2nd opinion protocol changes after failed ivf
3 Replies
hopefully trying - March 16

I've written to you before and you've been very helpful. thank you in advance. I'm 40 DH is 49 turning 50 in a month. I have unexplained fertility. Hx of hypothyroidism and recent dx of sperm antibodies. Hx of slight to absent periods my whole life...never regular. His counts are still in normal ranges. I just failed 1st IVF attempt with ICSI and PGD. I did BCP, lupron 10mg, and follistem 450 iu. They retrieved 9 eggs, 8 mature and fertilized, 3 normal and reached blast stage and were transferred, 5 were abnormal. My endometrium reached 5+ and had stripes. This is the thickest it's been and it's never had stripes before (I've had 3 IUI - 2 on clomid and 1 on 150 iu follistem). Needless to say we are devastated this didn't work. The RE has stated there is no reason not to try again. He is recommending change in protocol stay with Follistem but do a microdose lupron flare (as I understand it I would start the follistem earlier than the 1st protocol had me doing to "take advantage" of the initial surge). We have insurance coverage for 3 total IVF and have done 1. We're wanting to maximize our chances.

1) Do you think this change is protocol is sufficient? Would you suggest a different medication or are all the medicines about the same as my RE suggested?

2) What can be done if anything to increase endometrium? I'm currently on baby aspirin/day and RE suggested adding vitamin E but said other than that there is nothing else much we can do. (I had an estradiol level of 2700 day before egg retrieval and he said that estrogen is what thickens the endometrium and he's not sure why with that level I wouldn't have been thicker)

Thanks so much for your help!!


hopefully trying - March 16

FYI quality of embryos...1 grade A, 2 grade B (one of which was fille out and the other early blast)


Barry Jacobs, M. D. - March 16

I do not know why your endometrium did not become thick enough. There are abundant data implying that your endometrium neeeds to be greater than 7 mm thick to support a new pregnancy. Certainly the microdose flare protocol would be better for stimulating your ovaries, than the long Lupron protocol you used, before,
Good luck.


hopefully trying - March 17

Thank you for your response so much. Help me understand. If FSH drugs are all the same, why is it that so many women talk about changing protocols i.e. going to "other drugs" like repronex, (I'm forgetting the names)and getting different responses. I know Gonyl F and Follistem are the same but what about the others?

I"m so frustrated with my endometrium. Why can't it grow right? Why can't we fix it? The RE have learned so much about fertility but it seems that little is known. I'm suspecting that it may have something to do with my hypothyroidism since puberty but can't anything be done? She asks with tears in her eyes and desperation in her voice? I know ya'll can't wave a magic wand but God I wish you could!



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