Thanks heaps for all that info buliej. I definitely have heard of EPP and the A/ACP but was totally fobbed off when I brought it up with FS. I'm going to print this out and ask FS about it again.
It would be great to share the reactions/thoughts of each of our FS to this. I'm going to try to put an email together to send to my FS on Monday/Tuesday. Hopefully, she will think it over and get back to me...
Here it is written out by a Dr - but still understandable:
3) Agonist/Antagonist Conversion Protocol (A/ACP) with ?Estrogen Priming?: Estrogen primes follicle FSH receptors, thereby enhancing response to FSH. This forms the basis of the ?estrogen priming? approach in women with diminished ovarian response. The approach involves administering estradiol by daily injection, or by skin patch starting about 10 days prior to initiating high dosage gonadotropin stimulation. As with the A/ACP, the estrogen priming protocol is initiated a week post-ovulation (luteal phase start) or is launched off a birth control pill. It also starts with GnRHa administration for about 5 days whereupon menstruation ensues and the agonist is supplanted by an antagonist. But this is where things change slightly such that instead of directly initiating FSHr injections, the patient, while continuing to take the GnRH antagonist now receives twice weekly estradiol valerate injections or daily estradiol skin patches (I prefer the former) for a period of about 10 days. Thereupon, daily high dosage FSHr (600-750U) is administered once daily. Four to five days later, a small daily dose (37.5U) of LHr (Luveris) or Menopur is added. ?Estrogen priming? is continued until more than 50% of the follicles are at least 12mm in size whereupon it is discontinued.
My partner Jeffrey Fisch MD, Levent Keskintepe PhD, and I recently published on use of the A/ACP+ estrogen priming (Fertility and Sterility, 2008). Based upon a long experience using this approach, we unhesitatingly advocate the preferential use of this protocol in women with severely diminished ovarian reserve, who undergo IVF. *** I'm going to ask my FS to read this. The name of the Dr who wrote it is: Geoffrey Sher, MD.
Dutchie/Tigga - I'll PM you the link to the whole post by this dr.
I had an appointment with FS on Monday (my second follow since D&C complications). Looks like the antibiotics have sorted me out and bleeding has now all but stopped.
I asked FS about Estrogen Priming Protocols - unfortunately, he didn't go into any detail about it but did say "we could start tinkering with other options" for me. I suppose that was his way of saying it's worth a shot. I also asked about DHEA and he usually has refused point blank to prescribe - but this time he seemed more open about 'tinkering' with it. He said to do one more cycle at same protocol and if that didn't work - start experimenting with EPP and the likes of DHEA. I'm sorry I don't have too much info to share from him - he was not really in the mood to discuss it in detail on Monday's visit (don't you hate it when you feel like your bothering them with your Q's).
I won't be cycling for at least another 6 weeks or so - need to see out one normal period. I'm also still waiting for the cytogenetic testing results to come back - to see if this sheds any light on latest miscarraige. We had had karotype testing done when we embarked on IVF and both DH & I had normal results.
DH and I also went to an Adoption info night last night. Geez, I thought IVF was a challenge...the adoption process is as arduous (2-3 years) and is no guarantee either. It's given us some more thinking to do though. It REALLY shouldn't be this hard should it...all we want to do is share love and laughs and life with a child (or two or three)...how is that too much to ask? It's so unfair - especially when you hear there's 7,500 kids in Qld who for all kinds of reasons require foster care - because their parents can't/won't look after them. Sad hey!
Buliej, thanks again for all that info - it's really valuable!
Tigga - so happy to hear that your bleeding has almost stopped - mine hasn't quite yet - but it did take 2 weeks for it to stop after my first d&c.
We pay our FS so much money - whether they feel like answering questions should be irrelevant - they should suck it up and answer - otherwise, why pay for the consult - the very term "consult" describes something "consultative" requiring discussion. Sorry - I just get so mad - like we do half their work for them.
I have to say, I'm not convinced that EPP is "the answer" - but I just want my FS to consider it and then explain why it is or is not appropriate for me.
I was on DHEA for 2.5 months prior to this most recent cycle - am back on it again. It is suppose to take a full 3 months to really do its job - but that requires patience which I just don't have and my biological clock certainly doesn't have.
Tigga - maybe we will be cycling at the same time - I'm sure I'm approximately 6 weeks away...if not more
I think our Plan B may be a donor egg cycle in the US. We are not there yet, but I've mentioned it to DH and he has gone from a "NO - don't want to discuss" to a "let's see what happens with this next cycle first". I think doing a donor cycle here is just too hard and too long of a wait - in the US you get to preview all this information about potential donors and then pick one. Plus there are other benefits (privacy) in terms of doing it in the US - but this is off topic for this thread so I'll stop here.
I do not understand why adoption is so difficult here. I have read about this - Hugh Jackman's wife...Deborah F...s? has written extensively about this and it's shocking that it's so difficult when there is such a need.
Nothing would make me happier than to find a protocol that increases our chances - I sometimes feel on the verge of being so desperate and worry that I'm finding protocols that are designed only to appease and not to acheive results. I feel very vulnerable in that respect.
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