Oestrogen Priming Protocol

[WootyWoo]

Hi,

Has anyone tried this protocol? I am about to try it as research suggests it's good for poor responders. It doesn't seem like it's a protocol that my clinic use but they are happy to let me try it. From what I've been able to find out online, you should start taking oestrogen about a week before your period starts. My clinic have advised that I start taking it on cycle day 21 together with cetrotide.

Cetrotide has never been mentioned in any of the research I've done. Also I have quite a short cycle and think I should start the oestrogen before cycle day 21 (sometimes my cycle is as short as 22 days!). I'd like to start it on cycle day 18... Do you think there is any harm in that? Also any thoughts on the cetrotide? I've only ever used it to prevent ovulation. I'm concerned it would affect egg quality taken at this time.

I'm sure my clinic know what they're doing but I just want to understand their choices fully.

Any experience or advice would be great, I'm getting all stressed which is what I'm trying to avoid right before putting myself through IVF again

How are you getting on?

I've read a lot about oestrogen priming and makes a lot of sense for poor responders, as especially if you have short cycles, it should help prevent early recruitment of a dominant follicle which would then race ahead and gobble up all the stims, leaving the others for dust

It also makes sense that the estrogen artificially suppressing FSH could make the follicles more responsive to FSH when you do start stimming

I didn't do estrogen priming as such, although I did go on the pill to quiet my ovaries before my second cycle, and got really even follicle growth, because they were all developing from a standing start. Estrogen only presumably achieves the same but without risking the possible suppressing effect of the pill

If we do another fresh cycle I am definitely going to ask my consultant about it

I'm afraid I don't know about Cetrotide, except in Dr Sher's agonist / antagonist conversion protocol with estrogen priming for poor responders - this would have an agonist like buserelin in as well, so doesn't sound like what your clinic have got you on

But estrogen priming as a protocol sounds really positive and great that your clinic are up on different strategies to optimise the response for poor responders

Good luck!

Hi Banana, thanks for sharing your thoughts, it really reinforces what I've learned so far. From what I can gather the cetrotide also helps to prevent early recruitment of a dominant follicle although I'm not sure on the science behind it.
Unfortunately it's all fallen through as my prescription didn't arrive in enough time for this cycle, so I'm oestrogen primed but I have no stimulating drugs! (clinic is in Greece). Bit of a nightmare. I've converted to a natural cycle, which was my clinics original recommendation, just so I don't waste all the planning and time off work booked. I'm really disappointed though. Desperately looking for silver linings, I'm hoping that the little break my ovaries have had from FSH will have a positive effect...

I was so sad to have heard of your miscarriage on another thread. I had a miscarriage many moons ago at 8 weeks (before the agony of years of infertility). I can't imagine how devastating it would be at this stage. I'm so sorry for your loss x

Ah I'm sorry about your meds, I know when I had a cycle cancelled how immensely frustrating it was! Are you with Serum? I hear so many good things about Penny, and their individualised protocols seem to get terrific results

I'm sure a month off stims is no bad thing - another month to get your eggs cycle ready (although hopefully with a natural cycle this month might be the golden egg!)

Thank you so much for your lovely words. We are, as you can imagine, utterly heartbroken, but I'm just trying to focus on next steps. I'm very eager to get back in the saddle as soon as the Dr gives the green light

Hi Banana, yes I'm with Serum and absolutely recommend them. Penny is pretty incredible. You send an email at any time of the day or night and she always replies within a couple of hours, she must never sleep and without a doubt she's replying to emails from her home. She even gave me her home number to contact her on my last cycle when things were a bit touch and go. It makes the whole stressful business of IVF so so so much less so.

I totally understand you wanting to get going again as quickly as possible. I'll be rooting for you on your next round, hope it comes round fast for you x

Just noticed I can't spell Estrogen, not entirely sure why I thought it started with a silent 'O'

Oestrogen is correct - if you're British
It's just my phone thinks American spelling is correct (pah!) and corrects it

We say oestrogen, paediatrics and caesarian section

They say estrogen, pediatrics and cesarian

We are obviously correct!!

So so pleased you are in such brilliant hands. I only hear amazing things about Penny - sounds like you are in the very best possible hands

I am a fellow poor responder Wooty. Also like you, I have short cycles of 24 -25 days. I think the two go hand in hand. As our fertility winds up, our ovaries produce less follicles so in order for our sluggish ovaries to produce some follicles for ovulation, our bodies start the cycle with a higher amount of FSH being pumped out which leads to faster follicle growth, a shorter follicular phase and hence, a shorter cycle.

My first cycle I produced just two mature follicles. A third follicle was at 14mm on the scan just before egg collection. This poor result wasn't helped by the fact that the Dr doing EC somehow then thought only one ovary responded and only collected the one egg! It fertilised but soon died.

Like you, I then did research and was convinced the estrogen priming protocol was best based on studies showing significantly improved results for poor responders. Also like you, the Dr at my clinic had never heard of it but he was not willing to let me try and told me to take the pill for a month to shut down my ovaries so that all follicles would then grow more evenly for IVF the following cycle, saying 'It's the same thing, the pill also contains estrogen'. It obviously worked well for banana but I had read that the pill was not good for poor responders as the struggling ovaries cannot bounce back and was upset about him saying no to EPP, but I felt silly arguing to a Dr with a degree by retaliating 'Well according to Dr Google...' So I took the pill for a month and as I had read, my body did not bounce back. My period that was supposed to arrive when I stopped the pill was nothing more than a tiny pink smear on toilet paper when I went to the loo one night. I again had scattered follicle growth at my first scan and the smaller follicles again shriveled away leaving me again with about two mature ones. This time I cancelled the cycle.

I saw the Dr in prep for a 3rd cycle, where he says to me 'Oh the pill doesn't really work, you need to take nasal spray for a month to shut down your ovaries'. Then why the F did he insist it would work before the cycle?!?! I was really frustrated with him at that point and insisted I would be trying the EPP. For my third cycle, I had a day 2 scan which revealed only 8 starting follicles, but at my day 8 scan, I had 5 follicles that were all within the 10-12mm range. So just as the studies I read had showed, I had much more even follicle growth. I had 5 eggs collected and two embryos transferred, and got a BFN, but at least it was a step in the right direction.

That is the portion of my story relating to the EPP and how well it worked for me. I will summarise the rest as I could write a novel if I went into detail... I then worked on embryo quality and was amazed by the high protein low carb diet increasing IVF success to a staggering 80% and on my final cycle, the EPP in combination with the high protein diet finally saw me get a BFP.

Hurrah Banana I can spell after all

Hello lovely Shellster. I've spoken to you before but many moons ago. You were trying to holiday with IVF drugs and i think keeping them chilled was challenging! I've had a name change since then. Just wanted to wish you a huge congratulations on your pregnancy It's just incredible and I'm so pleased for you. I really hope you get the birth you want too x

Thanks for your thoughts on the oestrogen priming. Can I ask, even with your short cycles did you still start the oestrogen on cycle day 21? Did you take it alone or with cetrotide too (as my fc has prescribed me)?

I agree it is very very awkward to go against the recommendation of the expert. I try and reassure myself with thoughts that this is way more important to me than it is to them, and if none of it works I hope that at least I can feel some kind of closure from having tried everything I've researched that holds promise for my specific situation.

I'm a massive pain in the arse for my consultant, I'm sure. I come in with my enormous list of questions and I'm sure he must think 'oh god, she's got the notebook out. strap in!!' (I should say, if he thinks that he has a good way of hiding it, as he often says stuff like 'that's a great question' or 'you should be doing my job', which is quite sweet, as I am firing questions at him like the Spanish inquisition)

I am definitely going to ask about oestrogen priming before doing the next fresh cycle (he doesn't yet know I want to do another fresh, so that's on the big list of questions for the post ERPC follow up!)

I did well off the pill, in that it quieted my ovaries so all the follies came off from a standing start and grew reasonably evenly. I don't get early recruitment or have short cycles, but intuitively oestrogen priming rather than pill priming feels like it must achieve the FSH suppression without shutting everything down, so feels like an option worth considering. I know based on my last cycle I wouldn't be considered a poor responder, but I am a very very low AMH-er and so it's entirely possible the last cycle was a fluke, and we can't assume I'll respond the same way next time

So am with you ALL the way on researching everything to the nth degree, and badgering the Dr to death!

I was always stressed about what day was best to start the estrogen tablets Wooty,. I figured if the textbook cycle had ovulation occuring at 14 days and lasting 28 days, then starting estrogen on day 21 meant smack in the middle of the luteal phase. Since I would sometimes ovulate at day 14 and sometimes day 16, then my cycles were sometimes as short as 24 days and sometimes as long as 27 days, I was as confused as you about when I should start the estrogen tablets. I think I ended up deciding on day 20 for me, but hopefully you have a more regular luteal phase than me that enables you to calculate what the middle of yours is? Do you ovulate on a set day in your cycle?

I never took the estrogen tablets with Cetrotide and it was never something that my IVF Dr suggested so I am not familiar with that protocol to offer any suggestions.

BTW I was reading up on the oestrogen priming protocol and seems the Cetrotide can be added in the luteal phase so that the pituitary doesn't detect the rising levels of oestrogen and think it starts needing to pump out LH (as I imagine you don't want LH to be high at the start of the cycle, you want LH and FSH to be low)

That seems to make some logical sense I think!

Thank you both. Sorry I've not responded, I've been in IVF hibernation and now trying to get to get over yet another failed cycle .

It seemed that everything that could go wrong went wrong on this cycle. From the prescription not arriving on time so we had to convert to natural, to there being a shortage of Pregnyl trigger shot in the UK so my pharmacist actually couldn't source it! The UK manufacturer won't have any in stock until May...I mean !!! How are all the IVF ladies in the UK getting triggered for ec???

DH ended up phoning round a gazillion pharmacists and found one in London with some in stock who also did next day delivery - disaster averted, briefly as everything else after that also went wrong . As each nightmare presented I had the option to cancel but I just had these idiotic romantic thoughts like, 'aw this is the last 'test' after so many years ttc, the last fight to get through in order to get 'my baby', I don't want to miss that 'golden egg', so i forged ahead amid the huge stress. Gah. Big pile of poo. Not everyone gets a happy ending.

Just wanted to say well done banana for asking all the questions of your consultants. I was very shy and embarrassed about asking my questions early in our journey (now I care less). It takes guts though. I'm glad you've got a positive encouraging consultant.

Shellster I think you might be giving birth or hopefully have given birth by now!! I hope it's going well. I do actually think you should write a book of your experiences and research, I would definitely buy it! I'm just trying to decide what to do next and wonder if you could tell me your drug protocol that you settled on? I may try the oestrogen priming for my last go, which I think might be 2mg twice per day from day 20/21 (although midway through my luteal phase on some months may be cycle day 18...) and then I'm looking at letrozole 2 times 2.5mg from day 2 for 5 days together with 75iu of menopur. Is this similar to yours? I don't want to stimulate too much as realistically I'm looking at 3 eggs as a good haul and don't want to fry them with drugs.

Hi ladies, can you confirm which clinic you were given agonist/antagonist conversion with oestrogen priming treatment?