Responding poorly again in IVF#2

LeggyJeggy · July 2013

Any other poor responders out there? My first IVF in May was long lupron. I did BCP for 19 days, overlapped a week or so with 10IU of lupron. My suppression check was done 10 days after Lupron and my E2 was 27. I started 225IU of gonal-f 2 days later and reduced my Lupron to 5IU. After 3 days of 225IU onf gonal-f, it was reduced to 150IU per schedule. At that point, my E2 was only 60 (after 4 days) so they upped it back up to 225IU. Also, at that check, I had 3 follies around 8-9mm. After another 2 days, my E2 was only 99 so they upped it to 300IU for the remainder of the cycle. I only had 5 eggs with 3 being mature and only one made it to 3dt and was poor quality all around. Fast forward to this cycle and they completely changed my protocol. I started with taking 2mg of estrace twice a day ~9 days after I ovulated. After 6 days of estrace, I got my period, stopped estrace and went in for a suppression check on CD2. I started stims that night. I started with 375IU of gonal-f for the first 2 nights and 300IU the next 2 nights. I am also taking 0.25mg of dexamethasone to help with egg quality. My E2 yesterday after the 4 days was only 55 and they told me there are NO follies whatsoever. I was anticipating starting Ganirelix and Menopur yesterday but with such a low E2 and no follies that did not happen. I?m back up to 375IU of gonal-f until Thursday when I go back again. It seems like this cycle is worse than the first even without any suppression yet. Has anyone had any experience with being a poor responder? What protocols have you done? Our first IVF was the first time doing any meds at all as we are MFI and all of my tests look good. During our WTF, I asked about AMH, but my RE said that doesn?t matter since my FSH is 6.1. I had chosen this RE (team of 3 people) because the head RE is in the top 5% in the country. Our first cycle was partially OOP for meds. This cycle 50% OOP for the ER/ET and 100% OOP for meds (which have been over $5k now). Sorry for the rambling and thanks in advance for your input as always!

Twinkie0612 · July 2013

I don't have any experience, but here is an article that talks about FSH and AMH.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894827/

It is possible to have normal FSH and low AMH and according to this article, AMH and AFC are much better indicators of OR. If you read the conclusion of the study, it states that women with normal FSH and abnormal AMH "demonstrate significantly reduced oocyte yields."

I would push to have your AMH tested so you can know where you stand. I would want to know why I wasn't responding and AMH could give you a clue.

LeggyJeggy · July 2013

weeklyplanner:
I had trouble responding to meds and slow rising E2 levels with my second IUI which was with Lupron and Follistim. When we decided to do IVF, I was originally told I would not be using Lurpon and would be using Ganirelix. My RE believed that the Lupron suppressed me too much and that's why I didn't respond to stims. Two weeks later I get a phone call that I will be doing a Microdose Lupron Flare Protocol. Microdose Lupron is a way smaller dose of Lupron and is introduced after your body already begins to LH surge (or so I think after my reading). Anyway, it's a common protocol for poor responders and rather aggressive--at least according to things I've read online. I am having much better luck so far (day 5, only have had 1 u/s so far). I took microdose Lupron for 2 days and then I began stims: continued microdose Lupron and added 150 Follistim in the AM and PM and 2 vials/powder of Menopur (150?) at night.
Maybe talk to RE about whether or not this protocol might work? Seems they are trying different things, which is good. Hopefully they just have to find the right protocol for you. I hope this cycle turns around and you start to respond.

Thanks! I think the protocol I am on is similar to that, but they are using Ganirelix instead of lupron with Menopur added at the same time. I'm glad you are having better luck and hope it continues:)

LeggyJeggy · July 2013

Twinkie0612:
I don't have any experience, but here is an article that talks about FSH and AMH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894827/
It is possible to have normal FSH and low AMH and according to this article, AMH and AFC are much better indicators of OR. If you read the conclusion of the study, it states that women with normal FSH and abnormal AMH "demonstrate significantly reduced oocyte yields."
I would push to have your AMH tested so you can know where you stand. I would want to know why I wasn't responding and AMH could give you a clue.

Thanks Twinkie! That article is definitely helpful. I think regardless of the outcome of this cycle, I may get a second opinion and see if I can get my AMH tested. That's exactly why I asked my RE about it because I read the same thing as that article.

Twinkie0612 · July 2013

LeggyJeggy:
Twinkie0612:
I don't have any experience, but here is an article that talks about FSH and AMH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894827/
It is possible to have normal FSH and low AMH and according to this article, AMH and AFC are much better indicators of OR. If you read the conclusion of the study, it states that women with normal FSH and abnormal AMH "demonstrate significantly reduced oocyte yields."
I would push to have your AMH tested so you can know where you stand. I would want to know why I wasn't responding and AMH could give you a clue.
Thanks Twinkie! That article is definitely helpful. I think regardless of the outcome of this cycle, I may get a second opinion and see if I can get my AMH tested. That's exactly why I asked my RE about it because I read the same thing as that article.

I think that's a good idea. FX that this cycle works out for you.

twistsandturnsto2 · July 2013

No advice for you, I'm just sorry that this cycle isn't going better. ::::hugs::::

rrdiva1 · July 2013

Leggy how frusterating, huge hugs hun!

Amh does make a huge difference. Mine started at 1.05 on 1st cycle then by 4th cycle it was .69. My fsh was perfect like 5.4 .I say this because my first re had me on antagonist and was frying my eggs, and I ovulated too early.changed my protocol and got more, better quality eggs.

If I was you look into 2 nd opinions for re they may have to keep tweaking for you. It should be individualized.best of luck hun fx for you

RosyGlow · July 2013

I don't have any advice, but wanted to ask if this time is your first time on menopur? The LH in menopur drastically improved response in egg maturity and follicles during my 2nd cycle. I really hope it helps you, too. Thinking of you this must be so frustrating.

zazu13 · July 2013

I'm sorry you're going through this. I'm a poor responder, too. My AMH and FSH were in the normal range with a AFC of 17 on my first attempt and we also went straight to IVF for male factor. They used 300 IU to stim me and there was basically no response (antagonist protocol). My e2 was still below 100 on Day 7. My IVF #2 they started me at 450 and ended up bumping me up to 600 to retrieve 8 eggs. For my subsequent cycles I have started at 600 IU and got to 725 on my last few days and gotten 6 mature eggs. I know that this dose is higher than some clinics will go and debate about whether it is even effective. I tried microdose lupron at the same dose and had the same egg yield, but didn't get pregnant (I had early losses with antagonist both times). I'm back to antagonist, but with estrogen priming and a mix of menopur with Gonal-F. I didn't use BCP. Today is day 9 of stims I have a good number of follicles (at least 5 in the 10-14mm range, with some smaller ones). Best of luck to you. This process is so frustrating!

Lacyj67 · July 2013

Sorry Leggy. I'm am all to familiar with poor responding. My first IVF was my best shot over a year and a half ago when I did a basic IVF with lupron and menopur and I only produced 4 eggs two being mature at ER. Second IVF we did the mini stim IVF with clomid hoping for one or two good follies and had a big zero!! Last attempt with OE was a epic fail with only growing one follicle. That was max dose stims! I have since moved on to DE since we really want a family now but that decision is not easy. It had alot to do with money and paying out of pocket. I'd say keep trying and 5 eggs is better than 2. I would fight to take that to retrevial and possibly if you can afford it do some egg banking. Good luck

metalena00 · July 2013

PAIF Response (I don't remember what's in my siggy since I mostly mobile bump)

I'm sorry you are going through this. I too went straight to IVF/ICSI due to MFI. I do have DOR, if my memory serves me right my AMH was .39. The first 2 times I was tested FSH was around 9, but the 3rd time it was 10.1. The nurse told me 10 was the cut-off for dx DOR, so I was just over that threshhold.

Our first and only IVF I was on a Micro-dose Lupron Flare protocol, which I was told is for poor responders or those expected to be poor responders. I started on about 4 weeks of BCP, on CD3 I started 10iu MDL 2x per day, then the next day added 300iu Follistim and 75iu Menopur. After my first monitoring the Follistim was upped to 450iu for the rest of the stim cycle.

We retrieved 7, 6 were mature and 5 fertilized. All 5 made it to day 5, we transferred 3 (1 great quality, the other two not as good) and the last 2 did not make it to freeze.

Hopefully this cycle improves and is successful for you, but if not I would insist on having the AMH tested and ask about the MDL Flare protocol. Without the AMH, you don't have teh full story. Good Luck!

KRoseToes · July 2013

Our cycles sounds similar. My first IVF was long lupron because we thought our only issue was MFI. My response ended up being very underwhelming and at the end there was only 1 embryo to transfer (ended with a D&C). I changed REs and they tested my AMH and found it to be too low. So they tried a cycle with no lupron, just a few days of birth control. Once I started stimming, my E2 levels went down! By Day 5 they decided to cancel the cycle. It would have been too much to overcome the slow start. (IVF attempt #3 was cancelled due to a cyst.) For attempt #4, we are doing the LEAP (luteal estrace antagonist protocol) protocol, which is for those with a history of poor response. Haven't started stims yet, so I'm not sure how it will turn out.

We are 100% OOP. My doctor has been great and decided to put the money that we paid him for our IVF that was cancelled into our next attempt. We do have to buy more meds, but they also have been doing a lot to find me donations. It may be worth asking if you can cancel and start over and what kind of discounts they can offer you.

LeggyJeggy · July 2013

rrdiva1:
Leggy how frusterating, huge hugs hun!
Amh does make a huge difference. Mine started at 1.05 on 1st cycle then by 4th cycle it was .69. My fsh was perfect like 5.4 .I say this because my first re had me on antagonist and was frying my eggs, and I ovulated too early.changed my protocol and got more, better quality eggs.
If I was you look into 2 nd opinions for re they may have to keep tweaking for you. It should be individualized.best of luck hun fx for you

Thanks That's interesting, we have simliar FSH. I'm really going to have to push for this or just go somewhere else. So glad it's working better for you! This is definitely frustrating.

LeggyJeggy · July 2013

RosyGlow:
I don't have any advice, but wanted to ask if this time is your first time on menopur? The LH in menopur drastically improved response in egg maturity and follicles during my 2nd cycle. I really hope it helps you, too. Thinking of you this must be so frustrating.

Hi Rosy, yes this will be my first time on menopur, but I won't start until I start to surge - I'm guessing everyone is like that?? I really hope it helps. Thanks

LeggyJeggy · July 2013

zazu13:
I'm sorry you're going through this. I'm a poor responder, too. My AMH and FSH were in the normal range with a AFC of 17 on my first attempt and we also went straight to IVF for male factor. They used 300 IU to stim me and there was basically no response (antagonist protocol). My e2 was still below 100 on Day 7. My IVF #2 they started me at 450 and ended up bumping me up to 600 to retrieve 8 eggs. For my subsequent cycles I have started at 600 IU and got to 725 on my last few days and gotten 6 mature eggs. I know that this dose is higher than some clinics will go and debate about whether it is even effective. I tried microdose lupron at the same dose and had the same egg yield, but didn't get pregnant (I had early losses with antagonist both times). I'm back to antagonist, but with estrogen priming and a mix of menopur with Gonal-F. I didn't use BCP. Today is day 9 of stims I have a good number of follicles (at least 5 in the 10-14mm range, with some smaller ones). Best of luck to you. This process is so frustrating!

It sounds like we are on a similiar protocol right now. They call mine Estradex which is basically EPP with dexamethasone. Glad it's working better for you - best of luck to you as well!

LeggyJeggy · July 2013

Lacyj67:
Sorry Leggy. I'm am all to familiar with poor responding. My first IVF was my best shot over a year and a half ago when I did a basic IVF with lupron and menopur and I only produced 4 eggs two being mature at ER. Second IVF we did the mini stim IVF with clomid hoping for one or two good follies and had a big zero!! Last attempt with OE was a epic fail with only growing one follicle. That was max dose stims! I have since moved on to DE since we really want a family now but that decision is not easy. It had alot to do with money and paying out of pocket. I'd say keep trying and 5 eggs is better than 2. I would fight to take that to retrevial and possibly if you can afford it do some egg banking. Good luck

Thanks for the input Lacy. I hope that DE or something of the like wouldn't be our only option as my H is firm on no donor or adoption. I'm glad this cycle seems to be working out for you (so far!) and you're moving forward. I'll have to ask about egg banking.

LeggyJeggy · July 2013

Lacyj67:
Sorry Leggy. I'm am all to familiar with poor responding. My first IVF was my best shot over a year and a half ago when I did a basic IVF with lupron and menopur and I only produced 4 eggs two being mature at ER. Second IVF we did the mini stim IVF with clomid hoping for one or two good follies and had a big zero!! Last attempt with OE was a epic fail with only growing one follicle. That was max dose stims! I have since moved on to DE since we really want a family now but that decision is not easy. It had alot to do with money and paying out of pocket. I'd say keep trying and 5 eggs is better than 2. I would fight to take that to retrevial and possibly if you can afford it do some egg banking. Good luck

Thanks for the input Lacy. I hope that DE or something of the like wouldn't be our only option as my H is firm on no donor or adoption. I'm glad this cycle seems to be working out for you (so far!) and you're moving forward. I'll have to ask about egg banking.

LeggyJeggy · July 2013

metalena00:
PAIF Response (I don't remember what's in my siggy since I mostly mobile bump)
I'm sorry you are going through this. I too went straight to IVF/ICSI due to MFI. I do have DOR, if my memory serves me right my AMH was .39. The first 2 times I was tested FSH was around 9, but the 3rd time it was 10.1. The nurse told me 10 was the cut-off for dx DOR, so I was just over that threshhold.
Our first and only IVF I was on a Micro-dose Lupron Flare protocol, which I was told is for poor responders or those expected to be poor responders. I started on about 4 weeks of BCP, on CD3 I started 10iu MDL 2x per day, then the next day added 300iu Follistim and 75iu Menopur. After my first monitoring the Follistim was upped to 450iu for the rest of the stim cycle.
We retrieved 7, 6 were mature and 5 fertilized. All 5 made it to day 5, we transferred 3 (1 great quality, the other two not as good) and the last 2 did not make it to freeze.
Hopefully this cycle improves and is successful for you, but if not I would insist on having the AMH tested and ask about the MDL Flare protocol. Without the AMH, you don't have teh full story. Good Luck!

Thanks - I'll have to ask about the MDL flare protocol for next time as well or something mixed. Glad it worked for you!

LeggyJeggy · July 2013

KRoseToes:
Our cycles sounds similar. My first IVF was long lupron because we thought our only issue was MFI. My response ended up being very underwhelming and at the end there was only 1 embryo to transfer (ended with a D&C). I changed REs and they tested my AMH and found it to be too low. So they tried a cycle with no lupron, just a few days of birth control. Once I started stimming, my E2 levels went down! By Day 5 they decided to cancel the cycle. It would have been too much to overcome the slow start. (IVF attempt #3 was cancelled due to a cyst.) For attempt #4, we are doing the LEAP (luteal estrace antagonist protocol) protocol, which is for those with a history of poor response. Haven't started stims yet, so I'm not sure how it will turn out.
We are 100% OOP. My doctor has been great and decided to put the money that we paid him for our IVF that was cancelled into our next attempt. We do have to buy more meds, but they also have been doing a lot to find me donations. It may be worth asking if you can cancel and start over and what kind of discounts they can offer you.

How frustating that sounds - I had a cyst last week on my right ovary (which so far hasn't given me anything) but they had me proceed with starting stims. I'll be curious how the LEAP works out for you. We talked about asking to cancel if tomorrow didn't show any improvement. I think then we would get our ER/ET money back and luckily I ordered 300IU pens for Gonal-F this cycle. I had wasted over 800IU of gonal-f from last cycle and that was OOP -it sucked! Best of luck to you!

LeggyJeggy · July 2013

twistsandturnsto2:
No advice for you, I'm just sorry that this cycle isn't going better. ::::hugs::::

Thanks for the hugs twists, I didn't realize how frustrating this could become!

MsAmandaPants · July 2013

Twinkie0612:
I don't have any experience, but here is an article that talks about FSH and AMH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894827/
It is possible to have normal FSH and low AMH and according to this article, AMH and AFC are much better indicators of OR. If you read the conclusion of the study, it states that women with normal FSH and abnormal AMH "demonstrate significantly reduced oocyte yields."
I would push to have your AMH tested so you can know where you stand. I would want to know why I wasn't responding and AMH could give you a clue.

Yes I have a normal FSH and a low AMH. My ratio of FSH to LSH is also off. I would request the AMH. . . I'm sorry you are dealing with this.

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