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chatterbox

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1

Friday, October 15th 2010, 4:35pm

high dose menopur - affect on "older" eggs!?

Hi folks.

Having had a variety of tx cycles, long, short, buserilin, varian priming, cetrotide... all with menopur - I'm a bit wary over the tx protocol that's been prescribed.

In the past I've not responded brilliantly so the dose of menopur was increased. However, the higher the dose of menopur the worse my response and the subsequent quality of my embryos. On one of my cycles I had 8 amps and the embryos were fragmented and very poor (that was a bfn cycle).

The last 2 cycles were the best response with only 375 on cycle #5 (4 up to 5 amps) and 300 dropping to 225 on cycle #6 with the use of steroids.

CARE want to put me on 6 amps 450 of menopur this time. I'm a bit anxious about this as I'm worried about the affect on my eggs compared to other cycles. I read this about a year ago on the SIRM fertility webpage, and now its popped back into my head and I can't help but worry....

"Menopur has 75U of FSH and 75U of LH. In younger women with a normal ovarian reserve the use of these LH containing meds is probably OK. However, they should be used very sparingly in older women or in women with diminished ovarian reserve ( elevated FSH) where in excess, LH can compromize egg/embryo quality quite seriously".

Now I don't have elevated FSH, or at least I didn't last month when it was tested, but I do have low ovarian reserve and just feel that the proof for me was in poorer cycles in the past on higher doses.

Is it worth having this discussion with CARE, or am I going to get a "if that's what you want..." response (which I got after suggesting I liked cetrotide more than buserilin).

Anyone had higher dose with steroids and done ok?
xxx

Me 40 DH 35 TTC 10yr
peritoneal mesothelioma, cystectomy 97 & 00
peritonectomy, lost both tubes & most of left ovary Aug 07


Dec 07 BFP b/ov m/c 9.6wk
July 08 BFN
Dec 08 BFP b/ov m/c 9.6wk

July 09 BFN
Nov 09 BFP 2 x sacs 1 b/o 1 no hrtbt m/c 9.2wk
May10 BFP at 8+4 m/mc @10wk scan ERPC

Found: High NK cells, DQ Alpha match, LAD neg & PAI-1 pos...

NOV 2010 - Immune IVF at CARE Manchester
:BFP: [zx076] :girl: born 25/8/11

OCT 2012 - Immune IVF at CARE Manchester
:BFP: [zx076] :boy: born 24/6/13

Pootle

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2

Friday, October 15th 2010, 9:09pm

Hi hun, that all sounds a bit confusing for my brain at this time of night of a Friday!!! However, I wanted to say that I was on that dose and I did respond poorly, as predicted, but the quality of the 2 eggs I got was pretty good and one of them resulted in DD2.

xxxx

kimtia

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Friday, October 15th 2010, 9:30pm

Hey hun, I've posted in your diary too but I think you should discuss it with the clinic and take it from there. If it was me i would just go with it, I didn't want Menopur on this cycle as the only time I used it previously was when I had a cancelled cycle but hey something worked. Our thoughts this time was just do what they say and what they tell me to do. I got the least amount of eggs on this cycle too........I got 3, the least ever but the quality must have been good.

Wishing you all the best CB blowkiss

Maria72

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4

Saturday, October 16th 2010, 7:22am

I agree with Kim. Maybe talk to the clinic but trust them too, they surely know what they are doing! blowkiss

Bry

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5

Saturday, October 16th 2010, 9:03am

Hi cb

I had 450 of menopur both of my cycles. The first time started on menopur then changed to fostimon, the second started with gonal f then menopur. The quality of my eggs both times was good, although the quantity was low. It certainly did the trick for me anyway! :D good luck...

My Diary - Bry and the Flumps!


1st IVF March 09 :BFP: mm/c at 9 weeks :bawl:
2nd IVF Oct 09 :BFP: [zx076] [zx076]


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6

Wednesday, January 5th 2011, 4:03pm

Hi Chatterbox
Interesting to read about the theory that too much LH can affect egg quality - I have done a lot of reading around this and I also heard that, though probably not from a reliable source. At my review apt I asked the doc and she was adamant that I needed LH and that it would not affect egg quality. I suppose they are the experts (and are probably fed up of us amateurs googling and pretending we know better :snigger: ). Nevertheless I still think that individuals react differently to different drugs, and the docs do not know everything. In any case for what it's worth - I've done 2 SP cycles both on high dose Menopur (6 or 7 vials to start with, increasing to 8 daily) and my egg quality was crap. For next cycle the doc has suggested Clomid + Menopur. Will just have to see what this brings...
Good luck...
**Wishful**
Me: 41 :bawl: , short protocol- 1st ICSI June 2010 BFN
2nd cycle Oct, one egg fertilised but did not make it to ET :bawl:
3rd attempt - Feb 2011, BFN
Reversal Dec 2011 - negative SA after 2 and 4 months.
4th and last cycle Nov 2012 BFN


Wishful's ICSI Diary - third time lucky?

chatterbox

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7

Sunday, January 9th 2011, 11:34pm

Well just a quick update to this thread: I went with the high dose menopur but didn't respond very well, in my opinion this was down to the buserilin element of the tx protocol which boosts LH early on. I ended up with a good number of follicles initially (approx 11) but they didn't seem to want to grow. It was only when buserilin was changed to cetrotide (as in previous 2 good cycles) that my follicles seemed to respond. But only 4 really seemed to play ball.

I ended up with 6 eggs collected, 5 usable, 4 fertilised, 3 normally, one arrested, 2 back in, currently pg with one embryo. Talk about diminishing returns, but hey it only takes one as they always say!

xxx

Me 40 DH 35 TTC 10yr
peritoneal mesothelioma, cystectomy 97 & 00
peritonectomy, lost both tubes & most of left ovary Aug 07


Dec 07 BFP b/ov m/c 9.6wk
July 08 BFN
Dec 08 BFP b/ov m/c 9.6wk

July 09 BFN
Nov 09 BFP 2 x sacs 1 b/o 1 no hrtbt m/c 9.2wk
May10 BFP at 8+4 m/mc @10wk scan ERPC

Found: High NK cells, DQ Alpha match, LAD neg & PAI-1 pos...

NOV 2010 - Immune IVF at CARE Manchester
:BFP: [zx076] :girl: born 25/8/11

OCT 2012 - Immune IVF at CARE Manchester
:BFP: [zx076] :boy: born 24/6/13

taxihome

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Monday, January 10th 2011, 12:06am

Excelent news Chatterbox. Congratulations my lovely. :)

[zx071]
2 x man boys -MC,Ectopic IVF x 4 Natural BFP/Born sleeping 22/WksRIP LO
Jan/11:ICSI:BFP: bab21 [zx115] Our dream has finally come true
MY DIARY

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9

Monday, January 10th 2011, 5:21pm

fantastic news Chatterbox.

I too responded poorly to high dose menopur.
TTC 14yrs
Clomid x 6 BFN's
4 BFPs m/c's
2x IVF - poor response
NK CD19+/CD5+
Immune IVF -ve
Immune IVF +ve, m/c
3/16Hashimotos''s and peri-menopausal

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Reg: Nov 23rd 2010

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10

Thursday, March 3rd 2011, 2:49pm

Hi I'm new to this forum so I might state the obvious some times LOL! I had last Friday my first short protocol cancelled as my follicles hadn't grown enough. Ironically I had run out of Menopur on the Friday so that was a factor in cancelling my treatment apparently and if I'd had some left they'd have said carry on until Monday and we'll re-scan. I was on 3 vials on Menopur, Gonal F and Cetrotide and was verbally told by the nurse that there is "not much room for manouvre". We're not seeing the doc at CARE until 22 March (hubby is on Jury service and we think perhaps a few weeks "off" will be good for us). I also have hypoprolactinemia which is mega suppressed at the moment and am seeing the endo person on 24 March. I am worried we won't get another go at short protocol as I have had 3 months of cycloprogynova as well prior to this (one of which I didn't get tested on as it was right near Christmas). My doses of injections were Gonal F 375 iu, Menopur 225 iu and Cetrotide 0,125 mcg. Has anyone else had similar starting doses and been increased? What do we do about asking for this? Can we insist on another go? Should we ask for a change in drugs and if so what to? I know I should ask my GP all this but........ :rolleyes: It also doesn't help that 8 years ago we were given the incorrect semen results so we only recently found out we would have always had to go for ICSI anyway so years spent trying to treat my prolactin have been pointless in a way....I'm also in my 40s so I'm pretty upset about the way we have been messed around elsewhere (too long a story LOL!) :faint: . Can anyone give me any advice?

This post has been edited 1 times, last edit by "Budgiegirl" (Mar 3rd 2011, 2:51pm)


chatterbox

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11

Thursday, March 3rd 2011, 3:14pm

Hi there hun and welcome to :FZ:

Are you with CARE in Manchester? Your cycloprogynova should have "primed" your ovaries well for stimms but it does sound like the dose you were on was a bit on the low side. Even if your FSH was excellent (mine was good but due to low AMH was put on the large dose of menpour). Your overall dose of stimms was pretty decent, it might be that you'll respond better to one or other of the stimm drugs.

It does seem a bit odd that they cancelled due to you running out of drugs.... My follies were ridicuously slow to respond and I ended up stimming for 19 days!

That aside, yes have another go (in my opinion)! According to my consultant in CARE there is little point in upping your dose half way through a cycle, its better to have to coast you along with a lower dose if you're responding really well.

You probably won't have had a review appointment yet with CARE - but these are all the questions you need to be asking them. What can be changed for next time, why do they think the response was so poor, can they recommend which of the drugs might work best on their own...

Sorry if this seems a bir rushed- I'm off back to the docs in a mo. Please also PM me if you want any further info!

:D xxx

Me 40 DH 35 TTC 10yr
peritoneal mesothelioma, cystectomy 97 & 00
peritonectomy, lost both tubes & most of left ovary Aug 07


Dec 07 BFP b/ov m/c 9.6wk
July 08 BFN
Dec 08 BFP b/ov m/c 9.6wk

July 09 BFN
Nov 09 BFP 2 x sacs 1 b/o 1 no hrtbt m/c 9.2wk
May10 BFP at 8+4 m/mc @10wk scan ERPC

Found: High NK cells, DQ Alpha match, LAD neg & PAI-1 pos...

NOV 2010 - Immune IVF at CARE Manchester
:BFP: [zx076] :girl: born 25/8/11

OCT 2012 - Immune IVF at CARE Manchester
:BFP: [zx076] :boy: born 24/6/13

Posts: 56

Reg: Nov 23rd 2010

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12

Thursday, March 3rd 2011, 3:21pm

No that's great Chatterbox - and yes I'm at CARE Manchester, Mr Patel. I just sometimes think I'm going mad LOL! My FSH is all over the place. 18 months ago I was 4.3 (!) then I shot up to 76 then back down to 15 etc. As far as I know my AMH hasn't been tested (or at least I've not been told what it is). My estrogen was very low though and even though it had risen with a bump from Day 8 to Day 10 it still wasn't very high..... that is why I can't help but think this prolactin is impacting as that regulates the FSH production....I was only on stims for about a week as it was my Day 10 scan when the cancelled. Yeah I really need to go in with a clipboard with questions on it : D it's just "what questions?"!

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Reg: Mar 21st 2010

Location: West Midlands

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13

Friday, March 4th 2011, 9:35am

Hi guys may I please tag along with your thoughts.

I was reading this thread and became very concerned about my situation. I am too classed as a poor responder and low ovarian reserve due to a low AMH result of 6.45pmol/l (not sure what that means in nl) I have a normal FSH of 7.6 (approx) anyhow we had a cancelled cycle back in january as my only 1 of my follies grew to 14m (other 4 below 10).

My consultant has now said that I can start Short Flare Protocol on Buserelin and Menopur - 6amp. Can you please tell me is this the norm for Flare Protocol or should I pay more and go with the Cetrotide? What makes it the FLARE protocol rather than short?

Please help me as I'm waiting for the drug company to call me for payment and as we are self funding i'd rather give myself the best possible chance now.

Regards

HBK x

Posts: 56

Reg: Nov 23rd 2010

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14

Friday, March 4th 2011, 9:50am

I'm not sure how much help I can give you as I haven't generally a clue what's going on BUT I started my injections with Buserilin and then after I'd started the Gonal F and Menopur a couple of days later my protocol said I had to stop Buserilin on Day 5 and switch to Cetrotide. So are you staying on Buserilin and not switching? Are your ampoules of Menopur 75 iu? I was on 3 x 75 iu ampoules a day of Menopur and I'm not sure this was the highest dose.



I know what you mean about self funding as well. I just ordered everything from the drug company the hospital use as I didn't have a clue however I was told in passing by one of the nurses on my last visit (when my cycle was cancelled) that you can buy the meds from Boots and Asda (!) and when I spoke to the pharmacist at Asda she said they supply them at cost but they do need about 24 hours notice you need then...I guess they're not an "on the shelf" item LOL! Also check out your local independent pharmacist. We are going to do this for any further cycles as I was prescribed Noresthisterone and our local chemist sold this to us for £4.50. When I got my invoice it was still listed on it - for £15! That was taken off for a start.......



Sorry I can't be of more help. Are your nurses "friendly" and do you think this is the sort of thing you could ask them?



G

chatterbox

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Friday, March 4th 2011, 9:51am

Hi there HBK (my AMH was 9.25 - low, and my FSH this cycle was 4. something)

The flare protocol makes use of your own natural surge in LH and then boosts it some more with the buserilin. The buserilin then also acts as an ovulation inhibitor. The idea being you recruit more follicles to start with.

The short protocol just piggy backs your own natural hormones, with menopur priming all availale follciles with the same amount of stimms - hoping they will all grown at the same time. The cetrotide stops you ovulating but allows the eggs inside to mature.

The amount you specify does sound normal for flare protocol (I was on exactly the same dose). I personally didn't respond as well, but my body doesn't like buserilin and this was PROVED over previous failed cycles rather than something I plucked out of the air. I preferred the cetrotide approach and my body started to respond better once I switched over half way through.

There is a certain amount of trust you have to place in your consultant as *generally* the tx they prescribe is tried and tested. Don't be afraid!

Budgie - seems a bit sudden to have cancelled you on day 10! That's where I was when they thought they'd cancel... I was also unde Mr Patel.

xxxx

Me 40 DH 35 TTC 10yr
peritoneal mesothelioma, cystectomy 97 & 00
peritonectomy, lost both tubes & most of left ovary Aug 07


Dec 07 BFP b/ov m/c 9.6wk
July 08 BFN
Dec 08 BFP b/ov m/c 9.6wk

July 09 BFN
Nov 09 BFP 2 x sacs 1 b/o 1 no hrtbt m/c 9.2wk
May10 BFP at 8+4 m/mc @10wk scan ERPC

Found: High NK cells, DQ Alpha match, LAD neg & PAI-1 pos...

NOV 2010 - Immune IVF at CARE Manchester
:BFP: [zx076] :girl: born 25/8/11

OCT 2012 - Immune IVF at CARE Manchester
:BFP: [zx076] :boy: born 24/6/13

Posts: 56

Reg: Nov 23rd 2010

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16

Friday, March 4th 2011, 9:59am

I Know Chatterbox we were shocked too as we expected a bit longer - perhaps I'm just too old and knackered! Anyway we have an apt on 22 March so that gives me lots of time to write a clipboard of questions out for him - and practise my temper tantrums LOL! We've also been in contact with The Lister to see if we can have a second opinion - mainly because we really are floundering with what's going on etc. Your post yesterday was the first light of sanity we've had LOL! Mind you when I was on my cycloprogynova a nurse told us that it wasn't looking good and when we saw Mr Patel we'd probably have to decide on donor eggs (over the 'phone so I was quite upset) and when we saw him he immediately put us on this first short protocol! So I'm not sure anyone knows what's going on....The most important thing is for me not to get stressed as when I do my hormone levels (because of my prolactin problem) seem to go into meltdown - hence acupuncture.

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Reg: May 10th 2014

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Sunday, May 11th 2014, 6:04pm

LH and women over 38

Well, according to IVF doctors Jeffrey Fish and Dr Sher at Sher Fertility in USA, women above 38 are never given hormones with high dose LH as too much testosterone is considered detrimental to egg quality.

So dont always trust your doctor, since all doctors are different, with different levels of talent and ability as in any line of Work.

Ive done my own research after having been on 17 days of max stim Menopur and no fertilisation at my first IVF here in Denmark where the trend is to give older women LOADS of LH.

xx

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Location: Cumbria

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Wednesday, May 14th 2014, 7:42am

I am 39 & have very low AMH (2.4). My 1st & 2nd cycles I was on 450 of Menopur & also a few doses of Zomacton. 1st time none fertilised. 2nd time, with ICSI, I got pregnant, but then miscarried at 6.5 weeks. This time it's a different hospital & they use different medication - 225 of Merional & 225 of Fostimon, as well as 5 doses of Zomacton & steroid Dexamethasone. I'm nervous about different meds but the consultant assured me they do exactly the same job. The only difference is the added steroid should help improve egg growth.

Good luck Blissfull.
Dazzle


Oct 13 BFN
Feb 14 mc
May 14 mmc
EC Nov & Dec 14
Mar 15 mmc
FET Feb 16 bfp twins ❤️❤️

Posts: 15

Reg: May 10th 2014

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19

Wednesday, May 14th 2014, 8:47am

Have these guys never heard of low stim for 'older women'? Low stim i supposed to not destroy quality as max doses can. Best of luck!! ::P

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