Joined: September 16th, 2011, 4:55 am

March 25th, 2012, 11:10 pm #21

Hi Di,

Happy to share the details. First of all I'll defer to you re: those statistical corrections. Thanks for challenging me on them. I didn't really check my facts thoroughly and was recalling off the top of my head just to give her an idea of the odds. I couldn't remember if it was 1 or 2 normal eggs in 10 for our age. I think 1/5 blasts turning out normal probably the stat, but I said 2/5 because that was how many normals I actually had out of 5 blasts in my last 3-cycle banking results (so I'm hoping for similar this time, though I know there are no guarantees). The 40% normal blast implantation rate was what Dr. T told me after I got a BFN with my 2 CGH normal blasts.

Here's what happened with my last cycle, where I got twice as many frozen blasts as any other previous cycle. I think it was part luck, part Dr. T's follistim dosing expertise/experience, well-rested ovaries, fortunate AFC, and part luck of the Irish:

Let it be known that I had an unusually high AFC this cycle. 8 were visualized at cycle start, but I have a history of more popping out later, especially on my more dormant left ovary (the one with the endometrioma). My lefty had a bumper crop this time, with 3 antrals at cycle start, but 8 mature follicles in the end. I had 6 good ones going on the left. Almost every follicle magically matured at a similar rate this time (very rare for me), so I had a very even cohort.

As for the Saizen, I was prescribed an 8.8 mg vial, which I reconstituted in 10ml of solution and injected 1ml per day from the 1st day of stims til it was gone.

The other meds were dosed as follows & I started injections on CD2:
Stim Day 1 & 2 375 follistim + 1/2 vial Luveris
Stim Day 3 & 4 225 follistim + 1/2 vial Luveris
Ultrasound showed bumper crop growing faster than is the norm for me, so Dr. T wanted to slow things way down.
Stim Days 4-9 150 follistim + 1/2 vial Luveris
Triggered on Day 9 based on bloodwork

11 eggs retrieved
10 mature
10 fertilized (100%!)
10 embryos biopsied for CGH on day 3 (ranging 6-8 cells)
4 blasts frozen

My last cycle result(for comparison purposes. FYI: averaging 375 follistim per day and no saizen)
9 eggs retrieved
7 mature
5 fertilized
4 embryos biopsied on day 3 (6-9 cells)
1 blast frozen

Dr. T, needless to say told he was "very pleased" with my response this time -- LOL Mr. understated!!

Just goes to show, you NEVER KNOW!

I know GH is supposed to help with quality, but could it have made me more sensitive to the follistim? I can't figure out why I needed so much less of it this time to grow my follicles. In addition to GH helping the quality, I figure the lower dose of stims hopefully helped the egg quality.

So Di, I'm curious as to how my protocol was diff from yours? Do tell
Sorry it took forever to respond to this, but I went in for a baseline u/s in the interim and asked Dr. T about the percentages for blasts specifically, and he said that their clinic statistics for my age group are that a blast has about a 25% chance of live birth (I'm assuming that's including the 40% implantation rate and the probably close to 40% miscarriage rate and that he meant a chromosomally normal baby, but I didn't ask if that included termination of abnormal pregnancies after CVS/amnio). I asked if it shouldn't be lower because of the only 1-2 normal eggs in 10 thing, but he said that by the time an embryo makes it to blast, the odds of it being normal are a little higher because it's already passed a number of significant hurdles to get to blastocyst stage. So given that, I think the numbers you got of 2/5 as opposed to 1/5 blasts being normal do make sense.

My protocol was:

Femara 5mg starting on CD3 through CD7

1/2mL of HGH (omnitrope) daily starting CD4 through retrieval (would have been CD3, but the medication needed to be ordered that day & overnighted so I started on day 2 of stims instead of day 1... but I may call the day I start my period and ask them to order it for me in advance next month)

300 FSH starting on CD5

Ganirelix 250mcg starting on day 6 of stims (day 7 with the second cycle)

Also, during my second cycle everything grew more quickly so on day 7 of stims he had me go down to 150 FSH, and not take any more with my trigger (which was on day 9 of stims). The first cycle I didn't trigger until day 11, and was on 300 FSH until then including with the trigger. (I'm still convinced I might have recruited more follicles this last cycle if I hadn't messed up and missed some of my Femara doses, but not sure if that would account for everything growing more quickly or if that was just the luck of the draw. It does seem like we got a few more eggs when I stimmed longer, though.)

My comparative stats for those cycles were 8 eggs retrieved, 7 mature, 6 fertilized, 5 day 3 embryos, 2 blasts frozen (2nd cycle), and 5 retrieved, 4 mature, 3 fertilized, 3 day 3 embryos, and 1 frozen (3rd cycle). My first cycle was super high stim and I got nothing to freeze (I think it was 4 retrieved, 3 mature, 1 fertilized, 1 5-cell on day 3). My current plan is to do 3 more cycles, and depending on how many more blasts I can get to freeze, possibly do a fresh transfer on the last one--otherwise, transfer after that.

Anyway, thanks again for sharing all this--and given your last cycle, it sounds like your results are very encouraging! Fingers crossed for you, and I'll look forward to seeing your updates.

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TenaciousB
TenaciousB

March 26th, 2012, 1:58 pm #22

Di,

Cool! Glad to know my own personal cycle-derived, pasted-together stats are somewhat consistent with the percentages Dr. T gave you.

I really think 1 or 2 blasts per banking cycle is a good result for ladies in our age range (this was my own avg. prior to my last cycle) and if we have the resources to continue, we just may find success eventually!

You are one of about 4 ladies I've found recently to be on Dr. T's Femara protocol. I wonder if he perhaps started putting people on that AFTER I became his patient, but never switched me, since I was getting respectable results on simpler antagonist.

Heh, heh....I'm beginning to wonder what Dr. T would think about us comparing protocols online. I find all this info very insightful, but let's please don't mention each other when we talk to him directly. I have a good relationship with him don't want to stir up any "trouble!" I am, however, eternally grateful to have found out from you and Dee that he had you on HGH. I don't think he would have put me on that unless I asked him about it. He was all too happy to prescribe it when I asked, but never suggested it himself. Curious...


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Joined: September 16th, 2011, 4:55 am

March 26th, 2012, 4:04 pm #23

No problem! I actually think he knows a lot of us compare protocols--not us or this board specifically, but he gets that many of his patients are highly motivated and intelligent women, so why WOULDN'T we constantly be researching something this important to us? I don't mention any details about other cases to him beyond what's relevant to the questions I'm asking, because I feel like this information is confidential and the specifics aren't anyone's business, but I have a pretty good relationship with him too and he seems to appreciate my analytical nature. This is one of the reasons I like him as a doctor.

As far as your protocol, I think if something's working, sticking with it is logical... that's why I did the same exact protocol the last two times. And I agree that 1-2 blasts per cycle is good! I just can't help feeling greedy .

Interestingly, I think they're doing more HGH there now because I heard the new nurse coordinator on the phone with another patient saying it was going to be part of her protocol, with some explanation that led me to believe that they just suggested it to that patient without the patient asking first. But given the improvement it seems like you, me and Dee all saw in our cycles since adding HGH, I can see why--if it's going to help, why not try it, right?
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TenaciousB
TenaciousB

March 26th, 2012, 4:18 pm #24

Di,
Ha! I think you're right about his gathering enthusiasm for HGH. A 45-yr-old gal I met on another board just completed her first ivf cycle w/Dr. T (BFN). At her WTF consult he suggested HGH, saying it DEFINITELY improves egg quality. He said he would put all his over 40 patients on it, if it were covered by insurance.

I'm secretly pleased to think our results may have influenced his opinion & may help other ladies!!!
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SillyPuppy
SillyPuppy

March 27th, 2012, 12:01 pm #25

Di,

Cool! Glad to know my own personal cycle-derived, pasted-together stats are somewhat consistent with the percentages Dr. T gave you.

I really think 1 or 2 blasts per banking cycle is a good result for ladies in our age range (this was my own avg. prior to my last cycle) and if we have the resources to continue, we just may find success eventually!

You are one of about 4 ladies I've found recently to be on Dr. T's Femara protocol. I wonder if he perhaps started putting people on that AFTER I became his patient, but never switched me, since I was getting respectable results on simpler antagonist.

Heh, heh....I'm beginning to wonder what Dr. T would think about us comparing protocols online. I find all this info very insightful, but let's please don't mention each other when we talk to him directly. I have a good relationship with him don't want to stir up any "trouble!" I am, however, eternally grateful to have found out from you and Dee that he had you on HGH. I don't think he would have put me on that unless I asked him about it. He was all too happy to prescribe it when I asked, but never suggested it himself. Curious...

Because overall SIRM in general seems to be SO anti androgen producing meds and SO anti-Femara.

Just had a conversation with someone from their offices last week and again it was NO FEMARA all the way.

I wonder if they are more receptive to tweaking per individual and are really opening up the arsenal here for the 45 and over crowd?

What is your theory?
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Joined: September 16th, 2011, 4:55 am

March 27th, 2012, 3:38 pm #26

Well, I'm at S.IRM in NY and unlike the other S.IRM clinics, the medical director there does use Femara protocols now. He has never had me do anything androgen-producing except for adding in a tiny amount of Luveris towards the end of my first, high stim EPP protocol as is standard with that protocol (Google LA10E2V protocol).

I honestly don't know how much this opens up the arsenal for the 45 and over crowd, though--I do have high FSH and DOR, but my AFC is usually around 8 and I'm only 41.6, and while this clinic in particular has had very good results in the 41-42 age group, like everywhere else those stats drop sharply in the 43+ group so I don't know if he'd be able to offer you much better odds than a few percent either.

All that said, I think he is very open minded and very receptive to tweaking individual protocols, and will definitely work with older patients. Dr. T does phone consults, but unlike the other S.IRM clinics it is not free to have a phone consult with him. Hope this helps!
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Anonymous
Anonymous

March 27th, 2012, 4:59 pm #27

Thanks

I opted to do a consult with the other New York office (Westchester)
to have a faster consult than with Dr. T. The consult Dr. assured me that she was absolutely IN LINE with what all the SIRM clinics would see and if you read Dr. Sher you will certainly see he has NOTHING good ever to say about Femara (mostly it seems)

She was VERY lovely in the consult by the way but my takeaway from all of this was that in general for the over 40 crowd the numbers just are NOT good and so I am really wondering if I should bother with any of it.

I am TRYING NOT to be a negative nelly but it sure hits hard when they seem to just lump the over 40 crowd into this less than 5% range. I think they push it down to 2% when you are 45. If I had more feedback from actual women who are familiar with the IVF in the 40s and varying protocols that seemed to improve chances for success I would feel so much better about it all.


And it is certainly appreciated that the say this is reality and DON'T just ask you to sign up but at the end of the day I am really wondering how much risk to take,you know?
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SillyPutty
SillyPutty

March 27th, 2012, 5:01 pm #28

Well, I'm at S.IRM in NY and unlike the other S.IRM clinics, the medical director there does use Femara protocols now. He has never had me do anything androgen-producing except for adding in a tiny amount of Luveris towards the end of my first, high stim EPP protocol as is standard with that protocol (Google LA10E2V protocol).

I honestly don't know how much this opens up the arsenal for the 45 and over crowd, though--I do have high FSH and DOR, but my AFC is usually around 8 and I'm only 41.6, and while this clinic in particular has had very good results in the 41-42 age group, like everywhere else those stats drop sharply in the 43+ group so I don't know if he'd be able to offer you much better odds than a few percent either.

All that said, I think he is very open minded and very receptive to tweaking individual protocols, and will definitely work with older patients. Dr. T does phone consults, but unlike the other S.IRM clinics it is not free to have a phone consult with him. Hope this helps!
Curious why you are on estrogen priming? Are you cycles regular, do you ovulate? Is your lining good etc?

Is that just their protocol for all or are they tailoring it to your specific needs?
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Joined: September 16th, 2011, 4:55 am

March 27th, 2012, 5:55 pm #29

If you read my response in this thread above (blasts & my protocol) you will see that I am not on estrogen priming now. I was only on it for my first cycle, when we did SIRM's most aggressive protocol, LA10E2V--and it was a total failure.

I do ovulate regularly and have normal lining. Other than my age, low AMH and high FSH, and some immune issues (hypothyroid w/Hashimoto's, MTHFR, elevated natural killer cell activity), I have no reproductive problems.

Ultimately any good RE should tailor your protocol to your specific needs, and I do think my doctor seems very responsive about doing that. As you can see from the discussion in this thread about HGH, I think good REs as a group do constantly experiment with different things to see what works best for their patients, even though they may disagree amongst themselves about that might be (as with the different stances different S.IRM doctors take on Femara, for example).

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Anonymous
Anonymous

March 27th, 2012, 6:22 pm #30

thanks for that explanation.

Do you find your CD3 numbers and AMH staying rather stable as you have begun this process or are they fluctuating? If so, how?

I have a 42 yo friend TTC who was recently diagnosed with Hashimotos and that has left her very depressed in this process. What do they do to address that with you specifically?

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