ivf protocol

[sophie6]

Hi,

I just met with my doctor today, and I'm concerned about the protocol she is planning. I am 42, AFC avgs 6, normal day 3 fsh / e2. During IUI, I get 2 - 5 follicles using 225iu bravelle.

This is the protocol:

Start BCPs day 3 of cycle preceding IVF.
Add 10 units Lupron on day 19 preceding IVF
On CD 2 of the IVF cycle, lower Lupron to 5 units and continue until trigger, also start 225 fsh / 150 menapur.

I'm concerned that the length of time on Lupron will over-suppress me, and that the dose of fsh is not high enough.
Would really appreciate any input from you.

Thanks very much,
Sophie

[Scott Roseff MD]

You described a Lupron down-regulation protocol. Are you seeing a U.S. based doctor? Board certified in RE/I?

I don't down-regulate my patients in your age group....!

Dr. Roseff in Florida

[sophie6]

Thanks for your reply. My Dr is US based and board certified. I don't have a lot of options due to my insurance, so I will have to work on this with her. Don't know that she will be receptive to my input, but I was wondering what protocol you would use. Would a shorter course of Lupron (at same dose) be ok? Would you up the dose of fsh? I know my former Dr (who doesn't take new insurance) would have.

Thanks so much,
sophie

[Scott Roseff MD]

Hi Sophie,

I tyically use a microdose flare protocol in patients your age, with higher doses of both Follistim and Menopur to optimize the odds of having as many eggs as possible. I also use supplements like DHEA and have fertility acupuncture done as well.

Good luck!
Dr. Roseff in FL

[sophie6]

Thanks!

[sophie6]

Sorry-- one more question. My doctor may not be receptive to the flare protocol. If she is not, I wonder if reducing the dose of lupron would help. In your experience using a standard protocol, what is the lowest dose of Lupron that will still adequately suppress LH (both prior to and during stims)?

Thanks,
Sophie

[Scott Roseff MD]

Hi Sophie,

If your doctor is not receptive to your needs, then why wouldn't you switch to one who IS??? It's YOUR body, YOUR health, YOUR money (whether out of pocket or via insurance premiums), etc. etc. It doesn't make sense to me why someone would stay with a doctor in such a situation....

Dr. Roseff in FL

[sophie6]

I completely agree-- my insurance co is not as enthusiastic (and we can't afford this w/o insurance). I have only a few choices and she is actually the best option among them. So far, she has only agreed to up the dose. I knew my old RE well, but he doesn't take the new insurance and since I don't know this new doctor well, it's hard to know exactly how to approach this. Given that she is my only real option right now, I don't want to burn any bridges. So I'm hoping to find some middle ground, and perhaps lowering the dose of Lupron will have to be it.

I will try to further explore why she feels I need so much suppression. She mentioned OHSS when I brought this up (over the phone), but as mentioned...42, afc of 6ish... I'm not terribly worried about overstimming. I have responded fairly well to 225iu (IUI 2 - 5 follicles), but that's w/ no suppression.

Again, thanks so much for your input! At least I know my concerns are realistic.

Sophie

[sophie6]

Thanks so much for your kind words! I have an appt with her in a few weeks, so will try again to agree on a better protocol for me.

Best of luck to you too!
Sophie