My colorful protocol

Today, C and I went in for our IVF medications “teach class”. I’m not sure why they need to add the word ‘teach’ in there. Are there classes that don’t involve any teaching that they need to distinguish this one from? Are they distinguishing this class from a “learn class”? (Our legal counsel informs us that we can’t promise that you’ll learn anything, but by God, we’ll teach you!) Actually, maybe I can use this…I think I’m going to rename all my courses “teach classes” to spare myself any responsibility for my students actually learning anything…

Anywho, it turns out IVF is a hell of a lot more work than medicated IUI. (Once again, I can hear all the seasoned IFers in unison…No shit!) The list of medications that I have to take is long and expensive, and I can see why my insurance drew the line after IUI…

It also seems like my protocol is a little unusual, so I thought I’d share the details of it here:

First, my calendar for May:

Image

And my calendar for June:

calendar a

Here’s my limited understanding of what everything is for:

  • Zithromax – to ensure that C & I are infection-free prior to beginning the cycle
  • Estradiol – to help me recruit more eggs and to prevent any new cysts from forming (which would force me to delay the cycle)
  • Testosterone (gel & patch) – to try and recruit a few more eggs (In explaining this one Dr. Y was careful to say “in theory” several times, leading me to think that this claim has not been proven…)
  • Aspirin – to improve blood flow to my uterus
  • Menopur – to stimulate multiple follicles to grow
  • Clomid – to stimulate multiple follicles to grow
  • Dexamethasone – to help with implantation
  • Growth hormone – to help the eggs develop/mature fully (to achieve better egg quality)
  • Ganirelix – to prevent premature ovulation (We don’t want those eggs to drop; we want Dr. Y to suction them out with a needle instead…)
  • Follistim (FSH) – same general idea as (and one of the ingredients of) Menopur; I think this serves as a little boost to get the eggs ready to go for retrieval the next day
  • hCG – stimulates ovulation; I’m guessing this finishes getting the eggs ready to drop, but that we’ll time it so that I go in for retrieval before they actually drop
  • Doxycycline – antibiotic prophylactic to prevent infection from the retrieval
  • Prednisone – not sure what the purpose of this steroid is…maybe prevent inflammation?

Has anybody else used testosterone in their cycles? From the mysterious way that Dr. Y talked about it, I get the idea that it’s not part of the typical IVF protocol.

I think another unusual (weird?) thing is that I’m using pretty low doses of stims (especially considering the fact that I’ve got diminished ovarian reserve): 100 mg of Clomid and 150 IU of Menopur per day…that’s less than half the daily dose of Menopur that I used for IUI. Dr. Y says that they’ve found that success rates with the low stim protocol are comparable to those with high stim, but at much lower cost.

Lastly, you may have noticed that the calendar above doesn’t include an embryo transfer. Dr. Y insisted that an important feature of this protocol – and one that he recommends for old lady patients (and patients with old lady ovaries, like me) is that it does NOT involve a fresh embryo transfer following retrieval. Instead, the plan is to flash freeze (vitrify) my embryos and store them for a full cycle while my body purges itself of the colorful drug cocktail listed above. In particular, the Clomid is supposed to make for a somewhat hostile uterine environment. According to Dr. Y, for older women, postponing the transfer for a month actually gives higher pregnancy rates.

My read of the clinic stats seems to validate Dr. Y’s claim: In 2011, the % of FETs resulting in clinical pregnancy was 58.3% for 38-40 year-olds, compared to 56.3% for fresh transfers for the same age group – despite transferring more embryos on average for the fresh transfers (2.1 per transfer versus 1.8). For younger women, the fresh transfer is definitely better, so the only question is whether this 34-year-old with diminished ovarian reserve will behave more like the average infertile 38-40 year-old, or like the average infertile <37 year-old…

I guess we’ll see! Anyway, I trust Dr. Y and am perfectly happy to go with his professional judgment. (Of course, my trust for Dr. Y’s judgment didn’t prevent me from trying to mine the SART data to answer this question, but it turns out that my clinic didn’t treat enough <37 year-olds with DOR to give meaningful data…)

The punch line of this is that assuming my sonogram in two weeks looks good (crossing my fingers for lots of follicles and no more cyst!), I’ll be moving ahead with the egg retrieval in mid-June, and assuming we get any good embryos (fingers crossed yet again), I’ll take a uterus-cleansing drug holiday in July followed by a frozen embryo transfer in August!

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20 Comments

  1. How exciting! Instead of testosterone, I had HGH. I didn’t realize it was a big deal, until the doctor emailed me an entire study on it. Unlike you, I do not have a science background. That study made my head spin. However, the HGH was supposed to essentially do what your testosterone will do. Happy IVF to you!!!

    Reply
    • Thanks for your enthusiasm! I think I have HGH too (in yellow on the calendar), so I’m not sure where the testosterone fits in… The bad news about being a scientist is that it really only qualifies you to understand what’s going on in an EXTREMELY narrow field of interest (in my case natural products chemistry, a subfield of organic chemistry). When it comes to reading medical articles, I’m completely at a loss!

      Reply
  2. As a fellow DOR patient, I’m super interested to see how your protocol works out. I’m assuming the estrogen and progesterone are in place of BCP for suppression? I was oversuppressed on Lupron so they switched me to Cetrotide for my second cycle. Also, I’ve always done huge doses of Menopur and Gonal-F, so I’m really interested to see if the lower doses work for you. If so I might be printing this out and bringing it in to my RE for some inspiration! I really hope this works for you. (Oh, and I did the “freeze all” thing last cycle as well. It apparently can have great results. Just not for me, unfortunately.)

    Reply
    • I’m not sure about the estrogen, but that would probably make sense, since he said that it would prevent cysts from forming. I’ll definitely keep you posted as I learn more!

      It’s frustrating how all this stuff seems to work; it doesn’t seem to be rigorous, data-driven science at all. The rationale for a lot of the protocol changes seems to be “well, it seems to work for some people, so let’s just try it…”

      Reply
  3. AAR

     /  May 16, 2013

    let me know if you ever need help interpreting medical papers. i’m not an endocrinologist, but i know enough of the basic physiology to understand the ideas. i thought the testosterone addition was interesting too. here’s what i found. in my brief scan of these sites, you’re getting T because you have fewer follicles than average. “Androgens [blah blah] increase antral follicle count”:
    http://www.medscape.com/viewarticle/740680
    http://haveababy.com/fertility-information/ivf-authority/testosterones-role-in-infertility/
    http://www.bellaonline.com/articles/art8952.asp

    Reply
    • Thanks A! I’m so glad to have a physiologist buddy to help me out with this stuff. 🙂 I couldn’t open the medscape article, though. Any chance you could email me the pdf?

      Reply
  4. Knalani -Responding to your comment. I started out on the same forum (fertilitycommunity) and found the same issues, it just seems too busy and too scattered. I found blogging to be much more intimate and you can ‘chose’ your focus group a bit. I tend to follow people who are around my age, no children yet and less overtly religious. I joined the forum for my first IUI, but didnt find it was too helpful, I was becoming jealous of the BFPs and discouraged when women who’s partner’s had really high sperm counts didn’t work while we had a measley 4 million. I skipped it this cycle.
    BTW -when we get to IVF, can you make me a colour chart for my meds?

    Reply
    • Thanks for the reply & info…and I’d be happy to make you a chart, but hopefully you won’t need it (or IVF)!

      Reply
  5. Oh wow. Reading this is very very interesting as I am going to use some of the similar medications and for you to lay it all out is wonderful for me. It’s very interesting to see that the protocols are so different for different people with the same diagnosis. I guess it depends on the doctor’s experience and preference as well as the patient’s numbers. You are one organized person. 🙂

    Reply
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