Does lower stims equal fewer eggs/embryos or better quality?

[Joeysjourney]

Hi everyone. Hope you're doing OK?

I have a question around my next cycle. Long story short, I have high oestrogen and it means getting to transfer is difficult (both fresh and fet). Took us 11 months to do 1 collection and 2 transfers.

I have told my consultant I'd like to avoid this as much as possible and he's said there mightnt be much we can do except lower my stims dose and see if that helps. Last time my stims was lowered from 225 to 150 gonalf and I still couldn't transfer. I'm not sure it will make a difference as my oestrogen was through the roof for my last fet and I'd no stims in my system.

He did say it might impact the number of eggs I can collect (got 10 last time). Has anyone experienced that? I do worry about being left with less eggs and therefore fewer embryos although very aware numbers aren't everything!

I've also read though that a lower stims dose can actually improve quality as the energy is divided amongst fewer eggs. Again anyone else found that to be the case.

We've agreed that we will decide closer to the time but at the moment I'm minded to go for the lower dose as we aren't changing much else in this cycle and I have this build in need to do something different!

Grateful for others experience!

Big hugs

Joey x

[Tnthketnf]

Very interesting question. I will follow to see what other people think. I had looked into this too, I asked my consultant about mild/minimal stimulation and although he didn't exclude it he didn't favour it. I read on fertilityiq about a research Which basically says that there's no real difference for most ivf patients. As with everything in IVF you will find research in favour and research against it.

[Tnthketnf in reply to Tnthketnf]

It also mentioned that for some patients low stimulation might be better, such as"poor responders ".

[Joeysjourney in reply to Tnthketnf]

So true. If you look hard enough you can find the answer you truly want!

[Ivfgotadream]

yes I had much better results….and TWINS from natural modified IVF so very low dose stims

I did two rounds of conventional IVF first - both cycles 14 eggs each time. Both times less than 30% fertilised with ICSI . 2 average blastocysts from each cycle so 4 in total. PGS tested 2 neither normal (was allowed to transfer the mosaic one). 3 transfers - 2 were BFN, 1 was ruptured ectopic

So then I decided to try a 3 cycle package of natural modified with ICSI - 150ml Bemfola every OTHER day. 3 egg collections - 9 eggs - 100% fertilised with ICSI, 4 top quality blastocysts. Didn’t bother with PGS. Transferred the 2 “lowest quality” - had twins (2 5AA embryos still frozen)

[Joeysjourney in reply to Ivfgotadream]

That's really interesting!

I guess my objective here is actually to get as many good quality embryos as I can obviously. So is it better for me to sacrifice a fresh transfer and stay on high stims.....Or reduce stims and hope I end up with better quality and transfer at a later date.

Whys it always a head melt!

[Eswyn in reply to Ivfgotadream]

Wow, what a brilliant result! Congratulations on the twins!! Do you mind me asking if you were on a long or short protocol? Just had my first cycle - down reg with Prostap then on 450ml Menopur and didn’t respond at all. Clinic is changing protocol to just 150ml but continuing with the down reg. I’m wondering if I should try short?

[Ivfgotadream in reply to Eswyn]

I did tamoxifen tablets from cycle day 3 I think then added in 150ml every OTHER day or 75ml Bemfola and 75ml luveris daily from cycle day 4/5 - egg collection on day 13/14 that’s it - no down reg

[HopeNotTooLate46]

What's a 3 cycle package? Excuse my ignorance

[Ivfgotadream in reply to HopeNotTooLate46]

it’s just means you sign up to do 3 egg collections so the cost is cheaper than doing single rounds each time

[Chantysal]

in my case when i did lower stims i got more eggs and better fertilization rate . I guess everyone is different but with high stims in some cycles ended up with with no Embryos at all. I feel it depends on your body! There is no right answer

[MrsOrangejuice]

I had a long protocols cancelled due to no response, then on a short protocol which started on very low stims nothing really happened and they had to whack up the doses repeatedly - finally got 9 good quality eggs but due to a sperm issue on the day (terrible luck) less than half fertilised and got two blasts. Then did another round at a much higher starting dose and similar story however that time we got five eggs, all fertilised and went to blast (have a daughter from that). So it's possible fewer eggs = better quality and I got fewer eggs on higher stims, but so many factors can impact it. I'm about to start another round on even higher stims as my consultant thinks that's best, but will see what happens!

[Joeysjourney in reply to MrsOrangejuice]

Thanks a lot for the reply! I guess I'm trying not to be short sighted and prioritise getting to transfer vs getting more good quality embryos. Ie would I be better sacrificing a fresh transfer and stay on high stims in order to secure more embryos or am I better trying to transfer and reduce stims and hope numbers don't matter! Hope that makes sense! 😂

[MrsOrangejuice in reply to Joeysjourney]

I guess the only other thing I could add is I had two chemicals on back to back fresh transfers and it may have been a progesterone issue which was fixed for my FET, but I also wonder if my body is just not in a good state after a collection. I have discussed with my doctors doing a freeze all this time if we don't get many blasts just to give me a better shot as I seem to find FETs easier.

[Joeysjourney in reply to MrsOrangejuice]

Yes I know exactly what you mean. Sorry to hear about your chemicals. I've only ever had 1 fresh transfer but that was NHS and they didn't monitor my bloods. With my private round, my Dr noticed my lining had gone a bit wonky after the collection and did bloods which showed very high oestrogen. So I also think my body over responds to the drugs as well. He doesn't check progesterone though, despite my repeatedly asking!

Like everything with ivf, we just have to take each hurdle as they come eh! I mightnt even have any embryos to transfer this time so all my worry for nothing!

[MrsOrangejuice in reply to Joeysjourney]

I've managed to convince my clinic to add masses of progesterone straight after collection this time on the off chance we do have any/enough blasts to do a fresh and it makes any difference. I was lucky that my GP was Ok to order the progesterone tests and I also used an online company, so those may also be options if you want to monitor it, whether your consultant then does anything with the results is another matter I guess...but on my FET my consultant did agree to more progesterone because of my blood results.