders. If you can, get a second opinion. Good luck!

BootsOrHearts · March 2013

Estrogen priming and microdose lupron flare protocols are common for poor responders. You always want to ask them to do ICSI to help your fertilization rate since you are MFI and may have few eggs.

Has your husband seen a specialist about the MFI? Sometimes clomid and other medications can help.

Good luck whatever you choose!

crpate · March 2013

Thanks everyone. the only reason we have hung with this RE is that she is a friend and gives us a 15% discount. Discount or not, if she's not more aggressive and optimistic at our meeting i'm going to get a second opinion.

jilljillyt · March 2013

I agree with adding HGH. Maybe DHEA.

crpate · March 2013

He's been on clomid since July, had a biopsy (thats how we initially got the sperm). Now he's been on doxycycline which apparently helps with blockages. We've been to a urologist but not one who specializes in MFI. Have been bugging DH to make the 2 hr trek to see a specialist.

jakraft837 · March 2013

I agree with PP that it sounds like you should get a second opinion.

I don't deal iwth MFI, but from what i have always read here, especially with MFI, IVF gives better odds then IUI. Just curious, why are you striving to do IUI instead of IVF? Financial reasons?

Hopeful3434 · March 2013

I agree that you need a 2nd opinion. I feel I am in the exact same boat as you. I am 35 yrs old, all my test results have come back normal and we are dealing with MFI, our numbers are so low IVF/ICSI is our only option. We did our first Lupron with BCP long cycle in November as well. We only retrieved 2 eggs, 1 fertilized for transfer but resulted in a BFN.

I just went back to the RE on Monday and we are now doing a Clomid Challenge test to check my FSH levels, if the test comes back normal we are moving one to IVF#2 with BCP pills and Gonal-F and Menopur. I am hoping this works better this time.

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IVF protocol for poor responder.. Advice needed.

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