protocols for varying response in olderish women
3 Replies
postblast - July 13

Dear Doc Jacobs,

No poll - just couldn't post new topic.

I am a 41-yr-old woman who has undergone 2 IVF cycles and 4 IUI cycles. Husband has morphology issues (4%) but high count (60-100 million) and good motility.

1st - Feb 2008:
-Day 3 FSH 5.6, Estrogen 420 (Cdn values so I think around 200 US value); antral count total of 9 follicles
-Flare with Suprefact; 75 Repronex, 225 Puregon daily
-Produced 10 mature high quality eggs, 7 fertilized by ICSI (high quality embryos on Day 3), 2 early blasts, 1 morula (good to very good) transferred on Day 5, with assisted hatching.
-Lining "perfect"; no blood work done past day before trigger shot.
-Supported with Prometrium.

2nd - June 2008:
-Acupuncture for 3 months
-Day 3 FSH 6.9, Estrogen 224 (Cdn value so around 110 US, I think)
-Same protocol
-4 mature follicles, 2 immature, cycle converted to IUI.
-Supported with Prometrium

My RE is suggesting that I try microdose flare for last cycle, along with a 3-day transfer and assisted hatching. (450 Puregon, .2 Lupron per day) I have also heard of estrogen priming and antagonist protocols as promising for some women. I have read mixed reviews for microdose flare but see it is often used for those with low ovarian reserve.

In your opinion, which protocol might be a good one for me to try? Is the microdose lupron flare (no BCP) a good candidate? I understand that it is all individualized to patient and a bit of a guessing game. This will be our last cycle (unless we win lotto or reverse the clock) so I am just hoping to give us our best chance. I understand that it is a lot of guesswork and different REs and different clinics follow their own "protocols for protocols" but since reviews on microdose seem to be mixed, am looking at other options as well.

Unrelated question but would a DHEA supplement and baby aspirin potentially assist in my situation?

Finally, how long do you recommend between cycles? (Varied opinions say 2 months to 12 months but at my age, 12 months is a no go.)

Thank you for any insight or suggestions!!!


B. Jacobs, M. D. - July 14

I use a micro dose flare protocol. My pregnancy rates with antagonists are poor, but maybe I have not tried the right protocol, yet. Please note that the data concerning efforts to achieve a successful healthy pregnancy after the age of 40 are not at all encouraging. You may be better served using an egg donor. Please see the information I have provided on our web page, <>.
Good luck.


postblast - July 15

Hiya Doc,

Thank you for your very quick and helpful response. Egg donation is not an option for us as we cannot afford it in addition to IVF treatment. In Canada, it entails going to the US, since there are no anonymous egg donor programs up here. It sounds like it is just a trial-and-error game, to some degree, with protocols and that microdose flare is as good a one to try as any... I guess if I went to another clinic, they might try Estrogen Priming or Antagonist but who is to say the outcome would be any different? Too bad we are out of time and money....this is what happens, sometimes, when you start "trying" at 37 instead of 27. My mother had me at 42, so I wasn't too worried.

How long do your recommend between IVF cycles? There is much mixed info out there.

Thanks again and all the best to you.


B. Jacobs, M. D. - July 15

Please remember that the egg donor is the 1 who will require intence monitoring. The egg recipient requires very litttle monitoring. You my wish to investigate trael to trhe states. I have seen no good data regarding a time to wait. I place my patients on birth control pills for a minimum of 2 weeks before stimulation and a week off the pills. Of couce, wait for a period to start before starting the pills.
Good luck.



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