For the very low ovarian reserve ones that are poor responders (less 3-4 eggs, eggs not embryos) to standard agonist protocol
What stim protocol have you tried that improved (micro dose lupron, flare, priming, anything else? Any specific combination)? Or different approach such as natural cycles or oral medication?
I’m afraid of using antagonist as this induces a temporary menopause, and I’m afraid if that starts it will stay. Even though my periods are regular I think my reserve is low...
Already taking DHEA and CoQ10.
Thanks!
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BBHH1
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The antagonist protocol does not induce temporary menopause - that is the long/agonist protocol. The antagonist protocol is the short protocol you start at the start of your cycle (I think day 2 but not done short myself). With long you use an agonist from day 21 ish of your previous cycle for 2 weeks, in which you downregulate and this is the menopause bit.
Cycle 1: estrogen prime oral ethinyl estradiol from ovulation + 14 days of FSH 450ui + 150ui menopur. Follicles: R: 10.9, 11.5, 10.7 mm and L: 5.3, 5.3, 8.9 mm
Trigger 10000HCG when largest follicle 10 because estrogen stopped rising. Got 1 high quality embryo, had a chemical
Cycle 2: no prime because it was close after first. Clomid 100mg for 5 days + 11 days of FSH 450ui + 150ui menopur. Follicles R: 3.7, 3.9, 5.7 mm and L: 9.7, 4.7, 14.2 mm
Double trigger (10000HCG + Lupron) when largest follicle 14 because estrogen stopped rising. No embryos, embryologist said the eggs looked weird
Platelet rich plasma ovaries injection
Cycle 3: estrogen prime estrogen patch from ovulation + 10 days of FSH 450ui + 150ui menopur. Follicles R: 4.2, 11.6, 17.9 mm
and L: 6.7mm
Double trigger (10000HCG + Lupron) when largest follicle 18mm (which is the goal) and estrogen stopped rising. Got 1 egg that fertilized and waiting on results.
I seems that having 2 follicles going ahead inhibit the smaller ones so if we could synchronize better that would help. Before DHEA and CoQ10
Because my exams are bad we didn’t even try much natural before IVF. We tried once before IVF got pregnant but blighted ovum, and once between cycles 2 and 3 and had an early miscarriage at 8weeks after a strong 155 heart beat.
From what I can tell they have never used an antagonist or agonist, just oestrogen priming or no priming. I'm guessing this is due to your having very low AMH. Have they offered you antagonist? (Just wondering based on your original question.) I have never heard of an antagonist protocol inducing temporary menopause but if they are offering you antagonist and you're worried about it it would be worth clarifying the exact protocol with them. xx
They never offered antagonist because they think it’s very detrimental for very low ovarian reserve. But I see online some docs use it... I’m not thinking minor adjustments will make a difference. So I may be willing to try a very different approach as long as the worst outcome is a failure and not further compromising my situation. Especially because I don’t feel that hopeless towards nature that has given us our best chances so far. So I’m leaning towards a more natural approach unless another high dose protocol seems promising. I think one of the keys fit us is to get the follicles to synchronize better....
Yeah that is a major pain! I think even with the antagonist on board, follicles can develop asynchronously, which is meant to be the main advantage of the agonist protocol, but of course then there is the downregulation bit that you would quite rightly like to avoid. The doses of FSH sound really high so maybe mild IVF or natural modified might suit better. I have not tried these myself but they are common suggestions on here for ladies with low AMH or who find large numbers equate to crap quality. Hopefully someone else who has tried these will chime in. If you are interested, this is a paper on mild IVF:
Hey- I have low AMH and very low AFC and have only ever done the short protocol with max stims, gonal-f and menopur. I was never going to get many eggs but this resulted in 4 eggs my first round and 2 my second. I was worried about high stims due to hearing that natural can work best for low AMH. It seemed to work for me (as well as anything could when you only have 2 follicles on your baseline scan). That said, I speak to other ladies who have low AMH and they have found a better response when going from short protocol to mild or natural cycles. My clinic was also talking about trying dual stim protocol for my next cycle where you harvest eggs twice in a cycle. That could be worth looking into? Good luck xx
The natural cycles Im interested since despite my bad exams and failed IVFs we got pregnant naturally twice in 3 tries... I looked into the duostim and it seems very new so I'm not sure I would consider at this time, didn't see much advantage but would be nice to hear people experiences!
I am so sorry for your losses. I can't imagine how hard that is. It is encouraging that you have gotten pregnant 3 times. Have you tried a clinic that specialises in low AMH? I believe Create are good for that. They were next on my list if my current clinic didn't work out. I haven't actually heard of anyone doing dual stim yet. It must be quite new. x
I'm also low AMH, poor responder and over 40. I've had better results with natural conception versus meds.
My 1st pregnancy was at 38, AMH 0.52 -natural conception no meds.
Started trying for 2nd at 40 and had 2 chemicals from natural conception, so moved on to IVF.
1st IVF - short protocol max stims, cycle canceled as no response. AMH 0.45
2nd IVF - micordose lupron protocol with gonal f and menopur, 2 follicles, 1 egg, 1 embryo and BFN. AMH 0.16
At 41, I moved on to IUI with clomid for 5 days, one follicle, BFP but blighted ovum.
2nd IUI with clomid, 1 follicle and BFN.
Started looking into DE but 3 months later got pregnant naturally no meds. Almost 16 weeks now. Never took DHEA or any supplements other than prenatal vitamins.
Given my poor response to meds and the fact that my only fertility issue was my age, not blocked tubes or any other issues, doctors said IVF wouldn't give me much of an advantage over trying naturally. It came down to blind luck and catching that 1 good egg. Hopefully you'll get lucky soon!
Seems like you and I have similar situations. Not really having infertility (failure to conceive naturally in 6-12 months) but with low ovarian reserve and poor response to IVF. Those follicles numbers are your totals or you are only counting the larger mature ones?
Did the first pregnancy gave you a baby?
Glad you had success against the odds. Your history brings me hope that I can be lucky someday!
Yes, I have a 2 year old from my 1st pregnancy. Had some issues trying initially, so went to IVF clinic. The doctor fixed my thyroid and I got pregnant before starting stims.
As for the follicles, I'm pretty sure doc was looking only at the mature ones. I would begin my cycles with 4 or 5 AFC but only 1 or 2 would ever grow to 17 - 18 mm. Rest disappeared or stayed small and not usable. Even when I got those 2 mature follicles, my estrogen levels we quite low indicating I only had 1 egg in there.
When I realized that IVF wasn't going to help me, I started googling stories of women in my exact situation and came across an interesting thread. It was full of over 40, poor responders telling their success stories and how they got there. Many of them had to do 10 or more rounds of IUIs or endlessly ttc to finally get a baby. Since only like 1 out of 10 eggs is any good at our age. I was so encouraged that I continued trying but I aslo set a limit for myself. If I couldn't get it done in a year, 12 mo of contiuous trying (meaning giving 12 eggs a chance), I was gonna do the DE.
Being a poor responder with low AMH sucks but it's not a dead end. If all else is fine, we do have a chance to make it happen. Good luck🤞
I tried mild IVF and the short protocol with various strength of medication and various brand. I had no difference in the number of eggs retrieved. I only primed once and that was a disaster as the follicles stopped growing at 11mm. Cycle was cancelled. It was testosterone priming, so I would not recommend this.
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