i would be thinking less eggs, matured less rapidly would be the way to go hun - well, that would be my choice. i've been through both, and got our BFP on a lower, slower stim. it was only an extra couple of days to get to size, but obviously the egg was in better condition. i too respond with lots of eggs when heavily stimmed (22 eggs at EPU) but a crap fertilisation rate - so i'd rather have less impact on my body (OHSS sucks) and get the quality eggs kwim
WLAB, first of all, I just have this instant dislike of anyone jumping onto the 'age-related/egg too old' bandwagon too quickly, unless he can produce concrete evidence and have done enough tests to prove that. After all these years TTC and seen a few FS and read quite a lot, I think this is the easiest and most irresponsible way to label a patient that they fail...but that is just my opinon.
If you are a good responser and normally produce lot of eggs, I would tend to go 'steady and slow' approach so they are going slowly and tend to have better qualility. However, I can't recall if your problem is low fert rate. fail to progress to blastocyst or fail to implant etc.
The change of my protocal to antagonist cycle was intended to increase the quality of the eggs, to me, that didn't work well. The long and slow stim cycle have much better result. But again, now we know my problem is immue system related now which affect implantation.
Let me know what the major issue you are trying to overcome, maybe will have better advice.
I agree with BG, and do believe that a high number of eggs (and high FSH dose) can lead to poor quality eggs. I believe this happenend in my very first cycle (all crappy, slow growing eggs). My other thought though is that there will be a certain number of eggs that will fertlise to good embryos and be good blasties by day 5. When I look back over my cycles, my first EPU where I was not hyperstimmed, I got 12 eggs and 3 to blast. My last cycle I had 20+ follies and 23 eggs at EPU, I still ended up with 3 blasts. So my theory is, providing you aren't getting hyperstimmed, you will end up with the same number of blasts regardless of getting 20+ eggs at EPU or 10+ eggs at EPU. Regardless of my dose (I have had 75FSH v 100 FSH v 125 vs and responded differently each time) I have pretty much always ended up with 3 blasties.
This is just my theory.
I would however agree slightly with the thought of the more embies the more to work with, as long as it is within reason. My FS has always said the ideal is 10-12 mature eggs at EPU, but it is the balancing act that is the problem, and not everyone has time to play around with stim levels.
Is there are middle ground for you? Slightly lower dose to get less follies recruited, without risking a cancelled cycle if you don't respond enough?
Arghh, sorry not sure if this helps at all. I so so hope which ever way you go this is the one for you xx
My body is SO unpredictable, my first three stim cycle's where at
300, 300 & 350 iui had 16/15/11 eggs - could not get past day 2
Move to new clinic
4th cycle 400 iui - 23 eggs (3 blasts) excellent quality (2 tfd 1 frozen )
5th cycle 450 iui (isci) 25 eggs, 17 inseminated (7 fert) never icsi again, my eggs hated it, fragmented, poor quality
What did I do the cycle I had great quality ? I was prob more vigilent with tablets etc
The drop off rate for me (egg wise) is quite normally high, so I worry if I get 6 eggs at epu, I wont get to transfer...
Hi WLAB,
Looking at your cycles, I would be inclined to try to repeat your 4th 400iu cycle, 23 is a lot of eggs, but you still got 3 great blasties out of it. The lower dose doesn't seem to have worked, and you gave it three good goes. A very hard one. What FSH dose is the FS that is suggesting a lower dose recommending? Back to 300iu again? Strange that you had troubles getting to past Day 2 on those first cycles, did they have any reason why this might have happened? Or was it the clinic? This might make all the difference and throws another variable in the mix. With the new clinic you could very well do another cycle on 300iu and get less eggs and still end up with great blasts. Sorry I don't think this is helping . Such a hard decision. At least you know if you go with the 400iu and don't ICSI you will ideally get at least 3 blasties again? xx
Looking at your cycle record, I agree, no ICSI. This cycle, I had 15 eggs collected, 9 mature and only 5 fertilized, the lowest fert rate ever using ICSI for the 1st time. In the past, my fert rate using IVF has always been around 80%. I remember BW mentioned in some past post, ICSI could have potential demaging the spiral of the egg structure. So it is not neccessarily the more invasive the better.
Another thing I learned was from Day1-3, it is more likely to be egg quality issue, and from D3-5, it is usually sperm DNA kick in. So by the look at yours, increasing egg quality is the key. Have you thought about Antagonist cycle? this is the kind of cycle usually suggest to people who have lot of eggs but seeking better quality, or at least that was the reason when it was first suggested to me. But obviously it also depends on different individual, it didn't work for me. I do know a lot people change to different protocle and that was the trick they needed. I am not an expert on this but maybe worth asking your FS about it?
Just to make it so much easier (yeah right), I do agree that our body sometimes can be very unpredicable and every cycle can be so different too. It doesn't make thing easier does it?
If you feel that extra vitmins helped your for that excellent cycle, probably keep it up. Maybe adding in Royal Jelly to the mix as well as it is a major fertility booster. Fish oil and CQ10 is also helping and I know some ladies in PGD thread used to take DHEA to improve egg quality, but I haven't had any experience on it.
Low FSH Dose Vs. High FSH Dose
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xx
. Such a hard decision. At least you know if you go with the 400iu and don't ICSI you will ideally get at least 3 blasties again? xx
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