Long or short protocol for diminished ovarian reserve/low responder?

[DJ202]

Hello fellow warriors!

I wonder if you are able to share your knowledge and/or experience of long vs. short protocol for diminished ovarian reserve/low IVF response?

I've completed 3 ICSI short protocols (current AMH 1.7pmol) - Round 1 300 IU Menopur, Round 2 375IU Menopur, and Round 3 150IU Pergoveris. R1 and R3 resulted in 1 frozen embryo each (19 days of stims and no fertilisation in R2!). My doctor now wants to put me on a long protocol and I am worried that because it includes downregulation meds my ovarian response will be suppressed so much that there will be zero response altogether! Please help! Has anyone experienced good response with a long protocol with low ovarian reserve/poor response? Can you share any scientific articles looking into the effectiveness of each/comparing the two? Do you have any other advice/recommendations?

I'm really feeling at a loss now. I'm physically, mentally and cognitively exhausted from it all (3 rounds in 5 months) and would really appreciate some guidance/words of encouragement as I feel like I can't make any proper decisions now, it's been so taxing! Thank you all, really appreciate your support!! xx

[JA-fnuk Partner Nurse Fertility Network UK]

Ask doctor why he feels it would benefit your treatment as he knows your blood results & history Thinking of you

Janet

[zzko21]

I am 45 so definitely have diminished ovarian reserve….my AMH is 8 and the first clinic I went to had put me on the short protocol..however before we started We had to stop because they wanted to investigate my husband’s sperm …to cut a long story short …I decided to move clinics because they were so disorganised….the clinic I’m with now put me on the long protocol and although I had to stay a week longer on down regulation meds so far so good I had my first scan yesterday and they said I was responding well …tomorrow I have my second scan and will let you know how that goes…it’s my first round of ivf ….my clinic seems to recommend long protocol for low AMH

[DJ202 in reply to zzko21]

Thank you! How did your second scan go?? x

[zzko21 in reply to DJ202]

It was good…I have my egg collection on Monday so praying they will harvest a good number 🙏🏾

[DJ202 in reply to zzko21]

Keeping my fingers crossed for you!

[Tarasunny]

My clinic uses the Flare Protocol for low responders.

[letro112]

Hi DJ202 .. I have done 5 rounds of IVF in 11 months .. I totally understand your exhaustion. Equally I have a low AMH. Cycle 1 - 300iu menopur only 3 follies got 2 blasts

Cycle 2 - 225iu gonal f and 75iu menopur - no response

Cycle 3 - 325iu pergovaris - 1 follie no egg retrieved

Cycle 4 - tested my testosterone it was very very low, supplemented with DHEA. Stims 300iu gonal F and 150iu menopur with double trigger - 10 eggs collected, 6 mature and 4 blasts

These were all short protocols

Cycle 5 - had a cyst so they put me on the pill for 3 weeks so it kinda became a long protocol. Again 300iu gonal f and 150iu menopur and double trigger. Collected 7 eggs, 5 mature and 3 blasts.

So I wouldn't loose faith just yet although it's soo hard .. I do feel maybe a change in protocol and maybe testing your testosterone etc might help improve your response. After my third Cycle I was totally ready to just give me ... really glad I didn't when I see my last 2 cycles. We are not there yet as I have immune issues so there are additional hurdles for us so we are now considering surrogacy with remaining embyros

Pm me if u want anymore info on the stimulation side of things x

[DJ202 in reply to letro112]

Thanks Letro, much appreciated! I've tested my DHEA and have been taking supplements, which gave me pretty bad side effects. Taking a break now before transfer in January, and will then change clinics as my clinic is problematic in communication and in my opinion medically neglectful. Do keep me posted on your story, wishing you the best! x

[zytajones]

Hi DJ202,I have low AMH (last checked 0.9pmol/L at age 38) and both times was on long protocol as I response ok to it. First time 7 eggs were collected and 5 went to day 5 blast (but this was at age 33 when my AMH was a bit higher) and recently 4 eggs were collected and 2 went to day 5 blast. I have a son from IVF at age 33. This time no luck. I will be trying for the very last time soon, and again, long protocol. I never used short one as I had ok-ish results on long one and for some reason doctors at my clinic believes that long one is better for me.

Not sure if this helped you but wish you luck with your decision! x

[DJ202 in reply to zytajones]

Thank you hun! x

[Mdms]

I have just finished my 3rd IVF cycle. My first two were long protocol Bc of my age and ovarian reserve. Each time I had 18/19 eggs, of which 9/10 were mature. 5or 6 fertilised and each time we were left with two embryos (also following PGT-A). I had 4 transfers from these, 1 fresh, 3 frozen and none were successful. We recently moved so I started at a new clinic in another country and they put me on a short protocol with similar meds. I had 10 mature eggs, 9 of which fertilised, but only 2 made it to 5 day blasts. And just had a fresh transfer. In my experience, the long protocol was harder on me - the suppression hormones made me a bit mental! At the end of the day, I had the same outcome so will likely go with that next round (fingers crossed it’s not needed!). It may be the first two rounds they should have left me a bit longer to get more mature eggs. I’ve felt this short cycle was easier on my body - and as I’ve been at this for 3 years and have had every test possible without any explanation for why good embryos are not sticking - I’m also keen to not spend more time. But definitely talk to your doctor and try to understand why they want you on long protocol. Good luck!

[DJ202 in reply to Mdms]

Hi Mdms, that's very useful, thanks for sharing! The whole process has been very taxing on my body and mind and I don't want to put myself through a high power long protocol. My doctor unfortunately is useless and there are lots of communication issues with the clinic - I will therefore change clinics if needed after we've transferred the two embryos that we have. Wishing you luck in your journey! x

[BBHH1]

I think you should see once how max dose go for you. 450 of follistim + 150 menopur + 100/ day clomid first 5 days of cycle. In general I t’s better to trigger when lead follicle is between 16-18. Or when estrogen growth start to slow down. Also for few embryos day 3 fresh transfers work better. Good luck!