Ivf Antagonist Protocol - Advice Needed


#1

Hi,

My RE suggested this protocol, will be starting in jan anyone with any ideas much appreciated. My follicle count looks good on day 2 but not able to get more than 3 mature eggs i am deeply concerned what would happen this time and RE not willing to do more cycles if this fails i dont understand b’coz for some it takes more cycles before they conceive and right now i dont understand what to do next ? Why would they not do more than 3 ivf cycles all together and not willing to repeat previous protocols like flare,long lupron where i did not respond well . I can just pray god that it atleast works this time. Anyone with pros and cons regarding this protocol.?:pray:


#2

So hard to say…How old are you? I am almost 40 and have had four failed IVF cycles, three on straight antagonist and one on the estrogen protocol…None of my embies went past day three, and our last cycle was horrible…In general due to my age, I don’t get copious amounts of eggs…This time we did micro dose lupron and got our highest yield at retrieval and highest fertilization rate too…However, the fertilization rate may be better since we added in ICSI (even though we dont have a true MFI)…They may not want to do another cycle if they feel you have DOR or other age related issues…May be time for a second opinion too…

Sometimes I feel this whole thing is a crap shoot! We are excited for a 5dt on Saturday with 10 embies still holding on as of today, so you just never know…Sorry if I’m not a big help here, but I feel your pain!

[QUOTE=usa2011]Hi,

My RE suggested this protocol, will be starting in jan anyone with any ideas much appreciated. My follicle count looks good on day 2 but not able to get more than 3 mature eggs i am deeply concerned what would happen this time and RE not willing to do more cycles if this fails i dont understand b’coz for some it takes more cycles before they conceive and right now i dont understand what to do next ? Why would they not do more than 3 ivf cycles all together and not willing to repeat previous protocols like flare,long lupron where i did not respond well . I can just pray god that it atleast works this time. Anyone with pros and cons regarding this protocol.?:pray:[/QUOTE]


#3

Im in the midst of my first attempt at antagonist protocol. My first IVF was long lupron and it was a bust. I feel more hopeful about this protocol than long lupron and i have read many positive outcomes as well. If I were you I would get a second opinion depending on outcome. While I would assume your age is a factor I still think you need to explore options with another RE. Good luck!!


#4

If you see a slow responder with DOR anything that requires using the bcp is a bad idea. Also long lupron tends suppress slow responders. You should check out the slow responder forum. It my be dormant one but you will come across a ton of ladies with this problem and how antagonist worked or id not for them. I am a slow responder with DOR. Lupron/ bcp was a bust so after talking to tons of women I convinced him yo do estrogen priming with antagonist protocol. Google antagonist with dor and see what you find. It does seem to work for some. But as someone suggested you may want a second opinion.

Good luck and keep us posted. :grouphug:

Alicia


#5

I did this protocol for IVF #2 and was successful…for me, I think that it improved my egg quality (also used human growth hormone - Saizen).

I liked this cycle better as I did not like the effects of lupron.

If your current RE isn’t willing to treat you (should you need another cycle - prayers that this next one is a BFP), then you should move on to a clinic that deals with and has success with “difficult” cases (i.e. CCRM).

Good luck!


#6

[quote=usa2011]Hi,

My RE suggested this protocol, will be starting in jan anyone with any ideas much appreciated. My follicle count looks good on day 2 but not able to get more than 3 mature eggs i am deeply concerned what would happen this time and RE not willing to do more cycles if this fails i dont understand b’coz for some it takes more cycles before they conceive and right now i dont understand what to do next ? Why would they not do more than 3 ivf cycles all together and not willing to repeat previous protocols like flare,long lupron where i did not respond well . I can just pray god that it atleast works this time. Anyone with pros and cons regarding this protocol.?:pray:[/quote]

I have done the antagonist protocol twice. I am a poor responder so my first cycle was canceled. My second cycle was better at a higher dose. I got 8 eggs after an initial antral follicle count of 13. That one ended in a chemical.

I just met for my follow up yesterday and the Doctor says he almost exclusively uses the antagonist and will again for my 3rd cycle (in April) at an even higher FSH dose. He seems optimistic so I am, too.

Best of luck!


#7

I’m all for the antagonist approach since this is the protocol that worked for me. I was designated as a “poor responder” and RE thought I was being suppressed too much by the Lupron. Sure enough, 3rd cycle no Lupron and I’m almost 29 weeks pregnant now! Good luck!


#8

Hi
Thank you for your responses, I am 31 yr old and i did get second opinion and he said i should try more follistim and optimal dose of menopur my RE did not understand what is meant by optimal dose, and he said he would do long lupron but with any protocol the approach should be different for me (regarding medication dosage) he also said he is okay with antagonist protocol but would not do the traditional one.Do you have any idea about these? he advised more detailed semen analysis DNA fragmentation but my RE is not concerned about sperm issue. Do you think there is any diff between follistim ,gonal f ifthere is i would request my RE to change the medication too and how about menopur do you think i should change those b coz previous two cycles i used only those meds.Any advice would be of great help. I have a felling that this people would not like to deal with difficult cases and by giving you some other options they find there way out.:cross:


#9

second opinion taken

Hi
Thank you for your responses, I am 31 yr old and i did get second opinion and he said i should try more follistim and optimal dose of menopur my RE did not understand what is meant by optimal dose, and he said he would do long lupron but with any protocol the approach should be different for me (regarding medication dosage) he also said he is okay with antagonist protocol but would not do the traditional one.Do you have any idea about these? he advised more detailed semen analysis DNA fragmentation but my RE is not concerned about sperm issue. Do you think there is any diff between follistim ,gonal f ifthere is i would request my RE to change the medication too and how about menopur do you think i should change those b coz previous two cycles i used only those meds.Any advice would be of great help. I have a felling that this people would not like to deal with difficult cases and by giving you some other options they find there way out.:cross:


#10

Hi USA2011- I was also a positive outcome due to the antagonist protocol and would strongly advise others to try it if they get overly suppressed and have no luck with long lupron. This protocol gave me 3 embryos that all decided to stick around when transferred.

I used the menopur and follistim. I had used both of these meds with the long lupron protocol. I’m not sure what your RE is talking about with the optimal dose- but it sounds like you have some questions for your RE before you get started. On my last cycle, I was really up front with questioning every decision my RE made- I even put in my own requests on when to trigger, disagreed with when my RE wanted me to, and when I got the call to trigger, I told the RE I would stim one more day and then trigger. He respected my opinion and got some great results on retrieval. Without telling him, I also gave myself extra 50 or 25 iu of follistim per night because he was treating me with “kid gloves” and worried about hyperstimulation- of course I kept a close eye on my estrogen levels to make sure I wasnt in any harm.

You need to get multiple opinions-as you have, and ask loads of questions. YOU know your body better than the RE does (at least I found that to be true). So, do your research, use your past cycles and hormone levels to help you make decisions about your care. Good luck to you!


#11

Hi Usa2011, I am not an expert. I’ve only done 1 cycle of IVF (see my sig) but I feel like I’ve done a lot of research on this and here’s what I feel like I’ve found…

Antecdotaly, it does seem like DOR/poor responders do best on the antagonist protocol. CCRM seems to use this protocol with those women with good success. Also, anytime I see a DOR/poor responder say they are on lupron or BCP, experienced women always seem to respond that that isn’t right bc it is oversurpressing them.

The thing I believe about IF is that there is no real “best practices” established industry wide. I don’t think anyone but the patients would really profit from someone doing this or even curing this problem so there is no motivation to do so.

I also believe that RE’s all have their own motivations like you said. This is their business after all…so you really do have to advocate for yourself like you are doing.

I did long lupron my first cycle. My RE called this the “gold standard” of IVF, but everyone on this forum said “no, it’s just the generic starting protocol.”

I am doing micro-flare lupron for my second round. My RE refuses to do antagonist and I don’t know why until I get to meet with him again. I do have excellent med insurance coverage, so I am willing to experiment before deciding to switch REs so this is ok with me, but if it doesn’t work, and he still won’t try antagonist I will switch RE’s.

I will probably go to SIRM. CCRM is VERY expensive if that is a concern for you as it is for me…SIRM has several locations and they do free phone consults so you might think about calling them and doing a consult.

I have started lots of supplements this time too based on anecdotal stories from this and other forums. I will try to insert the list…ok, I don’t know how to do that! But if you look through my past posts, it is on the Nov 2011 take 2 thread, within the past few weeks…

Again with the supplements, no one’s going to get rich off a study that would prove if any of these actually can help with IF since supplements are not proprietary, so that is never going to happen…you just have to research them yourself and decide if you want to try it.

Best of luck to you and keep self advocating!


#12

The second opinion which i got is from SIRM st louis. I mentioned what we discussed in my previous post. I think i messed up everything in one paragraph sorry about that.


#13

Antagonist worked MIRACLES on me. Check my siggy.


#14

I also have DOR and the low stim antagonist protocol is what worked for me. I previously did 1 MDL protocol, and 2 SIRM agonist/antagonist conversion protocols 1 with estrogen priming.


#15

Thank you for your reply , I have a question what is estrogen priming i will request my RE because i dont remember her using that word when we discussed about the protocol, and for those people to whom antagonist protocol worked plz give me your meds dosages is that something to be concerned because my RE planning to push me hard with high doses and to start with i need 1800iu follistim and 10 vials of menopur and i might need more that is what they mentioned. Do i really need to be concerned about the medication? plz reply asap. Thank you


#16

Estrogen priming is when they add in estrogen supplmentation pryor to stims starting, the theroy is that it helps improve response and egg quality. And below was my med dosage on the antagonist protocol.

[SIZE=3][FONT=Calibri]Days 3-7 100iu follistim pm/ 75iu menapur am/ started ganirelix on day 5 and continued through trigger[/FONT][/SIZE]
[SIZE=3][FONT=Calibri]Days 8-10 100iu follistim pm/ 150 menapur am/ continued ganirelix[/FONT][/SIZE]
[SIZE=3][FONT=Calibri]Day 10 took 150iu menapur am/ 75iu follistim early pm then 10,000iu HCG trigger late PM[/FONT][/SIZE]


#17

Egg Quality

Hi
I have a question about the egg quality , can someone plz explain about the quality and grade? thanx i am confused on what basis they determine those.


#18

The only specific thing my RE said about my egg quality with antagonist vs long lupron was right after the egg retrieval. He said that the lab made a comment to him as the lab was getting the eggs during retrieval. The lab said, “Wow, these eggs look great- nice and fluffy.” Now obviously you can also get info about quality by watching how the embryos grow and develop. The estrogen my eggs were exposed to (and not allowed to be exposed to due to the lupron in previous cycles) helped my egg quality.

Here is a summary of my meds (keep in mind I have PCOS so my follistim was significantly less than the norm).
Every AM (for 9 days) One vial of Menopur
Every PM (for 9 days) 75iu (but I gave myself 100 iu) follistim
Started ganorelix (antagonist shot) on day 8 of stims because follicles were measuring 16mm and gave it on days 8,9,10 with trigger on day 10.


#19

Hi USA,

I wanted to reply to your question about what might be a high dose. I was a poor responder to my first IVF and 3 IUIs, so my RE had me on 300 iu of follistim and 300 iu of Menopur daily.

Good luck!


#20

Mine didn’t work, but here are my doses for comparison:

Here are the stimulation doses I was on:

1st cycle:
Days 1-4 = 300 units FSH (Bravelle)
Days 5 & 6 = increased to 375
Day 7: E2 dropped.
Cycle canceled

2nd cycle:
Days 1-7 = 450 units FSH (Bravelle)
Days 8-11 = 525 + Ganirelix. Egg retrieval on day 13.
8 eggs, 4 embryos = Chemical.

For my next cycle he will be starting me out at 600 units.