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How I got to this protocol (m/c ment)

May 3 2011 at 2:26 PM
Mrs. A  (no login)

Response to Mrs. A..

was after having done 2 EPP/high stim cycles with Cornell that resulted in BFNs. I moved to Check and did low stim and had my best response but ended with a chemical. I then figured co-culture would be the trick so I jumped back to Cornell. I asked Dr. Davis if we could replicate the Dr. Check protocol but he didn't agree with Check's protocol - said it leaves room for a lead to develop when you have such low stims. So instead he agreed that low stim was better but that the Clomid would allow for better even growth and for my own system to kick into the process.

The protocol was to start Clomid on CD2 assuming I had an FSH of 12 or under all on my own (we had given up on EPP by that point due to history of oversuppression). My CD 2 numbers were E2 less than 20, FSH 12.8, LH 4.3; u/s: 4-6 follicles less than 10 MM on each; lining was 4 MM. Even though I was above the FSH cut-off by 0.8, Dr. Davis allowed me to cycle. I started Clomid that day. 100 mg for 5 days. On CD 5 they started me on 150 Gonal F and 75 Menopur. My first b/w and u/s monitoring was not until CD 8. That day Dr. Davis was the RE who did my u/s and he noted 14.5 MM, 10 MM, one less than 10 on left; 4-6 less than 10 MM on right; lining was 5 MM. Given I had that 14.5 MM lead already (in spite of the Clomid) I had to start Cetrotide right then and there.

I continued to stim (and of course continue the Cetrotide) until CD 12. On CD 13 I went in for b/w and u/s and given my results (E2 679, LH 0.5; u/s: 23.4 MM, 18.4 MM, 16.6 MM on left; 15.5 MM, 12.9 MM, 11.6 MM on right; lining was 11 MM), I was instructed to only do the Cetrotide and trigger. THe following day (day before ER) my b/w and u/s showed E2 738; u/s: 25 MM, 20.7 MM, 16.2 MM on left; 16.3 MM, 15.6 MM, 13.6 MM on right; lining was 12.3 MM.

My RE for ER was Dr. Spandorfer and he only got 4 eggs out of the 6 follicles. sad.gif All were ICSIed but only 3 fertilized. (I have no MF whatsoever - in fact total opposite - but Cornell is big on doing ICSI especially with potential poor responders). On day 3 I transferred an 11 cell, a 5 cell, and a 4 cell. As Dr. Schattman (RE at transfer) put it, embies that were "too fast and too slow". sad.gif

The important thing to note about this cycle was that I altered my own meds CD 9 through CD 12. My experience between my 2 cycles at my local clinic and my 2 cycles at Cornell was that my meds were always kept at the same ratio throughout the whole stim cycle. But with my Check/Cooper cycle, my meds were adjusted based on the b/w and u/s results. I figured I had compromised with Dr. Davis by agreeing to the Clomid given his comment about leads but I just didn't feel comfortable keeping my meds at the 150/75 ratio all the way through. So as the cycle progressed I played RE. I'm glad for that because as you can see it was not harmful. It didn't kill off any follies and I believe that it actually helped some follies sprout up.

After the confirmed BFN, Dr. Davis and I agreed that it was right to try again with the same protocol given my response. Since I wanted to do co-culture I couldn't cycle right away due to needing a month off for the biopsy. So the following cycle after that we re-started. I decided that I would follow the instructions and not self-adjust meds. After 9 days of meds, the cycle produced 1 lead follie with sort of 2 others in play and Dr. Davis cancelled me and converted to IUI. sad.gif Cycle was BFN.

Back on the horse AGAIN, immediately following that BFN. After 11 days of meds I only had 1 follie and nothing else. I cancelled myself before I got the call. I just felt like I had it in me still to get a better response.

After that last try was when I jumped back to Cooper. And it was obviously the right move because that IVF, while it produced ugly embies and a BFN, I at least went to ER with 4 follies. This depsite the fact that I started the cycle with a horrendous AFC! By that point my AFC was barely registering. The AFC assignment I received was 0-2 on each ovary and it was more like 0 except that my local monitoring clinic doesn't just do "zero"; their lowest assignment is 0-2. Oh and my AMH had come in at 0.3 just 2 months earlier.

For my situation, it was obvious that Cooper could get me to produce more follies. But it goes without saying that my very first try with the Clomid/injectibles cycle did do the job. I just couldn't achieve the same follie success with the following 2 tries.

Now, bonus commentary to all of very first PG was during the cycle that I went for my very first RE work-up and they did the CCCT as part of that. So Clomid alone did actually work for me at one point; that plus the fact that I had an HSG done the same cycle. (Unfortunately that PG ended in m/c).

Have you asked Dr. Spandy if he is requiring an FSH cut-off for CD 2 to start the protocol? I think that is a very important question to ask if you haven't already.

Keep me posted and let me know if there are any other questions.

 Respond to this message   

  1. Mrs. A, you are A for Angel! - BabyDance on May 3, 2011, 2:58 PM
    1. Check protocol - Mrs. A on May 3, 2011, 4:09 PM
      1. one last point - Mrs. A on May 3, 2011, 4:12 PM
    2. btw, let me get back to you on the EPP/estrogen Q - have to run out n/t - Mrs. A on May 3, 2011, 4:34 PM
      1. OK so - Mrs. A on May 3, 2011, 10:13 PM
        1. Re: OK so - BabyDance on May 4, 2011, 2:52 PM