poor responder protocal Q's- GHOST/ladies please

[karenvancouverisland]

hi all..

as i'm about to enter our 5th and last treatment (3rd fresh IVF), i'm determined to be a strong advocate for myself... and i'm coming to realized my protocal from the last 2 cycles may be unusual.. so i'd LOVE some feedback.

background: i ovulate and have regular cycles, high FSH on day 10 (11.2 at last check, this is from the clomiphene challenge test, day 3 is fine), low antral follicle count (4 on one side, 5 on the other)

after my first IVF was cancelled due to dismal response, i was put on the FLARE protocal (i've done this twice), and was told there was no suppression AT ALL needed (this is what my question is about)... so i've taken NO BCP's and no LUPRON/ SYNAREL (agonist)... and just start FSH stims on day 3 or day 4 (gonal F, 225 ui 2xday) and at around day 6 cetrotide and luveris are added in...

so, is this normal? i did some googling and read that others on flare still do some BCP's or other things to prevent whatever happens with ovulation from not sabotaging the stims... and i ovulate.. so i don't get it? and my RE hates being questioned on how he runs my cycle and i find it very uncomfortable quesitoning him (i'm about to change clinics btw)

any input would put my mind at ease and/or help me prepare for my next cycle with a new RE, who, of course, i'll be asking him about this too !

[riogirl71]

Karen,

If you are on DHEA you might not want to be on BCP, I ovulated right through it and had my cycle postponed for a month. I sent you my protocol, antagonist but with 5 days of Femara, then Follisitm, menopur and then ganirelix. My doses started out small and increased. With my other RE I had a high dose from the start then he lowered a tid. THis new tweak made me double the amount of eggs and they were good quality eggs and embryos.

Good luck hun! I am here fingers crossed for you, I am on my 3rd fresh IVF too so I am hoping 3rd time is the charm for both of us!

[Ghost]

If you took "no LUPRON/ SYNAREL (agonist)", then how was it a flare protocol? All the flare protocols I know of start off with an agonist.

[karenvancouverisland]

hmmm... exactly my point ghost.. but i was told it was 'flare'.. my recent research alerted me to this difference...before i just took what my clinic said at face-value

and OMG rio- what happened?? i'll have to catch myself up on nov boards or pm you.. you're such a sweetie- i'm sorry i didn't know earlier.. i've been looking at your protocal and it seems you started stims on day 2 after AF... and i couldn't see where you suppressed on the chart ..

[karenvancouverisland]

ok rio- maybe i get it now... you're still PG, but waiting to make it through more milestones before 'counting on it'.. and i soooo get that

yes m'dear, we are in this together, i'll just be about 4-5 months behind you

so, ghost- if you're there... do you think my clinic screwed up? it's been known to happen... i just can't figure it out..

[Ghost]

so, ghost- if you're there... do you think my clinic screwed up? it's been known to happen... i just can't figure it out..

I suggest you ask them if they forgot the flare in your flare protocol.

[riogirl71]

Karen - the supression I think is the ganirelix I took. So femara before, start follistim, menopur, increase dose then ganirelix.

Yeah I had an early US and unfortunately had nothing but an empty sac and I am praying it was too early. Same thing happened to Blair. My next US is Thursday and I am terrified, I am praying so hard for a healthy baby. After my ectopic I am just so scared of bad news. You know how hard this is even if you already have a miracle! I really want this to be my healthy baby and I hope your 3rd is a charm too!

[to_have_fun08]

sounds to me you were on an antagonist protocol. no down regulation, start stims, then add in centrotide or ganirelix on day 5 or 6 of stims. yes, I would question you clinic. regardless if they like it or not, you are the one paying and should have all the information you can get.

[karenvancouverisland]

ya i sent the RE an email last night and he answered right away, not much of an explanation, but he said it's a short protocal that's the best for me being such a low responder.. it was clear he did it purposely (ie. it wasn't a mistake).... and thinking back- it couldn't have been a 'mistake' (meaning they forgot something)... as we did 2 cycles of it, and the first time i was meticulously prepped for it as i was part of a research study..

but it could be a 'mistake' in terms of it not being the best plan for me given that i ovulate still..

so chris have you done a cycle like this?? i'd just find it reassuring to know others have too... gawd, guess i shouldn't be so bothered about it as i got my son from the 2nd cycle in this protocal.. but i just wonder about next cycle and if i could have got better frosties from doing some suppression first..

[karenvancouverisland]

ya, now i remember the only time they said "flare" was after my first cycle failed.. the nurse explained to me they would do flare next time.... but i guess i was just put on this 'short, antagonist cycle" ... i remember them explaining things but i was soooo scared of never having a child at that point particularly, that i didn't hear details..

ghost- if you're there- do you have any insight on 'short antagonist" vs. flare?
i'd love to hear your thoughts... and i'm really looking forward to hearing my new RE's thoughts on our first appt jan 14!!

and rio- i think you and i have done similar 'short antagonist' cycles... ganirelex is an antagonist.... and unless it's not on the chart you sent me, it looks like you go straight to stims like me (except i did a day 3 start- you a day1)

and rio.... i'm praying for your next u/s.... it's such a mixed blessing when we get early u/s's... we want them so bad, but they often don't show yet what we find reassuring... i'm sending the universe 'beautiful, healthy, baby energy' for you

[riogirl71]

Karen i will check the list again and send it to you, i just know that th tweaks and femara gave me 2x the number of eggs than 3 years ago!

Thank you so much for the prayers, means a lot to me!

[Ghost]

ghost- if you're there- do you have any insight on 'short antagonist" vs. flare?
i'd love to hear your thoughts... and i'm really looking forward to hearing my new RE's thoughts on our first appt jan 14!!

We do the flare cycles only rarely, maybe one in 100 cycles. It seems most patients do no better with them, but once in awhile some patient with a history of poor response really takes off. No idea why.

[to_have_fun08]

Karen - Seeing that I have had 10 cycle total, 4 were canceled, I think I have done every protocol out there. I did do one flare protocol. That cycle was weird for me because I didn't start to respond to stims till really late in the cycle. I ended up stimming for 14 days, compared to most cycles that I ranged from 7days to 12 days. I think my body just likes to do whatever it wants.
I had my best results on an antagon/antagonist cycle. I think it is called antagon/antagonist because u take both lupron and ganirelix. take BCP's(mainly to get the patient into their batch cycles) 5 days of lupron, stop lupron, then i believe 7 days of .125u ganirelix, then start stims, taking .125 ganirelix till trigger with stims. I also did estrogen priming along with this which was just taking estrogen once a week for 3 or 4 weeks, and also taking estrogen suppositories.
Its is frustrating because every clinic thinks differently. Some clinics like the flare protocol, others don't recommend it at all.

[lt81]

I was also on an antagonist cycle - 225 menopur from day 2 and then cetrotide from day 6.

My next cycle would be another antagonist cycle but switching from menopur to Gonal-F at 450. I have read somewhere that menopur includes some LH which can convert to testosterone which is bad to have where you are a low responder so maybe ask your doc about changing from menopur to Gonal-F (which I believe is a purer drug and has no added LH/testosterone).

I am also going to use DHEA for the next cycle as my doctor is happy to support the use of it and is about to conduct a study on it in low responders.

[karenvancouverisland]

thanks It81.. i've also only done gonal f , and at 450ui daily.. i hope if youre part of a study they'll give you some free stuff! they did with me before...

do you mind me asking which clinic you're with? gawd, i'd love some free gonal f!!