Anyone over 40 get pregnant using Clomid plus injectibles?? nt.

Anyone over 40 get pregnant using Clomid plus injectibles?? nt.

BabyDance
BabyDance

April 30th, 2011, 1:19 pm #1

Anyone over 40 get pregnant using Clomid plus injectibles?? nt.
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Joined: March 21st, 2011, 6:06 pm

May 1st, 2011, 12:44 pm #2

My FSH was 23 in November at the age of 41 and the RE at Boston IVF felt it was not worth it to do IVF. He felt we could give it a shot with Clomid/IUI. I did not have much confidence this would work but on the second cycle when we added the HCG trigger I got pregnant. I unfortunately miscarried at 8 weeks after the heart beat was seen which was very sad. We are trying a couple more times before we move on to DE since we did have some success. I was lucky because it did not thin my lining or change my cycles. Since I responded they did not feel the need to add injectables....
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Anonymous
Anonymous

May 1st, 2011, 1:30 pm #3

And very sorry for your loss. Very good chance you will get your golden egg... keep going.. I really hope you do! Do you happen to know your AMH, btw? Good luck to you. xo
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BabyDance
BabyDance

May 1st, 2011, 1:33 pm #4

Didn't mean to put Anonymous. nt.
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Mrs. A
Mrs. A

May 3rd, 2011, 1:03 am #5

Anyone over 40 get pregnant using Clomid plus injectibles?? nt.
I did do the protocol 3 times with Dr. Davis at Cornell. Was waiting to post to see if you got any responders.
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BabyDance
BabyDance

May 3rd, 2011, 5:06 pm #6

I'd really like to hear as much detail about your response to it. For some reason, I've wanted to try Clomid, but I know it's not great for over 40. Spandy said that's when used alone or something. I'm real hesitant to give Cornell a go again, but also would if this protocol was worth it. Obviously, it wasn't magic for you, but if you did it 3 times, you must have had some response? Granted you were younger, with better stats.... Any input is much appreciated. This or back to Dr. Check for me. You know how much I love him, but a bit concerned about IVF with him, which I think I need due to MF. Thanks again. Hope you are feeling well. XoxoBD
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Mrs. A
Mrs. A

May 3rd, 2011, 6:26 pm #7

was after having done 2 EPP/high stim cycles with Cornell that resulted in BFNs. I moved to Check and did low stim and had my best response but ended with a chemical. I then figured co-culture would be the trick so I jumped back to Cornell. I asked Dr. Davis if we could replicate the Dr. Check protocol but he didn't agree with Check's protocol - said it leaves room for a lead to develop when you have such low stims. So instead he agreed that low stim was better but that the Clomid would allow for better even growth and for my own system to kick into the process.

The protocol was to start Clomid on CD2 assuming I had an FSH of 12 or under all on my own (we had given up on EPP by that point due to history of oversuppression). My CD 2 numbers were E2 less than 20, FSH 12.8, LH 4.3; u/s: 4-6 follicles less than 10 MM on each; lining was 4 MM. Even though I was above the FSH cut-off by 0.8, Dr. Davis allowed me to cycle. I started Clomid that day. 100 mg for 5 days. On CD 5 they started me on 150 Gonal F and 75 Menopur. My first b/w and u/s monitoring was not until CD 8. That day Dr. Davis was the RE who did my u/s and he noted 14.5 MM, 10 MM, one less than 10 on left; 4-6 less than 10 MM on right; lining was 5 MM. Given I had that 14.5 MM lead already (in spite of the Clomid) I had to start Cetrotide right then and there.

I continued to stim (and of course continue the Cetrotide) until CD 12. On CD 13 I went in for b/w and u/s and given my results (E2 679, LH 0.5; u/s: 23.4 MM, 18.4 MM, 16.6 MM on left; 15.5 MM, 12.9 MM, 11.6 MM on right; lining was 11 MM), I was instructed to only do the Cetrotide and trigger. THe following day (day before ER) my b/w and u/s showed E2 738; u/s: 25 MM, 20.7 MM, 16.2 MM on left; 16.3 MM, 15.6 MM, 13.6 MM on right; lining was 12.3 MM.

My RE for ER was Dr. Spandorfer and he only got 4 eggs out of the 6 follicles. All were ICSIed but only 3 fertilized. (I have no MF whatsoever - in fact total opposite - but Cornell is big on doing ICSI especially with potential poor responders). On day 3 I transferred an 11 cell, a 5 cell, and a 4 cell. As Dr. Schattman (RE at transfer) put it, embies that were "too fast and too slow".

The important thing to note about this cycle was that I altered my own meds CD 9 through CD 12. My experience between my 2 cycles at my local clinic and my 2 cycles at Cornell was that my meds were always kept at the same ratio throughout the whole stim cycle. But with my Check/Cooper cycle, my meds were adjusted based on the b/w and u/s results. I figured I had compromised with Dr. Davis by agreeing to the Clomid given his comment about leads but I just didn't feel comfortable keeping my meds at the 150/75 ratio all the way through. So as the cycle progressed I played RE. I'm glad for that because as you can see it was not harmful. It didn't kill off any follies and I believe that it actually helped some follies sprout up.

After the confirmed BFN, Dr. Davis and I agreed that it was right to try again with the same protocol given my response. Since I wanted to do co-culture I couldn't cycle right away due to needing a month off for the biopsy. So the following cycle after that we re-started. I decided that I would follow the instructions and not self-adjust meds. After 9 days of meds, the cycle produced 1 lead follie with sort of 2 others in play and Dr. Davis cancelled me and converted to IUI. Cycle was BFN.

Back on the horse AGAIN, immediately following that BFN. After 11 days of meds I only had 1 follie and nothing else. I cancelled myself before I got the call. I just felt like I had it in me still to get a better response.

After that last try was when I jumped back to Cooper. And it was obviously the right move because that IVF, while it produced ugly embies and a BFN, I at least went to ER with 4 follies. This depsite the fact that I started the cycle with a horrendous AFC! By that point my AFC was barely registering. The AFC assignment I received was 0-2 on each ovary and it was more like 0 except that my local monitoring clinic doesn't just do "zero"; their lowest assignment is 0-2. Oh and my AMH had come in at 0.3 just 2 months earlier.

For my situation, it was obvious that Cooper could get me to produce more follies. But it goes without saying that my very first try with the Clomid/injectibles cycle did do the job. I just couldn't achieve the same follie success with the following 2 tries.

Now, bonus commentary to all of this...my very first PG was during the cycle that I went for my very first RE work-up and they did the CCCT as part of that. So Clomid alone did actually work for me at one point; that plus the fact that I had an HSG done the same cycle. (Unfortunately that PG ended in m/c).

Have you asked Dr. Spandy if he is requiring an FSH cut-off for CD 2 to start the protocol? I think that is a very important question to ask if you haven't already.

Keep me posted and let me know if there are any other questions.

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BabyDance
BabyDance

May 3rd, 2011, 6:58 pm #8

You are an absolute angel to write all of that out. Thank you so much!

What was Checks protocol when you had the chemical and how many follies did you get that cycle? When I cycled with Check, I did 150 Bravelle, and they gave me cetrotide too early, so my E2 dropped the day after the trigger. My egg quality was very poor that cycle. Dr. Check said this wasn't the reason, but he did admit that Dr. Cho believes when E2 drops before ER, it affects egg quality.

I sort of want to try the Clomid protocol, but it's been so awful with Dr. S, and funds are tight for future cycles if I go back to Cornell. But, I don't want money to be the reason, I want to do what's the best protocol and the best shot.

It sounds like you responded well to the first Clomid cycle, but then it shut you down a bit for the next two? Would you say that's true? And after the 3 cycles of Clomid, you did another IVf at Check, before your natural BFP (that gave your more follies then the Clomid cycles - if so what was that protocol?)?.

Also, if I do go to Dr. Check next cycle, they had wanted me to do some sort of estrogen the cycle before to bring my E2 down, as it was 77 on my first IVF with them. I'm sort of thinking if I go right into the cycle that I won't have to because of the EPP. Any thoughts about that?

I hope you are feeling well, and I appreciate your help so very much. XOXO BD
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Mrs. A
Mrs. A

May 3rd, 2011, 8:09 pm #9

So Check's protocol for me wasn't a "protocol" per se. Meaning there's no defined set of meds ratio. My experience was that every med adjustment came as a result of that day's b/w and u/s results.

Cooper IVF #1
CD 2 - b/w: E2 24, FSH 11, LH 2, P4 .5
CD 3-5 - 75 Gonal F
CD 6 - b/w: E2 95.8, FSH 8, LH 1.2, P4 0.2; u/s: 15 MM on left, minor activity on right; up Gonal F to 150
CD 7 - start Ganirelix (given the 15 MM lead) and continue 150 Gonal F
CD 8 - b/w: E2 145, FSH 9.9, LH 0.4, P4 0.3; u/s: 13 MM, 10 MM, 9MM on left, two 10 MM and one 9 MM on right (SEE HOW THE GANIRELIX CONTROLLED THE LEAD BUT THE UPPING OF THE GONAL F SPROUTED SOME FOLLIES ON THE RIGHT?) Gonal F remained at 150
CD 9 - Introduce 150 Menopur in the morning and continue 150 Gonal F in the evening
CD 10 - b/w: E2 171, FSH 16, LH 0.8, P4 0.3; u/s: 2 on left; 3 on right (didn't write down the exact measurements this day); continued 150 Menopur but Gonal F was upped to 225.
CD 11 - b/w: E2 345, FSH 20.5, LH 0.786, P4 0.342; u/s: 16.5 MM, 15 MM on left, 15.2 MM, 13 MM, 12.5 MM on right; lining is 10 MM (FOLLIES ARE REALLY TAKING OFF NOW WITH THE UPPING OF THE MEDS)
CD 12 - Continue with 150 Menopur in the morning and 225 Gonal F in the evening
CD 13 - b/w: E2 522, FSH 22, LH 1.7, P4 .5; u/s: 2 on left; 3 on right (didn't write down the exact measurements this day); had already taken my 150 Menopur in the a.m. and after b/w came in was told to take reduce Gonal F to 150 and take it early in the afternoon at 4pm (vs. evening) and trigger that night.
CD 14 - pre-ER monitoring show b/w: E2 675, LH 8.0, P4 2.0; u/s: 21 MM, two 19 MM, a 17 MM and a 14 MM
CD 15 - day of ER; 6 follies, 5 eggs retreived, all fertilized naturally

Transferred 4 cell, 5 cell, 6 cell; not transferred: a multi-nucleated and an arrested 3 cell

Cycle resulted in a BFP (YEA!!! ) but ended in a chemical (BOO!!! ).

As you can see from above there's no way I could ever say to someone XYZ was my protocol because every single adjustment was done based on monitoring results. And if you look at the detail you'll see that the adjustments were very calculated, which was especially important because I did have that lead.

I know it doesn't feel that way...but I really believe that as busy as maniacs as they are down there at Cooper, when it comes time for someone to look at your file and give instruction for next step, I really think that they are paying attention and they really do care. The problem is the volume they are dealing with is so overwhelming that when it comes time to execute (i.e. phone calls to patients, OOT monitorings coming left and right from labs, clinics, faxing orders) that's where things get hairy. I know I've been on plenty of calls with them where the nurse is giving my my instruction and she gets interrupted 5 times because of some other patient matter. Even during my Check consult I can't even tell you how many times the nurses and even Dr. Brasile interrupted. I don't know how the poor man has time to go to the bathroom! One time they called me with instructions and then about a 1/2 later they called again and said the instructions are being revised and here's new set. Then another few minutes later Dr. Choe called me herself and apologized and told me the nurses made her be the one to call because as it turns out she was reverting back to her original instruction (the nurses told her they were not going to be made out to look foolish!). LOL! Yes it's crazy. But I chose to see it as wow - she gave an instruction but something stuck with her and rather than brush it off she gave it some thought and changed her mind.

It's too bad that Check can't wrap his arms around the whole process and streamline things and make things more efficient. I just think that they probably have such a high volume of OOT patients that that really adds to the pressures all around. I mean their OOT is not just women from the US - he's had patients on the boards cycling from the UK and even Australia. To top it off, I think that Cooper is dealing with such frantic women who have reached the end of their ropes (like me) that when something goes awry, we are that much more sensitive to it. I've come to learn that I was definitely very lucky in my dealings with them; never had any missteps on their part. But I can see how it can be stressful for some ladies.

Btw, I think I recall from a long while ago you mentioning something about Cooper and their use of Bravelle. I think it's just a matter of economics. Meaning, them looking out for their patient's costs. I just found out that Success Meds does not keep in stock Gonal F due to it's high cost. They stock Bravelle and I believe Follistim (although they will order the Gonal F if that's what the RE mandates). So that may be why Cooper tends to prescribe those meds more so than Gonal F. Freedom Fertility has a special and exclusive manufacturer rebate agreement for Gonal F that makes it impossible for any other pharmacy to compete with the pricing. But if you wanted to use Gonal F, I am sure Check/Cooper wouldn't have a problem with it. I had Gonal F and Menopur on hand so that is why I used those meds. Although I switched from Ganirelix to Cetrotide because of a comment Check made.

Even for my Crinone usage for P4 support in my natual BFP cycle, when the nurse called her words were Check wants you to use Crinone in the a.m. and vag supps in the p.m. but if you can't afford the Crinone because it is so expensive he is fine with you using the vag supps only. I told her I wasn't about to not follow his personal recommendation based on $$ so I would get the Crinone. Again, just a point to highlight that some of their decisions are based on advocating for patient cost. But don't ever hesitate to speak up!
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Mrs. A
Mrs. A

May 3rd, 2011, 8:12 pm #10

Check stimmed me for 11 days on BOTH IVF cycles.

All my other cycles I was stimmed for 9-10 days max.

Not sure if that extra day made a difference but it was definitely something different from the other 7 cycles I did elsewhere.
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