What went wrong for me? :(

[firefly37]

I know there are so many knowledgeable and experienced ivfers here and I'm calling out for some advice/help to understand!

I am 41 with AMH of 5pmol (0.7ng) and I have just had a cycle cancelled due to lack of response to stims (pergoveris 350, short protocol). I have 5 follicles on the right and at least the same on the left but only 3 were big enough to be measured at time of scan).
When I was 36, I had AMH of 7 and after a long protocol with gonal f, they retrieved 11 eggs with 8 that were mature. Follicles grew nice and even and quick.
When I was 39, I had AMH of 5 and after a long protocol with Menopur, they retrieved 10 eggs but only 3 were mature. Follicles grew all over the place with some huge that I think were lost whilst waiting for little ones to catch up.

Can anyone give any suggestion as to what had gone wrong for me this time ? I have a meeting with doctor on Tuesday but worried they will try and push donor eggs as they did that from the start following a high FSH which did lower significantly 2 months later with supplements.

My understanding is that stims medication is basically the same thing so why does it make a difference which u have? What benefit does the long protocol have as I don't actually understand it? An AMH of 5 (0.7) with a number of follicles seen should be OK shouldn't it? Or is my FSH likely to have let me down? Or just my age?

Obvs I will be asking my doctor all of this but I'm so upset, I would really like any insight from anyone please.

TIA xx

Every cycle and month is different- personally given age and AMH level I'd have gone forward to collection with the 3 you had but my final rounds (which were successful) were natural modified IVF so only going after a couple of follicles

Long protocol is designed to stimulate your follicles from a starting point of zero ie no follicles at all and do you are more likely to get the follicles growing at the same rate and size

Short protocol starts when you already have follicles and stimulates the ones you have already visible so there is the risk that you get a dominant one that takes over and stops the others growing

@tiggerwhocamefortea... Thank you for replying. Sorry, my post was not too clear... So after 5 days of stimms they measured 5 follicles on the right and 3 on the left (others seen on the left but were too small to measure). The ones measured were too small for 5 days... 1 at 6mm with the rest at 4 and 3mm. My doctor gave me the option to increase meds a little to see if they grow but her recommendation was to stop. Our clinic is in Prague so if we went ahead we would be flying 4 of us out there, booking accommodation etc for a very poor outlook.

Thank you for explaining re the short long protocol differences... That makes it clearer. But I am a bit annoyed at being put on a short... xx

I’m sorry for your cancelled cycle that must be hugely disappointing, especially considering your previous rounds.

I was on short protocol so don’t know too much about long, although my understanding is the same as Tigger’s in that you start from no follicles and they all should then grow at the same rate.
Did your clinic not explain why they were swapping you over to short at the time?

In terms of stims, they all do the same job but are slightly different e.g. Menopur has LH in it while Gonal F doesn’t (at least as far as I understand) and I believe it is possible that some women react better to some drugs over others.

Out of curiosity, did the quality of your embryos differ much in your previous two rounds? I’m wondering why they switched you over for your second round if your first went well overall, although I have heard that some Drs simply favour a particular drug for whatever reason.

If you plan to go again you could discuss going back to long protocol with Gonal F (perhaps with a slightly higher dose accounting for age and AMH) as this seems to have been your best round on paper?

Again I’m sorry you’re going through this and wish you all the success in your next round.

@RiverRiot thank you so much for your response and for helping me to understand. To be honest, up until recently I've not paid much attention at all to my ivf protocols. I've just done what I was told... My first cycle on day 5 I was left with a 4bb embryo and on day 6 two more were frozen having made a similar grade. The day 5 4bb is now my son. My second cycle was now private and we went to the Czech Republic... Out of my 3 mature eggs, all made it to day 5 and a grade 4aa was transferred and is now my daughter. The other 2 made it to day 6 and were frozen at around 4bb/bc grades... None of my frozen transfers worked therefore we are convinced fresh only for us. I guess I went into this fresh stupidly thinking it would all work out like the previous 2 :(
We are at a new clinic in Czech Republic only due to travelling (it's in Prague where as the other was a mission to get to)... I should have asked why the change of protocol but I just assumed it was what was best as they reviewed my old cycles and my blood work.
Money is so tight... We have wasted about £1500 on this failed cycle. We have about £500 worth of pergoveris left so was going to discuss a last chance long protocol using up the pergoveris and adding gonal f with it xx

It's really playing on my mind that now this cycle has been cancelled... The next one will be around my 42nd birthday where I should except pretty much no chance... I just don't want to stop yet!

I can definitely imagine it was a huge shock and it’s completely understandable you’d want to get some use out of the leftover Pergoveris.
I totally admire your ‘do what I’m told’ approach as well, I really wish I could be more like that! I drive myself mad with research and then consequently drive my Drs mad with questions! 🙈

In terms of age, if you’re planning on going again pretty soon i.e. if your birthday is in the next couple of months I’d try not to worry too much.
If it helps at all I started stims just as I turned 36 and at my review my Dr gave me a bunch of stats based on an age of 35 as she said it wasn’t that long since my birthday.
I appreciate 36 is a bit different to 42 but what I mean is that I don’t think things drop off a cliff overnight.

You seem to get pretty good grades overall on whatever stims you’re on so that’s good and extras to freeze is always a bonus too. My clinic say only around 40% of women get anything to freeze at all which surprised me. However, if FETs haven’t worked in the past and you find yourself needing/wanting one in the future I’d personally ask about having extra progesterone, especially if it’s a medicated FET.

I hope you’re feeling a little better today and you get some answers and positive steps forward at your review. I have everything crossed for you. xx

@tiggerwhocamefortea you explained it so well, thank you! You put everything together and it makes sense 🙌

@firefly37 I am sorry you had to cancel your cycle, it's devastating after all the preparation.