Long protocol or short protocol for low AMH

[otters2017]

Hi. Looking to get some advice about long vs short protocol for IV if you have low AMH. Bit of background - I'm 38, DH is 42 and we are on cycle 18. Had clomid for 4 cycles but unsuccessful. All tests are normal. I'm not ovulating based on progesterone results. Referred for IVF but currently delayed as I had an abnormal smear and that needs treating first. The NHS consultant we saw recommended short protocol based on my age and low AMH. However, we had a private consultation at a private clinic and he recommended long protocol. If anyone has low AMH and has been through IVF, please share your experiences with me. I am utterly confused. Thanks.

[cherryontopp]

Hi there. Ive been on various sites and boards over the years with my infertility and IVF treatment. I too wanted to know the difference between long and short protocol. It seems older women, those with low AMH have a lot more success with short protocol.
Reason being, long protocol is when they down reg first which is when they shut down the ovaries, then they wake them up with stimming. Women with low AMH don't respond to drugs as well, So to shut down their ovaries is not usually good and they find it harder to wake them back up so to speak. That's why the most part, show protocol in which they just stimulatethe ovaries is the usual choice.

[otters2017]

Hi cherry I was thinking the same hence asking the question. I am older at 38 and have low AMH. I know someone else who is 40 with low AMH and has been put on the long protocol. It's all such a mystery! Where are you at with your journey ?

[ellesbellesxxx]

My AMH was 6.3 when I was 31 and I was put on long protocol.. got 8 eggs!
Good luck xx

[AnaBeleza76]

Dear all: I am 43, very low AHM. I was subjected to the long protocol, had 8 folicules, 4 eggs, none prgressed to blastocyst stage. Very poor experience with the clinic, and quite disappointed that a short protocol was not even offered. I have subsequently discussed with two experienced fertility specialists in the UK, and also two other from two different European countries. All agree that short protocols are better suited for women with low ovarian reserve. Indeed, down-regulation is probably not a good idea for someone who is already expected to be a poor responder to stimulation.

[AnaBeleza76]

On the worse case scenario, the long and the short protocols seem to have similar outcomes in poor responders. So why do the long one? See in doi.org/10.1186/s40738-017-0041-1: "Comparing 2 ovarian stimulation protocols in 440 poor responders who had all failed to become pregnant during their first IVF cycle with long GnRH agonist protocol, Merviel P, et al. (2015) found that though the group treated with a contraceptive pill + flare up GnRH – agonist protocol had a higher number of embryos obtained, the implantation and ongoing pregnancy rates per transfer were the same between this group and the group with GnRH – antagonist protocol. It was concluded that these two protocols resulted in similar implantation rates and that a customized ovarian stimulation regimen including mild ovarian stimulation, sequential IVF cycles, oocytes – embryos freeze all protocols and blastocyst transfers after screening may improve the outcome.

[AnaBeleza76]

Also: "Most common strategy was the use of gonadotropin-releasing hormone antagonist (GnRHant), and was compared with GnRH agonist protocol (17 trials; n = 1696) for pituitary down-regulation which showed no significant difference in the outcome." (doi: 10.4103/0974-1208.183515)

[Stace999]

I have low AMH had 2 long protocol ivf both 6 eggs poor embryos only 3 left at day 3 1 was a chemical 1 a BFN
Then went on to 3 x iui (donor sperm) and actually over responded on my 2nd cycle had to have a follicle reduction. It seems a lower dose of stims agrees with me.
Just had an ivf with donor and short protocol we got 9 eggs 7 fertilised and ended up with 2 5 day embryos.. So for me short protocol seems to be the way forward. Everyone reacts differently to stims tho and each cycle will yield different results.