Some people prefer the term Diminished Ovarian Reserve or Low Egg Reserve for patients who meet this criteria, as the ovarian response to medications for this group is not always necessarily poor, but rather is simply expected to be lower at their given baseline. I did EPP my second round of IVF. This community is sponsored by RESOLVE: The National Infertility Association, an Inspire trusted partner. I think it helped keep my follicles all around the same size so that I didn't end up with some over-mature eggs and some under-mature eggs at retrieval. However, for poor responders many doctors worry such a long duration of suppression can hurt outcomes. Fortunately, there are a few steps you can take to prevent and. IVF#3 September 2009 - cancelled - poor response I am anxious to see if my dr recommends it. Has anyone with failed IVF stim tried mini/micro IVF? BFP October 22!!!! The data supporting the use of growth hormone in poor responders leading up to gonadotropin use is more convincing. I started epp with cetrotide x 3 days. This is the oldest IVF protocol and is especially effective in preventing premature ovulation during the cycle. The answer lies in the drug the protocol uses to trigger the eggs to mature so that they can be retrieved. Fingers crossed that your period waits for the right day. Success depends on many factors, including the woman's age and the quality of the sperm. 1997-2023 BabyCenter, LLC, a Ziff Davis company. Experience with Estrogen Priming Protocol? I started my estrace this morning and feel a little icky so far. After seven long years consumed by infertility I am finally moving forward, wishing my son was with me, but grateful for the two children I have here with me. On CD2 I started 300 Gonal F and 150 Menopur. IVF #2, we did estrogen priming, Follistim, Menopur, Tev Tropin (human growth hormone), Cetrotide. Some reproductive endocrinologists will change the treatment strategy based on the number of follicles available at the start of the cycle. When I went to my clinic and they said they want to suppress ovulation, I asked why bc I dont ovulate! Hi there. Johns Hopkins School of Medicine, Medical Director, REI I asked my local RE about it, but she wasn't familiar enough with it to try. The dose of gonadotropin is typically measured in International Units Per Day and ranges from 0 - 900 with most IVF patients receiving 250 - 450 IUs per day. Are you wanting to learn more about the IVF process? I did have a decent response on the MDL and 100% fertilization with two good 5 day blasts. This comes from a 38,000 patient European registry. I was on BCP for 20 years (have been off for several now) and it took me a long time to normalize after coming off them. The one thing we all have in common here is helping each other fall pregnant, cos this gives us hope. Second, this study was only done in cycles using a fresh transfer. Now this is a guesstimated number. For this reason, the antagonist protocol is a good option for those women most susceptible to OHSS. The stim phase was just like a usual antagonist cycle. Editorial Review Policy. Very helpful! Slightly higher doses of Follistim and Menopur to try to get a few more eggs. 14 retrieved, 9 mature, 5 fertilized normally, 2 grew to the 2-cell stage then arrested, 3 did not grow beyond one cell. He did say there are some studies that DHEA and CoQ10 could help, but the, Hi all. He usually gives the BCP before overlapping with lupron as a way to lower FSH and LH. I just had a consultation with an RE he recommended a "estrogen priming micro-flare lupron" protocol. If ok, then start stimulation The many repeat bloodworks & ultrasoundsLast stimulation shot + triggerRetrievalSo I started my process in the mid-September and my retrieval happened in early NovemberAlso, I was on MicroFlare protocol, so I am not sure what other medications you might be taking. I'm 40, doing IVFdue to age and a mc at 10 weeks due to Trisomy18. I was at the max stim dose to get the response I did. Our first cycles sound pretty similar. | Contributor. I have AMH of 0.1 or something like that. Did not cover diagnostics like doppler test (40 copay but insurance might have covered this), communicable testing ($400 per person), and specialty meds . After being on BCPs for so long, it took a long time for my period to come back (it's been 5 years though now), but my cycle has still never been the same so I'm wary of BCPs. How many follicles were you usually starting with? Whats important to stress here is that just because some low dose approaches drive comparable rates of success to conventional approaches, that doesnt mean all low-or-no dose approaches are effective. Implantation Calendar: What is Happening During the Two Week Wait. They thought they saw 4 follicles, but were only able to collect 2. Infertility Support Community in Partnership with RESOLVE. Im over 40 and did estrogen priming for a bunch of cycles and a Lupron stop. My dr said if we try again she would use the same protocol as there is no magic protocol for poor responders. Confirms hormone levels are baseline and gets antral follicle count as a basis for cycle prognosis. But not all patients respond equally to ovarian stimulation using these hormones. Today, most IVF cycles use a frozen transfer whereby embryos are frozen and transferred at least a month after the retrieval. Is a micro-dose lupron protocol considered a low-dose protocol? 6 responded, 5 retrieved, 3 fertilized normally, put all 3 back in at 3dpt - I am currently 27 weeks with one baby girl. Sadly, both my hatching blasts were abnormal. So I think I was on estrogen for about a couple weeks then started stimming (antagonist protocol). That could be bogus, but it makes sense, right? Beta 1117 From what I've seen on the boards, ladies get a higher number and higher quality. May I ask what your AMH was? This was my worst cycle ever only yielding 2 retrieved follicles that did not fertilize. My first IVF cycle I was on the antagonist with stims started on Day 3.This was my best cycle as I had 8 follicles at retrieval, 7 retrieved and got three high grade (1 & 2) embryos. I would ask your doctor, but I guess you just do nothing while preparing for the cycle. 2005-2023Everyday Health, Inc., a Ziff Davis company. What affect did the epp have on your follicles? We're not even 100% sure we are staying with my current clinic but I wanted to research ahead of time either way. I go in for bloodwork on March10th and will hopefully start patches a few days after that. Regular menstrual cycles between 21 and 40 days Presence of both ovaries Meets criteria for DOR by the recent ASRM/ACOG Committee Opinion antimllerian hormone (AMH) value less than 1 ng/mL antral follicle count less than 5-7 and follicle-stimulating hormone (FSH) greater than 10 IU/L or I think if I hadn't EPP, I wouldn't have had to stim so high. Yea, sometimes the smallest of tweaks can make such a big difference. There are a number of drugs that can be tacked onto the beginning of a cycle that may increase the odds of success. AMH 28. Has anyone else had this, Hi peeps. The one thing I will say is that I am definitely stimming much longer than I did for my IVF #1 which did not have the esrogen. Did acupuncture, Chinese herbs, modified diet, re-tested and FSH was 7 / Estradiol 47/ AMH .4 You are posting as a Guest without being logged in. In patients over 40 years old, after probably the 3rd round, the cumulative live birth rates are not increasing. BabyCenter may earn a commission from shopping links. Fx! As a result, the Antagonist strategy is generally preferred for women at especially high risk of developing OHSS, namely women with PCOS, younger women, women with high AMH or AFCs, African American women, and those who produced a high number of eggs in a recent cycle. Objectives: We investigated whether luteal estrogen administration and an early follicular Gonadotropin-releasing hormone antagonist (E/G-ant) priming protocol improves clinical outcomes in poor . Lupron when take in larger doses suppresses pituitary function, but when taken in smaller doses, it does the opposite. Beta 2093 And I think EPP is the standard at CCRM as well for DOR ladies. Back to home page. Thanks so much! Hi @cmugnolo, you have a similar situation to mine perhaps. This clinic only biopsies hatching blasts. Does anyone have experience with this? This will be my first IVF round and I w, Hi All, I did a low stim ivf (225 menopur & 100 mg clomid) with human growth hormone which is what my fertilty clinic does for women over 40 and poor responders. All rights reserved. Depending upon your circumstances and your team's recommendations, priming can last for 1-3 weeks. The meds alone cost $5,400. So there's one med w apositive side effect! I might have ovulated rather than had empty follicles. The doctor just wants to make sure you dont release an egg while getting your body ready for a retrieval or transfer. it's 1 week since last patch. Worked for me! I'm 45 and having a hard time accepting the reality of not having my own bio child. Transfer was canceled. They suppress leading up to your cycle so that when you start the meds you get a group of follicles to grow together. It is so hard to be hopeful after 3 failed attempts. i had success with DE. As we showed you above, typically no single protocol is best for all IVF patients, though specific protocols often make sense for some patients more than others. I know you ladies all have your own stuff going on and I feel terrible asking but I dont know who else to askBarb, penny, joy, anyone else, Ive read that an estrogen priming protocol is good for DOR women, do you know if this is true? My doctor will add human growth hormone during stims. As you may recall in the Revelli and Yousef studies, 150 IUs per day of gonadotropin were used, which is well higher than most things marketed as mini-stimulation approaches, and any natural (no gonadotropin) approach. I tried it and it seemed to help with even follicle growth but so some reason I had less eggs in the follicles than prior cycle when I was on bcp first? Comparing the good cycle to the other 3, I see why. day 1 of cycle/protocol: (day 2 of menses): cetrotide 0.125 mg subcutaneously 4 estradot patches (estradot patches to be stopped when lead follicle was greater or equal to 1.5 cm) days 2 and 3 of cycle: 600 iu gonal f 0.125 mg cetrotide days 4 - 6 of cycle: 525 iu gonal f 0.125 mg cetrotide days 7 - 11 of cycle: 225 iu gonal f 0.125 cetrotide Ovarian Stimulation Baseline Ultrasound They are generally used for suppression in Long Lupron Protocols. Thanks! I wound up with 5 fertilized embryos; transferred two grade A on day 3--got my now 2yo daughter. Omnitrope/HGH pricing and protocol question? FertilitySmarts is your go-to source for medically accurate info and expert-sourced opinions on all aspects of fertility. 10 retrieved, 6 mature, 6 fertilized (half with ICSI), transferred two 8-cell embryos on day three (both with moderate fragmentation, graded B and C-), the four remaining arrested by day 5. 45 and over - who are trying to get pregnant. To conclude, in the group of patients . So, I'm 39 with Amh of 0.07 (undetectable) and FSH of 9. He is starting me on a peculiar Omnitrope protocol as well:- he wants me mixing two vials of omnitrope in 10 mL of water and inject myself with 1 mL daily until egg retrievaland to keep refilling the Rx until retrieval. I started taking 4mg of estrace on cd 21. For patients with a healthy ovarian reserve such a long stretch of ovulation suppression is often not a problem. I did EPP, using a climara patch every other day starting day 8 after ovulation until period came. :) worked well for me. After my labs on CD6 they kept 300 Gonal F but upped Menopur to 300. I was on the highest dosage of Gonal with that cycle. Outdoor sports and activities of all types. Estrogen Priming Protocol- EPP Experiences. I understand the idea for the patch is to help time the growth of follicles vs. increase the number? Estrogen priming through luteal phase and stimulation phase improved ovarian responsiveness and this may lead to an increase in pregnancy rate in poor responders with failed cycle. Natural cycle is no meds to stim so u get 1 egg at best. To get FSH, patients take Gonal-F or Follistim (many consider them to be interchangeable) and to get FSH-plus-LH most women take Menopur (pretty much the only product on the market). Was wondering since your AMH was good and FSH, why did they recommend the Estrogen priming protocol for you? It is used on lowish amh patients and those who respond poorly to drugs which affect their lining. Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. . I'm now 19 wks pregnant with #2 from embryo from same batch. Oh yeah that could have been it or a combo! Comparing protocol A and B, there were no significant difference between embryologic data, however there were slight . They put me on birth control pills for a month and are skipping the early stage Estrace this time around. you are not supposed to TTC on the cycle you will be doing the EPP because of the ganirelix. DS was born June 22nd, 2007!!!!! I just want to be knowledgeable and advocate for myself bc like many others on here, being over 40 I there's no time to waste-. Create an account or log in to participate. I then switched clinics. Below is a meta-analysis of 17 (relatively small) studies that, taken together, show the strategies have nearly identical pregnancy rates. 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estrogen priming protocol success over 40 combivent