Hi Dr. Sher,
I started IVF when I was 30y/o and did 1 round with the standard antagonist protocol in March 2022 at CCRM Houston (BCP priming, 225u follistim, 2 vials menopur, ganirelix, combo trigger, dexamethasone qd). Stimmed for 8 days, peak estrogen was 3299, and numbers were 13 retrieved, 8 mature, 7 fert, all arrested at day 3. The very next cycle we decided to try again with a flare protocol (225u follistim, 3 vials menopur (dropped down to 2 after 3 days), 20u lupron bid, HGH 0.4 mL qd, dexamethasone, HCG trigger), stimmed for 9 days, peak estrogen 4190, and numbers were 11, 9, 6, and again all arrested. We did, however transfer 2 day 3’s fresh and got a chemical.
After this, we decided to switch clinics because our doctor said that he did not know what else to try with me and I would be better off trying naturally. The third time in October 2022 we did long lupron with estrogen, aygestin, and testosterone priming. Protocol was 300 follistim, 3 vials menopur, lupron 10u qhs and HCG trigger. Stimmed for 11 days, peak E2 was 1831. Numbers this time were 9, 4 mature, 3 fert, and we decided to freeze them at day 3 instead of letting to grow to blast. These 3 showed >50% fragmentation and was recommended we discard, but allowed me to freeze them against their recommendation.
I have hashimoto’s and celiac disease, questionable PCOS and on metformin, AMH between 3-6, AFC 11-16, and just had surgery with Dr. Vidali in NYC and was diagnosed with stage 4 deep endo to the bowel with left hydrosalpinx. I realize this is a loaded question but I am getting conflicting opinions on what to do next. Is there any truth to high FSH doses being detrimental to eggs/would minimal IVF stimulation be better for egg quality? What would be your recommendation for our next IVF protocol?