Menopur and poor egg quality

[Sophie2015]

Anyone over 40 and use Menopur during their IVF? I'm starting my first IVF cycle soon. My RE wants to use Menopur although I tend to over respond to Follistim alone. I'll be on both for this cycle. We can conceive without IVF but I've had 5 mc's in a row and RE feels I have an egg quality issue. I've been researching Menopur and am finding a lot of information linking aneuploidy to the excess LH Menopur causes. So now I'm worried my eggs will be defective because of the Menopur. Anyone have any thoughts on this?

 

[Lunabelle]

Hi Sophie,

I have gone through two ivf cycles and the last one using menopur. The first round we were using puregon and I had tons of eggs; 16 but none of the embryos were good quality. I got pregnant but miscarried at 7weeks (no heartbeat at 6weeks) and the second time (using menopur) I only had 5mature eggs but we got two perfect quality little blastocycts. I am pregnant again at almost 5 weeks and hoping that this one will last. The results so far have been much better using menopur so I definitely think it is worth the shot!

How many rounds of ivf have you gone through? Did you have the embies tested for genetically? That could decrease the risk of miscarriage for you.

Good luck for the round, i hope you'll get good quality embies!

 

[Sophie2015]

Thank you so much for responding! This is my first IVF cycle. We are only doing IVF so we can do PGS. We have had great success conceiving naturally or with IUIs. But I have mmc's every time. As my body tends to stay pregnant LONGGGGG after the HB stops my RE feels it's an egg quality issue. I have no issue with progesterone, lining, etc. My 4th & 5th pregnancies we tried Follistim with IUI. It worked both times and both times I over responded using Follistim alone (dose was rapidly decreased and I still had 7 follies both times). I'm going to start my IVF cycle with a much higher dose of Follistim plus Menopur. Really worried my E2 is going to shoot up way too fast plus I'm reading the extra LH in Menopur can cause chromosomal defects in the eggs.
This is probably our only IVF attempt. Really hoping they get it right the first time.

 

[Sophie2015]

Oh and congrats!!!!!

 

[Lunabelle]

I was also doubting the use of Menopur, but I think the best thing you can do now is to relax. You can always bring it up with the doctor if you have concerns. I read that they often use Menopur when there has been poor response previously or that egg quality is an issue. I read that on the menopur packaging, which put me at ease during the treatment.

My LH level was high in the beginning so they lowered the dosage. If your LH does shoot up, they will do the same to you. They will monitor you throughout the process.

 

[Sophie2015]

LH is not monitored. Only E2.

 

[messica]

Really worried my E2 is going to shoot up way too fast plus I'm reading the extra LH in Menopur can cause chromosomal defects in the eggs.

I was 32 when we did IVF. Menopur was part of the protocol my RE chose (long Lupron) and I was shocked that I needed to double my Follistim and Menopur to get even a menial response (especially because initial antral count was impressive). Despite the long and hard push during stim phase, at retrieval my estrogen levels were so *low* they anticipated only 5 mature. Ended up with 11, 8 of which were mature, so I definitely suspected quality was an issue. 6 fertilized, 3 failed by day 5, transferred 2 and the last one arrested the following day.

Our infertility was secondary (and due exclusively to male factor in my second marriage). By all accounts everything on my end was fabulous, and I had gotten pregnant first attempt twice before (carried successfully). I was by anyone's account a "fertile myrtle" so I did NOT expect such a poor response.

Please if you've only got one shot (as did we), explore and insist on discussing every single red flag you have. We got very lucky but from what I read after the fact you're right to be concerned about the Menopur in particular.

 

[Sophie2015]

Messica- thank you for your thoughts! I am very concerned. In June and July I did 2 IUIs with lower doses of Follistim than I'll be on for IVF. I had 7 mature follies by day 10 both times and conceived both times.
My CD 3 LH is normal. I OV on my own like clockwork every month. My RE has said if I don't want to use the Menopur I don't have to but he feels I'll have more mature eggs with it (as opposed to a lot of follies with immature eggs). I have 1 shot at this. IVF is somewhat covered by insurance because it's end of the year. Next year it will cost us approx 30k and we can't afford that. I don't know what to do. 😔

 

[messica]

It stinks there isn't a crystal ball for this stuff. My advice would be to proceed in a way that'll leave you as few regrets as possible regardless of the outcome. Lay it all out on paper:
If we do this and that happens, I will feel _____
If we don't do that and this other scenario happens, I will feel ______

That helped us narrow down what we both felt most comfortable with.

If it helps at all we tried to fit everything we planned to do in by the end of '13 and couldn't. An out of the blue bonus check in January allowed us to take the plunge with our IVF in spring of '14 and because of the expenses that bonus check didn't cover - the subsequent OB care, delivery expense and first month of newborn visits were all "free." Depending on where you're from you'll probably end up paying out one end of the process or the other. January/February would set you up for a one year wham bam, knock everything out in one tax year as opposed to meeting deductible's twice over two years to cover both.

(Money is usually a factor for couples on some level, but if it's something you could scrape together and need to do so later on down the road don't hesitate. It is sooooooo expensive but even now hubs says I can't believe we almost didn't because it was unfathomably hard to write that check for a mere chance.......he says he would have regretted not doing so the rest of his life. Even if we hadn't fallen pregnant I know we both would have always wondered).

 

[messica]

I love the quote in your sig line. I included it in our boys pregnancy announcement video. It's incredibly true and a good reminder when it feels the weight of the world rests on every one of our decisions. At the end of the day He is in control and whatever is meant to be WILL find it's way regardless. Take heart in knowing the plan already exists

 

[Sophie2015]

We kinda had that year this year. My mc in August I hemorrhaged. TWICE. Then 4 days after the 2nd hemorrhage I threw a clot and spent 4 days hospitalized with a PE. So we were hoping to take advantage of our bad luck with a partially covered IVF.
If we do a 2nd IVF next year it will cost more than double what this one is because our copays and deductibles are going up plus I have to be hospitalized before during and after ER so I can come off my Lovenox and be on a Heparin drip. This year that hospitalization is free. Next year it'll add about 10k to the overall cost.
I've thought about all the pros and cons of Menopur. Still don't have a decision. I'll wonder either way if it fails.