Protocol change?
3 Replies
tatty - September 11


I recently had my 2nd ICSI attempt, the first ICSI ended up either as a miscarriage or a ectopic which resolved itself. BHcg got up to about 1200.

This time they only managed to retrieve 4 eggs from me (5 last time) but luckily all 4 fertilised overnight. On day 3 I had 1x6 cell, 1x7 cell & 2x8 cell Grade 1 (Top) embryos. I choose to have all four transferred which my consultant gave us a 55% chance of success. Unfortunately this cycle has not worked and now I am at a loss of what to do next. It just feels like it will never work if not one of four good quality embryos do not implant.

On both cycles I have had quite a few follicles but they still only retrieve 4 or 5 eggs. My E2 level on day 7 of stimms was on only around 750 so I pretty much new they would only get a few eggs. Is it normal to have lots of empty follicles?

Do you have any suggestions on what we should try next, I would love to try to get the embryos to blasts but I never seem to get a good amount of eggs. I never get many eggs but the ones they do get seem to have a high fertilisation rate & are good quality. Is this normal. I am 32 with a FSH level of 2.9, my DP also has MF issues. I also suffer with moderate/severe endometriosis.

I also notice that I suffer with really bad night sweats on the 2ww, but I am unsure whether this is a side effect of the progesterone.

My consultant wants me to try the short protocol next as my body just refuses to downregulate & both times I have had to stay on downregging drugs (Nafarelin & Lucrin) for a long time (1st time 8 weeks, 2nd time 6 weeks). This cycle I also had to go on BCP's as my E2 levels took a while to reduce after having 3 ovarian cysts aspirated & then my period refused to arrive.

On my first cycle I used Gonal-F (days 1-8 150iu & then upped to 225iu, Days 8-12 Luveris(LH). Ovritelle HCG trigger(r-hCG).

On this cycle I had 225iu Menagon. Pregnyl trigger.

Any advice would be greatly appreciated,



B. Jacobs, M. D. - September 11

I do not have enough information about the laboratory you are using or the physician performing your protocols and retrievals. It is rare that we cannnot grow some blastocysts from eggs we have retrieved. It is rare that we cannot obtain eggs from most of the follicles we grow. I have no way of commenting on your problem.
Good luck.


tatty - September 16


Could you offer any advice on a protocol for my downregging problems which I feel has lead me to be over suppressed at the start of each tx.

I would really love to have another go at the long protocol but obviously need a change to my previous protocols. I have been researching this and am interested in using BCP's along with an Agonist. I have also read that poor responders can get better results with a agonist & antagonist cycle.

Thanks for any advice you could give me,



B. Jacobs, M. D. - September 16

For my patients who are poor respoders, I use a microdose flare protocol.
Good luck.



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