long protocol

[ajourney]

dear dr
I am undergoing the long lupron protocol and at the suppression test after 10 days of lupron(10 units a day) my e2 was 160 with no cysts on US - I was found to be not suppressed. I had been on bcp (21 days) before lupron.

I was then put on another week of lupron 10units a day to see if I get suppressed with this additional week on lupron. I did not get suppressed again and the cycle is being cancelled.
Please could you elaborate on:

1)How common ( for around what percentage of ivf cyclers) is lupron not working seen? Why do u think some people do not respond to lupron?
2)Do u think starting lupron at 20 units in a subsequent cycle may help (and hopefully not oversuppress) or a change of protocol to antagonist or flare maybe more appropriate?
3)Can my not getting suppressed be related to my unexplained IF diagnosis?
4) I also wanted to know what is a normal AMH value? My AMH was 3.5 but my inhibin was on the lower side ( I do not remember the exact value but will find it).

I will be meetng with my RE soon to determine the next step but wanted to know the options/protocols I may have.
(age 30 yrs, average antral count 20, fsh 6.5,diagnosis unexpla IF)

Thanks for any input

[Scott Roseff MD]

1)How common ( for around what percentage of ivf cyclers) is lupron not working seen? Why do u think some people do not respond to lupron?
==> About 5% of my patients don't respond to typical Lupron down-regulation. There are several reasons for this, but one of the more common ones is obesity. Another may be due to generic Lupron.

2)Do u think starting lupron at 20 units in a subsequent cycle may help (and hopefully not oversuppress) or a change of protocol to antagonist or flare maybe more appropriate?
==> It's possible. I've pretty much abandoned using Lupron in this fashion in most of my patients (except for some young PCOS patients).

3)Can my not getting suppressed be related to my unexplained IF diagnosis?
==> Not likely.

4) I also wanted to know what is a normal AMH value? My AMH was 3.5 but my inhibin was on the lower side ( I do not remember the exact value but will find it).
==> Normal AMH in a 30 year old (in my lab) is 2.8 and above (to about 5).

Hope this helps,
Dr. Roseff in FL

[ajourney]

thanks doctor...one more question pls

thanks a lot for the reply doctor.

finding reason why lupron did not work: I am not obese (5feet 5 inches, about 60kg). The lupron came from a specialty pharmacy.Its the 14 day kit and will call the pharmacy to see if it was generic .
If you do not mind me asking this basic question-What does generic mean and what thing other than the generic is available in this choice?

Please any other reasons for lupron not working that u can indicate will be most helpful..

thank you

[Scott Roseff MD]

Generic means the drug was manufactured by a company that is different from the original company that produced/manufactured Lupron. For example, Lupron is a BRAND NAME given to a drug called leuprolide acetate. That brand name (Lupron) was given to the drug by its original manufacturer, TAP Pharmaceuticals. When a patent expires for a brand name drug, other companies can manufacture it, call it leuprolide acetate (or whatever name they want), and that's called the GENERIC version of the drug.

While the government says the generic must be "just like the original, brand name drug", sometimes it's not (and may be less potent). If it's less potent, it may not work the way we want it to....

I hope this makes sense,
Dr. Roseff in FL (Have a great weekend!)

[ajourney]

thanks

yes makes sense..thanks for the explanation

[Scott Roseff MD]

You're welcome.