# Changing IVF protocol to improve egg quality



## TTB

I am wondering if any of you lovely ladies has had any experience in changing your IVF protocol to improve your egg quality?

I have had 4 failed ivf cycles on the short antagonist protocol which all failed, 3 out of the 4 cycles I had 1 average embryo which resulted in chemical pregnancies and 1 cycle I had nothing to transfer.

After taking a break for a while, we are starting a new cycle in May. I am on a healthy eating plan and trying to take a lot better care of myself.

My FS now suspects I may have a tiny bit of adenomyosis, so wants me to try a long protocol this time using synarel. I am just wondering if anyone has had success in improving their egg quality by changing the protocol used?


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## bugs

I can't help you with protocols but have you had any immune testing done. Just with having 4 early losses there could be an underlying issue xxx


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## TTB

Thanks bugs!

I have had pretty much every test under the sun, miscarriage work up, hsg, mri, uterine biopsy and all came back fine. I'm pretty sure the miscarriage work up covered immune testing, but i'll double check that with the clinic.


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## bugs

It's definately worth a looking at. I have raised levels ok NK cells but I also produce a lot of immature eggs on each cycle so I'm also looking for a new protocol. 

Looking at your sig your quality doesn't look that bad. We've never had enough to do a day 5 transfer so that's the hope for next time xxxx


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## Lucie73821

I do think a change of protocol can help. For our first ivf, I did lupron, 300iu of follistim and 1 vial of menopur for 9 days. I had 19 eggs retrieved, 13 were mature, and 9 fertilized. We transferred 3 on day 3 and had none to freeze. Of those three we transferred, none were great quality. 

For ivf #2, I switched re's. this time I did 150iu of follistim, 1 or 2 vials of menopur (it varied), and ganirelix was added for the last few days of stimming. I believe I stimmed for 12 days this time. I had 26 eggs retrieved, 25 were mature, and all of them fertilized. We put two back and ended up with 6 frozen. As you can see in my sig, they both took, but sadly I had a double ectopic (both implanted in my right tube).


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## TTB

Thanks ladies!

Just confirmed with the clinic that the biopsy, blood tests and all of that were fine. No immune issues.

bugs - I usually had 1 good egg make it each cycle, and that is what gives me hope. But its because its only 1 good one out of like 12 or 17 eggs that the doc is suggesting donor. My opinion is that as long is there is one good one in there, how can I possible think about donor.

That's exciting to see changing protocol can help egg quality. My FS didn't really indicate this change would help egg quality but suggested it may help with implantation due to a small amount of adenomyosis found on my mri, and that the down reg would suppress that. Fx for my next cycle

Lucie - sorry to hear about your double ectopic pregnancy, that is really such bad luck! Life can be so cruel sometimes!!


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## TTB

If anyone else has experience with changing protocol and resulting egg quality, I would live to hear more about them.


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## HappyAuntie

Hi TTB - there's no guarantee that a change in protocol will result in better quality eggs, but after four cycles on the same protocol with the same results each time, I think it's definitely time to consider a change. When my RE recommended changing protocols I was scared to death because I'd always responded well on the short antagonist, and I was afraid that a new protocol might mean a worse response. But he assured me that he wouldn't switch me if he thought I would respond worse. My nurse also encouraged me by pointing out that yes, I'd responded well on the short antagonist but I still didn't have a baby, so maybe a different protocol would produce a different end result.

1st cycle = short (natural start) antagonist. 8 eggs retrieved, 6 mature and ICSI'd, 4 fert, 1 blast and 1 morula on day 5. Elective single blast transfer, BFP, mc. The morula arrested, so no frosties.

2nd cycle = same short antagonist. 11 eggs, 8 mature and ICSI'd, 6 fert, 3 blasts on day 5. Elective single blast transfer, BFN. 2 frosties (FET also BFN)

3rd cycle = estrogen priming. 19 eggs! 17 mature and ICSI'd, 15 fert, 5 blasts on day 5. Transferred 2, BFN. FET of the remaining 3 = BFP, but another mc.

But what encourages me is that with the change in protocol, my third cycle was better than the first two combined (in terms of numbers of eggs/blasts). So I would advise that if your RE wants to try a different protocol, trust him. He has learned a lot about how your body responds over the first 4 cycles, and if he thinks a different protocol might produce a different result, it's worth a shot.

We're also taking a mental health break for the time being, but when we go back for cycle #4 I'll be on the estrogen priming protocol again.

(And I was 38 for the first two cycles, 39 for the third. I was pretty excited my 39yo ovaries spit out 19 eggs. :thumbup: )

Good luck to you. :flower:


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## Arlington_TTC

HappyAuntie said:


> Hi TTB - there's no guarantee that a change in protocol will result in better quality eggs, but after four cycles on the same protocol with the same results each time, I think it's definitely time to consider a change. When my RE recommended changing protocols I was scared to death because I'd always responded well on the short antagonist, and I was afraid that a new protocol might mean a worse response. But he assured me that he wouldn't switch me if he thought I would respond worse. My nurse also encouraged me by pointing out that yes, I'd responded well on the short antagonist but I still didn't have a baby, so maybe a different protocol would produce a different end result.
> 
> 1st cycle = short (natural start) antagonist. 8 eggs retrieved, 6 mature and ICSI'd, 4 fert, 1 blast and 1 morula on day 5. Elective single blast transfer, BFP, mc. The morula arrested, so no frosties.
> 
> 2nd cycle = same short antagonist. 11 eggs, 8 mature and ICSI'd, 6 fert, 3 blasts on day 5. Elective single blast transfer, BFN. 2 frosties (FET also BFN)
> 
> 3rd cycle = estrogen priming. 19 eggs! 17 mature and ICSI'd, 15 fert, 5 blasts on day 5. Transferred 2, BFN. FET of the remaining 3 = BFP, but another mc.
> 
> But what encourages me is that with the change in protocol, my third cycle was better than the first two combined (in terms of numbers of eggs/blasts). So I would advise that if your RE wants to try a different protocol, trust him. He has learned a lot about how your body responds over the first 4 cycles, and if he thinks a different protocol might produce a different result, it's worth a shot.
> 
> We're also taking a mental health break for the time being, but when we go back for cycle #4 I'll be on the estrogen priming protocol again.
> 
> (And I was 38 for the first two cycles, 39 for the third. I was pretty excited my 39yo ovaries spit out 19 eggs. :thumbup: )
> 
> Good luck to you. :flower:

Hi HappyAuntie -

I've been reading your EPP-related posts and wanted to ask you a question. I"m a 40 y.o. and in the middle of my 2nd cycle (the first one was a "lupron stop" protocol) which is a EPP/antagonist protocol. Did you have a slow start? From what I'm researching on different sites/forums, it's being described as a "slow burn" cycle, and that it's not unusual to start really slow. I'm really hoping that's the case, as my E2 numbers are bumping up really slow, even slower than my lupron cycle - which I thought over-suppressed me, and this is even slower! Would you kindly share how your E2 and follicle progression went for your cycle? thank you so much!


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## HappyAuntie

Arlington_TTC said:


> Hi HappyAuntie -
> 
> I've been reading your EPP-related posts and wanted to ask you a question. I"m a 40 y.o. and in the middle of my 2nd cycle (the first one was a "lupron stop" protocol) which is a EPP/antagonist protocol. Did you have a slow start? From what I'm researching on different sites/forums, it's being described as a "slow burn" cycle, and that it's not unusual to start really slow. I'm really hoping that's the case, as my E2 numbers are bumping up really slow, even slower than my lupron cycle - which I thought over-suppressed me, and this is even slower! Would you kindly share how your E2 and follicle progression went for your cycle? thank you so much!

Happy to help! Let me do some digging through my file and see what I can find. Off the top of my head, I don't recall getting off to any slower a start than I had with the first two cycles, but I do know I stimmed a day or two longer than I had with the first ones. I think, though, that had to do with letting the little ones catch up (since there were so many) and not because of a slow start.... :shrug:


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## HappyAuntie

Ok, here's what that cycle looked like:

Priming cycle:
- use OPKs to watch for LH surge.
- 10dp surge: start estrace twice daily
- 11, 12, and 13dp surge: add ganirelix once daily 
- wait for cd 1, continuing on estrace twice daily...
CD1 - estrace twice/day
CD2 - estrace in AM, bloodwork and ultrasound. When both are confirmed good to start cycle, discontinue estrace
CD3 - begin stims. For this cycle I was on 150iu menopur in the AM and 300iu Gonal-F in the PM, and those doses stayed constant throughout stimming. Ganirelix was added back in when needed. 

stim day 5:
E2 = 124, LH = 1.3, P4 = <0.2
follie count and sizes: 9mm, 8mm, 5 at 7mm, 3 at 6, 5 at 5, 2 at 4.

stim day 7: 
E2 = 378, LH = 1.55, P4 = 0.236
follies: 12.5, 3 at 11, 10, 2 at 9, 6 at 8, 3 at 7, and a whole bunch at 5.
Started ganirelix the next day.

stim day 10:
E2 = 1242 (LH and P4 unknown - I had a weekend nurse that day so I didn't get as much info from her as I can get from my regular nurse)
follies: 17, 16, 2 at 15, 14, 2 at 13, 3 at 12, 11, 2 at 10, 4 at 9, 2 at 8, 6

stim day 12: 
E2 = 2940, LH = 1.5, P4 = 0.77
follies: 3 at 18, 17, 4 at 16, 6 at 15, 13, 4 at 11, 10

stim day 13: 
E2 = 3769, LH = 1, P4 = 0.7
follies: 24, 2 at 20, 3 at 19, 4 at 18, 17, 16, 15, 3 at 14, 3 at 13, 12

stim day 14:
E2 = 4293, LH = 0.7, P4 = 1.1
follies: 26, 25, 22, 4 at 20, 2 at 19, 3 at 18, 2 at 17, 16, 14, 2 at 13, 12
Triggered that night with 5000iu hCG and 40iu lupron in PM and a 2nd dose of 40iu lupron the next morning.

On the previous cycle (my 2nd short antagonist cycle), my E2 got up to around 3200, so not far from where it hit on this one. 

I hope that helps. :flower:


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## Arlington_TTC

Thank you so much for looking up all that information for me. It certainly does look like you had a very nice response... perhaps mine will pick up soon. It's been maddeningly slow. 

I really appreciate your help again. From what I read - it sounds that you're on a short break and will be starting up again? If that's the case, the best of luck to you!

Thanks...


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## HappyAuntie

You're welcome, and good luck to you!


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## Wallie

I just wanted to say that I was with my first clinic for three cycles and I always did the long protocol. No success, no frosties, no chemicals. In the end the FS said I have a problem with my eggs and should consider donor, but that's not an option for me.

I changed clinics and they put me on the flare protocol. It was obviously a much quicker cycle from start to finish which helps you physcologically. I had roughy the same amount of eggs collected and three fertilised (ICSI) I know this doesn't sound alot but the quality of these three were seemingly excellent. I ended up having 2 transferred (1 Frostie) and had a chemical pregnancy.

The frozen embryo defrosted and was hatching by the time they transferred it back to me. Unfortuantely again this was a chemical pregnancy. 

I'm looking to do another cycle June/July this year and hope this one becomes a :bfp: I will be doing the same protocol as the quality of my eggs were much better. I felt the long protocol suppressed my ovaries too much and they had to fight to stimulate any eggs I had, therefore comprimising their quality. However it could just be a change of clinic/embryologist handling the eggs?

Also for next time the cycle before, in my LP,I will be having an edometrial scratch. Seemingly it gives a 70% chance of implantation. Also we could have EEVA (Early Embryo Viability Assessment Test) where a camera looks at the eggs to ensure that each stage of separation happens within a specific timescale. The embryologist can determine which egg will have more success.

So personally for me the quality of eggs have improved changing protocols.

Have you also thought about taking DHEA to improve egg quality? You take these for 3 months prior to any cycle.


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## TTB

Thanks so much for responding! I hope your next cycle results in your BFP!
I haven't tried DHEA, from what i've heard it is for a very specific group of people, I asked my FS and he shot it down.

I followed up with the clinic again regarding my biopsy results and it appears my nk cell CD57+ is borderline, so waiting to hear back whether they are going to treat it or not. My biopsy was done back in July last year so i'm a little annoyed they didn't mention that to me, they said it was normal back then :/



Wallie said:


> I just wanted to say that I was with my first clinic for three cycles and I always did the long protocol. No success, no frosties, no chemicals. In the end the FS said I have a problem with my eggs and should consider donor, but that's not an option for me.
> 
> I changed clinics and they put me on the flare protocol. It was obviously a much quicker cycle from start to finish which helps you physcologically. I had roughy the same amount of eggs collected and three fertilised (ICSI) I know this doesn't sound alot but the quality of these three were seemingly excellent. I ended up having 2 transferred (1 Frostie) and had a chemical pregnancy.
> 
> The frozen embryo defrosted and was hatching by the time they transferred it back to me. Unfortuantely again this was a chemical pregnancy.
> 
> I'm looking to do another cycle June/July this year and hope this one becomes a :bfp: I will be doing the same protocol as the quality of my eggs were much better. I felt the long protocol suppressed my ovaries too much and they had to fight to stimulate any eggs I had, therefore comprimising their quality. However it could just be a change of clinic/embryologist handling the eggs?
> 
> Also for next time the cycle before, in my LP,I will be having an edometrial scratch. Seemingly it gives a 70% chance of implantation. Also we could have EEVA (Early Embryo Viability Assessment Test) where a camera looks at the eggs to ensure that each stage of separation happens within a specific timescale. The embryologist can determine which egg will have more success.
> 
> So personally for me the quality of eggs have improved changing protocols.
> 
> Have you also thought about taking DHEA to improve egg quality? You take these for 3 months prior to any cycle.


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