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Aimee37 - July 25th, 2006 9:59 AM

Hi Dr. Jacobs-

My last IVF I was on 225 gonal f and 75iu Menopur. After 3 days of stims, I only had 6 follies. 5 on right ovary and 1 on left ovary. I was quite upset because I expected more, esp. since I had 9 follies show up when I was on 100 clomid for my IUI. I am thinking it was due to the long Lupron protocol? I started Lupron on 3 days before the last BCP, 8 days on 20 units and than decreased to 5 units on day 2 of stimming. I went back after 5 days of stims and still have 6 follies, this time I have 3 on each ovary. So my RE upped my meds to 300iu gonal and 2 vials (150iu) of Menopur. Things started improving after this. I ended up with 14 follies at the day I was to trigger and my estrogen was 4333. Two days later, I had 13 eggs retrieved, 9 were mature and only 6 fertilized. I was a bit upset that only 6 fertilized with ICSI. I really expected to have a better cycle since I am such a good responder. I had 2 eight celled embryos transferred on day 3 and it ended up with an early m/c. :( I am REALLY trying to push for a 5 day transfer!!! I am hoping for a better protocol.

I have my protocol now. The plan is to decrease the Lupron to 10 units and start 3 days before I stop the pill and to stop the Lupron the day I start to stim. My RE has me on the same 225iu gonal but this time start off with 2 vials of Menopur.

I am wondering why the gonal f was not increased I know my RE fears hyperstimulaton so I can understand why she is keeping the same dose. I would just like to have more eggs to work with for a 5 day transfer. Would an increase in stims help the number of follicle’s or just help the follicle growth? How does an RE determine stim dosages with thier patients?

Thanks! ;)

B. Jacobs, M. D. - July 25th, 2006 6:24 PM

Actually, if you require more than 300 units of FSH per day, pregnancy rates are poor. Gonal-F is FSH and Menopure contains FSH and LH. Each vial has 75 units of each hormone. I cannot speak for your RE, but I se straight FSH for all my stimulations. For my patients who are poor responders, I use a microdose flare protocol, instead of a long Lupron protocol.
Good luck.

Aimee37 - July 25th, 2006 6:30 PM

So you are saying you to not administer more than 300 gonal f? why are the rates poor? Is it because they are normally poor responders?

What would you call my new protocol of Lupron? Is this not a micodose flare protocol? Mini microdose protocol?

When you use straight FSH with your patients, have you had any that ovulated early?

B. Jacobs, M. D. - July 25th, 2006 10:24 PM

During an IVF stimulation using Lupron and an FSH product of any kind, you will not ovulate. I do not know what protocol is being used for you, or the doses of Lupron. As far as high doses of FSH being associated with poor pregnancy rates, I have seen no data to explain the observation. I assume, for the most part, the need for heroic doses of FSH is related to poor ovarian reserve, and older eggs. Usually the high doses are need to obtain a response in patients who are in their late 30's and early 40's.
Good luck.


Aimee37 - July 26th, 2006 5:47 AM

Right. According to my RE she says I am a good responder (even if I am 37) but I was off to a slow start the last round. She changed my Lupron dose from 20 units to 10 units (strat 3 days before I stop the BCP)and this time around I will stop the Lupron on the stim day. What do you call this? A microdose flare?

I am hoping to get more than 14 eggs (or more than 9 mature eggs) this time. Hopefully less Lupron will make a diffierence. ::)

My ER is not until Sept and will be on BCP's as soon as I get my period. This month is looks like my cycle will be about 38 days. It is long when not on BCP's.

Let me ask you this question.....Do you think my long cycle effects my ability to produce good eggs, even if I will be on the BCP's prior to my IVF to get a normal 28 day cycle? Does the artifical speeding up of my ovualtion with the BCP's effect the quality of my eggs?

My RE seems to think my egg quality is good because my estrogen was 4333 on day 10 of stims. But I just worry alot. Maybe I am doing way too much research and googling?

Thanks! :)

B. Jacobs, M. D. - July 26th, 2006 6:30 AM

Your spontaneous cycle is not an issue when you are using the FSH products. Actually, there may be a benefit to egg quality by stimulating your ovaries.
Good luck.


Aimee37 - July 26th, 2006 7:11 AM

Whew!!! ;D Thanks for your response Dr. Jacobs! Enjoy your day!

-Aimee


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