16 replies to this topic

[Abi]

Hi everyone,

 

Please let me know if you have similar experience or/and if you have any suggestions.

 

I'm 38. Infertility 10+ years. First went to a RE 4 yrs ago (34 at the time). Did lots of testing, didn't find anything wrong with me, my AMH at the time was ~ 2.3ng/mL, the only thing that was off was my husband's morphology (1-2%). At the time, we couldn't afford the IVF expenses, and I really hoped that if we tried hard, it could work. It didn't. 

 

Now at 38, I went back to my RE hoping to proceed with IVF. My AMH dropped to 1.03ng/mL, FSH on day 3 was 9 mlU/mL, which I was told was normal for my age. My RE never gave me false hope, but mentioned that he hoped that we could get ~10-12 eggs... which I thought was great. 

 

He put me on Gonal F (300) and Menopur (150) after the baseline ultrasound/bloodwork. No BCP or estrogen prepping before that. I was to come back on Day 5 for ultrasound/bloodwork. When I came, they never gave me the number of follicles they saw, but mentioned that I had some fluid "there" (still not sure where) and that they wanted to check my progesterone to make sure I didn't ovulate. I was so confused after this apt, and had a really bad feeling because I didn't have any side effects from stimulation. The same day, they called to let me know that I had to increase my Gonal F to 375 since my E2 was rising somewhat slowly. Menopur stayed at 150, and I added Ganirelix the same day.

 

On day 7 during my u/s, the nurse/technician told me how everything looked great and that I had 2 follicles on one side, and 2 on the other with the biggest one at 17mm...   I got so upset to hear that, but she kept telling me that I should "trust her experience", and how everything looked great. When I came home, my husband told me to text my RE which I did. My RE called me back and suggested to cancel this cycle or convert it to IUI if we wished because he didn't believe we could get more than one good egg this cycle. I was relieved that at least he didn't try to convince me that everything looked great. He suggested to try the Microdose Lupron Flare protocol next time. He said that it's the most aggressive protocol they could offer, and that they couldn't offer anything else. We did cancel IVF (converted it to IUI, which I have no hope for). They offered a refund, so basically we lost the money we spent on meds, but not the IVF money. They also said that they could keep the money in case we decided to proceed with a new protocol.

 

I looked it up, and as far as I understood once you're a "poor responder", you are most likely going to respond poorly next time as well. Considering my age, I really don't know if I should even care to try. I so got used to know that I can't get pregnant and see my AF each month; but going through this IVF attempt brought a new level of pain. I was somewhat ok at this point not to have kids, which took me years to train myself to feel like that, but now my pain is so raw again, and I don't know if I can go through this when inside of me I don't have any hope that it's going to work, and I feel like it will break my heart again and again.

 

Would you try IVF with a new protocol in my situation? Do you know anything about the Lupron Flare protocol for someone with AMH of 1.03ng/mL? Do you think it's worth getting a second opinion? We're paying out of pocket, so I really don't care who to pay, but of course it's more convenient to stay with the same clinic not to lose time trying to find a new one and starting all over again.

 

Thank you.

[returnable]

Abi I am really sorry that you are going through this. Next, I would suggest you speak with a counselor that specializes in infertility. Where are you located?

 

Although I was older than you when I started IVF, I was also a poor responder. I did both an estrogen priming protocol and a flare protocol (though mine was with orgalutran I think it would be similar to lupron). For sure if you have diminished ovarian reserve (DOR) you would never start a protocol with BCP as that may suppress you too much and you may have even a worse response. Either way, in my case each IVF resulted in only one embryo, and from each IVF each embryo was found to be genetically abnormal.

 

It does seem that once you are a poor responder, most often than not you will not produce a whole lot more eggs with a different protocol. I'm not sure if you've read it, but a few years back I put this together on AMH: https://ivf.ca/forum...it-explanation/.

 

After our second IVF my RE said that if money was no object, we could just keep doing IVFs and he believes eventually I would get a genetically normal embryo, but he could in no way predict how many tries that would take. Another option for poor responders is to do a mini-IVF and do a few of them. They tend to be cheaper for the drugs, though I'm not sure that they are cheaper for the procedure.

 

For sure there is someone that was a poor responder that eventually had a successful cycle, but that was one very very very lucky person. A lot of people either just give up, or move on to donor eggs. Either decision is difficult and very personal.

[annatarz79]

I m a poor responder. I had a successful IVF cycle at 37 with only two eggs. We transferred both and had a single pregnancy. What I can tell you is that I have always been a poor responder to medication not only IVF related. I'm a very slow responder to everything. I had a few retrievals that ended with nothing to proceed -bad quality. Also I would suggest to trust your instincts. I changed my clinic when i had started feeling they could no longer help me. I was told that I should get donor eggs and I was not ready for that at the time. Luckily I did only one cycle with my new clinic. Two years later and a miscarriage I also conceived my second bb. Each cycle is different. When will you know if the IUI result? Don't lose hope yet and good luck!

[Abi]

@returnable thank you for taking your time to reply. I’m in the US. If anyone knows good US based forums, please let me know. I did read a lot about AMH. Since mine is in the lower range of normal, and all of my other results are normal, my RE and I really hoped that we could get 12 eggs, but as it turned out, I’m a poor responder. 
 

@annatarz thank you so much for sharing your story! I’m so glad to hear that it worked out for you! My IUI is scheduled for today. I had my trigger shot on Wednesday. My husband and I are inclined to try a different protocol next cycle hoping that my body might respond differently considering that it’s back to back with meds in my system and more aggressive.  Thank you for your kind encouragement!

[jtstan]

Hey there...I think there’s hope to be optimistic for next cycle. I think the main problem with your protocol was that the stims were started a bit later and there was no pretreatment in the previous cycle with BCP or estrogen. Natural start IVF can work well particularly if low ovarian reserve if started when your estrogen is nice and low and your follicles are pretty quiet....but once your bod has “chosen” it’s one usual egg to mature that month...the stims may end up not being as effective or result in unequal follicle growth. The fact that your RE thought you’d likely only get one egg that cycle leads me to believe this is probably the case. 1.03ng/ml is lower but not end of the world low....and while I think 12 eggs would be ambitious...with your numbers I think with a change in protocol and the right cycle you could likely expect a decent showing (although there are no guarantees in IVF!). Hope this helps!

[Misskika007]

Hey Abi, I'm a poor responder too who just finished my third IVF with a microdose lupron flare protocol. My AMH is 1.5 pmol, so very very low! First try at IVF (antagonist protocol) led to 2 mature eggs, no embryo and second try (orgalutran start with antagonist protocol) led to 4 mature eggs, two low grade embryos, OHSS, one chemical pregnancy & one failed transfer. This round I switched to a new clinic/doc that specializes in DOR/poor responders and my doc focused more on quality rather than quantity since there is no significant difference in using high dose stims in poor responders and the high doses may actually impact egg quality. My protocol was: estrogen priming with testosterone, then 10 of Lupron, 225 of Gonal F, 75 of Menopur, Dexamethasone, Saizen (human growth hormone) and 4mg of Letrozole for 11 days. I ended up with 7 follicles, 4 eggs, 3 mature, 1 top grade embryo. That embryo has just been biopsied and I await PGS test results but I'm pretty happy with how it panned out given my AMH. I think there is something to be said about focusing on quality v. quantity and I would ask your doc about working on that aspect too (testosterone, dexamethasone & Saizen were all added to my protocol for this reason). We have decided that if this embryo isn't normal/result in a baby, we will try IUI focusing on improving egg quality (Saizen + dexamethasone) as a conjunct (we haven't done IUI yet... 1st clinic pushed us straight into IVF because they misdiagnosed blocked tubes). I hope your IUI is a success and you don't need to go through IVF to begin with! A good friend of mine has a 4 month old from a IVF converted to IUI cycle! 

 

Also, I don't know where in the US you are, but I'm with the Canadian equivalent of CCRM and this is the protocol they recommend for DOR! 

[Abi]

@jtstan thanks! I’m reading all of the responses to educate myself. 
 

@Misskika007 thanks for your detailed answer! Great results on your last retrieval, and I wish you the best outcome from this IVF! Hang in there waiting for your PGS results! I’ll check with my RE and see what he thinks about Saizen and dexamethsone. 

[Misskika007]

Another thing to note, I definitely felt "better" on the microdose lupron flare protocol- way less side effects. Despite all the drugs, It was overall a more comfortable IVF experience than the antagonist protocols! Good luck with your journey!

[Abi]

@Misskika, how’re you doing? My RE brought up HGH without me asking about it but let us decide if we want to add it or not. How much/often did you take it? He also said that I can try DHEA 25mg/day and Q10 (200mg) but again let us do what we want.  Have you taken any supplements? Honestly, I’m still so confused as of why I got such a poor response with my “reasonable “ numbers.  I guess, I’m willing to try HGH and supplements before moving to DE. IUIs are not going to do anything for us bc of 2% sperm morphology. 
 

Also, he mentioned that I’ll need to go on norethindrone for 10 days before starting Lupron. I can’t find a lot of info about it. Sounds like some kind of birth control pill based on progesterone. Maybe it’ll slow down my dominant follicle because it was growing fast and the other 3 were lagging behind?

[N1111]

Abi I am really sorry that you are going through this. Next, I would suggest you speak with a counselor that specializes in infertility. Where are you located?
 
Although I was older than you when I started IVF, I was also a poor responder. I did both an estrogen priming protocol and a flare protocol (though mine was with orgalutran I think it would be similar to lupron). For sure if you have diminished ovarian reserve (DOR) you would never start a protocol with BCP as that may suppress you too much and you may have even a worse response. Either way, in my case each IVF resulted in only one embryo, and from each IVF each embryo was found to be genetically abnormal.
 
It does seem that once you are a poor responder, most often than not you will not produce a whole lot more eggs with a different protocol. I'm not sure if you've read it, but a few years back I put this together on AMH: https://ivf.ca/forum...it-explanation/.
 
After our second IVF my RE said that if money was no object, we could just keep doing IVFs and he believes eventually I would get a genetically normal embryo, but he could in no way predict how many tries that would take. Another option for poor responders is to do a mini-IVF and do a few of them. They tend to be cheaper for the drugs, though I'm not sure that they are cheaper for the procedure.
 
For sure there is someone that was a poor responder that eventually had a successful cycle, but that was one very very very lucky person. A lot of people either just give up, or move on to donor eggs. Either decision is difficult and very personal.

[N1111]

How did your mini IVF cycle go? I have done two cycles and didnt respond well. First I got 10 eggs and 4 were mature and 2 embryos. But didnt result In pregnancy. Second IVF showed 9 follicles and looked like I would get 3 or 4 mature eggs but I only got two eggs and only one was mature. So I froze it. Now Im waiting to start another cycle and doctor wants to try mini IVF Especially since I dont get a lot of embryos. Im 40 years old with low MH. How was your mini IVF and wasnt worth it

[Misskika007]

@Misskika, how’re you doing? My RE brought up HGH without me asking about it but let us decide if we want to add it or not. How much/often did you take it? He also said that I can try DHEA 25mg/day and Q10 (200mg) but again let us do what we want.  Have you taken any supplements? Honestly, I’m still so confused as of why I got such a poor response with my “reasonable “ numbers.  I guess, I’m willing to try HGH and supplements before moving to DE. IUIs are not going to do anything for us bc of 2% sperm morphology. 
 

Also, he mentioned that I’ll need to go on norethindrone for 10 days before starting Lupron. I can’t find a lot of info about it. Sounds like some kind of birth control pill based on progesterone. Maybe it’ll slow down my dominant follicle because it was growing fast and the other 3 were lagging behind?

Hey Abi! That's great that your doc recommended HGH. DHEA and testosterone are sort of the same, my doc preferred testosterone as it is quicker and to the point, but it also may have something to do with the amount of estrogen one has. I tried CoQ10 but I had weird bleeding from it so ended up on the following supplements- Curcumin, NAC + ALA, Pycnogenol, Omega 3, Prenatal, L-Carnitine & Vitamin D. I think going to a naturopath may help you better understand supplements because we all have underlying issues that may impact how different supplements interact with fertility meds or underlying issues that could be addressed to promote fertility! For me, I have underlying estrogen issues + inflammation from endometriosis so this was the combo that was recommended for me.

A little update, I have a PGT-A normal embryo to transfer So I think I'm a fan of the microdose lupron flare protocol! Dr is also recommending an ERA to make sure the transfer window is appropriate! 

Sending big hugs for the next step of your journey. 

[Abi]

 

@Misskika, how’re you doing? My RE brought up HGH without me asking about it but let us decide if we want to add it or not. How much/often did you take it? He also said that I can try DHEA 25mg/day and Q10 (200mg) but again let us do what we want.  Have you taken any supplements? Honestly, I’m still so confused as of why I got such a poor response with my “reasonable “ numbers.  I guess, I’m willing to try HGH and supplements before moving to DE. IUIs are not going to do anything for us bc of 2% sperm morphology. 
 

Also, he mentioned that I’ll need to go on norethindrone for 10 days before starting Lupron. I can’t find a lot of info about it. Sounds like some kind of birth control pill based on progesterone. Maybe it’ll slow down my dominant follicle because it was growing fast and the other 3 were lagging behind?

Hey Abi! That's great that your doc recommended HGH. DHEA and testosterone are sort of the same, my doc preferred testosterone as it is quicker and to the point, but it also may have something to do with the amount of estrogen one has. I tried CoQ10 but I had weird bleeding from it so ended up on the following supplements- Curcumin, NAC + ALA, Pycnogenol, Omega 3, Prenatal, L-Carnitine & Vitamin D. I think going to a naturopath may help you better understand supplements because we all have underlying issues that may impact how different supplements interact with fertility meds or underlying issues that could be addressed to promote fertility! For me, I have underlying estrogen issues + inflammation from endometriosis so this was the combo that was recommended for me.

A little update, I have a PGT-A normal embryo to transfer So I think I'm a fan of the microdose lupron flare protocol! Dr is also recommending an ERA to make sure the transfer window is appropriate! 

Sending big hugs for the next step of your journey. 

 

OMG, I'm so happy for you!! I'm sure it's such a relief to know that you have a normal embryo! Are you planning on getting ready to transfer soon? So exciting!!

[Paris2020]

Hi ladies, I got my results with Dr Garbedian today, she offered me going on an IVF cycle again since last one was incorrectly cancelled by my previous RE. She offered me going on 2 retrievals to be on the safe side however since Hannam 's next government funded cycles will start in April 2021 and I am already running out of time, what do you think? I need your thoughts on this  please, I dont know who should I discuss it with.

Also does anyone know Dr Bradson or Branson in infertility, DR G said he/she might have Government funded cycles available, but i am still not sure if i should go on with another clinic or stay with Hannam.

[Misskika007]

Hey Paris- do you only plan to do a funded cycle or do you plan to also pay for a cycle out of pocket? If the latter, I would say pay for one first and then do the next in April with Hannam. I cant rave about Dr G enough and dont know if I would trust any other RE at this point. But if she did recommend you to a specific doctor and you only will do funded then it may be worth getting a consult with that doctor to see what their approach is before making any decisions. I think you can put your name on the Hannam list regardless if you go with them or another clinic for funded.

[Paris2020]

Hey Paris- do you only plan to do a funded cycle or do you plan to also pay for a cycle out of pocket? If the latter, I would say pay for one first and then do the next in April with Hannam. I cant rave about Dr G enough and dont know if I would trust any other RE at this point. But if she did recommend you to a specific doctor and you only will do funded then it may be worth getting a consult with that doctor to see what their approach is before making any decisions. I think you can put your name on the Hannam list regardless if you go with them or another clinic for funded.

Hi there, thank you for your opinion, she advised me not to wait for so long because of the risk of low AMH, so I dont know if I should wait till April. I am waiting for the nurse to send me the estimates to see if I can manage in somehow.

BTW, did you ask them to send you your results? is it ok to ask and will they send it?

And she also said that IUI might work for me if i only want one child with the chance of 10% I dont know if i should give it a try or not, i had one IUI cycle back in November 2019 with another RE.

[Misskika007]

Hey Paris, sorry didnt follow up. Did you make a decision? I do know they will send your results no problem if you decide to go with another clinic.

An update on micro dose lupron flare- I have a strong beta from our transfer so hoping this little one keeps growing strong. I think this was the right protocol for me so for those looking to try this protocol for DOR, go for it!