Protocols to sync follicles/avoid big lead follicle?

[Endofitall]

I’ve a recently cancelled cycle due to two lead follicles racing ahead and creating a big cyst (over 3cm) which was ruining my lining and suppressing rest of the follicles.

Just wondering if anyone with low AMH/poor response or issues with early recruitment and dominant follicle(s) racing ahead during stims has tried protocols involving:

1. Antagonist injections in the luteal phase

2. A type of long protocol

I’m nervous about long protocol due to my AMH. It is 4 pmol/l most recent though been lower. AFC 10-12.

Always done short protocol (this current was my 6th stim) and FSH predominant has given us best quality eggs.

When I tried oestrogen priming it just slowed down follicle growth leading to a prolonged stim and poor quality eggs, but didn’t stop a huge lead follicle racing ahead that time either.

I just feel if we could get it right my AFC isn’t bad it’s just everything grows so discordantly.

I have a review next week and be good to go in with ideas. Thanks for reading and any ideas/experiences xx

[Lelo3479]

Hi Endofitall, Sorry to hear your recent cycle has been cancelled. If you're having struggles with follicles growing out of sync, I'd suggest (in my very limited knowledge and experience) that a standard long Protocol could help. The down regulation shuts off your ovaries and then when the stims begin, your Follicles should all start growing reasonably similarly (you'd hope). My Egg collection all 17 eggs were mature with a standard long Protocol. I believe others benefit too from this. Defo worth a chat at your review appt. Best wishes xx

[Endofitall in reply to Lelo3479]

Thank you 🙏🏼 definitely going to ask about this xx

[Lelo3479 in reply to Endofitall]

Defo worth an ask and consideration ❤️, I've read comments below and realised I didn't share much data lol and that there is a very small risk after down reg that you you'd end up never coming out of it, so enter menopause, (I am on Zoladex), but it sounds like you've had many short Protocol's so sometimes it's worth trying a change just to see. I forgot to add I'm 40 and had this just when I turned 40 in the summer, I also have Adenomyosis and Endometriosis, AMH I think was about 8 nearly 3 years ago, AFC was 4 or 8, sorry can't remember which. But got 17 follicles with Gonal F 300 for 5 days, Meriofert 300 for 10+days until follicles were good sizes on the scans, thought we would get about 8 follicles but after trigger and Fyremadel to stop early ovulation we got 17, all of which were mature, so so shocked and grateful. All 17 mature, 15 fertilised, 9 blastocyst 522 or above, 1 x 511 transferred fresh and the rest frozen, 3 x 633 which clinic discarded as per their policy xx

[Endofitall in reply to Lelo3479]

Wow that’s amazing! I’ll defo ask about it. I do think need to try something different after all I’ve tried so far with no success. Ideally need a decent number for doing PGTA xx

[Kitkat10]

hi, I didn’t have a good experience with the long protocol as it shut down one ovary which then didn’t respond at all to stims, I was 40 at the time and AMH 8.2 pmol. Short protocol produces fewer follicles (6) and only 3 eggs but this was enough to give me 1 good blastocyst which became my son. Even though the numbers were lower, quality seemed higher. Sorry if that’s not helpful but I share your hesitation with the long protocol xx good luck, I remember what a rough time this is. Xx

[Endofitall in reply to Kitkat10]

Thank you. I’m so glad to hear it worked for you. It definitely makes me nervous. Can I ask what your long protocol was and if the effects on your ovary was for that treatment cycle or more long lasting? Thanks so much xx

[Kitkat10]

it was a while ago, but I think it was 3 weeks down regulation with Buserelin. The effects on one ovary happened twice for both long protocols I tried and then I switched clinics and they used short protocols as their standard and both ovaries responded normally to that protocol and that was the one which worked.

Could have just been coincidence but I also felt like the short protocol was a bit less gruelling on my ovaries too. Good luck x

[HelzBelzUK]

So sorry to hear about your cancelled cycle.

My consultant prescribes double stims because he says it evens out the follicle growth. We’re having treatment in Greece so we usually have a scan in the U.K. on day 6 and then fly to Athens on day 7/8. I have a scan on day 8/9 and he’s then able to tweak the dosage depending on follicle growth.

[Endofitall in reply to HelzBelzUK]

Thank you 🙏🏼 by double stims do you mean FSH plus LH or high dose?

[HelzBelzUK in reply to Endofitall]

Oh god I don’t know which is which sorry xxx My last cycle I was on gonal f and meriofert, before that I had bemfola and meriofert xx

I had both for 8 days and then I started cetrotide. So it’s a lot 3 injections but it does work xx