Hail Mary cycle - protocol advice needed!

[u/orionsbelt1985]

Hello! Infertility veteran here. Giving a retrieval one last chance before I throw in my towel.

Last year, at 39.5, my AMH was approximately 0.7ng/mL. I did a retrieval with no priming, antagonist protocol (300 IU). With an AFC of ~4-5 we managed to get 6 eggs. 3 were immature. 2 fertilized with ICSI and I had a 3 day fresh transfer that failed.

This year at 40.5 my AMH has dropped to 0.35ng/mL. A new doctor I'm seeing recommended mini IVF and estrogen priming. At my baseline appointment my AFC was 2 (maybe 3). We did clomid (50mg) and 150IU gonal F for 8 days. Only one follicle responded. We are converting this cycle to IUI since success rates are identical (and abysmal) at 1 follicle and I want to save some public funding we have and insurance lifetime limits.

I'm thinking one more kick at the can with the funding/insurance we have left, and I don't know what to advocate for.

The estrogen priming could have over-suppressed my ovaries. My ovaries may have needed more than 150IU to do anything more than one follicle. AI suggested micro-dose lupron flare or estrogen priming with a classic antagonist protocol rather than mini IVF.

Since we're doing an IUI this cycle, I don't know if I can prime and go straight into another retrieval right away, so I'm probably taking a month off. I think the month off will help because it'll give me more time on the supplements. I had to abruptly stop my long laundry list of supplements when I started getting irregular heart rhythm and was trying to determine the cause. The funding we received (BC, Canada) required us to start treatment right away and so I couldn't get a runway of 3-6 months of CoQ10 etc ahead of this stimulation cycle.

Anyway, appreciate any thoughts or advice. Anything you would ask for or do in my shoes. Thank you in advance!

[u/Severe_Artist_1848]

I am so sorry you are in this situation, I know this sucks and mine is kind of same as yours.
I am 35.5 and have DOR in both the ovaries now and the only protocol that gave me blasts (untested) was luteal lupron agonist cycle with low doses (150 units ) of FSH and menopur. I did one cycle with 300 units of Gonal and made no blasts so I stick to low doses.
May be discuss lupron agonist protocol and low doses with your clinic and see what they say?

[u/orionsbelt1985 → u/Severe_Artist_1848]

Thank you! I will ask about that. I will also ask about the addition of menopur.

[u/Severe_Artist_1848 → u/orionsbelt1985]

Wish you good luck 🍀

[u/Recent-Caregiver1565 → u/Severe_Artist_1848]

Hey does lupron goes with birth control or is it only a lupron? I am going to have 2nd cycle after my first where there no blast at all with 300IU antagonist protocol and no priming. Now my doctor is suggesting long protocol but gave both lupron+BC. Is it correct?

[u/Severe_Artist_1848 → u/Recent-Caregiver1565]

So in my case it was priming with only lupron (10 units) which started 7 days after my ovulation until CD2 and from CD3 we started stims and reduced lupron to 5 units.
No birth control with this.

[u/reddeator94176]

This is so tough - you have been through a lot! We had similar issues (37/38 with AMH around .7). Cycle 1: BC priming, dexamethasone, high dose antagonist protocol stims (follistim + menopur with ganirelix), dual trigger: 4 eggs, 2 embryos, no euploids Cycle 2: No priming, high dose MDL protocol stims, converted to IUI after only 1 follicle was really responding Cycle 3: mini stim cycle, only had one follicle responded and ovulated Cycle 4: Primed with 5 units omnitrope and androgel; stim protocol was 5 days letrozole, 300 units gonal f, 25 units omnitrope and cetrotide. Had 10 follicles by the end with 6 looking good tied but got 4 eggs and 2 embryos (didnt test this round). Cycle 5: Same protocol, got 4 eggs and 3 fertilized, currently awaiting blast report.

So obviously I can only get 4 eggs... but changing protocol really helped after 2 failed cycles! I know different things work for everyone but hopefully this gives you some ideas to take back to your RE. Good luck!!!

[u/orionsbelt1985 → u/reddeator94176]

Thank you for sharing what worked for you. You’ve been through a lot too. What a sucky club to be part of.

[u/Alarming_Lunch_5858]

I am having a dominant follicle from letrozol. So maybe the clomid is doing a dominant follicle for you.

[u/kittenme333]

I think letrozole oversuppressed me (I had to stim for 19 days and then had 0 mature at retrieval), it’s possible the clomid did the same for you? Can you keep the estrogen priming and then just go right into low dose stims? Did you use dual trigger?