Menopur, LH/FSH ?

BondletMom · 10-15-2009, 10:39 PM

I've been reading posts on the use of Menopur for the last couple of hours...I'm about to go cross-eyed. It seems it is commonly used yet I've also read that high doses (150iu) early in a cycle can "overcook" the eggs. I've also read that it isn't necessary as a woman's natural LH output is not affected unless she is on Lupron. So my question is.....

The ideal ratio of LH:FSH is 1:1 early in the cycle, yes? If that is the case, wouldn't it make sense to add LH while also putting FSH into one's body, particularly if the FSH was in enormous amounts? Wouldn't the added LH serve to bring the ratio closer to 1:1 and, if so, why isn't as much LH given as FSH?

My RE agreed with me (love it when I'm right) that my last cycle I stimmed way too fast (only 8 days of stims) and egg quality was affected. He's added 150iu Menopur starting same day as Gonal-F. I'm concerned about the high dose of Menopur especially after 2 hours of research yet at the same time it doesn't make sense to me why balancing FSH w/smaller doses of LH would be detrimental to egg quality. I'm also concerned because Menopur also contains FSH and with as fast as I stimmed last time, it doesn't seem right to be adding more FSH to my protocol.

UPDATE: I ended up sending my RE a letter detailing my concerns (mainly that adding Menopur increased the FSH level and would make me stim faster - the exact opposite he was hoping for! The nurse finally cornered him (literally) and had him read the letter, spread out my charts from my last cycle and guess what? I WAS RIGHT!!! He said adding Menopur in a high dose was the worst protocol for me!!! I am so glad I challenged this, so glad I stuck with it even after two phone calls that were "dismissed".

Thoughts from anyone not as confused as I am about meds/protocol?

smittygirl · 10-17-2009, 09:29 PM

I try not to look into too much when it comes to the IVF process. I do what the Doc tells me to, not looking up anything, especialy side effects. When the nurse calls with numbers, I ask if they are good. I know there's probably alot of girls that are reading this post, thinking "What a dumb ass", but I make myself CRAZIER with too much info!
So, I have no answers for you!

BondletMom · 10-18-2009, 08:56 AM

lol, I think what you do is smart and definitely not dumb. I have questioned my RE's protocol for me before and not had him change it yet got the very results I was afraid of getting (too many eggs of low quality) so I'm trying to figure out the Menopur thing as it is new this time for me. What I've found is that there are way too many views on the use of Menopur and women respond to it differently, so I guess I just go on and trust (a bit untrustingly, lol) what he has me doing and hope for the best.

kiellara · 10-18-2009, 09:51 PM

I think it really depends on your RE. I'm on my first cycle, so my RE is having to tailor the protocol to how she thinks I'm going to respond - presumably based on my antral follicle count, prior LH/FSH levels etc. While my hormones have always been 'normal', I had low counts, indicating possible diminished reserve.
So my RE wants to start me off on high doses and see how I respond. Her protocol has me on microdose lupron for a few days, followed by adding in Follistim am and pm and then after two days, I change the evening follistim to menopur. Apparently, that's a combination that my RE finds works well - I guess its kinda like cooking!
Anyway, I get blood work and u/s done after four days of stims and then almost daily after that so that they can adjust the dose accordingly.
So I would say that its good to talk with your RE and perhaps if you're concerned about things, ask for additional monitoring so that you can both track it and he can adjust the dose if things are going too fast?? My two cents.

K

tdg119 · 10-19-2009, 04:25 AM

I was on somewhat of a different protocol, but can tell you that my RE didn't add Menopur till the end, after I'd already had several follies growing and we needed to make them mature faster. Even then, they closely monitored me and increased/decreased my dose accordingly. I tend to think that a slower process is better for the eggs, but that is just what I've heard - I have not researched it to back it up.

I think it's important, either way, to bring it up to your RE if you're uncomfortable with it.

10-15-2009, 10:39 PM	#1 (permalink)
BondletMom 300-399 post 5 of hearts Join Date: May 2007 Location: AZ Posts: 300	Menopur, LH/FSH ? I've been reading posts on the use of Menopur for the last couple of hours...I'm about to go cross-eyed. It seems it is commonly used yet I've also read that high doses (150iu) early in a cycle can "overcook" the eggs. I've also read that it isn't necessary as a woman's natural LH output is not affected unless she is on Lupron. So my question is..... The ideal ratio of LH:FSH is 1:1 early in the cycle, yes? If that is the case, wouldn't it make sense to add LH while also putting FSH into one's body, particularly if the FSH was in enormous amounts? Wouldn't the added LH serve to bring the ratio closer to 1:1 and, if so, why isn't as much LH given as FSH? My RE agreed with me (love it when I'm right) that my last cycle I stimmed way too fast (only 8 days of stims) and egg quality was affected. He's added 150iu Menopur starting same day as Gonal-F. I'm concerned about the high dose of Menopur especially after 2 hours of research yet at the same time it doesn't make sense to me why balancing FSH w/smaller doses of LH would be detrimental to egg quality. I'm also concerned because Menopur also contains FSH and with as fast as I stimmed last time, it doesn't seem right to be adding more FSH to my protocol. UPDATE: I ended up sending my RE a letter detailing my concerns (mainly that adding Menopur increased the FSH level and would make me stim faster - the exact opposite he was hoping for! The nurse finally cornered him (literally) and had him read the letter, spread out my charts from my last cycle and guess what? I WAS RIGHT!!! He said adding Menopur in a high dose was the worst protocol for me!!! I am so glad I challenged this, so glad I stuck with it even after two phone calls that were "dismissed". Thoughts from anyone not as confused as I am about meds/protocol? Last edited by BondletMom; 10-23-2009 at 03:23 PM. Reason: more information

10-18-2009, 09:51 PM	#4 (permalink)
kiellara 0-99 post 2 of hearts Join Date: Oct 2009 Location: California Posts: 68	I think it really depends on your RE. I'm on my first cycle, so my RE is having to tailor the protocol to how she thinks I'm going to respond - presumably based on my antral follicle count, prior LH/FSH levels etc. While my hormones have always been 'normal', I had low counts, indicating possible diminished reserve. So my RE wants to start me off on high doses and see how I respond. Her protocol has me on microdose lupron for a few days, followed by adding in Follistim am and pm and then after two days, I change the evening follistim to menopur. Apparently, that's a combination that my RE finds works well - I guess its kinda like cooking! Anyway, I get blood work and u/s done after four days of stims and then almost daily after that so that they can adjust the dose accordingly. So I would say that its good to talk with your RE and perhaps if you're concerned about things, ask for additional monitoring so that you can both track it and he can adjust the dose if things are going too fast?? My two cents. K __________________ me 37, DH 44 TTC since 06. 3 x IUI. BFN IVF #1 with ICSI converted to IUI on 10/24 - BFN IVF#2 January 2010

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10-17-2009, 09:29 PM	#2 (permalink)
smittygirl 100-199 post 3 of hearts Join Date: Aug 2009 Location: Pennsylvania Posts: 102	I try not to look into too much when it comes to the IVF process. I do what the Doc tells me to, not looking up anything, especialy side effects. When the nurse calls with numbers, I ask if they are good. I know there's probably alot of girls that are reading this post, thinking "What a dumb ass", but I make myself CRAZIER with too much info! So, I have no answers for you!

10-18-2009, 08:56 AM	#3 (permalink)
BondletMom 300-399 post 5 of hearts Join Date: May 2007 Location: AZ Posts: 300	lol, I think what you do is smart and definitely not dumb. I have questioned my RE's protocol for me before and not had him change it yet got the very results I was afraid of getting (too many eggs of low quality) so I'm trying to figure out the Menopur thing as it is new this time for me. What I've found is that there are way too many views on the use of Menopur and women respond to it differently, so I guess I just go on and trust (a bit untrustingly, lol) what he has me doing and hope for the best.

10-19-2009, 04:25 AM	#5 (permalink)
tdg119 400-499 post 6 of hearts Join Date: Aug 2008 Location: Lehigh Valley, PA Posts: 483 Blog Entries: 207	I was on somewhat of a different protocol, but can tell you that my RE didn't add Menopur till the end, after I'd already had several follies growing and we needed to make them mature faster. Even then, they closely monitored me and increased/decreased my dose accordingly. I tend to think that a slower process is better for the eggs, but that is just what I've heard - I have not researched it to back it up. I think it's important, either way, to bring it up to your RE if you're uncomfortable with it.