Protocol question - Bravelle
3 Replies
Lila - August 14

I just got my IVF protocol and am trying to get a better understanding of the drugs involved. Please let me stress I am not second guessing or doubting my RE or this protocol in any way. I am just trying to learn more about it and understand a little about the factors involved in a protocol.

I will start 10 units Lupron on cycle day 21 (this Thurs). After the Lupron bleed (pending blood work). I will start Bravelle at 450 units till the HCG trigger (again pending blood work).

As I understand it older women, I am 38, can benefit from an estrogen priming protocol such as this – is that correct? I understand Bravelle, Gonal F and Follistem are all for FSH dominant protocols – is there a significant difference between these drugs that would lead a doctor to select one over another or is more often the case that a doctor develops a preference for one over the others?

I have noticed that many on this site seem to use Menopur along with the Bravelle. What does that add or change? Sorry if I am being dense I just did not understand if that was more of a norm for younger women. Is there any concerns I should be aware of if there isn’t LH involved in the protocol? I think I read in one of your posts from several months ago that you had improved results at your clinic when LH was not used and I was wondering if you could give me some insight into that – ie what type of patient would you use that or is that something you do for many patients, how does it help etc?

In case it matters a little history: This is my first IVF, as I said I am 38, most recent Day 2 FSH was 4.2, fertility so far unexplained all tests including DH sperm come back as normal. I have done 3 cycles with clomide, 3 cycles with clomide and IUI (unmonitored). I had Lap surgery last week CD9 to aspirate cysts. Earlier HSG and recent Lap and Hysteroscopy all showed everything was clear.

I realize that as a newcomer to IVF and as a layperson I can not begin to grasp all the complexities involved in protocol selection I am just trying to learn what my body will be going through and I am trying to keep my expectations realistic. I appreciate any insight you can offer. Thank you very much for your attention and expertise.


B. Jacobs, M. D. - August 15

Actually, It seems you have a pretty good grasp of the process. Bravelle is FSH extracted from the urine of menopausal women. Gonal-f and Follistim are FSH made in the laboratory. They are essentially the same product. It does not matter which is used. Menopure is an equal mixture of FSH &LH. For some reason, our experience differs from most, which has been reported. We have better pregnancy rates if we do not use a product which contains LH.
Good luck.


Lila - August 27

Dr Jacobs,
Thanks for the earlier reply I have some new questions. To recap this is my first IVF, I am 38, all tests so far have come back good (FSH 4.2/Estradiol 42) so we do not know what is the root of our problem, I started Lupron on cycle day 21 and did not take BCP. Thanks for any and all help with the following questions:

1. I have been on Lupron for 12 days. I have had no spotting or signs of AF - is it possible to be oversupressed by being on Lupron for too long?

2. If so does oversupression equall a cancelled cycle, a cycle with few quantity eggs, or a cycle with compromised egg quality (or I gues a combination of all)?

3. I do not believe they have done an antral follicle count yet is that something that at another clininc would have already been done or am I misunderstanding the timing and is that done at the U/S check the day you start stims?

4. If it should have been done already but was not will they even be able to tell if I am oversupressed? Or is that seen in bloodwork?

Any help would be much appreciated. I really think I understand the IVF process (as much as a layperson can) after the stims are started but I have to admit I do not really get the supression phase. It does not seem to get nearly as much attention in the books as the stimulation, ER and ET get so I apologize for being a bit ignorant here.

My insurance is broken down to coverage of 2 stimulations, 2 retreivals, and 2 transfers so if there is indication that this cycle may already be in jeopardy I would rather know this know so I do not waste any of my coverage.

Thank you so much for your time and expertise.


B. Jacobs, M. D. - August 27

1. Yes, it is possible to over suppress with Lupron.

2. Over suppression makes ovaries respond poorly to FSH (Bravelle, e. g.).

3. I do an antral follicle count before we start Lupon or other medications for IVF.

4. Since you have been on Lupron as long as you have been taking it, There is probably no good way to determine ovarian reserve, at this time.



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