Advice on EPP for IVF.

Advice on EPP for IVF.

Jasmine
Jasmine

April 13th, 2011, 4:04 pm #1

As some of you may have read, my last cycle was a negative with Dr. Check. I have one last shot at IVF and am trying again with a local Dr. who is willing to try a different protocol. We had discussed that I wanted to try the EPP and she had agreed. I just spoke to one of the nurses and this is what she told me my protocol would look like:

Start of AF - take estrace twice a day.
continue this for a week. Then start meds - Gonal-F.
Add in ganirelex when follicles reach a certain size as well as luveris.

Has anyone heard of a protocol like this? What do you think of this protocol? Do you think I should talk to her about doing a "true EPP" - you do the ganirelex patch 11 days after ovulation, ganirelex every other day...wait for your period then start meds? I would need to get the exact protocol from someone on this board if the Dr agrees to this protocol.

Thank you in advance!!


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JulesM
JulesM

April 13th, 2011, 4:19 pm #2

I started the estrogen patch 8 days after detecting ovulation (usually it's 10 days but I have a short LP so they had me start early). The day after starting the patch I did ganirelix every morning for 3 days and changed the patch every other day until AF. I got AF the day of my 2 patch (and 2nd ganirelix). I took my 3rd ganirelix the next morning (CD2) and had a baseline US but no labs. That evening (CD2) I started 300 of Gonal F and starting the next morning 300 menapur. I continue to take 300 menapur in the AM and 300 Gonal F in the PM for 5 days then on CD7 had only E2 checked, no US. Starting tomorrow CD9 (day 7 of stim) I will start frequent US and bld work. Once my E2 is over 400 they will add ganirelix back into the mix until trigger.
I can't comment on the protocol they want you to do, but I believe most EPPs start the estrogen priming in the LP.
Sorry this was a bit wordy, hope it makes sense.
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Jasmine
Jasmine

April 13th, 2011, 4:44 pm #3

Thanks! I also thought the EPP would start off in the luteal phase of the prior cycle.
I'll talk to the Dr and see what she says. Thank you for the detail of the protocol. I'll use that as a guideline for my Dr. Hopefully she goes with it. Good luck with your cycle!

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mtoto2
mtoto2

April 13th, 2011, 4:57 pm #4

I started the estrogen patch 8 days after detecting ovulation (usually it's 10 days but I have a short LP so they had me start early). The day after starting the patch I did ganirelix every morning for 3 days and changed the patch every other day until AF. I got AF the day of my 2 patch (and 2nd ganirelix). I took my 3rd ganirelix the next morning (CD2) and had a baseline US but no labs. That evening (CD2) I started 300 of Gonal F and starting the next morning 300 menapur. I continue to take 300 menapur in the AM and 300 Gonal F in the PM for 5 days then on CD7 had only E2 checked, no US. Starting tomorrow CD9 (day 7 of stim) I will start frequent US and bld work. Once my E2 is over 400 they will add ganirelix back into the mix until trigger.
I can't comment on the protocol they want you to do, but I believe most EPPs start the estrogen priming in the LP.
Sorry this was a bit wordy, hope it makes sense.
Just curious - what's the difference between Gonal F and Ganirilex(sp). I thought they basically did the same thing but are just from different companies? My assumption is probably wrong.
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Mrs. A
Mrs. A

April 13th, 2011, 5:19 pm #5

Gonal F is an FSH stim med to help grow follies. Ganirelix is an antagonist to help control your LH and premature ovulation.
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Mrs. A
Mrs. A

April 13th, 2011, 5:35 pm #6

I started the estrogen patch 8 days after detecting ovulation (usually it's 10 days but I have a short LP so they had me start early). The day after starting the patch I did ganirelix every morning for 3 days and changed the patch every other day until AF. I got AF the day of my 2 patch (and 2nd ganirelix). I took my 3rd ganirelix the next morning (CD2) and had a baseline US but no labs. That evening (CD2) I started 300 of Gonal F and starting the next morning 300 menapur. I continue to take 300 menapur in the AM and 300 Gonal F in the PM for 5 days then on CD7 had only E2 checked, no US. Starting tomorrow CD9 (day 7 of stim) I will start frequent US and bld work. Once my E2 is over 400 they will add ganirelix back into the mix until trigger.
I can't comment on the protocol they want you to do, but I believe most EPPs start the estrogen priming in the LP.
Sorry this was a bit wordy, hope it makes sense.
wishing you the best JulesM!!!!!
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Joined: December 15th, 2009, 8:50 pm

April 13th, 2011, 6:27 pm #7

As some of you may have read, my last cycle was a negative with Dr. Check. I have one last shot at IVF and am trying again with a local Dr. who is willing to try a different protocol. We had discussed that I wanted to try the EPP and she had agreed. I just spoke to one of the nurses and this is what she told me my protocol would look like:

Start of AF - take estrace twice a day.
continue this for a week. Then start meds - Gonal-F.
Add in ganirelex when follicles reach a certain size as well as luveris.

Has anyone heard of a protocol like this? What do you think of this protocol? Do you think I should talk to her about doing a "true EPP" - you do the ganirelex patch 11 days after ovulation, ganirelex every other day...wait for your period then start meds? I would need to get the exact protocol from someone on this board if the Dr agrees to this protocol.

Thank you in advance!!

But I started estrace in the luteal phase and I think I only took one pill. Search Kiwichick's protocol on the pg despite board, this is basically the one I followed-worked for her and me and others I think. It kept my FSh under 10 before starting stims. Also I did DHEA a couple of months before starting. Good luck.

jkl

Me:39
dh:41
FSH: highest 18, usually 11-12
ttc #2: over 3 yrs
5/07: BFP, m/c at 11 wks
10/07: clomid iui, BFN
11/07: BFP chem on a natural cycle
1/08: clomid iui, BFP chem
2/08: BFP chem on a natural cycle
4/08: injectable 150 gonalF/iui, 3 follies BFN
6/08: injectable 225 gonalF/iui, 2 follies low chem BFP
10/08 IVF #1: bcps, 600 iu gonal f, 3 embies tf---bfn
1/09 IVF#2: EPP, 225GF, 75 menopur, 4 embies tf---bfp!
8/09 29 wks. Stillbirth, beloved baby girl
11/09 IVF#3: EPP, 225GF, 75 menopur, 1 embie tf---BFN
12/09 IUI, EPP, 225GF, 75 menopur, HSG, 3 follies, BFP!
Betas: 14dpo, 451; 21dpo, 10,354
currently 25 weeks
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JulesM
JulesM

April 13th, 2011, 6:42 pm #8

wishing you the best JulesM!!!!!
I'm trying not to stress about it, but it's hard. I don't know my exact AFC other than the nurse saying I have a "few" on each side. My E2 yesterday after 5 days of stim was 211, the nurse said "that's not too high and not too low"... so really, they are giving me nothing. I have my 1st US tomorrow since starting stim so hopefully I'll have an idea where this is going. I started feeling my ovaries ache last night so I'm hoping that means lots of action.
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Joined: April 13th, 2011, 6:46 pm

April 13th, 2011, 6:53 pm #9

As some of you may have read, my last cycle was a negative with Dr. Check. I have one last shot at IVF and am trying again with a local Dr. who is willing to try a different protocol. We had discussed that I wanted to try the EPP and she had agreed. I just spoke to one of the nurses and this is what she told me my protocol would look like:

Start of AF - take estrace twice a day.
continue this for a week. Then start meds - Gonal-F.
Add in ganirelex when follicles reach a certain size as well as luveris.

Has anyone heard of a protocol like this? What do you think of this protocol? Do you think I should talk to her about doing a "true EPP" - you do the ganirelex patch 11 days after ovulation, ganirelex every other day...wait for your period then start meds? I would need to get the exact protocol from someone on this board if the Dr agrees to this protocol.

Thank you in advance!!

i have done this protocol.my first ivf was the long protocol ,ended with 5 eggs, 4 embryos ,transferred 2 ,negative result.
my second ivf was with the same protocol as yours it s called the antagonists, and i ended with nine mature eggs.we froze them as my husband was away and i ll use them next month.i think the last protocol is more productive!good luck!
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Mrs. A
Mrs. A

April 13th, 2011, 7:36 pm #10

I'm trying not to stress about it, but it's hard. I don't know my exact AFC other than the nurse saying I have a "few" on each side. My E2 yesterday after 5 days of stim was 211, the nurse said "that's not too high and not too low"... so really, they are giving me nothing. I have my 1st US tomorrow since starting stim so hopefully I'll have an idea where this is going. I started feeling my ovaries ache last night so I'm hoping that means lots of action.
to not stress but you are with a new RE and from your other posts it seems you really like her. So try to let the cycle just work through its process and not stress until there's an actual reason to.

You're going to come out on top of this FOR SURE!!
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