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  1. #1
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    Default Poor responders, what was the best protocol for you?

    Hi ladies

    I've just had my first antagonist cycle at a new clinic after 3 unsuccessful long down reg cycles at my old clinic. The antagonist cycle produced my worst results ever. I knew to expect less eggs because I've heard the antagonist protocol usually produces less than long down reg, but I was hoping for better quality. I went from getting 5-6 eggs with about 75-100% fertilisation on the LDR protocol and at least one 8 cell embryo to transfer on day 3 to getting 3 eggs on the antagonist protocol with one fertilising and that embryo was 4 cells on day 3. I've read on Dr Sher's blog (SIRM) that he thinks the antagonist protocol is not good for older women.


    I would love to hear others' experiences with these protocols. Also, did your FS tailor your protocol to you individually?

    Thanks!



  2. #2
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    Default Poor responders, what was the best protocol for you?

    Yes, my FS tailored mine. First cycle, long down reg with gonal-f. Poor responder. 3 follicles only on the first scan. 5 mature eggs in the end. Second cycle, antagonist with menupor. A lot higher dose. But some responded too quickly. 8 mature eggs in the end. Only slightly better but I got 7 fertilised this round and it only takes one. Currently pregnant.

    Btw, I have normal AMH for my age so quite a poor responder!
    Last edited by bbhope; 09-03-2015 at 14:39.

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    @Golden Egg Although I'm what they call a "normal responder", I know the AACEP protocol is one they recommend for poor responders and/or older women. It's on Dr Sher's website too. Agonist/Antagonist Conversion Protocol with Estrogen Priming. Hope this helps

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    Yes, my FS has changed things up quite a lot each cycle based on my response. My AMH was 17 in 2013, and then 31 a year later (go figure, huh?), so definitely not low, but nevertheless I am a ‘poor responder’.


    1st cycle – Antagonist, 150 units Gonal F, Orgalutran, Ovidrel trigger. 5 eggs retrieved, 3 fertilised, 1 embryo decent quality, resulted in a chem.
    2nd cycle – Antagonist – 300 units Gonal F, Orgalutran, Ovidrel trigger. 7 eggs retrieved, 5 fertilised, all embryos very poor quality resulted in BFN.
    3rd cycle – Super long down reg, 2.5 months on synarel, 450 units Menopur, Ovidrel Trigger, 15 eggs retrieved (10 mature), 8 fertilised, 2 embryos decent quality, not sure of the outcome yet


    So all things considered, I think we'll do long down reg with synarel and menopur again next time we stim because it seems to be the best one for me so far. I should add that we've never made it to blast, and never had anything that could be frozen...

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    Thanks girls.

    Congratulations bbhope and Blondeinbrisvegas and good luck MrsChino!

    It sounds like different things work for different people.
    @BlondeinBrisvegas, I've read Dr Sher's articles on AACEP. I haven't seen many pp mention it and I wonder if it's used very often in Australia. I don't hear of it often on the forums. I see though that you used that protocol and that you saw WDA. Did he immediately say that older women should be on that protocol? What protocol were you on prior to that and did WDA have any comments on that other protocol? Sorry for all the questions.

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    BlondeinBrisvegas  (11-03-2015)

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    @Golden Egg It is used here in Aus but not as much as the standard Flare/Long Down Reg protocols. Some FS do their own versions of the AACEP (for eg, not doing the estrogen priming component, but do the rest).

    I did a Long Down Reg protocol for my first 3 Cycles using Puregon on Cycle 1 and Gonal F for 2 and 3. Triggered with Ovidrel for them all. After Cycle 3's abysmal failure, I was so pi$$ed off and even more so when my FS wouldn't try anything different (like HGH, Melatonin/DHEA for eg) that I'd been asking him to do prior to starting Cycle 3 that I did my own research into who I thought was the best out there to help DP and I and our particular issues.

    Yes, WDA believes in this protocol and uses it a lot for his ladies as his specialty is treating older women and/or difficult cases. He also uses a myriad of supplements for both women/men (if you've got a male partner) as part of this protocol as well as treating his Ladies empirically for immune issues by adding medications to the protocol such as Clexane, baby aspirin, Prednisone "just in case". He will also do Endometrial Scratches/Lipoidal Flushes as part of your Cycle (did both for Cycle 4 and just the Scratch for Cycle 5) if the thinks it will help as well as give you the option of using HGH (Saizen for eg) as part of your protocol too (though it is exxy). He also uses Intralipid Infusions as part of the protocol if he thinks you need it.

    As he is also a Gynae/OB he will also do procedures like Hysteroscopy's for eg to try to find out if there's any issues in your oven if he thinks you need to. He also performs TESA procedures for the men as well if need's be. He's pretty much an all rounder kind of a FS and most definitely one of the best in both QLD/Aus that will throw the kitchen sink at you to try to get you your BFP and will tailor a protocol especially for you also if you require it.

    I don't think it's that he thought the protocol I was on was completely useless. It's probably the better protocol for an older woman who's a normal responder as the first port of call so to speak, but when that's not working after a decent amount of tries, something different has to be done and as I said before, he believes the AACEP protocol is the way to go.

    He also uses high dosages of stimm's in the protocol too. Anything from 450IU and upwards depending and he uses a combination of Menopur/Gonal F or Puregon that he gets you to do in split doses. Half in the morn/half at night (as he believes it leads to more uniform and even follicle growth) usually with other things such as Luveris for eg added in if he feels you need it. I used Lucrin/Cetrotide to stop ovulation and triggered with Pregnyl. However in saying that, I did lower my stimms for Cycle 5 down to 300IU a day (I also used Menopur/Puregon too) then increased it to 400IU a day for the last couple of days until EPU.

    It's a pretty full on protocol and I know a lot of the low cost clinics won't do it (cost factor) which is understandable in a way although usually they'll at least let their clients try Menopur instead of Gonal F/Puregon. There are some FS that use it or at least are willing to give it a go. Any good one will know about it at the very least.

    Anyhoo Luv, I hope this helps answer some of your questions. Don't be sorry either. We're all here to help especially one's like myself who have been lucky enough to get over the line and get our BFP(thank-you for the congratulations too). Pls let me know if I can help in any other way and Good Luck to you Luv!!
    Last edited by BlondeinBrisvegas; 11-03-2015 at 09:31.

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    Thanks so much for your detailed reply Blonde. That's all really interesting. WDA certainly sounds like a saviour for many. I've just made an appt to see him June in the event I don't have success before then! (Even though I'm in Syd) I'm particularly interested in your comment that WDA believes the protocolleads to more uniform and even follicle growth. That seems to be absolutely the key for us oldies.

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    @Golden Egg He believes splitting the dose of FSH, half in the morn and half at night, promotes uniform and even follicle growth..Sorry if I miscommunicated that in my previous post

    Hopefully you won't need to see him in June (if you ask to go on the canellation list, you may get in quicker. You'd just have to tell the Admin Girls you're coming from Sydney is all and how many days notice you might need) but I know he does remote Cycling with women from all over so that won't be a problem. Just have to get back up here for EPU/ET

    Will keep my eye out for you on the forum. I float around a few threads (mainly in the over 40's groups here and in the DIG too..so feel free to join them if you want. The Girls are all lovely and have a stack of knowledge to share too) Will be keeping my you get your BFP asap Luv!!

  12. #9
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    SpotTheOcelot is offline 'Only those who dare to fail greatly can ever achieve greatly.'
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    I'm a poor responder (pathetic really) - first IVF was down reg, and nothing fertilised so moved on to Flare cycle with ICSI. Average response.

    Then moved on to antagonists ICSI for the rest of my IVF life with varying success. Averaged around 4 - 6 eggs with 50% fert. rate using 300u gonal-f, Orgalutran, and an Ovidrel trigger.

    Usually had one or two to freeze.

    4 miscarriages, 2 stillborns and now one bouncing miracle baby - all took 13 rounds.

    Good luck.

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    Blonde, no no you didn't miscommunicate - that was just my sloppy translation back to you. I knew exactly what you meant. Thanks for the words of encouragement!

    Spot, OMG i absolutely admire your tenacity. I plan on doing the same - going and going until I have that baby. I figure it's a numbers game and as long as I'm still ovulating I'm still in the game.

    My FS is now back and has suggested a flare cycle (apparently she has a colleague at Monash IVF who is having some success using this protocol with DOR patients) and although i've read mixed things about it and thought it had had its day, I figure what the hell, I'll try it and see how it goes. So it's straight into the next cycle. I do love the short cycles compared to the long ones. It's sooo much easier on the mind and body.

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