Moving from Mild to Standard IVF

[Mouseorchestra7]

I have had two rounds of ‘mild’ IVF, with lower dose stims (125 Bemfola). This has not been successful for me, with only 25% eggs retrieved becoming average Day 6 blasts. I have had two failed transfers.

Has anyone moved from mild IVF to standard with much higher stims and had more success? I only seem to hear about the reverse (I.e., people moving from standard to mild IVF following a lack of success with standard). I plan to move to LWC for the standard IVF (currently with Create) and they are proposing a different trigger for me and 225 Menopur. I have no known fertility issues and am 36.

Thank you!

My first round was 150 bemfola. No embryos made it to blast. Moved to embryo banking on max dose 450 and subsequent rounds made 2, 3 and then 1 top quality blasts. I am now pregnant from a transfer although early days.

I had 450 stims (various diff drugs) on all of my 3 rounds. I have one dc and am pregnant from these. When things weren't going well I asked my gynae about lowering the dose and she said it was a load of rubbish. Apart from Create, most places seem to think it's a numbers game and therefore to give as much drugs as required to get the max response. I don't think it's likely that all of these experts are wrong although there are certainly people who do better at create. Best of luck, I hope it does work. You're still young and the fact they haven't found anything wrong is probably a good sign too.

I think it's very much about finding the right mix of drugs which work for your body that particular month - for some that's higher dose and others it's low dose. What works one month might not work the next

For me I took a leap of faith and changed to natural modified which gave me my twins but my issue was found to be egg quality so less drugs and fewer follicles worked for me but If say the issue was male factor then you'd maybe be wanting to get as many follicles as possible due to drop off after day 3?

Most clinics build their entire business model around getting as many eggs as possible so are going to be sceptical of what other clinics are doing and the same for Create for whom it's the reverse and are looking for quality over quantity. What is clear though from having spent years on this board and other forums is that high dose or low dose most women only get 1 good blastocyst or maybe a couple of spare embryos to freeze unless they are in their 20s when they might get several. Which would suggest then that most women are only capable of producing a couple of blastocysts per month no matter what the protocol. It's about finding what mix of drugs will give you the best quality

If you are able financially/emotionally then try something different - follow your gut - I insisted with Create that I change to natural modified and my hunch ended up being right x

Agree with almost everything @tiggerwhocamefortea has said, particularly about following your gut. It's definitely not the case that one size fits all in ivf, and if you're not winning with what you've tried so far it's definitely worth switching it up.

One thing though - I don't think it's true that most women only get one good blast on high dose. Only one of my ovaries works so the max eggs I've ever collected is 12, and in my other 2 rounds it was 8 each. I was 36 for round 1 and 38 for 2 and 3. In all 3 rounds exactly 50% of my eggs made it to day 5 or day 6 blast. The grading was never particularly high on any of them but actually my experience has been the worst graded embryos got me pregnant anyway.

My doctors hypothesis would be that to find one euploid blast we need to make 2-4 depending on age/egg quality. And that quality is pre determined and not impacted by collecting more, so we need to collect as many as possible. I think it's definitely worth a shot for you on higher stims.

@Inabitoftime thanks for your message and congrats on your pregnancy.

Thanks @whatcangowrong. It very interesting that your Dr. said that. My Dr. at LWC had a similar response. Do feel now that if I am going to go through all the faff and pain of IVF, I might as well try and get as many eggs/embryos as possible. Thanks for the encouragement. Do you mind me asking how many transfers you needed and what grade your successful embryo was?

@tiggerwhocamefortea congrats on your twins! I have heard good things about natural modified. Maybe that will be my next stop if higher doses don’t work. It’s actually weird because my first round of mild IVF, embryos generally looked good on day 3 and then there was a drop off to day 5. On the second round (a month later), none of my embryos were that great on day 3 and then I had an even bigger drop off to day 5. I’m concerned it’s an egg quality issue.

Hi @Mouseorchestra7 - ugh number of transfers for us was a bit of a disaster in that obviously they started with the "best" ones but for us the worst ones worked! So we had to go through a lot of expense and suspense to get there.

Round 1 (36) - 4 blasts, 2nd transfer worked. Don't remember but none were amazing grades probably mostly BBs

2021 (38) - transferred 2 remaining blasts from round 1 - bfn and a chemical.

Round 2 - 6 blasts, all BB but we also did caremaps and had from 8/10 down to 2/10. First 3 transfers failed, so we went to round 3 and decided to do pgt a to try and find out what the problem was.

Round 3, 4 blasts, best grades of all, ABs and 2 9/10 on caremaps. All were abnormal on PGT A 😩

So we transferred 2 of the 3 we had left from round 2, both BB and only 4/10 and 5/10 on caremaps. One barely survived the thaw. Both have stuck (for now).

Morals of the story from my point of view are: don't get hung up on grades, transfer what you have before collecting more (would have saved us a lot!) and I think really that having numbers gives you more chances as lots just don't work as you get older - i have had 3 stick from a total of 13 either transferred or PGT tested and destroyed, and I don't think that's particularly surprising. It's possible some euploid ones were transferred but didn't stick as even with a euploid you only have 60-70% chance or something!

It was much easier at 36 than 38, if you want lots of children it is definitely worth considering embryo banking now although if you're like me you will just want to get on with your first pregnancy ASAP.

@Mouseorchestra7 has your DH been investigated properly - semen analysis and DNA fragmentation test? Have you checked your testosterone levels?

My twins are also my lowest graded out of 4 (my little girl was likely the day 6 4bb)

@whatcangowrong Thank you. What are your thoughts on PGT, given the outcomes from your three rounds? I do have a Day 6 5BC from Round 1, and have sort of discounted it. I’m 36, so would you, in my position, bank more or would you try transferring the 5BC? I’m thinking I should bank more because I do want a second child if at all possible.

@Inabitoftime Semen parameters all fine, but no DNA fragmentation testing. Could this be a cause of poor quality and fewer embryos? DHEA-S is also on the higher end of normal. Anything else you think it is worth testing for?

@tiggerwhocamefortea Amazing. Maybe I should be more hopeful for my frozen Day 6 5BC!

@Mouseorchestra7 it’s just when you said drop off between days 3-5 that’s usually when sperm takes over. It could be no harm to check DNA frag if finances allow in case it’s the missing factor.

On PGS testing i tested on a previous egg collection and didn't get any normals - I decided not to test again and had my twins on the next transfer

I joined lots of groups after my PGS testing results and whilst in the U.K. you aren't allowed to transfer abnormals it's pretty common in the USA and lots of women had healthy pregnancies from abnormal embryos.

For me I knew I could mentally/emotionally cope with another miscarriage if it was the difference between destroying the only embryos I had and giving them a chance x

I started with bemfola 150 and had a cancelled egg collection due to poor response. Next we did a round on 225, I responded very slowly but ended up with 5 embryos so a great success.

Following that I had my NHS round and passed all info on previous cycle. My AMH was retested and had slightly dropped so they put me on maximum dose of Menopur (6 vials). I ended up with 6 embryos.

Strange (but grateful) the little difference between 2 cycles that are completely different in protocol. But 150 bemfola was hopeless for me!

I’m in the same situation. I have one day 6 frozen with Create but I am considering changing clinic.

I had 8 blastocyst at day 3 and only 2 survived by day 5. I had moderate OHSS which required a hospital stay though, so I am unsure if I will be able to switch to standard easily. I was on Bemfola 125 and have unexplained infertility.

If you do switch clinic please let me know how successful it is for you, as I am looking to start treatment again in a few months.

@BewilderedBee That’s a great result. Do you mind me asking what your AFC was? My new clinic is not testing AMH. Part of me doesn’t want to know in case it has dropped a lot, but also worry that 225 Menopur might not be enough. The last time I had my AMH checked was about 2018. Did you see any difference in quality of blasts between the two rounds? Have you had any embryos transferred? Sorry for all the Qs!

Hi @Mochii I won’t start my cycle at LWC until April, by which time it would have been six months since my last cycle with ABC. The Dr at LWC did suggest that it could be a lab issue with Create/ABC that led to poor-ish blast quality. Could also be egg quality, sperm quality, etc. I will be on different meds on LWC, so Menopur instead of Bemfola, Fyremadel instead of Cetrotide and Gonasi instead of Ovitrelle, so I’m hoping that makes a difference. You may find that a change of meds is helpful in your case. Are you at Harley? Will
update on my next round, although it’s quite far off.

@Mouseorchestra7 I think on my baseline scan with the clinic I had 7 follicles on the one ovary but the other couldn't be seen due to a cyst.

We did get some good quality embryos on both rounds. A 5AA on the bemfola and a 4AA on menopur as the highest.

We transferred our 5AA and sadly miscarried, and we haven't used any more of the bemfola ones due to receiving nhs funding.

Our menopur NHS ones - we have transferred 3. Our one fresh didn't work and then we transferred two frozen at the same time, and I'm seeing the early pregnancy unit at the moment. It's either a miscarriage or an ectopic!

Thank you @BewilderedBee for taking the time to respond to me. It’s encouraging to note that you had marked difference in results when taking Menopur.

Im sorry to hear about your current experience. I’m wishing you all the best