Urgently Need Advise- High Vs Low Stimulation Drugs

[sparkle183]

Hi, in October we are going to be going for our third round of ICSI.

A bit of our background story:

I am 37 years old, and have a AMH level of 2.0 but that test was taken a year ago so I may have a lower AMH level now.

On the first cycle i was put on 450 GonalF on a long protocol. Only one follicle grew to the right size, and one mature egg and one immature egg was retrieved. Neither fertilised.

On our second cycle I was put on 450 Menopur on a short cycle. 4 good sized follicles but still only one mature egg and one immature egg was retrieved. But the mature egg seemed a good quality and fertilised. But unfortunately a BFN.

My Dr has told me I can only expect one egg each cycle 😔

I've looked into having a lower dose of Menopur, it sounds like having a lower dose would help egg quality in women like myself with a low egg reserve. As having a high dose will only be pushing my ovaries to do more than they are capable of which would effect egg quality.

I spoke to my dr about it and she phoned me back today after talking to another dr, and putting me on a lower dose is something our clinic doesn't practice. But other clinics do. They are worried that a low dose with me may produce no eggs, but I was on a low dose of 50mg Clomid last year (before starting ivf) and I ovulated every month. So I would have though a low dose of Menopur would be ok?

If we want to try a lower dose then we have to go to a different clinic. Problem is I don't drive and the nearest clinic I can find that practices low stimulation near me is in Bristol which is 2 hours away from me. And I don't have anyone who could take me regularly for appointments.

I'm not sure what to do. Do I accept the Dr's opinion and just go on a 450 dose of Menopur on a short cycle again?

Or do I look into a different clinic?

We have to make our decision within the next couple of days or we'll miss out on being able to do another cycle in October as planned with our current fertility clinic.

We have to get a loan for this next cycle so it's already really scary and stressful.

I'm just lost. I don't know what to do! I want to do a plan that is going to be more successful, I'm just not sure what that is 😔

Any advice would be appreciated thank you xx

[DJ202]

Hi Sparkle, this sounds like a difficult decision to make, I hear you! We're in a similar situation. I'm 38 with low ovarian reserve/ poor responder and have completed 2 cycles on 300 and 375 menopur daily, with the second resulting in 2 eggs retrieved, none fertilised. Because of this I'm similarly keen to go on to mini ivf which I've asked my doc about and I think this is what we'll be going for. If the response isn't good at first scan the dosage could still be increased. I hear that for DOR mini ivf can produce better quality eggs which are more likely to fertilise. I'd like to b give us the best possible chances and I think it's worth trying out a smaller dosage to improve quality!

I hear you with the extra hassle of longer journey to the clinic and also the financial hardships. We're doing treatment abroad so travelling is always involved. Spending all my savings on ivf too which is frightening. My thought is though that this is something worthwhile if it gives us the chance at parenthood! Keeping my fingers crossed for you and do keep me posted on what you decide to do! x

[Sunshine809]

My clinic are very reluctant to give the higher dose of Menopur - 300 is the standard dose. My consultant doesn't think there are many more benefits at pushing it to 450. It's very annoying that your clinic won't listen to you - it's your body! I have realised over time though that different clinics/consultants have their own preferred methods.

I don't think you should do this but technically, since you inject the drugs into yourself each night, you can just give yourself 300 instead of 450 at the start and reassess at your first scan. I know it's not comfortable to go against your clinic's advice though, and you would end up paying for more drugs than you use. I started on 300 on my first cycle then after the first scan my clinic did up it to 450 as I wasn't responding as well as they liked.

I really don't advise this as they are the experts and if things go wrong you would likely blame yourself. It sounds like if you want your protocol to change significantly you would need to change clinics.

In terms of travelling to Bristol, since you have a loan, can you add a couple of taxi/train rides into the ivf cost? And then beg and borrow different friends/family members to help you on the other days? I feel your pain as we feel in a similar situation where our clinic is an hour's drive away but if we change clinic we would have to travel 2 hours each way, which would be very difficult with work.

Your clinic does sound very rigid though, and trying somewhere new might be a better result. Best of luck xx

[Koala365]

Hi Sparkle183, I am 45 years old with an AMH of 6.9. I have done 3 unsuccessful cycles so far and will be doing my 4th cycle around about the same time as you do your third. My first two cycles were normal IVF and I was on 300 Ovaleap plus 150 Menopur for both of these. I got 5 eggs of which 4 were mature the first time but nothing to transfer or freeze as all degenerated and 6 eggs second cycle with 4 mature and 2 transferred but BFN. I tried mini IVF or New Hope Protocol for my next round. The idea as you explained is to get fewer eggs but better quality. I took Letrazole for 5 days then started Ovaleap 150 for two days but although things had looked good at my baseline scan and after the letrazole they warned me there was a chance this cycle might need to be abandoned as the Ovaleap 150 (which I understand is similar to Menopur 150) wasn't really doing anything. My consultant decided to up the dose to Ovaleap 300 every day for 3 days and at my next scan things had improved and I was able to get 3 eggs at egg collection of which 2 were mature. One fertilised normally and formed a top grade embryo which was transferred on Day 2 but again BFN. In your situation, I would discuss the milder protocol with my consultant and ask whether it was suitable for me. If in doubt, I would spend a couple of hundred quid or so to get a second opinion from a highly regarded specialist consultant at another clinic to find out whether it would be suitable for me. I got a second opinion myself and was recommended to do a milder protocol than my first and second cycle but not as mild as my third cycle. All the best for it all xx