Protocol Help Please!

[firefly37]

Hi All,

I am desperately seeking those AMAZING women on this forum who KNOW SO MUCH about IVF, meds etc and hoping for some advice and help to understand ...

In brief;
2016 aged 36, first fresh IVF, FSH about 7, AMH 7pmol, long protocol with BCP, Buserelin, Gonal F and Ovitrelle trigger, 11 eggs, 8 mature, 5 fertilised and 3 made it to day 5. One 4BB transferred and my DS resulted.

2018 aged 38 (nearly 39), second fresh IVF, FSH about 6-8, AMH 5.2pmol, long protocol with BCP, Buserelin, Menopur and Ovitrelle trigger, 10 eggs, 3 mature, 3 fertilised and 3 made it to day 5. One grade 1 transferred and my DD resulted.

2021 aged 41, trying third and final fresh IVF, FSH 15 in May, 6 in September and 9 in December, AMH 5pmol. I was put on a short protocol with Pergoveris ONLY. No ovarian response to 5 days of stimms and cycle cancelled. My clinic have amended the protocol to add Decapeptyl 0.1mg to start on the same day as stimms remaining as a "short protocol". They will not entertain a long protocol and I absolutely do not understand why .... My clinic are in Prague and therefore to ask questions is difficult (I felt like I quizzed them a lot in a Skype meeting after my recent cycle failed) ... I feel like I am being rude in questioning the Doctor who certainly knows this stuff better than me ... but my bloodwork hasn't changed that much since my last successful IVF so I don't understand why they wouldn't mirror a previous long protocol.

We have spent a fortune on Pergoveris in the last couple of months and now need to buy a load more! I am really hoping that someone here could help me understand what the addition of Decapeptyl will do as it would appear not to be for "down reg" as I start it the same day as stimms ... I know that my high FSH reading in May of 15 is horrid but on starting numerous supplements it has come right down ... but is this the reason they wont entertain a long protocol do you think??

I would really appreciate any insight, advice or help to understand and thank you in advance.

Happy New Year All and New Babies for us All xx

Hi there,

I have no experience on long protocols, I have only done short ones. Both cycles I triggered with Decapeptyl. From my understanding, it prevents premature LH surge and ovulation. I am not sure how the long protocol works, but during short protocols they try to even the development of the follicles because some grow ahead of the others.

No experience with Pergoveris.

Hope this helps a little bit!

Thanks @Yuliaaa for responding ... I have done my over the top googling trying to find out what this protocol is about! All I have found is that Decapepyl doesn't cause a "down reg" effect for a couple of weeks ... and that initially it causes an LH and FSH surge! I dont understand why I would need that but I guess I have to trust the experts!

Adding the decapeptyl adds an initial flare effect to try and turbocharge your response to stimms. It can be deleterious for egg quality if you’re older or have poor egg reserve, as I found out - I had a spectacularly bad round (nothing suitable for fertilisation) on this protocol.

Pergoveris is a good drug for older ovaries, my successful rounds involved this & Gonal F on a long protocol.

www.drgeoffreysherivf.com/selecting-the-ideal-protocol-for-controlled-ovarian-stimulation/

@Porridgeislife.... Oh no really?!
Then I don't want this protocol at 41 then? Can I ask what ur age, fsh and amh were when it failed for you?

I think my AMH is about 5 and FSH about 9-10. I’m a little younger than you. I got the 8-9 eggs I normally do which looked fine at egg collection, but once they stripped them of their hard outer shell for ICSI they could see they were very poor quality.

@Porridgeislife... Similar to me then with figures ... Was the quality definitely linked to the protocol? Or could it have been a bad round?... I asked for a long protocol as have been successful on it before, but they don't think it's right for me now particularly as my ovaries didn't respond well earlier this month with pergoveris alone and cycle was cancelled

It sounds like they're going for a FLARE protocol this time, probably because the response to the short protocol last attempt wasn't good. FLARE protocols involve giving the ovaries a bit of a "kick-start" and harnessing your own pituitary hormones to help with this with a hormonal "surge" early in the stimulation phase.

One possible reason they might want to try this rather than a long protocol, is that a long protocol effectively switches the body's own ovarian stimulation processes off and then the meds restart things. As women get older and egg reserves diminish, it takes more and more hormones to achieve ovulation (higher FSH levels = your body having to release more FSH to achieve this). One of the risks of a long protocol can be that the ovaries are "switched off" overly effectively and then they may take a while to get back into action, leading to a cycle where response to stims may be delayed or even non-existent. They may be thinking that the lack of response to the short protocol attempt may mean another long protocol attempt would also be more likely to be unsuccessful, while a FLARE protocol starts with a surge rather than suppression, so might increase the chances of a response.

It's definitely worth asking them for specifics of your situation and their decision making. This is a big investment of time, energy and money, as well as a medical process involving your body, so it's important that you feel informed and confident in your clinic.

[quote firefly37]@Porridgeislife... Similar to me then with figures ... Was the quality definitely linked to the protocol? Or could it have been a bad round?... I asked for a long protocol as have been successful on it before, but they don't think it's right for me now particularly as my ovaries didn't respond well earlier this month with pergoveris alone and cycle was cancelled [/quote]
For me, it was definitely the protocol. I did some reading after it failed and the coflare/micro flare protocol can cause excess androgens to reach the eggs early in the stimulation. If you’re younger this isn’t an issue but not as you get older.

We did two long protocols after that were tweaked to downplay the availability of excess androgens and they were both quite successful (currently pregnant with first frozen transfer - all rounds were freeze all).

@Scirocco... Thank you so much for your response. Very helpful. Do you know if this protocol affects egg quality? I know my clinic are dubious for some reason of my recent AMH result of 5pmol mainly as it was 5.2pmol in 2018... They believe my AMH would have decreased further than the result showed?!

I'm not sure, @firefly37, sorry - I've only done one cycle and it was short protocol, so I haven't done much reading about FLARE protocols. Your clinic should be able to give you data on its effects on egg quality though?

@Porridgeislife... Thank you. I'll speak to my doctor x

@Scirocco thank you x

@mycatistrans... How dare u question my life or choices! You have been reported to admin...