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mary5 - July 20th, 2006 6:59 AM

Hi Dr Jacobs
While I am aware that there is not that much that can be done to improve egg quality, I was wondering if there are any protocol you would recommend over others to help. Also any other suggestions such as shorter/longer stim phase, higher dose trigger shot etc.

I am 32 and have had 3 fresh attempts. The first was an antagon with menopur 225 per day, got 7 embryos, 2 were good quality, rest were poor. Second cycle also antagon and 225 menopur, started antagonist drug too late, had 9 eggs but only 2 embryos, lots of fragmentation.
3rd cycle long lupron and follistim 300 for 13 days, 13 embryos out of 20 eggs, mostly average to poor quality, clinic have highlighted an egg problem. My best quality embryos (and therefore eggs?) were from a menopur cycle, is this just a fluke or do you see similar results from your patients. we have no other factors apart from some immune issues treated with ivig for the 3rd cycle, my fsh is around 5-6.
thanks for yout thoughts
mary

B. Jacobs, M. D. - July 20th, 2006 6:07 PM

We discontinued using the atagonist analog preparations, like Anatagon. We did not like the quality of the eggs and embryos, compared to the Lupron prptocols.
Good luck.

mary5 - July 21st, 2006 3:07 AM

As I stated in my original message the 3 rd cycle was a long Lupron cycle and yielded average/poor embryos with a day 3 transfer.
As far as the stimulation phase is concerned what is your preference for women with poor egg quality?
I am just wondering whether to try a menopur only cycle again as this is what gave me the best embryos in terms of quality however I have also read that it is not advisable to have too much LH and would value your opinion as to whether a small amount of LH (i vial per day in addition to follistim) might help. I was planning another long lupron cycle for pituitary downregulation.
mary

B. Jacobs, M. D. - July 21st, 2006 6:08 PM

I do not use any LH in my stimulation protocols. I use straight FSH. We feel we get better quality eggs and embryos. I do not know if you have polycystic ovaries, but women who do, tend to have a higher percentage of poor quality eggs. Women with PCO also, usually, have higher LH levels. I have no experience with a protocol called a prolactin rebound, but the single report in the literature is interesting. I do not know if there will be any real benefit.
Good luck.


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