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  1. #1
    Fer
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    Estrogen Priming Protocol (EPP)

    I figured I'd start a new thread that dealt specifically with the Estrogen Priming Protocol. It seems that the EPP holds a lot of promise for a lot of girls w/ High FSH and / or poor responders, so please feel free to post your success (or not so successful) stories here! I know that there are at least two or three others of us that are currently undergoing the EPP, so if you have a chance, please post here to let us know how your protocol is going. I just started my protocol (and will update this post as I go along), but here is how mine is being done:

    CD2
    B/W Only: FSH - 10.7 (YAY!); E2 - 52; P4 - .20; LH - 2.0; Lining - 8

    CD 11
    Ovulation likely occurred (According to CBEFM)

    CD 15
    B/W Only to confirm ovulation

    CD16
    Started 2mg Estradiol (Estrace) pills (1 tablet 2x/day)

    CD22/CD1
    Spotting / AF (Notice the shorter cycle during the Estrogen Priming Phase)

    CD3/SD1
    B/W Only: E2 - 187 (Supposed to be higher than a non-EPP cycle b/c of the Estrogen given in the Priming Phase)
    --Continue w/ Estradiol pills
    --450 iu Follistim PM
    --150 iu Menopur PM

    CD6/SD3
    B/W Only: E2 - 193 (Happy w/ gradual rise - Some ladies' E2 dips during the beginning of the EPP. I was pleased it rose just a little bit, then, since I fear that I will develop a lead folly that grows too quickly).

    --Continue w/ Estradiol pills and same dosages of Follistim and Menopur

    CD8/SD5
    E2 - 194
    U/S: R - 3 unmeasurable follicles; L - 2 unmeasurable follicles; Lining - Good (6?)

    --Continue w/ Estradiol pills and same dosages of Follistim and Menopur

    CD10/SD7
    E2 - 251
    U/S: R and L - few, unmeasurable follies; Lining - Thin

    --Continue w/ Estradiol pills and same dosages of Follistim and Menopur

    CD12/SD9
    E2 - 214
    U/S: R and L - few, unmeasurabel follies; Lining - 6.0

    --Stop all medications - CYCLE CANCELLED


    GENERAL PROTOCOL NOTES:

    1) My RE feels that the EPP is supposed to better help poor responders in that it is less suppressive than the pill and also does not promote dysfunctional cysts (which can happen on the birth control pill...which does tend to happen to me all of the time).

    2) I did not take Ganirelix during the estrogen priming phase like a lot of women who are on this protocol are supposed to do. My RE is not a fan of using the Ganirelix in the suppression phase b/c it seems like overkill. Cornell was doing a study on this comparing with and without Ganirelix, but he hasn't seen the results of this yet.


    3) While I was prescribed estrogen pills, my RE also prescribes the patch. He finds that the pill is easier and stated that the patch often gives skin reactions and falls off.


    Needless to say, I have total confidence in my RE and just love him to pieces for his responsiveness and genuine care for his patients!
    Last edited by Fer; 05-17-2011 at 02:22 PM.
    My Story

    Me (39) DH (35)
    High FSH - (31.4) and High TSH
    IVF # 1 - 9/09 - 1 Egg Retrieved / 1 Embryo Transferred - BFP!
    IVF # 2 - 11/10 - 1 Egg Retrieved / 1 Embryo Transferred - BFN
    IVF # 3 - 7/11 - 2 Eggs Retrieved / 1 Embryo Transferred - BFN
    IVF # 4 and 5 - 0 Eggs Retrieved
    DE IVF at RBA - 9/12 - 6/6 Eggs Fertilized / 1 Blast Transferred / 1 Frostie


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  3. #2
    prayingforpeace
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    Well, I've been MIA for a long time, but I'm in the home stretch of IVF3 (#2 w/SIRM and first EPP). My diagnosis was high FSH (between 11 and 16 for the past 2 years, lowest being 4 and 5, but with normal AFC of 14) My first SIRM cycle was not EPP, since my first, non-SIRM cycle resulted in 9 eggs retrieved, 100% fert and 4 blasts (transferred 3, froze 1). That first cycle ended in m/c at 8 weeks (twin blighted ovums). First SIRM cycle was the LA8 protocol w/out EP. I had problems with follies being all over the place size-wise, went into retrieval with 8 but retrieved only 5. 4/5 fertilized and 3/4 made it to blast on day 5. We transferred 2 Grade 1A blasts and froze the third (also a grade 1A). I did get pg but it was a freak ectopic (no preexisting tubal factor) detected at almost 8 weeks**with betas over 10,000. It was rupturing (and had fetal cardiac activity of 130 bpm) *so I had to have emergency surgery to remove it and my right tube. Even after surgery, I remained clinically pg from late July until the first week of Oct and finally got beta below 5 as they were about to*treat with methotrexate.*
    I had a total thyroidectomy in Dec to treat my medication non-responsive Graves disease. After 3 months of getting my Synthroid dose adjusted and my TSH under 2 (it's at .77 now) I was cleared to start my second SIRM cycle. This time was the LA10 with estrogen priming. I was on BCPs the month prior (actually, for 4 months while waiting to get my TSH down). I started Lupron Apr 1 (10 units/day for 5 days), .5 dexamethasone (for the entire cycle). Stopped BCPs on Apr 5 and decreased Lupron from 10 to 5 units for two more days. On Apr 8, I began 1/2 dose daily of Ganirelix (continued daily up to and including day of trigger). I did 2 Delestrogen IM injections the week prior to starting stims, started Lovenox for a clotting disorder just prior to estrogen IM shots,*which I will be on for the duration) and added an estrogen (2 mg) vaginal suppository the night before stims and continued it until day 8 of stims. Stims included 600 iu Follistim/day for 6 days, with 75 iu Luveris every other day. Days 7-9 of stims was 375 iu Follistim, with 75 iu Luveris days 7-8 and 150 iu Luveris on day 9. This time, all 8 follies were almost exactly the same size at each of three u/s checks. Triggered on cd *10 with 10,000 units HcG. Retrieval this past Sat-lost the smallest (18 mm) and largest (26 mm) follies, but the other 5 were easily retrieved, all mature, and this time all 5 fertilized. We're aiming for another day 5 blast transfer this Thurs. I was disappointed we still only retrieved 5, but the RE said EPP not only improves response in low responders but also improves overall embryo quality. We get the status report tomorrow afternoon and hopefully will have 2 high grade blasts by Thurs.*

    Hope this helps and good luck!
    Me (35), DH (40-perfect)
    Dx-high FSH (4-16/normal AFC), Graves, MTHFR, +nka
    Natural BFP 05 (mc 11 wks)/06 (m/c 8 wks)
    IVF 1-5dt 3 blasts-BFP w/twins! Blighted ovums 7 wks
    IVF 2-5dt 2 expanded blasts-BFP! HB but ectopic-Surgery-lost tube
    Total thyroidectomy
    IVF 3-EPP, 6dt, 2 Grade I expanded blasts. Froze 1, Grade II. BFN (1.4). FET Aug-tx 2, d6 BFN/2 still frzn. Last fresh cycle Nov-Dec 11


  4. #3
    KNotNelson
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    Hello,

    Like Fer, I am also just starting the EPP Protocol. I have been dx with High FSH/DOR and I have hypothyroidism. The hypothyroidism is under control using Synthroid. This will be my 3rd IVF attempt. The last two were converted to IUI's due to poor response. I tried the MDL protocol and antagonist. Both resulted in BFN's. Here is my EPP protocol so far. I am still waiting for AF, so I just need to change the estrogen patches every other day until AF arrives.

    CD11 - LH Surge detected using OPK
    CD20 - Start Estrogen Patches (.1mg Estrogen)
    CD21 - 1 shot ganirelix AM, Estrogen patch
    CD22 - 1 shot ganirelix AM, change patch
    CD23 - 1 shot ganirelix AM, patch
    CD24 - change patch
    Call when AF arrives
    CD2 - B/W and U/S. If all clear, start stims PM
    Me 34 DH 35
    TTC#1 since 2009
    Dx: High FSH /DOR
    Hypothyroidism
    IUI#1 &2 - 2008 = BFN (With Ex-DH)
    IVF#1 - 8/10 -->IUI - BFN
    IVF#2 - 9/10 -->IUI - BFN
    IVF#3 - 4/11 --> CX due to cysts; got DE speach.
    12/3/11 - Start EPP IUI --> CX FSH too high
    3 months of BCP --> FSH still too high, decide to stop IF treatment forever.
    My Blog
    http://dragonblossominfertility.blogspot.com/


  5. #4
    Fer
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    Thanks, Ladies! I hope this thread keeps going strong so we have a good place to go for a wealth of information! So far, all three of us also have thyroid issues...interesting...

    And KNot - I hope you get your AF soon! Did you call them to find out if you need to start Provera?
    My Story

    Me (39) DH (35)
    High FSH - (31.4) and High TSH
    IVF # 1 - 9/09 - 1 Egg Retrieved / 1 Embryo Transferred - BFP!
    IVF # 2 - 11/10 - 1 Egg Retrieved / 1 Embryo Transferred - BFN
    IVF # 3 - 7/11 - 2 Eggs Retrieved / 1 Embryo Transferred - BFN
    IVF # 4 and 5 - 0 Eggs Retrieved
    DE IVF at RBA - 9/12 - 6/6 Eggs Fertilized / 1 Blast Transferred / 1 Frostie


  6. #5
    prayingforpeace
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    It took years before I was diagnosed with Graves (overactive thyroid), and I wasted 2 years on PTU that never got my TSH higher than .2, stillnhad to be on beta blockers to control cardiac symptoms, and the drug was liver toxic. After the ectopic, my TSH dropped below .01 and I knew I had to do something definitive. Since I'm deathly allergic to iodine, radioactive iodine treatment was not an option. So I told the RE in Oct that my regular endocrinologist recommended surgery. RE was not on board, saying that it's a dangerous, bloody surgery and my TSH was ok for future IVF cycles as is. I explained that I could no longer live in that condition (I struggled to maintain the minimum weight for each cycle, too) so I decided to have the surgery. It was inpatient but not too bad. I have felt better the past 4 months than I have in years. Fast forward to SIRM pre-cycle consult and now RE claims "we" made the right decision to have the surgery and it would likely help us achieve IVF success. Oh the arrogance!
    Me (35), DH (40-perfect)
    Dx-high FSH (4-16/normal AFC), Graves, MTHFR, +nka
    Natural BFP 05 (mc 11 wks)/06 (m/c 8 wks)
    IVF 1-5dt 3 blasts-BFP w/twins! Blighted ovums 7 wks
    IVF 2-5dt 2 expanded blasts-BFP! HB but ectopic-Surgery-lost tube
    Total thyroidectomy
    IVF 3-EPP, 6dt, 2 Grade I expanded blasts. Froze 1, Grade II. BFN (1.4). FET Aug-tx 2, d6 BFN/2 still frzn. Last fresh cycle Nov-Dec 11


  7. #6
    Amber209
    is currently pregnant
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    praying - I am shocked and angry that your RE would call thyroid removal dangerous and bloody. I had mine removed about a year ago and while it is not trivial, its not quite "dangerous and bloody", in fact when I met with my surgeon he said the amount of blood lost was very minimal (I was concerned as I bruise easily and my mom has some clotting issues). Glad you are feeling better and that your RE did not scare you away from the surgery.
    Me 38 DH 43
    FSH 11 and Stage 3 endometriosis (lap removed Jan '11)
    TTC 5 years
    6/07 natural BFP m/c @ 9wks
    IUIs 1-3 (Jul-Sep '08) BFNs
    IVFs #1-4 11/08 - 6/09 2-13 eggs, 0-3 embryos, all BFN egg quality issues
    12/09 - thyroid cancer removed 3/10
    Apr '11 Natural BFP betas 14, 18, 27 Chemical preg
    IVF #5 Aug '11 one 12 cell embryo on day 3 - BFP!


  8. #7
    Fer
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    Praying - Just wanted to say that I hope you get a good report today! Let us know how it goes!


  9. #8
    prayingforpeace
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    Amber-I totally agree that RE was only concerned with getting me in cycle again (I'm in a 3 cycle plan with SIRM). And he was trying to prep me to cycle again while my beta was still around 10! The surgeon who did my total thyroidectomy was also concerned about blood loss since a Graves thyroid is "hyper-vascularized" and I also couldn't take the potassium/iodine solution for the weeks pre-op due to iodine allergy. But my surgeon was fantastic, said he could manage blood loss (I donated my own blood pre-op for use in operative transfusion). While there was significant blood loss, I just put back in my own blood and did great post-op. I knew what the RE's motives were in advising against surgery but since I'm just a uterus and ovaries to him, I decided to listen to the doctors who viewed me as a whole patient and not a baby factory. Best decision I've ever medically made. I do require a fairly high dose of Synthroid (200/day), my TSH is good and holding. But it did crack me up when RE claimed the thyroidectomy decision as his own, saying it should help. Sometimes all you can do is laugh at their arrogance.

    Fer-thanks for thinking of me today as we wait on the embryo growth update. I've only done day 5 transfers, and yet it still scares me taking the risk of having nothing by day 5. I just keep reminding myself that we just need 2/5 to make it to Grade I or II blast by Thurs, and even if we only had 1, we'd thaw one or both frozen ones and do a day 6 transfer. It all sounds very logical as I read/type it, but of course the nerves are still there. I don't expect to hear anything until late afternoon, but I'll keep you posted.

    For what it's worth, the EPP cycle has been the easiest on my body of all 3 cycles. I'm not doing PIO this time since I developed cysts/infection from it last time, so perhaps this post-retrieval period is easier without the dreaded nightly IM shot. I'm using P4 vaginal capsules 3x/day. I hope you both find the protocol to be easier on your bodies and produce great results!
    Me (35), DH (40-perfect)
    Dx-high FSH (4-16/normal AFC), Graves, MTHFR, +nka
    Natural BFP 05 (mc 11 wks)/06 (m/c 8 wks)
    IVF 1-5dt 3 blasts-BFP w/twins! Blighted ovums 7 wks
    IVF 2-5dt 2 expanded blasts-BFP! HB but ectopic-Surgery-lost tube
    Total thyroidectomy
    IVF 3-EPP, 6dt, 2 Grade I expanded blasts. Froze 1, Grade II. BFN (1.4). FET Aug-tx 2, d6 BFN/2 still frzn. Last fresh cycle Nov-Dec 11


  10. #9
    prayingforpeace
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    Well, I already got the call (5 hours shy of the 72 hours of growth point) post-fertilization, and we have 4, 8 cells (Grade I) and a 6 cell (Grade II). He thinks the 6 cell could reach 7-8 cells by late afternoon. So we're pushing out to transfer Thurs. He thinks we should have 2-3 blasts. He's always advocated against transferring more than 2, but for some reason said he'd consider transferring 3. I assume it will be based on whether they are grade I or II blasts. If we have 2 grade Is, we'll probably just transfer 2. If everything was grade II, then I'd go for all 3. I'll have to talk it over with hubby tonight.
    Me (35), DH (40-perfect)
    Dx-high FSH (4-16/normal AFC), Graves, MTHFR, +nka
    Natural BFP 05 (mc 11 wks)/06 (m/c 8 wks)
    IVF 1-5dt 3 blasts-BFP w/twins! Blighted ovums 7 wks
    IVF 2-5dt 2 expanded blasts-BFP! HB but ectopic-Surgery-lost tube
    Total thyroidectomy
    IVF 3-EPP, 6dt, 2 Grade I expanded blasts. Froze 1, Grade II. BFN (1.4). FET Aug-tx 2, d6 BFN/2 still frzn. Last fresh cycle Nov-Dec 11


  11. #10
    Fer
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    Praying - So all five are growing and thriving and doing well - that's terrific! I'd have a tough time deciding how man to transfer. I guess in a way only having one egg retrieved is a good thing b/c I don't have to think about how many embies to transfer.


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