Hi all, Can I get opinions on opinions on a drastic protocol change for cycle 2 after low mature in cycle 1 please.

[Victoria357]

Protocol was 300iu Gonal for the first 4 days then 250 for the last 7 (changed down to 200 after day 9 scan) with Cetrotide 0.25 for the last 5 days. Trigger shot was 0.1 Decapeptyl x2 on Monday night, Retrieval Wednesday morning.

We had good scans showing 14 follicles, eventually 11 retrieved but only 3 mature, 1 in M1 stage and 7 in the GV stage so totally immature. Sizes on day 9 were

4 follicles 17-18mm, 4 follicles 13-16mm, 2 follicles 13-15mm.

Sizes were not recorded on ER day but given it was 5 days later i dont think that should be the issue.

Of the 3 we had left all 3 fertilised and looked good on day 3 but only 1 made it to Blast with a Grade 4AB. Currently in PGT-A testing. Having done research and got opinions on my first post we saw talk about trigger shot problems mentioned lots and how a dual trigger may help with maturity. Thats what we expected our clinic to change and leave the stimulation largely the same. Just a Decapeptyl & Ovitrelle dual trigger added.

We just got the new protocol and they have changed to a longer "Down Regulation" one with a 3mg Decapeptyl between days 21-23 of this cycle then 14ish days later stims of 375iu Pergoveris for the first 5 days, 300 for the last 6. Trigger shot of Ovitrelle 250mcg so no dual trigger just a different one.

This protocol seems more intense in regards to meds dosage, longer and still without a dual trigger. We are going to question them on this and why they feel the need for such a big change but just wonder if people would be kind enough to give their opinions as i know many here have lots of knowledge.

[Endofitall]

I would question why you keep being given protocols with a drop in your stimulation dose after 5 days. Get them to explain why they think this is necessary.

Double trigger sounds a sensible thing to try. But you can’t do this if you’re on long protocol as they’ve suggested now.

Given you had a decent number of follicles developing why do they think long protocol needed? Could oestrogen priming help with evening out your follicle growth?

Just some questions I’d raise. I’m no expert though.

Best of luck

[Victoria357 in reply to Endofitall]

Thanks so much for your reply. Ive only had one cycle so wasn't aware that dropping the stimulation down isn't the norm, will definitely ask this. I do think they set this as an initial guideline to be fair and alter based on the scan results. After my second scan on day 9 in cycle 1 they altered my planned dosage.

The double trigger is something I've read so much about in regards to low maturation so really would like to try it. I think they said something about being able to have a dual Ovitrelle trigger? Obviously that isn't the same as the double with 2 different meds which is what I've primarily seen people try.

They said that in regards to long protocol they weren't sure if my biggest 2 follicles ruptured last time and the long would give them more control. They didn't mention anything about a possible rupture after ER though so don't think this happened, I think she's possibly trying to find excuses for the down reg now it's been questioned. Haven't heard about oestrogen priming, I will have to look into it just a bit overwhelmed 🙁

Thanks again