Long protocol or short protocol IVF? ... - Fertility Network UK

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Long protocol or short protocol IVF? Please help!

Hi all,

I'm very new to the forum and have only just started my IVF journey. My husband and I are both 26, we were trying for a year and then found out I had PCOS and he has a very low count.

Since December I've lost 18lbs and brought my hormones into the normal ranges but I still have cysts on my ovaries. We have to have ICSI due to hubbys low count but I've been told I can choose either long or short protocol. Long might give us more eggs but I'm at risk of OHSS. Short is less risk of OHSS but probably fewer eggs so might have to go through it more times?

Since finding out I have PCOS a lot of my mood swings and down days have started to make sense. I've heard that a long cycle has a much bigger impact on your moods and mental health and that as I have anxiety a short cycle might be better for me mentally.

On the cost side though this round is NHS and as long cycle is much more expensive should I just get as many eggs as I can whilst they're free?

I'd value any advice, this is a total nightmare to decide!

P.s. sorry for the essay!

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Hey, me again! I was told I would be on a short protocol (NHS). And the doctor just said when asked why the difference "Long is longer, short is shorter" - so that was really helpful LOL

In my basic understanding, the longer protocol involves a lot more drugs and is more taxing on the body but you're right, will yield usually more eggs. The Shorter is very fast! 2 weeks! Plus a month before that on the pill. I produced 9 eggs, 5 fertilised, 3 made it to higher grade Blastocyst, 2 in freezer one put back but that ended in the chemical pregnancy.

All the ladies and nurses will say it's quality of quantity. Some women collect 20-30 eggs and only have one or two that make it to a viable embryo.

It's a personal choice!

Good luck to you!

x

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Thanks so much for the help. It just feels like a huge choice to make. With either protocol it looks like I won't be able to start until September as I have a holiday booked and neither would be the right timing for before we go.

I know that you're born with as many eggs as you're ever going to have but is there anyway to improve egg quality? Like you said it's quality over quantity x

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Yes - although we have all eggs when born, they are not mature. SO we can influence quality. Ubiquinol COQ10 daily (I take 300mg in the gel tablet form) in the run up to your treatment in September would be advisable and following a "Fertility Diet" (lower carbs, higher protein, lots of veggies) will help too. Cutting down on alcohol and caffeine and sugar too. All these things will help with your PCOS too! Take this time to "eye of the tiger" it and get in the best shape you can.

"It starts with an egg" and "Get a life - IVF survival guide" both good books!

x

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Thanks, will definitely pick up the books that you've suggested. I've tried hard to lose weight and get healthier but I hadn't really thought about egg quality before.

Is the ubiquinol safe to take during IVF? Sorry I've just not heard of it before but willing to try anything!

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I stopped when I started injecting. What you do now will influence the eggs you release in several months time as they take a long time to mature

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zitawest.com/improve-qualit... some more info on egg quality x

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Thanks! X

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Just to say I second you on 'it starts with the egg' - I've read countless books about pcos and fertility and this one really stood out, I think it's amazing & should be prescribed on the nhs 😂 have seen a gynae privately, nhs, fertility nurse specialist and GPs and noone told me about any of the supplements she advises - I take metformin (prescribed), conception multivitamins, omega 3, Co enzyme Q10 and inositol! Has only been about 6 weeks so too soon to say if its had any effect on my cycle /hormones but I'm hopeful!

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Sounds like it's really helpful. I will definitely check it out. Thanks so much for taking the time to reply :)

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Generally with pcos a short protocol is suggested to avoid the risk of ohss. Short protocol is easier on the body too as there’s no down regulation involved xx

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Thanks, my ovaries have cysts but all my hormones are in the normal range now. I'm glad I'm eligible for both but it's very confusing! X

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I had a cyst too which dispersed by itself but although I don’t have pcos I have a polycystic ovary. So I wasn’t given the choice between protocols on our fresh round, I was told it would be short due to ohss risk. I did down regulate for my next fet though and that was awful. So the following fet I opted to have a natural modified cycle instead of medicated as it was so much easier on my body xx

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Thanks for letting me know, sorry if I sound silly but what's a natural modified cycle please?

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No down regulation, so no (dreaded) buserelin. I really suffered on it. Modified meant that I was on some other meds; cyclogest and Lubion xx

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Thanks. There's so many drugs, side effects and protocols to learn. I have no idea how people get through this without a PHD!

I honestly don't know what I'd do without people to ask :)

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You’ll soon become an expert! 😂 xx

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Here's hoping! I'm surprised how little research seems to have been done into how long or short protocol effects your mental health.

I struggle with my hormones and when I first came off the pill I got really depressed. I'm scared of getting depressed again during IVF and I'm worried about long protocol and down regulating making me into a weepy mess!

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If it helps, on my short protocol I got 14 mature eggs and have been told many times over that it’s a great number. Even on the short protocol I ended up being borderline ohss and had to have an internal the day after EC (not nice) and measure my stomach with a tape measure every day due to bloating xx

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I'll have to make sure I get a tape measure! Thanks so much for telling me how it went for you. I've been in a bit of a spin about it and finding out you can still get a lot of eggs on short is really good to hear :)

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You’re welcome. Short protocol was obviously the right choice by my clinic for me. If I’d done long I think I would have been more than borderline ohss, despite being regularly monitored throughout. Good luck in what you decide xx

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Thanks so much :)

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It’s really weird why they are having you choose - surely they would advise on the best protocol for you. Anyway my hormones have always been in the right ranges and I always seems to ovulate, regular cycles etc but my ovaries were polycyclic. Typical string of pearls look to them. I had a cyst 2 years ago which was surgically removed. I was in the short protocol for my first round. Got 8 mature eggs but the consultant said there were a lot more follicles just not the right size - said it was discordant growth. They didn’t grow at he same rate. We ended up having none fertilise via IVF (something to do with my husband’s sperm we didn’t know about). But because of the discordant growth, they put me in the long protocol for the second round. And also to get more eggs in order to increase our chances given the disastrous first round. Had 15 eggs, 12 fertilized with ICSI and 6 blasts. I recall feeling about the same in both cycles. Both times I was on 150iu of Menopur. The extra injections were just annoying and after doing the short protocol, the long one just seemed soooo long. But of course looking back, it seems like a blip in time. I did feel like I got mild OHSS on the second round... consultant said they might not do a fresh transfer but then day of collection said it’d be fine to do a fresh transfer. So I did and got a BFN. And a positive on my 1st FET. Good luck! I think no matter what you really never know what the right decision is until you go through the first round. And each round can be do different even if everything else stays the same. Your doctors should be the one to advise what protocol to put you on....

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Thanks so much for letting me know. They've advised long as they think they'll get more eggs from me but warned me of the risk of OHSS and warned because of my history of anxiety and hormonal depression that long might be very difficult for me (emotionally).

Basically they can monitor the physical impact and make sure I don't get OHSS but they can't judge what the impact on my mental health will be... It's up to me to decide if I think I can ride out to extra hormones but never having had IVF before I have no idea how it'll hit me!

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Being honest my consultant isn't very sympathetic... he seems to think that mental health issues have nothing to do with my IVF treatment and I should go with what is physically most likely to be effective even if I might end up in a depressive phase :(

I guess he's an IVF doctor not a shrink but as it's my hormones that cause depression you'd think he'd want me to take the emotional impact into account!

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I found long protocol hard but I wasn’t given any choice as it’s what they do at my clinic. Like Tugsgirl, I struggled with the down regulation. It made me have night sweats so then I couldn’t sleep so then I was tired which was worse for my hormonal moods.

You might find that long protocol isn’t that much more expensive than short- it was only one extra internal ultrasound for me, and, depending on the down reg drug, i don’t think it’s necessarily the most expensive drugs either. Maybe investigate that further if the cost is worrying you.

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Thanks so much for sharing your experience of it. I really appreciate it as I think it's better to have an idea of what's coming!

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My clinic advised short due to polycystic looking ovaries. Although I have irregular periods and persistent adult acne my hormone profile was normal. I didn't get a great response on short protocol. My consultant has just advised upping the drug dose. When I mentioned long protocol he said there wasn't much in it which is not the impression I get from women's experiences on here. He' said it's up to me but like you I'm quite anxious about the side effects and possible over down regulation considering I was a slow and low responded. Good luck with you decision making.

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Thanks so much for sharing, I'm just trying to get as much advice as possible as it seems like this first round is just a shot in the dark and then they'll work it out from there!

Don't you think it's frustrating when they say 'its up to you', how am I supposed to know 😂

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Exactly! I've come to the conclusion that ivf is an art not a science.

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How difficult for you having to choose when you don't know how you will respond or how your mental state will be affected, I really feel for you. My circumstances are different, but short protocol worked better for me - I got more eggs and better quality embryos, and a bfp after 3 failed long cycles. I do think that the shorter process and not so many drugs helped my mental state and I was more relaxed and positive. As for cost, it wasn't much different. The number of appointments and procedures is the same really (the expensive bit), so the difference is the drugs cost. I had more drugs after the egg transfer on my last cycle, to help implantation. This was unrelated to the protocol used, so my last short cycle actually ended up being more expensive than the previous long cycles, so I wouldn't take cost into account when deciding xx

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Thanks you so much for taking the time to respond. I really appreciate any help I can get. I hadn't realised that there wasn't much of a cost difference and in our area we only get 1 NHS cycle so it's felt like a huge decision to make!

I know every woman is different, I'm just so glad I found this forum or I'd be completely in the dark!

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By the way, congratulations on your BPF (sorry I had to look it up!). Wishing you a comfortable and uncomplicated pregnancy and a very healthy baby x

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