Poor responder protocol

[ivyandriollo]

Hi all,

I'm a poor responder to IVF. Didn't do well on daily 450 units of Gonal-f stimulation. I'm wondering if anyone has similar poor responder experiences. If yes, would you mind sharing any protocols that you know of, whether it works or doesn't work. Thank you very much.

Ivy

[justonceplease2]

Hi Ivy,

I don't normally post here but I saw your post and had to reply. I am a poor responder too. Produced 5 follicles on high dosage of Follistim. Four were mature enough to ICSI and two fertilized. The cycle did not work.

I am very discouraged as well. I had a phone consult with SIRM and may decide to have a cycle there later this year.

I hope some of the other ladies are able to answer your question about succesful protocols for poor response. I would be very interested in their answers.

Good Luck!
Erin

[magpiesvn]

hi Ivy!!

I am a poor responder too! This is my 3rd IVF. All three times I have only produced 2 or 3 eggs. This last time they changed a couple of things, they gave me an insulin test, and found out I was insuling resistant so put me on Metformin...and also put me on what they call a short protocol, meaning I didnt start using the nasal spray until AF arrived (CD#1). I still only produced 2 eggs this time around, BUT after ER, the RE DID say that they were good eggs and they DID fertilize. He was pleased this time and said that it was the Met that did the trick.
I am sorry you are a poor responder, dont get discouraged when you read about all the eggs that everyone else produces, remember its quality not quantity. Sometimes the 1st IVF is just the practice round unfortunatley, some get lucky, some of us dont'. hang in there, there is a protocol out there just PERFECT for you! Ok.....sweetie...
take care

Dawn

[agnes2712]

Hi again Ivy,
Just thought I would post again about SIRM. Just in case you havent read my other post yet (I cycled with Dr. Fisch at SIRM in Las Vegas a few months ago).

I am definitely a poor responder. My 1st attempt at IVF with my RE here in TX was cancelled after 5 days of stims due to no response. So....I had a consult & switched to SIRM. First of all, they dont give up quite so easily. I was on much higher stims (750 Gonal F) and they used what they call "estrogen priming" protocol. They will explain it if you have a phone consult. When I asked Dr. Fisch about the possibility of cancelling again, he said we would not cancel and we didnt. Needless to say, I only had 2 eggs but they both fertilized and I ended up with a chemical pg.

Remember you only need one though! Good luck!!

Hugs,

Tammy

[Miriam]

Ivy - My first 3 IVF's I responded very well. 11,15 and 11 eggs. This last cycle I only had 5 follies so we cancelled my cycle. I'm going to be starting my stims again at the end of the month and they only made a small change to my protocol. I'll be on 450 daily of follistim and 30 units of Low Dose HCG. Last cycle I was only doing 15 units of the LDHCG. Hopefully this slight change for me will make the difference.
Are they going to change your protocol?

Miriam

[AmyLeigh]

I am a poor/low responder.... have been through quite a few protocols to get a better response out of me.

I think the BEST protocol I have been on that gave me the most (10 follies) with the best embies (6) was the: NO BCPs, ESTROGEN PRIMING, MICRO-FLARE LUPRON, HIGH DOSE OF GONAL-F 750iu, MINIMAL DOSE FOR 2 DAYS OF REPRONEX 75iu.

I have heard for low/poor responders and IMO ... the HIGHER the dose of FSH stims (Gonal-F) and only use the LH stims (Pergonal/Repronex) for the 1st day or two of stimming.

It is all by chance.... constant tweaking and changing until you get the correct cycle/protocol that gives you the BEST.

Best of luck to you !!!!!!

[chelby]

I had my first failed IVF attempt and I didn't respond well as well.
Only had 5 follies/eggs and 3 fertilized. I don't know why my RE never considered cancelling (I didn't know what was normal then).

I started with 300u follistim on CD 3 and up'd it to 325 (since my E2 wasn't hight enough on CD 5) and started adding Repronex on CD 9-ish. I didn't do any BCP? or Lupron? a month before.

Our DX is male factor and I'm 36 but I think I needed a higher dosage. I don't know if it's normal to start off this low...??

[ivyandriollo]

Thank you veryone, for sharing your experiences and information. And also thank you for all the encouragement!

for my last IVF, I was on BCP for 5 weeks! Then started stim with 450 units of gonal-f with low dose Hcg. Have 5 matrue follicles, but couldn't get any egg out at retrieval, so cycle had to cancel.

Erin, good luck for your cycle with SIRM later this year.

Dawn, so what was the outcome for your cycle with the Metformin? Maybe I should ask to be checked for the insulin resistance. Is there any symptoms that comes with insulin resistance?

Tammy, thanks for the info about SIRM. So are you still going for anymore cycle?

Miriam, I noticed that you are also in New Jersey. Which fertitility clinic are you using? I am currently using RMA of NJ. My current RE said for next cycle, he is going to use the micro flare protocol with lupron. I'm keeping all my fingers cross for this protocol....

AmyLeigh, thank you for sharing your best protocol. Your protocol sounds very similar to the ones they use in SIRM. Did you cycle with them?

Chelby, thanks for sharing your experience, I wish you all the best for your next cycle.

Hugs
Ivy

[momwannabe]

Ivy,
I have always had a difficult time responding and the ONLY drug that I respond to is the Repronex. Gonal doesn't do a thing for me. My best (and successful) cycle was a "down regulation" cycle with 3 wks bcps, overlapped by 2 days of Lupron, then continuing with lupron and adding 4 amps daily Repronex and very little Follistim. Dropped the follistim 7 daysinto the cycle and added more repronex. Was also on Metformin. Had the best egg quality and it was successful, just ended badly. Tried 50 units of LDHCG this past cycle with4 amps of Gonal daily and NADA - no response until we added 6 amps of Repronex daily on day 7 and dropped the gonal. But my egg quality was so screwed up by then that it was a bust.

Good luck! I hope all the advice you got helps!
Robin

[Twins_Squared]

Hi,

I am a poor responder, too. I have done 3 fresh IVF cycles, two of them resulted in pg (twins both times) but sadly I have only one set of living twins who are now 17mos and lost my first set to neonatal death.

For my two successful cycles (I cycled at CCRM in Denver) we used:
Doxycycline (to clear any infections)
BCP's (for 10 days)
micro-dose lupron (diluted 25x)
Gonal F (4 vials per day)
Repronex (2 vials per day)
Estrace (to help w/my lining issues)
accupuncture (many weeks prior to cycling and also post-transfer)
Dexamethasone
baby aspirin
Vivelle patches (post transfer)
Medrol (post retrieval)
ICSI
Assisted Hatching
Embryo Glue

I am a consistent poor resonder with 8-9 follicles but then end up with only 3-4 mature eggs and of those, all fertilize but then one embry arrests at 4 cells leaving me w/just 3 and 2 embryos (respectively) to transfer.

Just remember it is not the quantity of eggs, but the quality of embryos that you are after.

I was told that upping the dosages of meds beyond 6 vials per day, does nothing for the number of eggs produced, though I know many clinics do a high dosage of meds at the beginning and then drop down to 6 or so vials.