Switching to a long protocol for my next ivf cycle

[Pep1952]

Hi everyone

Sadly my first ICSI cycle didn’t work :(

We collected 5 eggs (AFC 7) which were all mature but only 2 fertilised and 1 made it to a day 6 average quality blast. BFN.

Anyway, we did ICSI because we found out on the day before my egg collection that DH has dna frag of 32%, his SA was always fine. Incidentally he has bilateral varicoceles (diagnosed in 2019, he was told no intervention needed) which causes him pain / dull ache so he’s booked for a repeat ultrasound and will also see a urologist (Mr Tet Yap). Mr Ramsay is fully booked for the next two months.

The fertility dr is suggesting we try a long protocol next time we do a cycle. I wonder if anyone had a better experience with long protocol after trying a short one? I’m a bit concerned about oversuppression and I thought 5 mature eggs from 7 follicles in the first round was a good response but dr thought it’s worth trying a long protocol to see if we can get more eggs to mature.

Thoughts?

Hi @Pep1952
I'm in a similar position. I had a good response to the first ICSI cycle (8 eggs, 7 mature, 5 fertilised and 3 blastocysts but sadly none tested normal). My AFC was 10 one month, 12 another.

On cycle 2 now with a long protocol. I'm also a bit nervous in case I don't respond as well but we'll see. I'm thinking surely doctors know what they're doing 🙂

When are you due to start cycle 2?

Hi @bubu24 did you not try a fresh transfer? Sorry none of your blasts tested normal and wishing you the best of luck with the long protocol. How long was your break following your first cycle? Are you unexplained infertility? Hopefully the switch in protocol will do the trick. All fingers crossed for you.

My DH just had symptomatic covid and since we are waiting to see a urologist, fertility dr suggests we try naturally until at least Jan/Feb to give his sperm time to recover and also by thenwe have more info from the urologist and know what the plan is.

Dh reminds me the same thing, doctors know what they’re doing and that he wouldn’t suggest something that will knowingly set us back. Sometimes I think maybe I should stop reading stuff online because I just end up confused/drained each time!

Hi - ask your doctor about duo stim.

My first was long protocol, I found it very physically and emotionally tedious and was at risk of OHSS. My next 3 were short protocol and final one a duo stim (abroad). I wish I did duo sooner.

It's about the same amount of meds as a long protocol but you release the eggs/fluid in between the cycle, so I didn't feel as bloated/miserable. The second phase aims to stimulate your slower follicles.

I normally get 2 embryos per cycle and got 4 in my duostim round.

All the best.

I know what you mean about reading stuff online. You can learn a lot but who knows what's true 😀

We didn't do a fresh transfer as we wanted to do pgt-a testing on all embryos. We have one that tested high level mosaic and we could technically transfer but decided against that for now.

I had the first cycle in September. Started downregulation the following month so no break really.

My partner has extremely low sperm count, so we were told ICSI is the only option for us. I also have endometriosis and AMH almost halved in the space of a year (I'm turning 40) so overall our changes are lower than normal but we remain hopeful ☺️

How do you feel about delaying the next cycle into Jan/Feb?

Who knows you might get lucky trying naturally... I hope you do! 🙂

Thanks @MsPeony pleased that you got great results with duo stim.

@bubu24 i was actually referred back in June to the endometriosis clinic (Gp kindly referred me as I always spot before my period) at the NHS and have my appointment next month!

I’m a bit nervous about waiting until next year but hopefully the urologist could guide us in terms of what the next steps are / when to try for another cycle etc. I’ll probably get my amh rechecked too. If it drops we might need to change tac.

Please let me know how you get on. I’m rooting for you!! X

Thanks @Pep1952
I'll let you know. Hopefully I'll have positive feedback for the long protocol.

I was actually scheduled to have a laparoscopy earlier in the year as the consultant said it might help increase my chances of falling pregnant naturally. But first she wanted my partner to do a semen analysis test and that's when we discovered his low sperm count and cancelled my laparoscopy. For me because I have it on my ovaries, removing it would have likely decreased my egg count/quality.

I hope all goes well at your appointment. It's good that both you and your partner are doing further investigations before proceeding with the 2nd cycle.

I switched from short to long protocol and had mixed results.

My first cycle - short protocol - I got 3 eggs, 1 made it to blast and was transfered but BFN.

Second cycle switched to long protocol to try get more eggs. But I only got 1 egg, so actually had even worse results! But, that one egg made it to blast, was transferred and got a BFP, am now 27 weeks pregnant. So in the end it was the cycle that worked for me.

The thing to remember is there’s no one approach that will always produce better results for every women. If there was then that’s what everyone would always use! But we all respond differently, and each month will vary so my attitude was that it was worth trying something new when my first round wasn’t great.

And incidentally, on covid - me and my partner both got covid during the stims stage of the successful second cycle, and we decided to continue with treatment.

@AnnieStar12 thanks v much for sharing and congrats on your pregnancy! What a roller coaster of emotions it must have been only getting one egg but that one made it all the way!! Assume you’re low AMH too? I feel like we must have crossed paths in a different thread as your name is familiar. Xx

@bubu24 thank you, tbh there are moments when I just want to do another cycle asap. I’m 36y/o amh 3.5 last time it was checked in June so we have no time to hang around but knowing that DH has symptomatic varicoceles and his DNA frag isn’t great we feel at least we should speak to a urologist and see what he thinks. Still a bit nervy about the long protocol but like you will trust the professionals - they are the experts!

Thank you, yes it was an intense emotional and mental rollercoaster!! But also made me realise how random (in)fertility is and how anything really can happen.
Yes, I had low AMH which seemed to decline really fast. First tested in August 2023 was 4.8, tested again March 2024 was 1.7 and my AFC seemed to align with this decline.

Hello all! It’s breaking my heart to read what you’re going through ❤️ The positive story from @AnnieStar12 was truly amazing and it gave me hope. Huge congratulations!

My husband and I are planning to do our first round of ICSI in January after 3 failed letrozole & trigger shot rounds. I have low AMH and he has low morphology. I was told that I’ll be put on a long protocol so I’ll be reading this thread although I can’t contribute. Sending you my best thoughts! Xx

Good luck @BreakfastOats please let us know how you get on! Do you know what’s causing the low morphology?

Thank you! @Pep1952

No, we don’t know and neither his GP nor my private consultant is interested in that tbh.

We’re now waiting for the results of his second SA, which he did on the NHS. His count and motility were really good on the first one so we’re hoping they will remain like that 😅

He doesn’t smoke, he’s fit and healthy. He used to binge drink once a month but he stopped 4 months ago after the results of his first SA just in case. All his friends that he used to meet once a month have children and a couple are due their babies soon 🤷🏻‍♀️

All fingers crossed for you @BreakfastOats! Sounds like he’s done everything he can to improve his sperm quality so hopefully the repeat SA is good and you’re all set for your upcoming cycle.

Hello! Hope you had a good day Xx

We got the results of SA number 2 today!
SA1 vs SA2 below

PH went from 8 to 7.5
Volume from 4.7ml to 7.5ml
Count from 103m to 270m
Concentration from 22m to 36m
Motility from 57% to 60%
Morphology from 1% to 2%

We were hoping that morphology would have improved more, wondering whether this is down to genetics!

@BreakfastOats it looks like an overall improvement though so the changes he made are helping. What did your doctor say?

@Pep1952 Yes definitely, we have a better sample for ICSI now!

Nothing much from the doctor! Most of the sperm is headless and we’d love to understand why but this falls outside the GP’s expertise, and where we live the waiting times for specialists are really long. I was referred to the fertility clinic 4 months ago but the waiting time for an appointment is 12 months😅 My husband thinks that trying to get to the bottom of this, even privately, might just end up delaying us.

Do you know when is your second ICSI round ? We wanted to do our first in December but we can’t because of the Christmas closure at the clinic.

@BreakfastOats Wow 12 months?! Will you get the ICSI done privately then?
We’re also w a private clinic because we didn’t qualify for nhs funding due to my AMH. We would have qualified if we didn’t move houses last year as our old area has much less strict rules!
Technically we can do our second cycle now but our fertility dr suggested we speak to a urologist first re DH’s varicoceles although he is of the opinion we shouldn’t delay the cycle significantly (eg by 6 months) to sort them out.

I hope things are going well @bubu24 xx

Hi @Pep1952 so far it's been okay. Although I naively thought that I got used to injections and they are painless now but that was only the Buserelin.. now that I started stims it's definitely starting to hurt again. But I am on a high dose of medication so maybe that has something to do it with it.
I had my first scan today (day 6 of stims) and I think I counted 8 follicles and a few more <6 ones which might not grow (that's what happened last time anyway). So far it doesn't appear long protocol is making any difference but there is still time. I'm happy that at least I don't have less follicles...

How are you getting on? When is your partner seeing the urologist? Is it this month?

@Pep1952 Yes, we’ll have to pay for it privately so hope it won’t take too many rounds because we’ll go bankrupt 😅

It’s quite unlucky that your area has stricter rules. I don’t know the criteria in my area (my AMH is 0.7 at 35) but even if we were seen by the fertility clinic soon, as far as I’m aware they usually offer IVF after 2 years of trying. We’re just not willing to wait that long given our circumstances.

I really hope the urologist helps with the varicoceles x

Sorry to hear the stims are causing you pain @bubu24 How long will you be on them? The follicle growth sounds really promising! 🍀

Hi @Pep1952 and @BreakfastOats . Thought I'd give you an update. Had my egg collection yesterday and they retrieved 17 eggs, 14 were mature and 10 fertilised.
Compare that to 8 eggs retrieved, 7 mature and 5 fertilised in my first round with a short protocol..
Hope the blastulation rate stays the same and we get double the number of embryos too and hopefully some euploids this time round!
I'll keep you posted but just wanted to put your mind at ease - in my case anyway, long protocol definitely yielded much better results.
I did stims for 12 days though and was in pain after egg collection (still have slight discomfort today) whereas last cycle I had no pain at all. But I'll gladly take the pain to have double the number of eggs :)

That’s amazing @bubu24 🤗 I’m really happy for you! I hope you get positive news about the rate 🤞 Thanks so much for sharing, I am speaking with my consultant on Saturday about our first round in early January and I feel much better about it!

@bubu24 thanks for the update, I actually thought about you today! Fantastic results, i’m so pleased for you! Can i ask what your latest AMH was please? Fingers crossed this is it for you. Are you doing genetic testing again? Good luck xxx

We’re seeing a private urologist on Monday to investigate my husband’s dna fragmentation (32%) and varicocele. We’re hoping we can have a plan and schedule our next cycle. Your results are really encouraging!

Thank you @BreakfastOats. Hope the consultation goes well this Saturday.

@Pep1952 thank you! My AMH was 7.2 earlier this year (Feb I think).. My AFC was 10 when I first had it done which they said was in line with my AMH.
It could be that the long down-regulation helped my endometriosis and reduced the cysts and maybe that helped. Really not sure. I was shocked to get so many follicles this time round and then even more so to say they retrieved 17 eggs. I even asked the consultant "17 eggs, or 17 follicles"? 😅
Yes, we will be doing genetic testing again. Really hoping we get some euploid this time. We said we would only do 2 cycles at the start so this is it for us.

Hope the urologist will be able to give you some tangible solutions. Keep us posted.