So I'm looking for advice/experiences with the different dosage of meds. To give a brief history, I got pregnant on my first IUI (single using donor sperm). Several unsuccessful IUI's after that.
3 IVF's, 1st, long protocol, downreg with the pill for 14 days 300iu Gonal F 10 follicles (sadly ovulated before collection)
2nd, long protocol, downreg with the pill, 300iu Menopur, 8 follicles, 6 eggs, 2 5day Blasts both transferred BFN
3rd, short protocol, 300iu, 7 follicles, 6 eggs, transferred 2 day 3 embryos, singleton pregnancy.
Tragically neither of my boys from either pregnancy survived because I've just discovered I am a carrier for a genetic condition so am now going to do PGT-M testing. I changed clinics and he wants me to do estrogen priming and to put me on the higher dose of meds, 450iu of a combination of both gonal and menopur. I've just had my AMH rechecked and it's come back high for my age, (17.4 and 19, 5 weeks apart so it's not fixed for anyone getting too fixated on the numbers!) I'm 44, never any pcos just respond well and quickly to the meds.
I'm reluctant to go on the higher dose of meds because I don't think it's good for older eggs in general. He also said that clinically there doesn't seem to be significant difference over 300iu so I'm not sure I see the point. I'm also not so keen on downreg at all as I don't think it's good for the older ladies to shut down anything but if it's only short term I'm willing to try it.
Obviously I need to get as many eggs as I can to give me a greater change of one being euploid after testing but I'm uneasy using a higher dose of meds as again I feel that the older eggs need to be treated a bit more gently. I only stimmed for 7 days in my last cycle and triggered earlier than they wanted me to and that resulted in a pregnancy. So any advice or experience would be welcomed (I guess the history wasn't that brief after all!)
Hi 👋🏼 I am the same with down reg and it looks like short protocol gives roughly the same result without it so I would defo ask for that again, in terms of the dose could you perhaps start on 300 and then up to 450 if they don’t see the progress they are looking for? My clinic do day 2 bloods after stims and day 4 scan and bloods so they can up meds if required as like you said you want the balance of quality and quantity (and they also want to avoid OHSS). I think I would feel the same as you xx
It gave the same results for me anyway, quantity wise there wasn't too much difference between the two for me and I achieved pregnancy with the short protocol. As it's a new clinic, I'm slightly torn between seeing if they can do something different to increase results or sticking with what worked before and hoping it wasn't just a once off fluke. I think that seems to be a good plan, start off with the lower dose and see how I get on. Thanks for sharing xx
Hey, I also respond really well to the meds, so here's my experience of different dose meds:
Age 41: 225iu, increasing to 300iu. All good on 9 day scan, Gonasi trigger - 20 eggs collected, 16 mature, 14 fertilised, 1 transferred day 5 fresh, 2 frozen on day 6, double FET, 10 month old daughter 😃
Age 43: 450iu. 9 day scan showed 30+ follicles, alternative trigger (busterlin) - 18 collected, 13 mature, 2-3 fertilised, 2 blasts on day 5, 1 transferred fresh - BFN
Seems odd that the fertilisation rate changed so much. Embryologist hinted that high dose stims might be a factor, but consultant indicated had nothing to do with it 🤷 Maybe the meds were spread thinly across all the eggs and they didn't mature so well?? Or maybe my eggs are just older!?
Next time (August!) I'm going for 300iu with a scan on day 7 to look at progress. As previous poster says, I think that's the best bet, more monitoring earlier.
Great to see you responding so well at 44, that's really encouraging. I love seeing progress stories from the 40 pluses. Please keep us updated! This whole thing seems trial and error and figuring it out as you go along.
Hi, I actually read some of your posts when I did a search on higher stims so I was interested in your experience. It does seem like a big difference alright and hard to know what caused it but the higher stims would certainly cause me to wonder. I've been watching Dr Norbert Gleicher on youtube, he's the medical directer of the Institute for Human Reproduction that seem to specialize in older women and his research and theories make sense to me such as triggering earlier than a standard cycle as older women's eggs mature quicker and can be 'too ripe' to fertilize. It's all such a head wreck knowing what the right thing to do is and a lot of trial and error as you say, just really expensive trial and error! Thanks so much for sharing, it's really helpful and will have fingers crossed for you too in August xx
I also have high AMH but I have opposite problem as I take forever to respond and they kept having to whack up the doses. I didn't get on at all with the long protocol and had a cycle cancelled on that. So I had two short rounds pretty much back to back and was on 300+ global f for most of it (stimmed for 17days). Egg quality was not affected and second round we got all to blast and have a one month old from that. So, I think that each woman's response is so individual and needs to be tailored, but being on max doses for ages for me didn't impact quality. But if you're a really quick responder and have ovulated early maybe trying a middle ground of being on around 300 and then having more early scans so they can up doses might work, but it's probably best to really grill your consultant - I did that for my second round and I probably drove him mad but I wanted to really understand the rationale and that every option had been considered; sometimes they seem so busy and maybe they can't always really delve into the 'problem' and solution. They may still advise the same thing but it really helped to understand, see whether they'd had success in similar cases and know we weren't missing something.
Hi, thanks for your experience, really helpful and I'm smiling away at your suggestion to grill the consultant. I went in with a looong list of questions that I had from talking to an embryologist friend and am on phone and email to them constantly. I'm sure they think I'm a pain in the ass but I'd rather that and get as best response as I can then leave anything to chance and have regrets afterwards. It's funny I actually think a slower response can be better for quality and someone I was listening to likened it to microwaving your meal or slow roasting it! The slow roasting can give better quality I think! xx
Haha, I've heard people talk about overcooking their eggs but hadn't heard it taken as far as specific cooking methods - definitely don't want to microwave them I think by the time my consultant had finished answering all my questions and having had numerous calls with me, he was more invested in my treatment and outcome but even if he had just found me annoying, it's so important it doesn't matter. Fingers' crossed for you this time.
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I think by the time my consultant had finished answering all my questions and having had numerous calls with me, he was more invested in my treatment and outcome but even if he had just found me annoying, it's so important it doesn't matter. Fingers' crossed for you this time. 
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