stimulation protocols
6 Replies
rafiki - March 30

Dear Dr Jacobs,
I have just had one unsuccesful cycle of ICSI. I am 38 and had 3 FSH tests under 9, but failed to produce more than 2 eggs. The number of follices per ovary was 4 & 5/6 respectively. I have read various reports on different drug protocols which may help to improve ovarian response such as the Microdose Lupron Flare Protocol and the GnRH anatgonist protocol. Also the use of baby aspirin and luteal phase support in poor responders. Can you suggest what I might try? Its impossible for me to properly evaulate the information and my doctor doesn't seem to be very clued up. Is it worth me trying to find a clinic which has particular expertise in treating women with poor ovarian response?
Many thanks.

 

Barry Jacobs, M> D. - March 31

For my poor responders, I use a microdose flare protocol. That still does not guarantee improved follicle developement, but it works better for these patients than the long Lupron protocol.
Good luck.

 

DianaEvans2 - April 2

Dr. Jacobs:
Backstory= IVF in January, was micro-dose Lupron on Day2 start, result was 11 eggs, 3 immature, 8 ICSI'ed, 6 fertilized, 5 transferred, 1 implanted, pregnacy blood confirmed on 2/14 and then saw fetal heartbeat at 6 weeks of 83bpm. Week 7, no more fetal heartbeat 3/17.
Went D&C route instead of uncertainty of natural complete miscarriage. Back at square one.

If I may: Questions please: The cycle was at age 42.8 and resulted in a pregnancy, so am I considered a "poor responder"? and is the micro-dose Lupron protocol the very best of the protocols out there?

My only follow up to the blood pregnancy confirmation was daily progestrone injections. Would have any other pharmaceticuals been prudent to include beyond sustaining the pregnancy with progesterone? I don't think any drug would have "converted" the slow bpm fetus to a normal bpm?? (but I am not sure). Thoughts?

I am having genetic testing done on this D&C. I had a natural pregnancy at 39 with no trying (with not much care clinically) and it was a blighted ovum (no fetal pole). Other than these 2 missed abortions, I am blessed with extraordinary solid health for the last 43(just had the birthday) years. Beyond never smoking, not drinking, eating organically, doing accupuncture, exercising with moderation, reducing stress, what else to be mindful of?? Thank you kindly in advance. Diana

 

DianaEvans2 - April 2

Dr. Jacobs:
Backstory= IVF in January, was micro-dose Lupron on Day2 start, result was 11 eggs, 3 immature, 8 ICSI'ed, 6 fertilized, 5 transferred, 1 implanted, pregnacy blood confirmed on 2/14 and then saw fetal heartbeat at 6 weeks of 83bpm. Week 7, no more fetal heartbeat 3/17.
Went D&C route instead of uncertainty of natural complete miscarriage. Back at square one.

If I may: Questions please: The cycle was at age 42.8 and resulted in a pregnancy, so am I considered a "poor responder"? and is the micro-dose Lupron protocol the very best of the protocols out there?

My only follow up to the blood pregnancy confirmation was daily progestrone injections. Would have any other pharmaceticuals been prudent to include beyond sustaining the pregnancy with progesterone? I don't think any drug would have "converted" the slow bpm fetus to a normal bpm?? (but I am not sure). Thoughts?

I am having genetic testing done on this D&C. I had a natural pregnancy at 39 with no trying (with not much care clinically) and it was a blighted ovum (no fetal pole). Other than these 2 missed abortions, I am blessed with extraordinary solid health for the last 43(just had the birthday) years. Beyond never smoking, not drinking, eating organically, doing accupuncture, exercising with moderation, reducing stress, what else to be mindful of?? Thank you kindly in advance. Diana

 

Barry Jacobs, M. D. - April 2

At the age of 42, your risk of miscarriage is about 34%. That is because your eggs are more likely to have the wrong number of chromosomes. Chromosome analysis, is difficult, since by the time you get the tissue, most, if mot all of the calls aredead. It is unlikely that any medication protocol would have changed the outcome. The fact that you are almost 42, and have fewer eggs than you did a few years ago makes you a poor responder. For my poor responders, I use a microdose Lupron flare protocol. You may wish to consider using an egg donor.
Goo dluck.

 

DianaEvans2 - April 4

Dr. Jacobs: thank you very much for your response.
If I may, quick follow up questions:
My HcG is still at 137 (10 days after the D&C). I am told that bloodwork will be done until I hit zero again. Is this high HcG indictive of anything??? Outside of time passing, is there anything that I may do to help accelerate the droppage to zeo??

Last one: is there a unique difference between a microdose Lupron (Day 2) protocol versus a microdose FLARED Lupron protocol?? Or is it just terminology?

Thank you so ever much in advance for your kind response.

PS: yes, I've been doing preparation reading around donor egg in the event the third time is not a charm....but hope springs eternal...

 

Barry Jacobs, M. D. - April 5

It takes a while for the hCGto become negative. I would not be concerned about your current level. If it does not continue to decline, you may need a D & C for retained fragmants of placenta. There is more than 1 version of a microdose Lupron flare protocol, but they are essentially the same idea. I think you are identifying a minor matter of terminology. It is probably the same thing.
Good luck.

 

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