Poor Response to Stim Med's
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Doctor: I am 38 - My husband 44. We are preparing for our 4th IVF cycle.
1st cycle - 3 yrs. ago - resulted in healthy baby girl. We used Lupron/Repronex/Follistim. Retrieved 14 eggs - transferred the best 4.
2nd cycle - 2 yrs. later - miscarried very early at 8 weeks. Used same protocol, but didn't respond as well. Only retrieved 7 eggs - only 3 to transfer.
3rd cycle - January '06 - Unsuccessful. Changed Protocol - Microdose Lupron and 200 units Follistim every 12 hrs. Even less of a response - only retrieved 4 eggs - only 2 to transfer.
For our 4th cycle scheduled for May '06 - RE has changed my protocol to Microdose Lupron with 225 units of Bravelle every 12 hrs. for 10 days.
My day 3 FSH is always within the normal range. My husband has poor morphology - so ICSI is performed. (As well as Asst'd Hatching). I also now have a large fibroid (that I am told will not interfere with implantation - it's on the outside wall near my cervix).
Since this will be our last cycle, I want to make sure we aren't missing something... and doing everything possible to give us the best chance for success. My RE has told me that she doesn't want to increase my stim med's too much because there is a fine balance between quality and quantity. Her hope is to have 4 embryos to transfer. Based on your experience does it appear we are headed in the right direction?
Thank You!
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For my patients who are poor responders, I use a micro dose flare protocol, and have my patients use 150 units of FSH (only) every 12 hours. In our program, we seem to get better eggs and embryos if we do not add the LH, which is in Fertinex. Please remember that the quality of 38 year old eggs is not good as 28 year old eggs.
Good luck.
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