PCOS and immature eggs - Protocol questions loss mentioned

blueeyes233 · April 2014

I have a consult on 4/14 with new RE for round # 4 (fresh IVF # 3). I'm hoping to sign the consent forms and get a calendar. My first two fresh cycles were on the long lupron protocol.

IVF #1 I was on Menopur and Bravelle (doses of each med changed a couple of times though total dose stayed around 300/375). Stimmed for 12 days to try to get small follicles to catch up, sacrificed two mature follicles doing so. We retrieved 16 eggs, 6 were mature, and 5 fertilized with ICIS. We had two high grade blasts on day 5 and one ok blast. We transferred two and froze 1. BFP with singleton - low progesterone (low as 4 high as 12 RE prescribed compound PIO in addition to 3x day Endometrium). MMC diagnosed at 9 weeks

Since we had such a low maturity rate (38%) RE thought that I'm sensitive to the LH in the Menopur so he suggested switching to low dose hCG injections during stims. Also he had me on OHSS protocol the first time due to the PCOS and this time he wanted me to do luteal phase hCG injections to boost progesterone levels.

IVF # 2 micro dose hCG and 300iu Bravelle. Stimmed for 8 days, retrieved 27 eggs, 17 were mature (happy that maturity was up to 62%), only 7 fertilized with ICSI, embryologist said bad semen sample from DH. Only 3 embryos made it to day 3 so we transferred two and let the 3rd grow to day 5. Froze 1 excellent blast. Luteal phase hCG injections seemed to work great progesterone 7dper was just under 100. BFN

The new RE wants to move away from the long lupron and try the antagonist protocol. I'm not overly familiar with it. Any thoughts? New RE did say that she would try the micro dose hCG with me since I seemed to respond so well to it (she has never done micro dose hCG but another RE in the clinic has so she will be consulting with him).

Tea+ · April 2014

Sorry no advice but wanted to wish you luck! [:

pblge · April 2014

I'm sorry you had that experience. ((hugs)) That phone call must have been awful! I have bad IVF experiences for entirely different reasons. While some of us can play armchair RE a bit, this is a pretty advanced question you're asking! I have no idea about the answer. You might be interested in reading Dr. Sher's (super fancy-pants RE) blog. I found one post that seems relevant, but you could try searching, too:
https://haveababy.com/fertility-information/ivf-authority/case-study-poor-quality-eggsembryos-in
https://haveababy.com/fertility-information/ivf-authority/immature-eggs-and-post-mature-eggs

You can also try posting your question there.

Good luck!

Rebecca'sMama · April 2014

I am doing my first IVF cycle, and my RE went straight for the antagonist protocol. I have PCOS and my AMH was high. The research suggests the antagonist protocol reduces rate of OHSS in PCOS women, keeping the take home baby rate use as good as the long Lupron protocol. My protocol was a month of BCPs, baby aspirin, and Metformin. Then now I have started stimming with 300 IU Gonal-F, 150 IU Menopur. Will be adding Cetrotide sometime this week. Sending you FX for your new cycle!

blueeyes233 · April 2014

I'm going to talk to the RE about it tomorrow. Good to know about the lower OHSS risks. Fortunately, I haven't had any issues with OHSS with any of the cycles yet, even with the last one where I was taking extra doses of hCG.

Rebecca'sMama

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