Egg harvest between stimulation cycles? Low AMH and poor reaction to stims

[RekaV]

hi everyone

I have a low AMH (6.2) and had one stim cycle on high dose of hormones( 350 Pergoveris). I didn’t react very well to the stimulation and out of 4 follicles they harvested 2 and only had one egg that reached blastocyst stage. It was a grade 4BB but the PGT-A test came back abnormal. We will be doing PGT-A testing for all embryos as I already had 4 miscarriages ( all naturally conceived)

Next month I got a pre-stimulation scan done and 5 follicles were visible of which one was 16mm. I asked my clinic if that could be harvested but they said they can’t do it on such short notice. Since then the big follicle is still there but it is smaller in size so they cancelled my next cycle and put me on birth control pills until next month. Does anyone have a similar experience? Do you know about any clinics that might do egg harvests between cycles?

I’m devastated because I feel like they are wasting my follicles and I have such a low number of them anyway. Is there anyone who tried different protocols that might have increased the number of follicles in a cycle? Thank you all!

[Hidden]

hi

I had a bad experience with pergoveris with my first two cycles. I was given 300 Iunits. The first cycle resulted in 7 eggs, 4 mature and only 1 fertilised - abnormally but it developed into a 4AB blastocyst which was a fresh transfer - bfn. Transfer was tricky because I had a large fibroid, which has since been removed.

2nd cycle with above regime - no eggs!

I went to a clinic that specialised in mild ivf after that. Decided on embryo banking 7 eggs/8 eggs and 5 egg over 3 cycles. IVF was used and not ICSi and I had 2 day 5 embryos and 3 day 3 embryos.

Unfortunately I had a miscarriage after my double FET. But this has been the furthest I have got compared with my first clinic. My AMH was 5.1pmol so slightly less than yours.

My consultant feels that mild ivf in older pts with reduced ovarian reserve tend to respond better to lower dose meds. After my experience I would have to agree. I was stimulated with 150 iunits of Bemfola.

Good luck x

[RekaV in reply to Hidden]

Thank you for sharing your experience and I am really sorry about your miscarriage I know how devastating it can be. Can you clarify when you say you used IVF not ICSI? We used ICSI for our first cycle because my OH also has mild azoospermia. My clinic also wants to put me on a mild cycle next month so fingers crossed!Can I ask you to PM me the name of the clinic you used for your mild cycles? Good luck to you as well x

[finup0321 in reply to RekaV]

Hi! I also am 38 and I have DOR & low AMH (it was 2 last year). I just did my first round of mild stimulations (started with clomid and estrogen priming, max dose of meriofert & fostimon & zomacton every other day, no cetrotide) last month, and I only grew 4 follicles, 1 of which was thrice the size of the others. We cancelled this cycle, though my consultant really wanted to collect that 1 big follicle. I’ve never been so disappointed in a cycle, my follicles grew so slowly and unevenly despite all the measures taken to prevent that, ugh.

I had previously done 6 egg collections at high dose stims (max amounts of meriofert & fostimon & zomacton with cetrotide) and always had 10-12 follicles, with 2-5 mature eggs retrieved each time. I’ve been fortunate that every cycle has produced at least 1 blastocyst, so we have a few on ice that are waiting for PGT.

My point is that I feel like I wasted a cycle with the mild approach, which was really disappointing as I’d read it’s better for older patients with DOR. It may be better for some, but unfortunately the only way to find out is to try it yourself. I’m going back to high dose protocol this month, with a couple of new tweaks (different trigger shot etc). I think my body really does need that extra kick in the pants. This is so tough, I hope you find a protocol that works best for you!

[RekaV in reply to finup0321]

Thank you for sharing your story. It is interesting to see that we all react very differently to the various protocols. Can I ask if you high dose stim was a short or long one? I did a short one but I didn’t expect such a poor response, I wa really disappointed. I hope your next cycle goes well I have my fingers crossed for you!

[finup0321 in reply to RekaV]

Oh I’m happy to share! Just trying to be a resource for others and also learn at the same time. Yes we all react so differently, it makes this whole process seem very “Wild West.”

I have always done short protocols. I recall my consultant saying that long wasn’t necessary for me but I don’t remember why.

[Spicycurry in reply to finup0321]

It sounds like you did a mild cycle with 450iu every other day. A short cycle is better where you can still use zomacton and 225iu meriofert and 225iu fostimon every day. They used to use cetrotide but I suppose it might be discontinued. An alternative would be indomacin every day to prevent ovulation. If you did oestrogen priming and you still had a lead follicle, were you using provera? Also, I too have high fsh and I had to take the progesterone pill for longer and use hrt some times 3 times a day. I used progesterone tablet twice a day until cycle day 40. That way I used more hrt and fsh went down to 2.

[finup0321 in reply to Spicycurry]

Yes, this was a mild cycle with 225+225 and zomacton every other day. I had a horrible result and I cancelled the cycle. I didn’t think it was worth retrieving potentially 1 egg, or worse 0 if the follicle was empty. Now I’m going to try the flare agonist protocol, so full steam ahead with daily injections and no priming. I have always taken provera prior to start of stims. I did 6 rounds of the short protocol with cetrotide, and in total I got 20 eggs over all that time. I think I can do better than that, but will see with this new flare protocol.

[Spicycurry in reply to finup0321]

I did the flare with oestrogen priming and it did affect egg quality. I had high fsh. Are you with CRGH? It’s just that the methods sound familiar.

[Spicycurry in reply to finup0321]

If it was 450 iu stims daily, it’s not mild. Did you do this every other day? If so, can you have the short protocol with cetrotide? I had a bad experience with flare. I had a lot more eggs but bad quality.

[finup0321 in reply to Spicycurry]

Correct, it was 450 every other day for the mild protocol, and 450 daily for the short, all done at CRGH. I have DOR, so don’t have much to work with but thankfully quality hasn’t been affected by any of the treatments. Quantity is the only thing that has suffered and I’m trying to get that up so I can stop doing these endless retrievals!

Thank you for sharing your experience, it’s nice not to feel alone in all of this.

[Spicycurry]

You need to do oestrogen priming. That means you take progesterone tablet from cycle day 14 until cycle day 25. From cycle day 21 until you get your period, you use hrt 2mg twice a day. This will ensure you don’t have a lead follicle and all the follicles will start off near the same size. Also, meriofert and fostimon are better for follicle growth. My clinic used to do 225iu meriofert and 225iu fostimon. It seems egg quality is good. Also to maximise chances even if sperm is ok IMSI is better than icsi. Good luck

[Spicycurry]

Hi. 350iu is not that high actually. 450iu and 600iu are doses often used but I had more success with 225iu meriofert and 225iu fostimon.