Which protocol?
1 Replies
4everhopeful - July 5

Dear Dr Jacobs,

I posted this question to Dr Smith, and he has been a great help, but for some of the medical questions, has refered me to you :) I hope you can help!

I'm asking you this on behalf of a very confused friend! She is 38 and has undergone two full cycles of IVF with ICSI on the L/P using syranel (sniffing), Gonal F on cycle 1 and menopur on cycle 2.

She and her husband have m/f IF caused by varicocele and undescended testes. Proxeed and supplements have helped see an improvement in his overall numbers and quality of sperm, which have been quite low in all areas.

On her first cycle she got 15 eggs of which 5 fertilized... 2 embryo's were transfered on day 2 and after starting bleeding early, she sadly tested negative

On her second cycle she got 5 eggs of which 5 fertilized... 2 embryo's were transfered on day 2 and she again sadly got a negative result :( On this cycle the embryologists noted that the eggs were 'grainy' :-\

She has since just got the results back of her day 3 Inhibin B test, and was devastated to find it come back at 28.6 Her latest FSH result however, which was taken at the same time as the Inhibin B, was 6.3 and her LH 3. Last year her FSH was 5.6 and her LH 3.8.

I'm confused by this coz I thought that the lower the Inhibin B result the higher the FSH?

The clinic where she is currently, have recommended she do a third cycle using the same L/P as before, but using a higher dose of menopur. They say the L/P is best because it will make the eggs mature more slowly, which will help with the quality ???

She has also been to see another RE, at a different clinic, who said she would do much better on the S/P, and have advocated A/H and the possiblity of taking her embryo's on to blastocyst. They have also recommended follistim instead of menopur ???

She's obviously very confused now about what to do for the best Funds are tight, and she has to go with the clinic and regime which is going to give her the best possible chance of getting her a positive result.

In your highly valued opinion, would someone of 38 with seemingly dwindling ovarian reserves, stand a better chance on the S/P, with the possiblity of doing blastocyst transfer with A/H, or should she stick with the clinic who know her case history and follow the L/P with a day 2 transfer and no A/H?

I must also add that she has been taking DHEA, as recommended by her current clinic, who have reported seeing improved results from poor responders who take it.

Your advice would be very much and very gratefully appreciated :)

MANY THANKS,

Nat :)

 

B. Jacobs, M. D. - July 5

I have seen no reliable data that taking DHEA provides any benefit for anything. For my patients who ar 38 and older, I use a microdose flare protocol, administering micro- dose Lupron with the start of the stimulation. We get a better responce, than using the long protocol. Also, please note that at the age of 38, a smaller percentage of her eggs are capable of a successful pregnancy.
I wish her luck.

 

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