Thoughts on Estrogen Priming Protocol

kk4564 · November 2016

Hi Ladies,
I've taken a bit of a break on here since my failed IVF cycle in July/August. DH and I just decided that we will try IVF one more time...

A re-cap of what happened with our last cycle- We did antagonist protocol (bc, gonal-f, menopur, hcg trigger). They retrieved 30 eggs, 17 fertilized, but 0 embryos made it to blast. RE was perplexed as to why our embryos were such poor quality, but possibly a combination of egg quality and sperm quality issue.

After feeling like we were done with IVF and were trying to make peace with the situation, mostly because of finances (we are paying 100% out pocket), we decided that we weren't ready to give up just yet. We are signing up with our RE's next group cycle in Jan/Feb. We are trying to decide if we want to stick with antagonist protocol and hope for better quality this time around, estrogen priming protocol, or using a long lupron protocol.

If you have used estrogen priming protocol, or will be using it, can you tell me a little bit about why you/your RE chose to use it, and how it worked for you? Or any information that is worth telling. Other than estrogen being used at the beginning of the cycle instead of birth control, what did you do for the rest of your cycle?

Our RE is leaving the decision up to us. He has only used EPP a few times, and results weren't great, but he is willing to try anything we want. If any of you ladies have any input, it would be greatly appreciated! Thanks!

Kp214 · November 2016

@kk4564 I'm sorry you didn't have success before. It's tough to be paying oop and not be finished with this.

I just did EPP. I don't know how this cycle will end since I'm waiting for a day 3 embryo report. As you can see in my signature, I have dor and also egg quality issues. However, I did Estrace for 10 days, up through day 3 of stims, 150 follistim and 150 menopur, added 50 units of HGH around stim day 8, Ganirelix around stim day 5, and stimmed for 13 days. My afc was 5, but they ended up seeing 15 the day before I triggered. 10 were retrieved, 10 were mature, and 7 fertilized with icsi. My first cycle, I did a day 3 transfer because they weren't looking very good. My second cycle, the embryos arrested in day 2. I'm praying they are still growing. I will find out in the morning. We want to do genetic testing since we think there are egg quality issues.

I did acupuncture, supplements and have no idea if any of them have helped with egg quality. Ultimately, it has been out of my hands. I did push to try EPP after my re had me doing Max stims with lupron the first two cycles. I felt like she had given up on me this cycle, but she became encouraged when she saw my response. She told me that some do ok with EPP; others not so much. She wants more studies to be done, I think, before she starts recommending it. She was of the mindset that it couldn't hurt.

Everyone responds to different protocols. I don't think this was a fluke cycle since I've had such low response before. Quality, though, is going to be harder to affect. Good luck. If you have other questions, tag me or pm me.

kk4564 · November 2016

Thank you for the response @Kp214! Hoping this was your much needed protocol and this will be your magic cycle. Fingers crossed for you. I have been following the Nov IVF board so I'll look for an update. Dif you switch RE's or stay with the same RE will all your attempts?

It's hard when everyone responds to certain protocols differently. I wish we had the luxury of being able to try multiple times until we find the right protocol for us. Being that we are OOP, this will be our last shot, so I'm really stressing about which protocol to try.

kangastein · November 2016

@kk4564 I'm sort of in your same shoes because although we get a lot of eggs they don't do well and by day 5 we have few blasts and they look poor, One resulted in pregnancy but I miscarried at 6 weeks due to fibroids. I did long Lupron and although I responded well the embryos didn't develop well. We are looking into estrogen priming because the estrogen supposedly "feeds" the eggs. I would ask your RE honestly about how Lupron would effect egg quality and if he she would be concerned about OHSS if you are responding so well. I've gone to three REs and they all want me on an antagonist protocol, but the RE I'm going with will not estrogen prime because she thinks my ovaries don't need it. Other solutions I have found for our problem are PICSI which we will try this cycle and growth hormone which we won't. I'm curious to see what you choose and how you do.

kk4564 · November 2016

@kangastein what makes your RE think that your ovaries don't need estrogen priming? So does that mean you will start the cycle with birth control pills?
Through my research, I haven't read that lupron affects eggs poorly, but I'm sure it depends on the person, since we all respond differently to different meds. What is PICSI? I haven't heard of that before. We did ICSI since we have a male factor issue to deal with. When does your cycle start?
I know I was at an increased risk of OHSS the first time around since they retrieved 30 eggs, but fortunately, I didn't get it.
Although I do like and trust my RE, he really isn't helping much with our decision. He just told me that we know how I respond on antagonist protocol, which was a lot of eggs, but poor quality embryos, but we have no idea how I will respond with any other protocol and that it will just be an experiment. He is willing to try anything, but doesn't really have a suggestion with which one to try.
Thank you for your response!

kangastein · November 2016

@kk4564 That is really annoying he won't give you more guidance. It's interesting that we are essentially swapping protocols. I go back 11/19 for monitoring and we are doing an antagonist protocol. No bcp nor estrogen priming, but I have to clarify the estrogen. I've talked to a lot of REs about this problem and one thinks I have mild PCOS which could be causing the poor quality and high turn out. PICSI is a more in depth ICSI where the use a solution to select the sperm that bind to the solution and the idea is that those sperm are healthier. I've read so many conflicting things that ICSI already selects the best sperm and so bad embryo development means bad eggs or that if you have good eggs poor embryos at Day 3 could be DNA fragmentation which PICSI should solve. The director of a huge clinic here told me my issue could be solved by a good protocol only. Needless to say, I didn't go with them. I honestly think you would do well on either protocol, long Lupron did really well for me in terms of getting 21 eggs but we ended up with 1 5 day blast, one 5 day moreola and froze a 6 day 3BC blast. I had a really great cycle my first cycle which was a mild IVF with tamoxifen to prep and then 150 gonal f resulting in 21 eggs and 6 blasts, one took but miscarried. I think she thinks I don't need the priming because I respond so well. I'll clarify on Saturday to see what exactly we are doing. Sorry for the length but I'm just trying to give you as much information as possible. I think PCOS is notorious for bad egg quality, did the RE look into that? I was told even with regular periods you could have it.

mandasd · November 2016

@Kp214 I believe my RE will be doing a similar protocol for me that you did. I failed miserably on the Lupron protocol, which only produced one huge follie so RE was cancelled. I don't have the exact details about our next attempt in January but it sounds very close to what you did with EPP and combination of meds. Hoping to get a better outcome!

Kp214 · November 2016

@mandasand I am very pleased with my results from this protocol. I received the day 5 results this morning. 7 are still growing, 1 arrested. 3 were biopsied today, and the other 4 will be checked tomorrow. If the grading works like I think it does, one that was biopsied today is really good and the other two are good-really good. We are excited! I can now stop to meds for a transfer this week since we are doing CCS. That takes about 4 weeks from what I've been told, but I read online that some places get the results out sooner. Looks like I'll be doing a FET in January.

I hope this protocol works as well for you as it has for me.

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