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femara, clomid, testosterone, and a tiny boost

May 15 2012 at 11:06 AM
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BroodyHen  (no login)

 
a lot of recent posts are of great interest to me, so thanks ladies happy.gif

i have decided to try femara this cycle. in researching it, i came across some info that femara may, by stopping estrogen production, increase testosterone. then mel posted about testosterone and shared some interesting studies about t levels. what do you think? is this similar to what MIR & B are talking about with clomid? i know femara and clomid are different mechanisms, but maybe the end result is the same with a boost to testosterone inverse to suppression of estrogen. is there something to the process of "naturally" increasing FSH via clomid or femara vs. increasing FSH by taking FSH?

when i asked my RE about femara she said that it has a slowing effect while follistim has a growing effect. for me, when i have just done low-stim my cycle is accelerated and i ovulate 2 or 3 days early, which has only allowed for around 7 days of stims. others have posted about how there is an optimal number of days to stim, and i fear 7 days is too short. my RE agrees, and thinks that by starting with the femara for 5 days it will slow my cycle while coaxing more follicles (from my crop of 5 antrals, one of which was already at 11 on CD2, which worries me but doesn't worry my RE. i'm afraid i'm not going to get more than one). then i'm going to add 75 follistim for a few days and see what i've got. i'm going to start testing for my LH surge way early, though, because i'm still afraid i'm going to miss it. anyway, antonialisa had posted about c.heck's tiny boost protocol, which is really interesting. adding the 75 follistim around day 8 seems a bit like a tiny boost, doesn't it? interesting that clomid or femara followed by a tiny boost might be a winning protocol. i certainly hope so!

i've never tried femara and this is a different protocol for me, so i'm kind of excited and nervous about it. we'll see...

if you are interested, i'm interested in your thoughts. thanks again, everyone!

 
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AuthorReply

(Login miraclex2)

My experience with Clomid

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May 15 2012, 12:10 PM 

First of all, I think I am an good responder on Clomid, because I always respond with follicles and the side effects are small compared to lots of things I read - but it may also because I don't have period any more, so I just go by the estimated luteal phase no matter what.

Clomid definitely slows down the stim time for me. When on injectable FSH, my stim time is 6-10 days, anything below 8 days is definitely not good news, hence the horrible egg quality. When on Clomid, my stim duration is 9-15 days, I was a bit worried about being on it for 15 days, but my RE assured me that Clomid stim is typically longer and 15 days of stim is nothing to worry about. He said it is because Clomid induces my own body to manufacture FSH, and that process takes longer than injecting recombinant FSH directly. The exact chemical makeup of the two is not identical.

I haven't had a transfer so far, so I don't have the final verdict on the quality, but the fact that so many of my arrested embryos stopped at morula or beyond stage and I repetitively made highest grade blasts tells quite a bit compared to my embryos that died left and right at 2-4 cells on day 3 when I was on high dose recombinant FSH. Lab will have something to do with it, but my eggs still have to carry most of the weight. I also don't think it is a fluke, because I did 4 conventional cycles and 4 mini-cycles so far, so there is enough data point that I can use for comparison.

So apart from the lab, I think low-stim IVF has two legs: 1) low dose that minimizes aneuploidy 2) the addition of Femara or Clomid to induce one's body to manufacture natural FSH vs recombinant FSH


    
This message has been edited by miraclex2 on May 15, 2012 12:16 PM


 
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Anonymous
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Re: My experience with Clomid

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May 15 2012, 5:48 PM 

thanks for the reply, MIR. your experience is illuminating. a few more questions:

1) so you think the benefit of clomid/femara is that the FSH is home grown rather than imported?
2) do you think it also has anything to do with testosterone?
3) clomid vs. femara - does it matter? is one better than the other?
4) do the days taking clomid or femara before/without FSH count as stim days?

thank you!!



 
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BroodyHen
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ooops! sorry, that was me above n/t

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May 15 2012, 5:49 PM 


 
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(Login miraclex2)

It depends on the individual

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May 15 2012, 8:23 PM 

1) From what I read, it seems like recombinant FSH has very similar chains as natural hFSH (human fsh) but not completely identical. So whatever components that are different may account for the quality difference. It makes sense to older ovaries. For younger ovaries, recombinant is enough of a stimulus. Older ovaries are less responsive and therefore may need that extra kick of natural hFSH.

2) I think everyone should take a testosterone test, and I did. If your testosterone level is normal, I suspect adding testosterone priming will do much (hence the mixed results at CCRM). If one is marginally low, then adding testosterone is beneficial.

3) I have never been on Femara, so I can't comment on that. I hate the rock the boat that is working for me right now. But I would love to learn about it from those who have used it.

4) Stim days only count the days on which you are doing the stim.


    
This message has been edited by miraclex2 on May 15, 2012 8:23 PM


 
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BroodyHen
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thanks

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May 16 2012, 10:49 AM 

ok, the days on clomid/femara don't count as stim days. wow! i'm supposed to take femara for 5 days staring on CD3 which means ovulation shouldn't be before CD16 if a min 8 days of stims is optimal?! wow - i sure hope i make it that far. i guess i'll have to wait and see if femara, indeed, has a slowing effect. how many days do you do clomid before starting stims? after the femara i'm only going to be doing 75 follistim. how much do you take after the clomid? and do you need ganirelex typically with this type of protocol?
thanks you!

 
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MIR
(Login miraclex2)

Sorry, I was not clear

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May 16 2012, 12:24 PM 

The days on stim drugs including Clomid is counted in stim duration. However, I am not sure about Femara, because it is really a cancer drug used in fertility, so I am not sure if it is a priming drug or a stim drug by itself.

 
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BroodyHen
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thx for clarification and one more question

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May 17 2012, 12:11 AM 

right, i'm going to ask my RE if they think days on femara count as stim days.
do you think 75 follistim daily after the 5 days femara is reasonable? is that what you do after your clomid? oh, and do you need ganirelex on this protocol?
thank you!

 
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Anonymous
(Login di_nyc)

At my clinic, they count days taking Femara as part of stim days nt.

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May 17 2012, 1:03 PM 


 
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BroodyHen
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thank you di_nyc!

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May 17 2012, 6:38 PM 

do you have a lot of experience with femara? do you think you did better on it than with other protocols? thanks.

i hope you are feeling better from your retrieval.

 
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di_nyc
(Login di_nyc)

Re: thank you di_nyc!

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May 17 2012, 6:51 PM 

Yes, but the only other protocol I was ever on was super high stim, and lower stims were clearly the way to go for me. Since I never did Clomid, I really can't weigh in on the Clomid vs. Femara question. However, I've done Femara protocols for my past 3 cycles without incident (as far as anyone can tell at this point... I think my RE thinks the study linking Femara to possible birth defects is flawed, though I can't recall his exact words on the subject).

And, thank you! I'm still recovering from the retrieval--my bladder continues to be irritated and my baseline u/s yesterday was the worst it's ever been, so I think I will probably end up waiting ten weeks instead of six to let my body heal completely from this ER before cycling again.

Good luck to you with trying the Clomid (or Femara) if you decide to do it!

 
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BroodyHen
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Re: thank you di_nyc!

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May 20 2012, 10:59 AM 

thanks. i am trying femara this cycle so i'll report back on how it goes.

sorry to hear about your baseline. that is a drag. hopefully you'll enjoy your rest/break and come back with some juicy follicles... feel better!

 
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(Login miraclex2)

75IU injectables per day

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May 17 2012, 7:33 PM 

On a typical Kato-style mini-IVF, it is about 50mg Clomid for ~13 days + no more than 3 Menopur shots @ 150IU each. I have seen New Hope doing 1 or 2 75IU Follistim shots on top of Menopur shots. The total Menopur IU is 450 or less.

So if you stim on injectables for about 8 days = 600IU, I'd say the dosage is about comparable for both protocols.

 
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BroodyHen
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thanks, MIR

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May 20 2012, 11:00 AM 

that is what i'm doing - 75 follistim daily after 5 days of femara.
thank you!

 
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