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IVF Protocols for PCOS

pcos agonist protocol antagonist protocol question ivf

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#1 s00n

s00n
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  • Gender:Female
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  • Interests:Him- Potential SA issues Me- PCOS like crazy/anovulation/long cycles. Started TTC before 30.TTC/Secondary Infertility(2008-2015) - Adopted from public system in Ontario 2012.Freeze-All IVF after OHSS, and successful FET 2015 @ 36Yrs Old.
  • Dx:PCOS
  • My Clinic:OFC

Posted 10 October 2014 - 09:52 AM

We've decided after years to take one stab at a fresh IVF cycle.  (Hopefully we will have frozen embryos if we don't get a positive result initially.)  It's exciting and stressful.

 

For those of you with PCOS who've gone through IVF, did you do an agonist or antatonist/ or short or long protocol?

 

I'm curious what worked well for you.

 

I have PCOS and have actually had regular cycles generally since losing weight and taking Metformin semi-regularly.  Previously I had extra weight and 60 day cycles.

 

I don't know if I O on my own.

 

Thanks for your input!


See my about me page for details on our IF journey including adoption and other avenues.

#2 TryingForOur2ndChild

TryingForOur2ndChild
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  • Location:London, ON
  • Dx:Male Factor

Posted 10 October 2014 - 10:51 AM

Hello......

I have always had very normal/regular cycles but have PCOS-like ovaries which was found with my AMH and AFC testing.... so it sounds like you and I are similar. My first IVF cycle was this past June and I was on a short term protocol but it was extended for a couple of extra days. You will see in my signature all of my details of exactly what they had me on and the doses... I've done this purposely in the even it can help even one woman. ;)  I can't say as I'll be a good example because I ended up having 22 eggs retrieved but sadly only 8 got ICSI'ed, 6 fertilized and 4 made it to freeze on day-3.... we chose to freeze on day-3 because we didn't want to risk having no embryos or just one at day-5 seeing as on average you lose 50% of embryos from day-3 to day-5, but it all depends on how you feel about this. Please feel free to ask any questions you might have.


  • s00n likes this

See full journey details on my profile:

 

About Us:

​Trying to conceive since 2013 (male factor); Me: 39 yrs old; DH: 37 yrs old; low testosterone; very low sperm count; on Clomid for testosterone

 

~ 2014 ~ IVF Cycle #1:

 

Cycle Info:

- Antagonist protocol

- Retrieval: 22 eggs retrieved; 8 injected (ICSI); 6 fertilized; 4 embryos divided - 2 embryos are 4 cell grade 1, 1 embryo is 5 cell grade 2, and 1 embryo is 8 cell grade 2

 

FET #1 - medicated cycle (2014)

- transferred two day-3s: one 10 cell grade 1 and one 12 cell grade 2; Beta: BFN; approved to do a natural FET next time

 

FET #2 - Non-medicated cycle (2014)

- added Teva-Doxycycline 100mg (antibiotic) started one day before procedure: 1 tab 2xdaily until finished) 

- transferred two day-3 embies (1 is 10 cell grade 2 and 1 is 12 cell grade 2); took 1 tab of Apo-Diazepam (valium) 5mg 45mins before FET        

​- HPT = th_abfp.gifbanana.gifbanana.gifth_abfp.gif  Welcomed our little babygirl.gif in summer of 2015

 

~ 2016/17IVF Cycle #2: Project Sibling

 

Cycle Info:

Oct. 29: Retrieval - 23 eggs retrieved; will be a freeze all cycle

Nov. 2: Dostinex 0.5mg every other day for a total of 8 days has started to alleviate OHSS 

Nov. 4: Day 6 report: 5 embryos on ice... yay! 4 day-5s (4AA and 3 are 4BC quality) and 1 day-6 (5BC quality)

 

FET #1 - Non-medicated cycle (2017)

Feb. 6: start Teva-Doxycycline antibiotic100mg one day before procedure
Feb. 7: scheduled transfer at 11:45am; 1 tab of Apo-Diazepam (valium) 5mg taken 45mins before transfer; transfer of one 4AA blast

Feb.20: BETA - BFN; approved to go right into another natural FET with no cycle in between

 

FET #2 - Non-medicated cycle (2017)

Feb.24: CD3 - u/s and b/w= nothing said about lining; E2 19, LH 4.4 IU/L, FSH 6.6 IU/L, Prolactin 8.1 Ng/mL, TSH 2.22 IU/L, Progesterone 1.6 nmol/L, Glucose 4.1 - I requested (norm is 3.6-7.7); back on CD15; acupuncture 2x weekly until fet to try and bring on LH surge sooner than CD17.

Mar.6: OPK positive in the evening so looks like I will be going into the clinic tomorrow

Mar.7: CD14 - u/s and b/w= 11mm triple lining; E2 712, LH 32 IU/L

Mar.8: CD15 - b/w= confirmed LH surge was yesterday; E2 343, LH 8.12 IU/L; start Endometrin 3x/daily

Mar.11: start Doxycycline antibiotic 100mg (8 pills total) one day before procedure: 1 tab 2xdaily until finished

Mar.12: scheduled transfer at 10am of one 4BA blast; 1 tab of Apo-Diazepam (valium) 5mg taken 45mins before transfer

Mar.23: HPT = th_abfp.gifbanana.gifbanana.gifth_abfp.gif

​Mar.25: Beta #1= 788 hcg, Progesterone 107 nmol/L; RE happy with results so skipping beta #2 and going right to u/s

​Apr.4: had light bleeding last night so went to clinic where they did an u/s; too early to really see much but did see a gestational sac; u/s moved from Apr.8th to 15th

Apr.18: First u/s scheduled (at 8 wks).... omg there are twins!!! One had a heartbeat of 140 and the other only 80 so being referred to the head OB of internal fetal medicine as it looks like I may have a vanishing twin which RE said 50% of twins go down to one before the 2nd trimester.

 

 

 

 

 


#3 Watermelon

Watermelon
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Posted 10 October 2014 - 11:17 AM

pcos or pcos-like ovaries are tricky. I have pcos like ovaries, but not pcos. I produced lots of follicles and eggs, but most were immature or such poor quality that they actually stuck to the inside of the follicle and were not useable. The other tricky part is that we often have sky high estrogen levels on account of the many developing follicles. This can be very dangerous and lead to OHSS if not managed well. The safest protocol for someone who produces a lot of follicles (be they useable or not) and high estrogen is an antagonist protocol as you can trigger with something besides hcg (which is what often triggers OHSS). That said, I had poor egg quality on an antagonist protocol (at age 29). It's hard to say though if that's because I was overstimulated, if my body just didn't like the antagonist protocol or if I really do have rotten eggs.

I am in the process of getting second opinions and so far, despite my initial poor outcome on antagonist, 3/4 clinics have told me they will only recommend antagonist for me because of the estrogen getting so high. The other clinic said agonist, but said they may cancel my cycle completely if my estrogen got too high. So...who knows!

Best of luck!
  • TryingForOur2ndChild likes this

Me -29 31- unexplained poor egg quality. I was told I had endometriomas.....but repeat ultrasounds at other clinics have said no sign of endometriomas. Maybe PCOS-like ovaries, but no PCOS - AMH, AFC are great. No one can explain why my eggs are so poor sad.png

DH 30 - severe teratospermia, count and motility are excellent.

May 2014 - 2.5mg femara - BFN (ovulated night before)

June 2014 - IUI with 5mg femara - BFN (ovulated night before)

August 2014 - IVF with ICSI - Antagonist protocol, 150Bravelle, 75 menopur, stimmed 8 days

- 19 follicles (all 15-22mm at trigger), 12 eggs retrieved, 7 mature,, 5 fertilized with ICSIsad.png

- only 7 mature eggs with an estrogen of 20000?! wtf?! Sigh...Freeze All

-only one BB Blast made it. Freeze "all" became "freeze one". All others arrested between day 3 and 4 sad.png

January 2015 - FET of lone embryo - c'mon little figher

- BFP!!! Beta 1 475 at 10dp5dt , Beta 2 - 1495 at 12dp5dt

Baby boy born Sept 28/15


#4 s00n

s00n
  • 1000+
  • 1247 posts
  • Gender:Female
  • Location:Canada
  • Interests:Him- Potential SA issues Me- PCOS like crazy/anovulation/long cycles. Started TTC before 30.TTC/Secondary Infertility(2008-2015) - Adopted from public system in Ontario 2012.Freeze-All IVF after OHSS, and successful FET 2015 @ 36Yrs Old.
  • Dx:PCOS
  • My Clinic:OFC

Posted 10 October 2014 - 12:39 PM

Thank you ladies.  Both of you.  Good luck with your frozen potential and with your journey.

 

I have to redo my bloodwork since we've been away from our clinic for years, so I won't be at the medicated part of this until end of November likely.

 

I'm sure that my Dr will have suggestions for me, but since we're only going through one fresh cycle I want to ensure I do what makes the most sense in my mind.


  • TryingForOur2ndChild likes this
See my about me page for details on our IF journey including adoption and other avenues.

#5 TryingForOur2ndChild

TryingForOur2ndChild
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  • 791 posts
  • Gender:Female
  • Location:London, ON
  • Dx:Male Factor

Posted 10 October 2014 - 12:41 PM

Just like Watermelon, I too had to avoid being triggered with hcg and had a lupron trigger instead to shut down the chances of OHSS but then they figured I'd be a freeze all case to begin with.


  • s00n likes this

See full journey details on my profile:

 

About Us:

​Trying to conceive since 2013 (male factor); Me: 39 yrs old; DH: 37 yrs old; low testosterone; very low sperm count; on Clomid for testosterone

 

~ 2014 ~ IVF Cycle #1:

 

Cycle Info:

- Antagonist protocol

- Retrieval: 22 eggs retrieved; 8 injected (ICSI); 6 fertilized; 4 embryos divided - 2 embryos are 4 cell grade 1, 1 embryo is 5 cell grade 2, and 1 embryo is 8 cell grade 2

 

FET #1 - medicated cycle (2014)

- transferred two day-3s: one 10 cell grade 1 and one 12 cell grade 2; Beta: BFN; approved to do a natural FET next time

 

FET #2 - Non-medicated cycle (2014)

- added Teva-Doxycycline 100mg (antibiotic) started one day before procedure: 1 tab 2xdaily until finished) 

- transferred two day-3 embies (1 is 10 cell grade 2 and 1 is 12 cell grade 2); took 1 tab of Apo-Diazepam (valium) 5mg 45mins before FET        

​- HPT = th_abfp.gifbanana.gifbanana.gifth_abfp.gif  Welcomed our little babygirl.gif in summer of 2015

 

~ 2016/17IVF Cycle #2: Project Sibling

 

Cycle Info:

Oct. 29: Retrieval - 23 eggs retrieved; will be a freeze all cycle

Nov. 2: Dostinex 0.5mg every other day for a total of 8 days has started to alleviate OHSS 

Nov. 4: Day 6 report: 5 embryos on ice... yay! 4 day-5s (4AA and 3 are 4BC quality) and 1 day-6 (5BC quality)

 

FET #1 - Non-medicated cycle (2017)

Feb. 6: start Teva-Doxycycline antibiotic100mg one day before procedure
Feb. 7: scheduled transfer at 11:45am; 1 tab of Apo-Diazepam (valium) 5mg taken 45mins before transfer; transfer of one 4AA blast

Feb.20: BETA - BFN; approved to go right into another natural FET with no cycle in between

 

FET #2 - Non-medicated cycle (2017)

Feb.24: CD3 - u/s and b/w= nothing said about lining; E2 19, LH 4.4 IU/L, FSH 6.6 IU/L, Prolactin 8.1 Ng/mL, TSH 2.22 IU/L, Progesterone 1.6 nmol/L, Glucose 4.1 - I requested (norm is 3.6-7.7); back on CD15; acupuncture 2x weekly until fet to try and bring on LH surge sooner than CD17.

Mar.6: OPK positive in the evening so looks like I will be going into the clinic tomorrow

Mar.7: CD14 - u/s and b/w= 11mm triple lining; E2 712, LH 32 IU/L

Mar.8: CD15 - b/w= confirmed LH surge was yesterday; E2 343, LH 8.12 IU/L; start Endometrin 3x/daily

Mar.11: start Doxycycline antibiotic 100mg (8 pills total) one day before procedure: 1 tab 2xdaily until finished

Mar.12: scheduled transfer at 10am of one 4BA blast; 1 tab of Apo-Diazepam (valium) 5mg taken 45mins before transfer

Mar.23: HPT = th_abfp.gifbanana.gifbanana.gifth_abfp.gif

​Mar.25: Beta #1= 788 hcg, Progesterone 107 nmol/L; RE happy with results so skipping beta #2 and going right to u/s

​Apr.4: had light bleeding last night so went to clinic where they did an u/s; too early to really see much but did see a gestational sac; u/s moved from Apr.8th to 15th

Apr.18: First u/s scheduled (at 8 wks).... omg there are twins!!! One had a heartbeat of 140 and the other only 80 so being referred to the head OB of internal fetal medicine as it looks like I may have a vanishing twin which RE said 50% of twins go down to one before the 2nd trimester.

 

 

 

 

 


#6 TryingForOur2ndChild

TryingForOur2ndChild
  • Global 100+
  • 791 posts
  • Gender:Female
  • Location:London, ON
  • Dx:Male Factor

Posted 10 October 2014 - 12:43 PM

Thank you ladies.  Both of you.  Good luck with your frozen potential and with your journey.

 

I have to redo my bloodwork since we've been away from our clinic for years, so I won't be at the medicated part of this until end of November likely.

 

I'm sure that my Dr will have suggestions for me, but since we're only going through one fresh cycle I want to ensure I do what makes the most sense in my mind.

 

You might want to ensure they do your AMH blood testing just so you have an idea of your follicle reserve. Wishing you all the very best on your next cycle and please feel free to contact me and ask absolutely any questions I might be able to help you with. :)


See full journey details on my profile:

 

About Us:

​Trying to conceive since 2013 (male factor); Me: 39 yrs old; DH: 37 yrs old; low testosterone; very low sperm count; on Clomid for testosterone

 

~ 2014 ~ IVF Cycle #1:

 

Cycle Info:

- Antagonist protocol

- Retrieval: 22 eggs retrieved; 8 injected (ICSI); 6 fertilized; 4 embryos divided - 2 embryos are 4 cell grade 1, 1 embryo is 5 cell grade 2, and 1 embryo is 8 cell grade 2

 

FET #1 - medicated cycle (2014)

- transferred two day-3s: one 10 cell grade 1 and one 12 cell grade 2; Beta: BFN; approved to do a natural FET next time

 

FET #2 - Non-medicated cycle (2014)

- added Teva-Doxycycline 100mg (antibiotic) started one day before procedure: 1 tab 2xdaily until finished) 

- transferred two day-3 embies (1 is 10 cell grade 2 and 1 is 12 cell grade 2); took 1 tab of Apo-Diazepam (valium) 5mg 45mins before FET        

​- HPT = th_abfp.gifbanana.gifbanana.gifth_abfp.gif  Welcomed our little babygirl.gif in summer of 2015

 

~ 2016/17IVF Cycle #2: Project Sibling

 

Cycle Info:

Oct. 29: Retrieval - 23 eggs retrieved; will be a freeze all cycle

Nov. 2: Dostinex 0.5mg every other day for a total of 8 days has started to alleviate OHSS 

Nov. 4: Day 6 report: 5 embryos on ice... yay! 4 day-5s (4AA and 3 are 4BC quality) and 1 day-6 (5BC quality)

 

FET #1 - Non-medicated cycle (2017)

Feb. 6: start Teva-Doxycycline antibiotic100mg one day before procedure
Feb. 7: scheduled transfer at 11:45am; 1 tab of Apo-Diazepam (valium) 5mg taken 45mins before transfer; transfer of one 4AA blast

Feb.20: BETA - BFN; approved to go right into another natural FET with no cycle in between

 

FET #2 - Non-medicated cycle (2017)

Feb.24: CD3 - u/s and b/w= nothing said about lining; E2 19, LH 4.4 IU/L, FSH 6.6 IU/L, Prolactin 8.1 Ng/mL, TSH 2.22 IU/L, Progesterone 1.6 nmol/L, Glucose 4.1 - I requested (norm is 3.6-7.7); back on CD15; acupuncture 2x weekly until fet to try and bring on LH surge sooner than CD17.

Mar.6: OPK positive in the evening so looks like I will be going into the clinic tomorrow

Mar.7: CD14 - u/s and b/w= 11mm triple lining; E2 712, LH 32 IU/L

Mar.8: CD15 - b/w= confirmed LH surge was yesterday; E2 343, LH 8.12 IU/L; start Endometrin 3x/daily

Mar.11: start Doxycycline antibiotic 100mg (8 pills total) one day before procedure: 1 tab 2xdaily until finished

Mar.12: scheduled transfer at 10am of one 4BA blast; 1 tab of Apo-Diazepam (valium) 5mg taken 45mins before transfer

Mar.23: HPT = th_abfp.gifbanana.gifbanana.gifth_abfp.gif

​Mar.25: Beta #1= 788 hcg, Progesterone 107 nmol/L; RE happy with results so skipping beta #2 and going right to u/s

​Apr.4: had light bleeding last night so went to clinic where they did an u/s; too early to really see much but did see a gestational sac; u/s moved from Apr.8th to 15th

Apr.18: First u/s scheduled (at 8 wks).... omg there are twins!!! One had a heartbeat of 140 and the other only 80 so being referred to the head OB of internal fetal medicine as it looks like I may have a vanishing twin which RE said 50% of twins go down to one before the 2nd trimester.

 

 

 

 

 


#7 s00n

s00n
  • 1000+
  • 1247 posts
  • Gender:Female
  • Location:Canada
  • Interests:Him- Potential SA issues Me- PCOS like crazy/anovulation/long cycles. Started TTC before 30.TTC/Secondary Infertility(2008-2015) - Adopted from public system in Ontario 2012.Freeze-All IVF after OHSS, and successful FET 2015 @ 36Yrs Old.
  • Dx:PCOS
  • My Clinic:OFC

Posted 14 October 2014 - 01:29 PM

Thank you - AMH tested, follicle reserve high, which is a relief.  The one thing I hear about AMH for PCOS is that it's unreliable, but then I always hear that one should have it tested.  Anyone else hear anything about this?

 

I am a few days away from a cycle hopefully, so we should be able to get the tests re-run and to get started in November OR new year.


See my about me page for details on our IF journey including adoption and other avenues.





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