Need advice on IVF protocol

[Ikigai22]

hi, as the title says, I'm looking for some advice on protocol for next IVF cycle. The second IVF cycle was in January where I took Buserelin 0.5 ml on day 21 of previous cycle and 0.3 ml when the stimulation started, also oestrogen priming on day 21 and growth hormone priming for a month and during sims. Baseline was 10 follicles, 8 collected, 6 mature, 5 fertilised and all 5 became blastocysts. 3 fertilised normally as 2pn and they came back euploid. One fertilised as 3pn, it somehow became the best looking day 5 blastocyst but had 3 sets of chromosomes. The other was 1pn, and became an embryo on Day7, it was biopsied but came back inconclusive, embryologist said a lady at the clinic had day 7, 4cc come back euploid and got successfully pregnant, so that's why they biopsied it.

Embryologist said the embryo development was good given there are not so many embryos to work with. What I'm struggling with is that one of the day 5 embryos is 4cc, day 6 ones is 5bb and 4cb. I'm wondering if we could change the protocol in some way to get better embryo grades and more day5s. The doctor said euploid is what matters but I've read studies that says grades also matter. Sorry if I hurt anyone's feelings with my post. In the first cycle, we got 0 blastocysts, so I'm obviously very grateful for 3 euploids. I turned 38 in February, last AMH was 4.73 in Dec 2023. Had a 3rd IVF cycle in March and it was a total bust due to Prostap, Buserelin was our of stock and Prostap over suppressed me. TIA

@Ikigai22 Rather than changing protocol, which is obviously working for you, you could focus on trying to improve egg quality. Also, grades aren't everything! I've had a 5AA day 5 blast lead to a BFN, but am pregnant just now with a lower-graded embryo.

@2mumlife thanks for your response and good luck with your pregnancy. Our best looking embryo was a Day 5 4or 5AA. Thanks to the embryoscope and a good embryologist, they saw it fertilised as 3pn and were already sceptical. Unlikely it would be euploid and it wasn't. If I were doing a fresh transfer and there was no embryoscope, that's the embryo a clinic would use. So, you may be right. I've spoken to 2-3 doctors so far and embryologist as well and they all say not to worry and euploidy is the main thing. Both consultants thought we need one more euploid for two children but the papers I read, I wasn't completely sure.

We've been working on improving egg and sperm quality throughout. I think this is the result of all that work as well. Do you have any specific suggestions for this? During the second cycle, the embryologist said the sperm was not fit for IVF and we needed Zymot I think it's because my partner was ill with low fever before second cycle. The sperm quality has improved in the third cycle so I wonder if that has an effect as well.

We discussed everything with the doctor yesterday and since I had a dominant follicle on Day 1, we decided long protocol was again required. However, she said since my FSH is low, oestrogen priming is not required and it may suppress too much. I think this may have happened in my second cycle. Two layers of down regulation - agonist and oestrogen priming was a bit too suppressive and may have affected the results. We will also try Meriofert instead of Gonal f and higher dose to start with. 5 weeks of hgh priming instead of 25 days last time. So, I'm hoping the next cycle will have at least the same, if not better result.

@Ikigai22 hi sorry to jump on and ask this but how did you know you over suppressed on prostap?

I had prostap on 01/05 and had the rarest of side effects which was terrible vaginal pain and discomfor with weird discharge.
And then I started my period week later and was on for longer. And now finally when I though it was all okay down there I tried having sex yesterday and omg it hurt. It was so uncomfortable and weird. I cant explain. My clinic said theyl review this on Monday but haven't said why I'm experiencing this

@Sherr33 based on my response during the IVF cycle after taking prostap vs buserelin, I could tell and the doctor also confirmed that prostap causes more suppression than Buserelin. Prostap is a higher dose all at once that shuts down everything for around 2 months, Buserelin is used in a drip like manner and out of the system within 24 hours. I use Mira and after using Prostap, I could see my hormones returned after a very long time. I had a 38 day cycle while I usually had 24-27 day cycle. I wish I'd never taken Prostap but can't undo the past but it works for others, so I guess I got unlucky that time.