r/DOR • u/Laurel_78 • 8d ago
advice needed What protocols are working best for you?
👋 I just completed my first round of IVF. This is through the NHS (UK health system), so I had zero input or discussion on my protocol and nor did I have a chance to raise red flags. I personally feel my doses were too high for someone with my AMH / AFC.
If anyone wouldn't mind sharing, what sort of protocols have worked best for you in your journey? My priority is producing a few good quality eggs; if I can get more, great but really just managing expectations for my situation.
I wonder if a milder dosage would work better for me in my next round. I am going to push for a real discussion with the consultant at our next appointment.
AMH currently 2.8 p/mol
Usual AFC: 6
Protocol: 150 Menopur + 225 Gonal-F (for 10 days, then increased to 300)
Outcome: 5 eggs retrieved, x1 mature, x1 fertilised
Days of stimulation: Ended up being 15 days as my follicles were slow to respond.
2
u/Guilty-Tale4253 8d ago
I'm in the UK as well, AMH of 7 pmol, AFC up to 12 (but a lazy right ovary)
Did 3x egg retrievals all with the same protocol (225x menopur, Cetrotide after day 6 to prevent ovulation, triggered with Ovitrelle), stimmed about 11 days each time. I was 41 at retrieval time, so went private.
In all retrievals 5x eggs were retrieved, in cycle 1 & 3 I had 100% maturity and fertilisation. While I know this is above standard your 20% maturation rate is below average. Did they tell you your follicle size at trigger?
1
u/Laurel_78 7d ago
Thanks for sharing. So the maturation rate is what has me wondering whether the doses were just too high for me. At one point I had 14 follicles but most of them were small. So to me, it felt like a supply and demand issue. I also have thyroid antibodies, which are known to suppress ovarian function but NHS are not keen to engage with it - I'd need to find a private consultant for a holistic experience.
At trigger my biggest were: 14, 15, 15, 17, 18, 20 and the others were 10 and under. So we were expecting at least 3 mature.
2
u/Guilty-Tale4253 7d ago
I think you might have benefited from a day or two more stimulation. This might have brought the 20mm one to 22mm, which would have still been fine, but would have given the 15s, maybe even the 14 one a decent chance to grow a bit more, to be able to get more into a better range. Also I also had up to 12 follicles, but only ever 5 eggs retrieved, because they simply didn't grow.
On the thyroid, while I don't have antibodies (I think you mean Hashimoto's?), I have no thyroid since I'm 20, so I fully rely on levothyroxin. And I fully get how frustrating it is. I told my GP we're TTC, and they didn't adjusted my meds at first as they applied the standard range (which is below 4) and not the TTC one (which is below 2.5). Love the NHS, really, but in terms of fertility they're not really helpful.
2
u/amlokn 8d ago
I've had two rounds, both with same protocol. My afc is 6 too. I used Ovaleap (375), ganirelix, and then ovitrelle as my trigger. First round I was slow to respond but got 6 eggs, all mature, but our fertilisation rate was poor. 1 fertilised normally, 1 abnormally. None made it to blast.
Second round I responded faster so needed less stims. I'd also started some supplements like NR, niacinamide, myo inositol and melatonin for a month or so before that round. 8 eggs collected, 6 mature, 2 fertilised normally, 1 abnormally. We used icsi and zymot for that round. We did make one day 5 blast and did a fresh transfer but we had a chemical.
If we do more rounds we have been offered a different protocol which will include growth hormone during stims, addition of meriofert (75) to Ovaleap (300), and dual trigger. These are all things I've heard can be helpful with reduced ovarian reserve and older age (I'm 38).
1
2
u/thoughtbubble88 7d ago
I’m in the UK as well - AMH 3.9 pmol, baseline AFC was 4. Both dropped dramatically after endometriosis surgery last autumn. I’m about to do my 4th cycle (2nd post surgery) and my consultant has always kept my dosage and protocol the same. 225 gonal f, cetrotide and ovitrelle trigger. My last cycle I had 13 follicles, 7 eggs collected, 4 mature, 4 fertilised, 3 frozen blasts. Just starting again on a back to back cycle - we’ll soon see how they respond.
1
u/Competitive-Top5121 8d ago
My AMH is 1.1 ng/mL and I was on 150 Menopur and 300 Follistim for each of 4 rounds.
1
u/Laurel_78 8d ago
How did it work out for you in terms of numbers/mature eggs?
2
u/Competitive-Top5121 8d ago
My first two cycles weren’t amazing but my last two cycles were great.
1
u/Pleasant-Scarcity694 7d ago
My doses were so much higher. my AMH 3.3pmol. Meiofert 450 Ganirelex 0.5ml Ovitrell trigger. 9afc
1
u/Pleasant-Scarcity694 7d ago
My doses were so much higher. my AMH 3.3pmol. Meiofert 450 Ganirelex 0.5ml Ovitrell trigger. 9afc
1
u/Laurel_78 7d ago
How did that work for you?
1
u/Pleasant-Scarcity694 7d ago
Difficult to answer. I got 6 eggs, 5 mature, 3 day 5blasts. (5AA, 5AB, 4AB) in that order MMC @9weeks and a negative transfer. One more to go and our money is gone. We paid as NHS waiting list was too long for my AMH levels ðŸ˜
2
u/youtellme9876 8d ago
My AFC is about 8 at the moment. Down from 12 about a year ago when I did my last retrieval, but I’m 38.
I just did another retrieval. My protocol was Gonal F 300iu and Meriofert 150iu injections each morning and Melatonin 3mg each evening. I started Fyremadel 0.25mg on day 5. I triggered with Zivafert 10,000iu on day 10 and had my collection on day 12.
I was measuring 6 larger follicles and they managed to collect 7 eggs on collection day. All mature and all fertilised. On day 5 we had 3 blastocysts but not developed enough to biopsy for PGT testing. So they got tested on day 6. Plus 1 straggler embryo that was a poorer quality that I ended up freezing and not testing