Long protocol - experiences / opinions?

[AnnieStar12]

Background - I have just had a failed 1st cycle of ICSI after 12 months TTC. I had about 5 follicles grow, but they grew quite unevenly and in the end we only got 3 eggs retrieved, and 1 wasn't mature. Of the 2 remaining eggs, only 1 made it to Blasto stage which was transferred at day 5. It was poor grade 3BC and resulted in a BFN. I have low AMH 4.8 so was never expecting very many anyways.

My clinic has now suggested we try a long protocol to see if that helps my follicles grow at the same pace in the hope there's more to work with at retrieval stage.

I am nervous about the extra drugs, and also about losing one cycle to down reg. Also, seems different clinics and doctors have different opinions about long v short, with some places saying people with low AMH should only do short.

What have people's experiences been on long protocol? Anyone got any advice about what I should do, or questions to ask at my next consultation?

@AnnieStar12 I'm sorry you've had a disappointing result after your first cycle. I have experience of doing a long and a short protocol (though this was in 2021 so my memory is a bit rusty). We did a long protocol first when I was 31 and had a normal AMH with prostap for downregulation and menopur as the primary stim. I responded poorly - so my follicles were growing but quite unevenly and I had a very clear dominant follicles growing. At egg collection, they didn't get an egg from many of my follicles (empty-egg syndrome, though my consultant said he doesn't believe the follicles are empty, but that the egg is not mature) and only got 2 mature eggs which resulted in 2 high grade embryos, but fresh transfer was a BFN and FET was a chemical. My second egg collection we changed a LOT, because I was really keen not to just do the same thing again and have another poor outcome.

So we did a short protocol, I took high dose Ovaleap for the primary stim drug. They let my follicules grow bigger than they would normally do and they did my egg collection slightly delayed after the trigger shot (to give it longer to mature the eggs). We got 6 eggs that round, all mature, all made it to day 5 but only 3 suitable for freezing (we did a freeze all cycle as ironically, after retesting my AMH after the first cycle to try to see what had happened, they decided my AMH had gone up and was now on the higher side and I was at risk of OHSS which is laughable). First FET resulted in my DD :D and we did a second FET which has resulted in my current pregnancy (just reached 12 weeks).

This is definitely not an argument for or against a particular protocol, I would more argue that if you tried 1 protocol and it didn't work well for you, that its worth trying something different, as your body is unique and individual and might respond better to a different protocol.

Best of luck whatever you choose to do for your next cycle

Hi, my first cycle was the long-protocol (although a normal AMH for my age 14.8 at that time, I really should have been put on the short-protocol, I think...). It was a lot more drugs over a longer period but it did yield a lot more eggs compared to my subsequent cycles. I was very very bloated.

Long protocol - 16 eggs, 14 mature but they forgot to do ICSI (even after recommending it!) so only 4 blasts... very annoyed.
Mild/short protocol - Ranges from 7-9 eggs, 2 blasts each time

I think AMH is one thing, how your body responds to the meds needs to be taken into account too..

@2mumlife thanks so much for sharing, it’s really helpful to hear other people’s experiences. Congratulations on your two successful transfers. I know someone else who failed with all 5 blasts from their first round, but went on to have three babies in a row from the second round of IVF. I think those are wise words you say about needing to try something different if the first one doesn’t work, but that meaning something different for each of us.

@blahblahetc wow, that’s quite a big difference in numbers. I hope I’ll also be able to double the number of Blasts if I do long protocol. I can’t believe they ‘forgot’ to do the ICSI part!! That’s the main reason we’re doing this is due to mild male factor issues - I’m going to remind them when I have my next egg collection to make sure that doesn’t happen! And do you mind me asking have you gone on to have any successful pregnancies?

Is it mad that the main thing I’m nervous about is if we do long protocol it means not giving a chance to the egg that releases naturally before starting down reg? I’ve been told you mustn’t try naturally to get pregnant that month. After doing everything we can for over a year each month, it feels counter intuitive to loose that one month - what if it’s a perfect egg?!

@AnnieStar12 I definitely think you can have better and worse cycles. My second round I also did acupuncture, ate a lot more protein and used the “mindful ivf app”. I also have a superstition about not testing early, as with both my pregnancies I waited until OTD and all my negative outcomes tested early.

I k ow lots of people also recommend the “it starts with an egg” book if you’re looking to maximise your egg quality

I think you just need to get to a place where you see doing a longer protocol and not trying for a month as maximising your chances in the long run. But I think ultimately go with your gut - my gut said I absolutely wasn’t ok just trying the same thing and hoping for a different result. Just do the thing you feel is right for you

@AnnieStar12 Yes, I was so upset when I found out and asked them why?! They said the sperm looked ok on the day… this is so stupid as it was them who advised there are morphology and motility issues. Wasted my eggs!

Unfortunately no, no success so far.. I have 6 day5 and a day3 so hoping at least 1 (2 really..) will work. I haven’t tested them.

Too many ‘what ifs’ in this journey to consider, so I think you just need to know you have done/tried everything possible. That’s kinda where I’m at 🙃

I hope your next round is more successful.