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  1. #1
    SmilingHelps
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    Question Low Responder Protocols & IVF??

    Hi Everyone

    I actually have posted this question on another thread, but a friend has told me to come and join this one. Hopefully someone can help
    For starters, I am 25 years old. My husband is 37 years old. We have been married for 5 years and we have a wonderful relationship (he really is a Prince Charming). We have been trying to have children for almost one year now (in August) and have been seeing a RE specialist for 7 months. We have had two failed IUI cycles and many cancelled cycles (due to no response or poor response). My husband has a fanastically high sperm count, but I am the troublemaker I have a bleeding disorder (although they have said this doesn't affect infertility) and also, I am a poor responder to all of the meds. My last cycle, I was on 40 micro-dose Lupron and 1,000 Follistim daily. That resulted in 2 mature follicles (6 total follicles). My doctor has said that IVF is probably not even an option and he is really really pushing for an Egg Donor. I am still uncomfortable using an egg donor (I just don't have enough experience to understand it), and honestly i would like to try IVF.
    I have an appointment with my Doc on Monday and then my husband and I will have to make a very important decision: Tell doc OK for using an egg donor or beg him to let me do IVF.

    If you are a poor responder/low responder (or if you even KNOW a poor responder), PLEASE tell me your protocols and if it was successful ("successful" meaning that you had enough eggs to try IVF). I am desperate for knowledge and I need it all by Monday. I don't want to feel pushed into deciding on an egg donor if there are other options that I don't even know exist.

    Any help you can give will be GREATLY appreciated
    Everyone Take Care,
    Jen.


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  3. #2
    50/50
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    I have a friend who was on gonal F and repronex...not sure what the protocol name was? Anyhow, she only had 2 eggs at r/t and is almost ready to deliver her miracle baby. Also, only one embryo made it to 3 day and she still got preg!

    Don't give up yet. You might want to get a 2nd opinion, especially if your RE is pushing DE and you are uncomfortable with it.

    Good luck to you!


  4. #3
    Twins_Squared
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    Loss ment./babies ment.

    Jen,

    First, I'm sorry you are facing this battle with IF...it is a tough road to travel!

    Second, I am wondering what your CD3 (cycle day 3) FSH and E2 levels are? Do they indicate that you may have low ovarian reserve? And, have you tried the CCT yet (clomid challenge test)?

    I am a poor responder with elevated FSH (its 11) and, though my Dh's sperm analysis looks great on paper, he has some fragmentation issues that turned up in the SCSA at 35%.

    That said, on IVF #1 (I used a regular, long lupron protocol w/Follistim and Repronex). I had 13 follicles, 7 mature eggs retrieved but ZERO eggs fertilized naturally. We did rescue ICSI and 5 fertilized but were of very mediocre quality and that cycle was a bust.

    IVF #2 we did the poor responders protocol (lupron flare, and I took ~4 Gonal F and 2 Repronex each day as well as Dexamethasone, Medrol and Tetracycline (at prescribed times). That cycle produced 8-9 follicles and only 4 mature eggs retrieved. All 4 eggs fertilized w/ICSI but one embryo arrested by day 3's transfer, though we did put all 4 back and also used assisted hatching and the embryo glue which my clinic developed. That resulted in a twin pg, but I had negligent OB care and went into preterm labor and lost my twins to neonatal death.

    IVF #3 did the same protocol as #2 but had an even worse response. Again 8-9 follicles but only 3 mature eggs retrieved. All 3 eggs were fertilized w/ICSI but by day 3 one embryo had arrested again. We transferred all 3 and I now have living twins who are 21mos old!

    My RE feels that beyond 6 vials of total stim meds per day do not have any addt'l benefit to the patient (I know other RE's disagree w/this) and that Follistim is not the best stim med for poor responders. You also didn't mention if your RE used assisted hatching on your embryos and/or the embryo glue? Many other poor/low responders have success using an antagon protocol, though I am not versed in that particular method.

    I would also second the idea of a second opinion before making any serious decisions.


  5. #4
    SmilingHelps
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    Smile


    50/50- Thank you for your response. my husband has a saying, "it only takes one egg and one sperm so never give up". I always found it a little cheesy, but your friend has proven that maybe it is possible

    Julie- Thank you so much for your response. Your successful IVF has been an encouragement to me - maybe there is light at the end of the tunnel

    I didn't mention my FSH or E2 Levels because I don't know them. My doctor takes all kinds of tests and only gives us the result if there is something unusual about it. I have asked him if anything has come out irregular to indicate that I am a poor responder and he said no, but that I am obviously a poor responder because I have no response to the meds. I also don't know about the clomid challenge or ovarian reserve tests. He has taken a lot of blood and done a lot of tests, but in particular, I don't know what they are called. He said, medically, there is no explanation as to why I am a poor responder.
    I don't understand what you are referring to when you talk about "assisted hatching and/or embryo glue". I am so in the dark. We had follistim injectables and the lupron micro-dose then we had insemination. While on the table, I asked if there was anything else we could do to see if I would ovulate and they said that I definately will ovulate because of the size of my follies and the HCG shot.
    It's so confusing to me because I have the best RE in the entire state. He has the highest success rate and people are flooding to him from not only all around our state, but other states as well. ...yet I'm totally in the dark about what is happening. I wonder if the problem is that I am not educated enough in this or if he isn't explaining enough??
    Now the doc has labelled me a "low responder" and is pushing using a donor egg. I have asked the nursing staff (two ladies that I feel close enough to probe with my questions) and they said, "oh yeah. if i were in your situation, i would do that."
    I'm SO frustrated. WHY aren't they giving me any answers? why not any OTHER options? My husband has mentioned to me about using an RE in Chicago. It is 3 hours away and I would have to stay in a hotel for the duration of my cycles each month, but hubby wants this so badly that money is no obstacle.
    I don't want to go to chicago. I just want my RE who is the best of the state to freaking answer my questions and give me OTHER options that AREN'T "well, you are a hopeless cause, so use a donor egg". I'm 25 years old, why would i need a donor egg SO soon?

    ok. I'm so upset about this, so I apologize for dumping on you. Thank you so much for your response. I see my RE on Monday and I have a long list of things to discuss with him. I am going to find out my FSH and whether or not he did the "clomid challenge" to check my ovarian reserve. We have to make a decision as to what to do by Monday and I am more in the dark now than I ever was. I just don't get it.

    Congrats on the twins! I'm so happy for you! I have wanted twins for so long. You have been very very blessed I know that you worked hard for them and you deserve every piece of happiness that you have recieved!

    Take Care,
    Jen


  6. #5
    Twins_Squared
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    Jen,

    I wanted to mention/add a few things:

    First, no need to apologize...you didn't dump at all and even if you needed to, everyone here understands!

    Second, you have the right to know the test results of all the tests you are put through at your RE's office and I would start by inquiring about the results I mentioned (day 3 FSH and E2)...those two things will be the most telling. An FSH of 10 or higher is an indicator of diminished ovarian reserve. An E2 reading of 70 or higher indicates that the estrogen is working overtime and is artificially lowering the FSH levels, meaning a high E2 could mean an even higher FSH number in reality.

    I don't mean to put down your RE, but it sounds like he needs to back up his stats with some good bedside manner. Many RE's will be quick to push donor eggs or other options because they don't want their success rates lowered. A good RE will suggest these things after carefully reviewing your case (typically involving more than two failed IVFs) and explaining everything to you in a thorough manner. Just make sure you aren't being rushed to a decision for the wrong reason.

    Lastly, at the time of all three of my IVF cycles, I lived in San Francisco, CA and travelled to Denver, Colorado. Though there were RE's in my home town, we elected to see the RE that we did and took on the additional burden/costs of travel. Though it added some extra elements to the package, we are hugely glad we did this. The RE that we had been seeing in SF had a very different approach, ran his office in an unprofessional manner and left us feeling more stressed. I share this because I wouldn't be so quick to rule out travelling for an IVF cycle. BTW, this RE I saw in Denver sees 40% of its patients from out of state or country.


  7. #6
    penny427
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    Hi! Can someone please tell me what embryo glue is?? I ahve borderline high fsh and we have MF. We will be doing IVF/ICSI at the end of August and if embryo glue would help then I sure want it...thanks..Penny


  8. #7
    marya
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    I would seriously consider getting a second opinion from another RE. Get all of your test results and take them to another practice.

    I'm not sure how to do all the conversions -- they used to measure dosages differently when I was on IVF, but it sounds like you might be on a lot of lupron, which could be oversupressing you. I started on 20 units (.2 cc) with my first cycle and then a drop to 10 units (.1 cc) and didn't get a great response. My next cycle I was on 10 units during the supression phase and 5 units during the stim phase. I also switched from straight gonal f (a FSH only drug) to a combo of gonal f and repronex (which has both FSH and LH). I got a much better response on the second round.

    Frankly I would not put much faith in an RE who wants a 25 year old woman to look into donor eggs based solely on a poor response to one IVF cycle. Donor egg recommendation at that age should be a result of an actual dx of premature ovarian failure which would through red flags on a lot more of your tests (the ones Jillie already mentioned). I would really try a different RE.

    Good luck.
    marya
    DX: Severe MF
    My avatar is the Sanskrit symbol "ohm" It has many interpretations, among my favorites is "the realization of the divinity within all man (or within oneself)."


  9. #8
    Cathin1
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    You might benefit from something like a lupron stop protocol. Sometimes a higher dose of lupron is better, because the initial surge of fsh on lupron helps recruit follies. Or switching to repronex and follistim or gonal-f. There are too many options. I agree, a 25 yo that hasn't been dx with pof should not be recommended to d/e. You really should find yourself a better clinic. I would imagine that some RE's have cookie cutter protocols, and don't want to deal with the challenging cases. Also know that just because you are resistance to stims, doesn't necessarily mean there's a problem with your ovaries. Some woman just don't do well with stims, and have a better chance conceiving naturally. Since your husband has a great sperm count, you may have a higher success with an unmedicated IUI too. Good luck and don't give up!


  10. #9
    Lauren2005
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    Yes, I agree... BYE-BYE to the "best" RE in the state. Objectively, this is not the BEST. Please realize this:

    * The reason you gave for him being the "best" is his excellent success rates.

    * People who don't TRY any IVF aren't part of those statistics.

    * Therefore, he may be deliberately affecting (inflating!) his "success" statistics by rejecting women that other RE's would accept. In other words, if the woman's case is even a BIT more challenging than normal, he says no.

    * In your case, the eggs possible seem a bit more challenging (although I agree with earlier posts, this is a rediculous way to judge that). So he immediatly says "Go with donor eggs" and rules out IVF for yours.

    * This increases HIS odds for "success" statistics, thus perpetuating his reputation as being the "best" in the state.

    RUN, don't walk, to another RE.

    And, this gives you a chance to support DH. They're so helpless in this whole process, it's amazing what a boost it is to them when we're able to say "Hon, you're right. Let's do what you've suggested!"

    Anyway, good luck to you!!!!!! Baby dust sprinkling all over you.

    Lauren


  11. #10
    Cathin1
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    I just read your 2nd post, sorry I didn't see it. Something sounds very funny to me that he has ppl coming in out of state. Usually couples resort to out of state for 2 reasons. Either their fees are cheap, or they're difficult cases that need a clinic that deals with difficult cases. Or like Lauren2005 says, he's got great success rates, but obviously we all know now why - because they've got strict criteria, and boot out anyone but the easy cases for IVF.
    Last edited by Cathin1; 07-09-2005 at 02:15 PM.


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