2 x failed rounds, same protocol. Stick or change clinics that don’t want to tweak my meds???

[lolly2019]

Hello everyone, so just had my second failed cycle last week and after a few days of trying not to think about things too much I’m already thinking about round 3! I’m 44, AMH 2.75. First cycle failed as eggs fertilised abnormally, second cycle got a grade A 5day blastocyst but it failed to implant. My clinic have written to me saying my age is the issue and nothing wrong with the protocol. I was on the same short flare protocol both times, no down regulation and 2wks of Gonal F 225. The thing is is that I read about people my age with similar Amh on higher doses than this and having success but clinic says they don’t want to change it. Obviously I know my age is a factor as is my AMH but surely after each failed cycle there should be a little tweaking of treatment. Now I don’t know whether to stick with them for my third round or try elsewhere....

[Hope76]

Hi Lolly I think it’s awful they are adamant to stick to same protocol. Yes age may be a factor, however surely with 2 failures they can see it is worth tweaking your protocol.

I cannot comment on low AMH as my clinic will not recommend testing mine due to my FSH level being satisfactory said would be waste of my money. I have asked about further tests to check if I still have endometriosis for example and check my tubes again as my diagnosis is suspected tubal blockage’ they just say not necessary. I am at stage if this cycle doesn’t work will be seeking second opinion. Being near Aberdeen my choices are limited but I have heard good things about Dundee.

I can tell you I have been on the maximum dose at my clinic they recommend for my age (43) which is 300IU surely you should be in the maximum by now and as a paying patient you have the right to request this !?! They could also try a different FSH drug for example Menopur which some women respond to better than gonal f.. in my case I have tried both and know I respond better to gonal f. I had to insist however to get back in gonal f and was told it was likely my age not the drugs. My last cycle gave me 5 eggs instead of 1 so I know it had to do with drugs.

Also my last 2 protocols I was started off with buserelin which is meant to boost quality . Then Gonal F, also had cetrorelix to stop ovulation just before EC. I hope this helps.

Good luck with your follow up appt 🤞🏼.

May be worth a second opinion if you are not happy with outcome x

[Mantaray75]

If you are not happy with your clinic then it may be best to go somewhere else as you don't want to think 'what if'. That said, it is highly likely that your age is influencing the outcome.

I'm 43 and my AMH was around 10-15 but 4 cycles with my eggs still didn't work. My clinic did change protocols. I had max dose Gonal F (twice, one BFN and one miscarriage at 7 weeks), then Menopur (only 2 eggs), then did one cycle using clomid to stimulate (obviously only get one egg doing this but apparently can give better quality). When we went for the final review with them and looked at all my cycles it was clear that it was likely egg quality was poor.

I now have a gorgeous 4 month old daughter after my first round with donor eggs. However, you need to feel ready to go down this route.

You need to feel that you have done everything possible and that may mean changing clinics.

x

[Millbanks]

Hi Lolly, if it was me in this position I would definitely be tempted to get a second opinion. I think it always helps, even if they confirm that what you are doing is the best route. Good luck xx

[Hidden]

Hi Lolly, sorry about ur recent negative I too had a negative recently it’s tough hey and I am 42 soon to be 43 so feel time isn’t on my side. My consultant put me up to the maximum dosage on the last cycle and had 2 trigger shots as the previous one although I got 8 eggs none fertilised even though they did on the previous cycle I ended up getting 13 eggs and 11 fertilised not all made it but ended up with 6 making it to blastocysts. So in essence I would say ur hospital should be looking at what they would change and do differently especially as ur last cycle. It might be worth having a consultation else where to see what they might suggest. Hope this helps and best of luck for ur appointment xx

[Alexa3]

Hi Lolly, sorry to hear this...yes I think it might be worth reviewing your protocol. I would have thought that given your age and AMH, you need the highest dose they can give you for whichever drug you’re prescribed (that’s an assumption).

I don’t know the highest dose for gonal F but I know the highest dose for menopur is 375 (I am currently on that because of age and AMH). The reasons for lower dose would revolve around risk of hyper stimulation. Second, not everyone responds equally to flare protocols. I did one flare protocol and it was my worst cycle yet...only 1 egg and it died on day 4 before implantation. I respond best to longer down reg cycles and produce a few more eggs from these cycles (they take a few weeks but have been worth it for me). I know it’s a pain but it might be worth finding a clinic that will listen to your concerns and tailor an individualised protocol to you based on your history so far. Good luck. Go with your gut on this one. Xx

[Shelleybean]

Hi Lolly, hope you’re holding up ok. I stuck with a clinic that were insistent on same protocol despite poor results for my age and amh and I do now regret it, so personally I would at least go and get a second opinion. In the end I responded better to long protocol (down regged with Buserelin and then stim with Bemfola (like Gonal F) 300 dose) compared to short protocol with Meriofert 225-300 dose.

My clinic only went up to 300 max dose, but another clinic we saw said go up to 450. It would be worth asking though if that is a good idea for your age and amh though, as I think I recall a Consultant once saying that not always good to stimulate too hard??

Good luck with whatever you decide ☘️ Xx