Which protocol?
1 Replies
4everhopeful - July 5

Dear Dr Smith :)

I'm asking you this on behalf of a very confused friend! I hope you can help!

My friend who is 38, has undergone two full cycles of IVF with ICSI on the L/P using syranel (sniffing), Gonal F on cycle 1 and menopur on cycle 2.

She and her husband have m/f IF caused by varicocele and undescended testes. Proxeed and supplements have helped see an improvement in his overall numbers and quality of sperm, which have been quite low in all areas.

On her first cycle she got 15 eggs of which 5 fertilized... 2 embryo's were transfered on day 2 and after starting bleeding early, she sadly tested negative :(

On her second cycle she got 5 eggs of which 5 fertilized... 2 embryo's were transfered on day 2 and she again sadly got a negative result :( On this cycle the embryologists noted that the eggs were 'grainy' :-\

She has since just got the results back of her day 3 Inhibin B test, and was devastated to find it come back at 28.6 :( Her latest FSH result however, which was taken at the same time as the Inhibin B, was 6.3 and her LH 3. Last year her FSH was 5.6 and her LH 3.8.

I'm confused by this coz I thought that the lower the Inhibin B result the higher the FSH?

The clinic where she is currently, have recommended she do a third cycle using the same L/P as before, but using a higher dose of menopur. They say the L/P is best because it will make the eggs mature more slowly, which will help with the quality ???

She has also been to see another RE, at a different clinic, who said she would do much better on the S/P, and have advocated A/H and the possiblity of taking her embryo's on to blastocyst. They have also recommended follistim instead of menopur ???

She's obviously very confused now about what to do for the best :-\ Funds are tight, and she has to go with the clinic and regime which is going to give her the best possible chance of getting her a positive result.

In your highly valued opinion, would someone of 38 with seemingly dwindling ovarian reserves, stand a better chance on the S/P, with the possiblity of doing blastocyst transfer with A/H, or should she stick with the clinic who know her case history and follow the L/P with a day 2 transfer and no A/H?

I must also add that she has been taking DHEA, as recommended by her current clinic, who have reported seeing improved results from poor responders who take it.

Your advice would be very much and very gratefully appreciated :)


Nat :)


Dr Smith - July 5

This is more of a question for an RE, since it involves stimulation protocols, which are technically out of my realm. Furthermore, I'm getting the information fourth hand (doctor to patient to friend to me) and sometimes things are "Lost in Translation" - BTW great movie if you haven't seen it. With all that being said, I'll put in my two cents (tupence?) worth.

I think its time for a change. I agree that the short protocol would be more appropriate and I'm always in favor of blastocyst transfer and assisted hatching of blastocysts. Hopefully, she will have more follicles develop on the short protocol and have more embryos available for culture to the blastocyst stage (like she did on her first cycle). Follistim supplmented with Menapure may work a little better than Menapur alone (at least that has been our experience).

As for the Inhibin B - FSH relationship and the DHEA story, I'm going to defer to Dr Jacob. Please post your questions on Dr Jacob's Infertiltiy 101 Message Board and see what he has to say.



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