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"Poor Responder Protocol"
hi all,
so my first IVF cycle was cancelled on day 8 of treatment due to poor response. the doc has now suggested that i try what he terms the "poor responder protocol" (ahhhh, isn't that such a nice name?). it feels really aggressive, but i am new to this whole IVF thing, so i was hoping someone else may have some input...
i am 37, with elevated FSH (15.6). the first protocol was lupron, followed by 300 units of gonalf once daily (which was increased mid-cycle to 450) and low dose HCG. this didn't work. my new protocol is:
BC pills for 14 days, with lupron starting on day 13. on day 1 of menstruation, i begin ganirelix injections (125 mcg) once per day and estrace (2 mg tab) once per day. this happens for days 1-7. then the fun starts...on day 8 i begin gonalf 300 units twice per day, plus HCG 10 units per day in addition to continuing the ganirelex and estrace.
this protocol seems crazy, but like i said, i am new to this. any thoughts? please?!?
kp :-)
so my first IVF cycle was cancelled on day 8 of treatment due to poor response. the doc has now suggested that i try what he terms the "poor responder protocol" (ahhhh, isn't that such a nice name?). it feels really aggressive, but i am new to this whole IVF thing, so i was hoping someone else may have some input...
i am 37, with elevated FSH (15.6). the first protocol was lupron, followed by 300 units of gonalf once daily (which was increased mid-cycle to 450) and low dose HCG. this didn't work. my new protocol is:
BC pills for 14 days, with lupron starting on day 13. on day 1 of menstruation, i begin ganirelix injections (125 mcg) once per day and estrace (2 mg tab) once per day. this happens for days 1-7. then the fun starts...on day 8 i begin gonalf 300 units twice per day, plus HCG 10 units per day in addition to continuing the ganirelex and estrace.
this protocol seems crazy, but like i said, i am new to this. any thoughts? please?!?
kp :-)
Hi all. Can I have peoples thoughts please. Am feeling really sad. I had my first scan today at day 12. I've been on gonal f 600 units a day and cetrotide to stop ovulation days 1-3 and then 8 - 12. I have two follicles on the left, 1 reasonable size and one small and another reasonable size follicle on the right. I am just 43. I have been told to continue on the same drugs and amounts with another scan in 5 days. Have been feeling good until the scan today and wonder what happens if it gets cancelled. Are there alternatives... :(
I'm not an expert on this but my first 2 IVF were on an antagonist protocol.
The clinic were I was prefer to use this protocol because is faster and it does not use any Lupron.
The antagonist protocol is usually for "poor responder" (I hate this term...).
Anyhow I was on BC 23 days then Follistim + menopur for 7 days then added the ganirelix and then the HCG shot.
I hope this helps.
The clinic were I was prefer to use this protocol because is faster and it does not use any Lupron.
The antagonist protocol is usually for "poor responder" (I hate this term...).
Anyhow I was on BC 23 days then Follistim + menopur for 7 days then added the ganirelix and then the HCG shot.
I hope this helps.
Hi,
I have an elevated FSH too (ranges from 8-13)....anyways here is the protocal that my RE has used..she says with poor responders Lupron wll just shut down your ovaries.
I was on 3 weeks of birth control..NO Lupron.
STarted 450 units of repronex on day 2...3 in the morning 3 at night. ARound cd 10 I started Ganirelex.
Had 9 follicles....they retrieved 7 eggs..all 7 fertilized...not a ton but not bad either since I guess the norm is 8-12.
I'd really ask about the no lupron...my RE really thinks it's a bad bad idea with high FSH.
I have an elevated FSH too (ranges from 8-13)....anyways here is the protocal that my RE has used..she says with poor responders Lupron wll just shut down your ovaries.
I was on 3 weeks of birth control..NO Lupron.
STarted 450 units of repronex on day 2...3 in the morning 3 at night. ARound cd 10 I started Ganirelex.
Had 9 follicles....they retrieved 7 eggs..all 7 fertilized...not a ton but not bad either since I guess the norm is 8-12.
I'd really ask about the no lupron...my RE really thinks it's a bad bad idea with high FSH.
Thanks for the info! So my FSH is high, but my initial US indicated that my antral follicle count is also high. I guess that is partially good news?!?
Have a great day, Julie.
kp
Have a great day, Julie.
kp
Hi there, antral follicle count is a very important factor in determining how many eggs you'll have each cycle to mature, retrieve, and fertilize. A normal-average range is 8-10. Good count is 13-15. And anything below 7-8 is low. Of course I have read that this does vary from cycle and cycle for some women. Even with a lower follicle count, with a very good FSH level, you can still get great looking embryos!! So all the best to you this cycle:))) Lastly, SSBD is super sticky baby dust.
Julie
Julie
thanks Julie and others for the comments...
I am not sure why the BC pills??? I thought that was just standard protocol, but what do I know (I'm just the patient ;-) ).
I have talked to the doc about the risk of hyperstimulation. He felt that it was better to closely monitor and cancel if this happened, rather than not have enough happen again. Re: the HCG, it is 10 units subQ/day.
Yes, I am currently on Prometrium (200 mg/day). I am only suppose to be on this for 5 days. As I was told, it was to facilitate my period, and also b/c my blood work on monday was indicating low progesterone and high levels of estrogen (I think).
I will certainly let you know how the estrace goes. You mentioned you were on a patch? My protocol calls for one 2 mg tablet per day...
As for my antral follicle count, at my baseline US it was 13 (3 mos ago). However, during my last IVF cycle (which was cancelled on day 8) I had only 5 follicles (14, 12, 11 and 2 at 6.5).
Any thoughts on the antral follicle count? Or having only 5 follicles (3 that were actually growing)?
Last question...what is SSBD?!? :-)
Hope you are well,
kp
I am not sure why the BC pills??? I thought that was just standard protocol, but what do I know (I'm just the patient ;-) ).
I have talked to the doc about the risk of hyperstimulation. He felt that it was better to closely monitor and cancel if this happened, rather than not have enough happen again. Re: the HCG, it is 10 units subQ/day.
Yes, I am currently on Prometrium (200 mg/day). I am only suppose to be on this for 5 days. As I was told, it was to facilitate my period, and also b/c my blood work on monday was indicating low progesterone and high levels of estrogen (I think).
I will certainly let you know how the estrace goes. You mentioned you were on a patch? My protocol calls for one 2 mg tablet per day...
As for my antral follicle count, at my baseline US it was 13 (3 mos ago). However, during my last IVF cycle (which was cancelled on day 8) I had only 5 follicles (14, 12, 11 and 2 at 6.5).
Any thoughts on the antral follicle count? Or having only 5 follicles (3 that were actually growing)?
Last question...what is SSBD?!? :-)
Hope you are well,
kp
I too was a poor responder & had one cycle cancelled right before retrieval. Your new protocol sounds aggressive but hey, if it works, then that'll be great. My poor response was credited to my age so thank goodness you're quite a bit younger and have a better chance of a good outcome. Good luck and SSBD!
Ladies, I'm a poor responder too. My FSH is fine but I respond poorly to meds. I've done 2 ivf's with only a couple of follicles. Probably should have cancelled but anyway... I'm meeting with my new RE in a couple of weeks and hope he can come up with a plan to achieve a better response to meds. Those protocols sound very aggressive and not like anything I've done in the past. I'm praying it works for both of you and interested to find out if you respond better.
Best wishes.
F.
Best wishes.
F.
Hi there,
I'll try to get you some answers since I'm a poor responder myself, so hope it helps! I think you're doing a protocol known mostly as the "Luteal Estradiol" protocol. However, I'm puzzled at why you're still supposed to take BC pills for 14 days, since for poor responders, BC pills always over-suppress the ovaries.
So it's almost 600 units of gonal-f a day, which I'm guessing will supercharge your ovaries:)) Hope you have talked to your RE about OHSS (ovary hyper stimulation) which is always something to look out for, for poor responders. Btw, the 10 units of HCG per day is going be an intra-muscular shot?
I have several questions to you too, hope you'll answer them:)) Has your RE prescribed you any progesterone? Also, once you start taking Estrace, could you please share your experience about any side effects in case you have them? Don't want to scare you, but I had a very rare side effect of major chest pains within a few hours of taking the patch. My RE still insists that it never happens, but it did happen to me:( Lastly, what is your antral follicle count?
Wishing you the best of luck for your ivf cycle and sending you lots of SSBD!!!
best,
Julie
I'll try to get you some answers since I'm a poor responder myself, so hope it helps! I think you're doing a protocol known mostly as the "Luteal Estradiol" protocol. However, I'm puzzled at why you're still supposed to take BC pills for 14 days, since for poor responders, BC pills always over-suppress the ovaries.
So it's almost 600 units of gonal-f a day, which I'm guessing will supercharge your ovaries:)) Hope you have talked to your RE about OHSS (ovary hyper stimulation) which is always something to look out for, for poor responders. Btw, the 10 units of HCG per day is going be an intra-muscular shot?
I have several questions to you too, hope you'll answer them:)) Has your RE prescribed you any progesterone? Also, once you start taking Estrace, could you please share your experience about any side effects in case you have them? Don't want to scare you, but I had a very rare side effect of major chest pains within a few hours of taking the patch. My RE still insists that it never happens, but it did happen to me:( Lastly, what is your antral follicle count?
Wishing you the best of luck for your ivf cycle and sending you lots of SSBD!!!
best,
Julie
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