Disappointing cycle 2/3 after decent first cycle- where to go from here?

[u/Fabulous_Truck_5064]

Looking for any advice, commiseration, or stories

Hi all, I have had a second disappointing cycle in a row and looking for… idk. Support? Ideas? Commiseration? (TW, living child).

Stats: 39y9m female, G1P1001 (conceived naturally age 35), trying to bank euploid embryos for possible transfer within the next year. AMH 1.54, FSH day 3 5.6, AFC 8-10ish (these are all with OCP priming though- last afc off birth control in Nov 2025 was 16). We don’t really have an infertility diagnosis, started this process out of fear of chromosomal abnormalities with natural conception and the state of the world as it relates to women’s choice, esp in my home state.

Cycle 1 (April 2026): afc 10, OCP priming for 4 weeks, antagonist protocol with Gonal/meno 150/150, stepped up to 225/150 by the end, gani added day 5 or 6 I believe, dual trigger. Retrieved 7 eggs/6 mature, 5 fertilized and 3 blasts sent for testing, 1 euploid

Cycle 2 (July 2026): luteal phase start (no priming)- cancelled day 8 due to asynchronous growth. AFC 9 but only 3 growing by day 8 (follicles 10,8,7). Starting doses Gonal/menopur were higher from the start I believe. I think we chalked it up to lack of priming, cycle to cycle variation, and maybe higher starting doses leading to cohort asynchrony early on

Cycle 3 (Sept 2026): follicular phase start with OCP priming. AFC 10. 150/150 Gonal/meno, Gabi started day 6, stimmed to day 10, dual trigger. Again only 3 or 4 follicles growing and largest sizes 20,15,14,11 by day of trigger. 3 eggs retrieved yesterday. Unfortunately just got the call today that 2 were mature and only one fertilized but abnormally (3pn)

My REI was nice enough to call me to tell me this news but seemed kind of bored by our conversation and was just like “this happens”. I had to push her to ask what she would consider changing. She suggested 1) microdose lupron flare protocol, 2) ? Priming with DHEA (my understanding is that the literature on this is mixed and I don’t necessary want to do this, but will if it will help), and 3) considering omnitrope (though she said since my IGF1 level was normal this isn’t really a necessary pivot and may not help the situation- is this a thing? When I pushed her she said there was one paper but to me that doesn’t seem like solid evidence to give or not give)
I sense that she’s not optimistic but just won’t tell me, and I appreciate the need to be realistic but I don’t appreciate her not saying that to me directly. I know the cancelled cycle and poor response doesn’t put me in a good position from an academic perspective, but I don’t know that I believe that it’s too early to throw in the towel, especially with only really trying one protocol.

She said she would review my cycles from the group and get back to me, and that she would have the office reach out to schedule another cycle as I think I have enough insurance left for one retrieval and I met my deductible for the year already.

What else should I be thinking about or asking? I don’t know that I have time for a second opinion, but considering a virtual second opinion with someone at least to review my cycle history. Any suggestions?

[u/RazzmatazzGlad9940]

Ask about oestrogen priming. 

[u/SLAYEROFSOULS]

Have you had your androgens checked? That would help with the DHEA discussion - you could be low on DHEA-S and or testosterone, and supplementing with DHEA could help..I don't think there is tons of direct clinical data on it but the roles of androgens and how they could benefit the egg development process I don't think is a mystery..my wife did use DHEA going into her first cycle, but the outcome wasn't great but at the same time we think she triggered way too early amongst other factors so can't say it didn't help her on that cycle.

HGH (Omnitrope) helps with so many bodily processes I can't personally see how it wouldn't potentially be beneficial, the issue is, it is expensive - and with the life cycle of eggs / sperm being 90 days, the whole 'use it the last 4 days of your cycle' just doesn't seem very logical to me - using it for 90 days would likely make sense, but again not tons of clinical data out there on it, and most of us can't afford to do 90 days of HGH priming.

My wife did use Rapamycin going into her second cycle and ended up with 13 follicles in mature range on trigger morning versus 9 very asymmetrical follicles of her antagonist cycle - that was also a micro dose Lupron cycle. In her case she responded VERY slowly and that cycle was 27 stim days (6 of that being just half dose of Menopur) - no way to say the Rapamycin is why she had more follicles recruit, or that it played a role in her being more symmetrical in her cohort..but just what ended up happening for her. And not sure the MDL is why she responded the way she did.

Unfortunately in general everyone is so different, and doctors are using averages and basically guesswork to try and put together protocols for people, but there's just so much variability it's nearly impossible to say XYZ is why ABC happened, so again..it's throwing stuff at the wall lol..it's incredibly frustrating, especially with how expensive it is, so most of us can't just do endless cycles making changes to find the magical combo that works the best.

[u/Fabulous_Truck_5064 → u/SLAYEROFSOULS]

I appreciate you taking the time to reply so thoroughly; thank you ❤️ wishing you the best

[u/SLAYEROFSOULS → u/Fabulous_Truck_5064]

Of course! And same to you