Gonal-F protocol - help in understanding dosage...too high/too low/just right???

[CharlotteLM]

Hello all,

I am 45 years old with AFC of 8, FSH of 9.2 IU/l (1.5-133.4) and AMH of 10.5 pmol/l (0.1-19.3). My doctor is proposing a protocol of 75 of Meriofort + 300 of Gonal-F for the first 4 days and then 375 of Gonal-F. I am wondering what others think of this protocol (if reasonable given my age and stats or if too high that it might affect egg quality???)… For those that used Gonal-F, what was your protocol and, if you don’t mind me asking, age/levels of reserve (asking just to be able to understand comparisons better). I know each person is unique but trying to get a general sense of protocol/dosages...

Thank you!!

[Football61]

Hi. I’m 44 and started my first IVF cycle this week. My AFC is 8, my AMH is 11.5 and my FSH is 8.8. For the first three days, I was on Meriofert 150iu, Gonal F 100iu and Dexamethasone 1mg. From this morning (Cycle Day 6), I’m now on Meriofert 150iu, Fyremadel 250ug, Pergoveris 100iu and Dexamethasone 1mg. Going in the right direction so far (fingers crossed). At my baseline scan on Weds, I had 6 follicles that looked like a good size. Yesterday, I had 11. Wishing you the very best of luck, and please do feel free to message me x

[Orangeflowers in reply to Football61]

Good luck 🤞 I'm the same age and starting my next round shortly too x

[Football61 in reply to Orangeflowers]

Thanks so much. Best of luck to you too ❤️

[Orangeflowers]

Hi, I wouldn't worry it sounds about right.

I've just turned 44 and my Drs have been happy with whatever dose I want as I respond well and it shouldn't make much difference. I've been on a total of between 375iu and 450iu. The outcomes have roughly been the same. With the highest dose I get the most eggs, but only 2-3 blastocysts at day 5/6 regardless.

I think lower doses only really have benefit for people with a low AMH. This is because it doesn't work pushing the ovaries to produce more eggs if only 1 or 2 are going to be viable. You might produce a few more eggs, but not necessarily viable ones.

My consultant says that at advanced age higher doses are needed as there are only 20 or so eggs waiting each month, as opposed to over a thousand

For context, my AFC is around 20. I've not had my AMH done in over a year but it was about 13.5.My FSH was around 7.5.

I've mainly used Meriofert, but tried Menopur too. Latest protocol is starting with 450iu Meriofert, switching to 300iu Gonal-F and 150iu Meriofert.

I'm starting stims for my next round (6th fresh since last April) at late may bank holiday.

Good luck with your round. Let me know if you have any Q's. Feel free to PM x

[Ganges]

Hi, my dr has suggested 450 Gonal for my next round. I’m 40 AMH just tested and it’s 8. I’ve had max dose of a different drug, then gone lower. I have roughly the same outcomes to be honest. Good luck x

[CharlotteLM]

Many thanks to all of you for the replies - really helpful to have a sense of others' experiences and to navigate this journey! Wishing you all good luck!

[Pipidugacarapa]

Trust your doctor. I’m 37 (soon to be 38), my tests are all normal, we were trying for two years, had two miscarriages and decided to go for ivf and genetic testing. I’ve never done ivf prior to this and was shocked to discover that doctor put me on 375IU Gonal F to start with. After 4 days they did checks and lowered to 250IU and added Menopur 75IU (in the evening) and antagonist in the morning. I had total of 12 days stimulation, every two days they had me test blood and US and my gonal F was lowered to 150 and then to only 75IU last couple of days, Menopur was on 75IU all the time. To be honest I felt bad with all the hormones and my estrogen was very high and at the end they had me trigger only with Lupron to avoid OHSS (I got mild anyhow). But, the cycle turned out good. I had 20 eggs, 16 fertilized, 10 were blastocyst and 7 came back genetically normal. So, doctor knew what he was doing with starting high dosage. I’m not gonna question him again for sure. Just follow your protocol and hope for the best and don’t compare, every person is different 🙏🏻 now I just finished BCP and on Friday have first check for first FET, they’ll have me on letrozole 5mg for 5 days, then ovidrel for trigger and prednisone for 5 days (having natural ovulation I wanted to question but decided to trust the doctor haha, although it’s hard, we always wanna more explanations and have doubts) and let’s see. 🤞🏻 Good luck to all of us 🙏🏻

[CharlotteLM in reply to Pipidugacarapa]

Sorry for the delayed reply - thanks so much for sharing. Wishing you the best of luck!

[Mcher]

Hello Charlotte, I'm 32 and only done the collection once. My clinic prescribed Gonal-F 125 and my AMH was 5. They retrieved 8 eggs, and all fertilised and 6 made it to blastocyst stage. If I'm to do IVF again I would likely have a higher dose.

[CharlotteLM in reply to Mcher]

Thank you - and that is really great that you had a high ratio from eggs to fertilisation to blasto stage!