natural of mini ivf for poor responder/AMA?

(8 posts)(4 voices)
  1. Hi,

    What do you ladies who are dealing with DOR think about natural or mini ivf? I know there is a board on this subject, but I'm interested in hearing from over 40's.

    I sometimes wonder if all those high stims are affecting my eggs. I always respond about the same on high and lower doses of stims anyways, and don't get more than a handful of eggs each cycle, so maybe doing a less is more approach is better?

    Maybe a mini ivf is a better idea, less expensive too. Then doing back to back cycles and freezing in order to get a fair amount of embryos to FET later.

    Or is it better to keep doing EPP/antagon a better approach to have more to work with and hopefully find the golden egg.

    I\'ve had repeated m/c's and am trying to think of a way to avoid anymore losses. I am also considering some sort of cgh testing, although I don't produce many embryos, so not sure if it would be possible.

    What do you ladies think?

  2. Dear aindia:

    You are asking some really important questions and like you I am hoping this board is able to generate a discussion on the subject. I wonder if any over 40 have successfully tried this approach. I am also wondering what if any advantage a mini-IVF has over an IUI (or lightly medicated IUI)?

    My previous RE with whom my first IVF cycle was cancelled certainly feels that my ovaries are going to produce the same limited number of follicles whether I am on high doses or low doses of medication. i wasn't prepared to buy that argument until I tried another protocol that I felt was less suppressive than theirs. So I moved to Cornell and will hopefully be beginning IVF #2 on an EPP/antagon cycle with them in early November. So the verdict is still out on my ovaries, we will see ...

    I do look forward to hearing about the thoughts and experiences on the subject. Thanks aindia for initiating the discussion.

  3. Thanks Bluenile,

    Hopefully there will be others chime in.

    I did EPP/antagon at Cornell last year in hopes of a very aggressive protocol getting more eggs. I still got the same amount as I did on long lupron with much less stims(although I was younger) and flare with also min stims. I did bcp antagon as well, and again got about the same amount of eggs/embryos. I think in my case I will always get only a 4-5 eggs. Luckily my fertilization is always 100% and my embryo quality is good, although I still m/c.

    Hope your ivf#2 works good for you and you produce more on EPP. Good luck!

  4. Out of curiosity helena, what were cornell's suggested next steps for you. did you do all your protocols with them? And what are you working on at present?

    i will keep you posted on how well i respond to the the epp/antagon - the protocol prior to this was SIRM's on agonist/antagonist conversion protocol with EPP. Very poor outcome - I'm hoping I do better on Cornell\'s.

    Best.

  5. HI,

    Dr D suggested that I do EPP/antagon again with him, but since I'm from OOT, I decided to stay home and cycle locally doing the same protocol. It didn't make much difference in my case (although quality at Cornells labs was a little better). I only did the one cycle at Cornell and also a FET. I did get bfp on the fresh cycle but it was ectopic. I got bfn on the FET. I seem to always respond the same on every protocol I do... I've done long lupron, flare, EPP, antagon and still always get about 4-5 mature eggs that all fertilize and look good. That is why I'm 'thinking' about mini ivf and banking (freezing) all my embies until I have a decent amount for FET later on. OR, I'm thinking of doing CGH (which SIRM and CCRM only do) in order to find any normals. I have had multiple losses, so really want to avoid anymore. Just trying to figure out what the best approach.

    Good luck with your Cornell cycle. I really did like Dr D and the lab is excellent.

  6. helena,
    The other thing to consider if you want to bank cycles is which clinics vitrify, especially if you are AMA. Standard freezing is hard on the embies and vitrification has a much, much higher success rate for thaw. It's certainly not 100%, but it seems to be well into the high 90%s. I know CCRM vitrifies b/c that's where I am, but I think there are a few others, so even if you just bank without testing, you'd want your embies vitrified. Personally, I couldn't deal with ALL those transfers (I mean how many would they be willing to put in at a time, even with AMA? 6? 7?) over and over again--too emotional. There's one woman around on the boards who seems to have banked a very high number of embies and I just can't imagine having to go through that many transfers to find that one or two normals and the CGH will help you narrow things down. The problem you'll have with that though is that at least at CCRM they generally want to see at least 6 embies on day 6 to go to blast b/c they test at day 5 or 6. SIRM I believe tests on day 3, so that might be more do-able but of course there is some debate over whether day 3 potentially harms the embie more than day 5 test (which only takes placental cells). Good luck, check out the Denver board if you have more questions on their CGH program, there are a lot of threads on it and their own web-site has some information too.

  7. helena, I encourage you to go this route. Banking is also less demoralizing, because you are not getting BFNs all the time. It makes good sense to me, and it's what I focused on towards the end. I am not a poor responder, just AMA. But low stim makes sense for you, as you don't get many eggs anyway, and you should always aim for the dominant follicle. At most mini-IVF clinics, they tend to do SETs. So you might not be able to do a multiple transfer at the end. What I did was do several kinds of protocols. I knew I was going to do an IVF every month, and I decided what I was going to do at the beginning of the month. With the mini-IVFs, if I was feeling tired of clomid, I would ask for letrozole. If I were feeling strong that month, I would do a low/medium stim. If I felt like giving up, I would just do a natural IVF (well, close to a natural). And in this way I was able to continue to cycle back-to-back, and bank some embryos. I intend to do a series of FETs. My embies (I only have a few) don't do very well in the dish, so I will transfer them all back early and not grow to blast.

    One thing that doesn't get discussed very much here is the approach used by Cooper center in NJ ccivf.com They don't do mini-IVF, more low/medium stim. They have tons of experience with DOR, AMA, high FSH. I would explore that too. You can work with one RE, or go to a couple of REs. As long as they do vitrification, you can experiment with the protocols. Actually I would try many things, changing the variables, until I found the approach that works best for me. Good luck.

  8. Thanks very much for your thoughts. It still is hard to figure out which route to go, since where I live there are no clinics that currently do vitrification. That means I'd have to travel and if I do low stims at NHF or Cooper or even SIRM, I'll have to travel over and over each month, which will be crazy.

    I could try CCRM, but I don't think they do the mini ivf's. I would be willing to do a high stims there if I could do cgh, but- I don't know if I can get 6 embryos on day 3 or not. I usually get about 4-5, but I could try to push them to go to blast, or I could just do a day 3 transfer and gamble on another m/c. Then I think is it worth all the extra cost to go to CCRM if I'm doing the same thing I'd do locally, except they have better labs and protocols?

    Such a hard decision and I don't have time to waste. Hopefully I'll make a decision soon.

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