Protocol thoughts

I am 40, turning 41, decent but not great responder to med. I had a 22 month old child conceived on our own. DH was diagnosed with low sperm and low morph so we are in the IVF/ ICSI realm. I'm gratefu fo rmy son but want to give him a sibling.

First IVF# BCP, 300 Gonal f jacked up to 450 towards the end, Menopaur and Ganirelix. This gave me 7 follicles, 6 eggs retrieved and 4 fertilized. I am kicking myself for not transferring all 4 because I was afraid of multiples so the lab pushed to blast adn I got two good blasts. I transferred one and froze the other

IVF #2: BCP, Hoping to get more follicles I was on BCP, 450 Gonal f , MEnopaur and Ganirelex. I got 7 follicles again, 6 mature and only 3 fertilized and these were less quality.

I am now debating protocols.I thought since i responded well to clomid on my iui's (had to do first for GHI) that why not add it to the injections and go without BCP's. Do no BCP, lower to Gonal F 300, lower Menopaur and add Ganirelix. Other option is no BCP, clomid 300 Gonal F or follistim and menopaur. I currently go to RS of NY and felt I had to suggest the idea to them. ECF suggested my second protocol. IS clomid dangerous to take with injects because RS of NY said my lining was always good.

I am so confused and wonder if I should switch to ECF because I did not have suggest ideas to to Dr. Zapantis. I had been dealing with Dr. Trivax at RS of NY. At first he and Dr. San Roman did not want me on the clomid with injectibles now they are OK with it. FM if you need to. Thank you so much!

Message edited 10/7/2011 3:37:16 PM.

Re: Protocol thoughts

honestly you absolutely should not be suggesting the protocol to your doctor!! that is their job! why are you even seeing them if you have to tell them what to do??

IMO clomid is a waste once you are on injectables, it can only hurt the lining. im no doctor but ive never heard clomid used in an injectable IVF stim protocol so Im sure theres good reason for that.

i would def make sure you are comfortable with the RE you are seeing and that they are doing their job to find the best protocol for you!! good luck!

Re: Protocol thoughts

I have heard really good things about adding clomid with injectables for poor responders. This is a very popular protocol for Dr. Check (Re in NJ that is very high fsh friendly)
My RE Dr. Davis uses this protocol now too. You stim for a longer period of time though.
I don't know much about either of the doctors you mentioned but if you are having doubts about the one you are seeing, I would look into other REs. Good luck

Re: Protocol thoughts

Yes...Dr. Check does use Clomid and injects as does Dr. Zhang at New Hope. This is a standard protocol for low responders at these clinics. My Dr. however is not a fan of Clomid and I'm not sure it's the best for us older girls...besides causing lining issues, I think I've read that it can cause your FSH to skyrocket in subsequent cycles which can make it even harder to stim...but look that up.

What I will tell you is that my clinic is not a fan at all of protocols that use LH early in a cycle for poor responders, older women and those with PCOS...and in your case you are using Menopur which contains LH. They believe that the early exposure to LH causes bad egg quality as it exposes you to too much testosterone. They therefore suppress LH from the start of your cycle with Ganerilix or Cetrotide and then only add in LH later because some is needed for egg quality.

Message edited 10/7/2011 11:54:47 AM.

Re: Protocol thoughts

Maybe just accept the fact that all I will produce is 7 follicles, go with the original protocol off 300 Goanl f then at the end increase it to 450 at the end, use 1-2 amps of menopaur then Ganirelex. THe only difference will be no BCP. Have any of you not useed BCP before stimming. Maybe that is why the Dr. at RS of NY shrugged their shoulders after my second protocol when I asked what else I could try. I then suggested clomid - at first they said if you were only producing 3 follicles we would but you are producing 7/8. At first they did not want me to do third cycle without BCP but then when I brought it up again they said OK. In a recent consult they mentioned they were flexible. Also I had tiny polyp back in June that they felt need not be removed because it was not in the area of implantation, rather parallel to where the catheter is inserted (lower uterine wall area). Is the first protocol the best?

Message edited 10/7/2011 3:15:24 PM.

Re: Protocol thoughts

From what I told you , do you think I am low responder for my age? Really?