Low FSH Dose Vs. High FSH Dose

Hi all, I am hoping for some advice, or past experiences

I am having mixed thoughts on what I should do for my next cycle

I have seen two highly respected FS's, and both have different suggestions for our 6th Stim Cycle.

I am a robust responder, producing a lot of eggs .. however .....

#1 FS- Lower the dose of FSH (Puregon) to 150 - her way of thinking is the eggs may like lower stims

or

#2 FS - Says my problems are age related, not stim related, the more eggs I retrieve the
more I have to work with

What do u think ? Any ideas or your thoughts would be appreciated

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.

Hi WLAB,

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 :crossfingers: xx

Thank you friends for responding ..

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 :redface:. 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.

Food for thought anyway. HIH.

BDTime - The new FS at my old initial clinic, wants to use 150 iui, so it's allmost like a natural cycle, I think they are just throwing different idea around to keep me happy. I dont know, I just dont know :wall: The old clinic clearly was not able to get me past day 2, and almost laughed when I said I was moving to a clinic that specialised in Blasts.

Then you see gals like BGirl, who had success lowering the stims, so it can work

CPie - Never again would I do ICSI - I think it's great for poor swimmers, but my eggs hated it . The new fs at old clinic, did say my first antag cycle produced better quality eggs. So your right, maybe that's the key.

For a little bit of info, for futher reads of this post, my FS said he is going to use Calcium in the Petri Dish, it wakes the sperm up and makes em move quicker. Though we dont have sperm problems, so I dont know, maybe I am not explaining it properly.

He did say I should keep cycling, not to give up. I will continue to take my basket full of meds, religiously before the next cycle, cq, r.jelly, preconception tabs, thyroid meds, high protein shakes, and of course support from you lovely gals :p

Just to throw another idea out there... Can your new clinic do ICSI with polscope? I was told a lot of fragmentation with ICSI comes from spindles being in the "wrong" spot (just not where they are traditionally found) and ICSI process damages the DNA in the egg. Using the polscope they can see the structures in the egg and inject without damage.

Have to say I'm a BIG fan of less eggs and better quality. I had bad OHSS on two cycles. 26 eggs on the first, resulting in 4 blasts. We got 2 miscarriages and the other 2 failed to thaw. Second gave us 32 eggs, 7 blasts but again we had one miscarriage, one BFN and the rest failed to thaw. Blasts aren't necessarily all that great. We may have been getting to blast, but my blasts were basically rubbish.

Third cycle where we got 20 eggs gave us a much better result. I realise that's still a high number, but not when you're dealing with PCOS. We didn't get many mature eggs on that cycle, but it's the one that gave us Sam. From a day three embro, too.

BW

I have to go against the grain!

I have always produced a large number of eggs.
IVF EPU 1 - 12 eggs 8 ferterlised all BFN
IVF EPU 2 - 16 eggs 16 ferterlised 2 BFP mc due to hydro (9 day 3)
IVF EPU 3 - 17 eggs 16 ferterlised all BFN (day 2 embies only)
IVF EPU 4 - 28? eggs 23 ferterlised 3 BFP (12 blasties) mc due to hydro

i have always read how women feel their cycles are more successful after producing lower egg numbers, as you know i am yet to prove that theory wrong by having a baby so i dont know what answer to give,

hope you are able to make a informed choice and achieve what we all set out for.

Thanks again BW and Loula

BW - The ICSI was just thrown in, if one thing is lucky DH has no problems with fertilisation, its the egg quality

I have tried a variation of Blasts Vs. Day 2/3 - Im ok with either, I just need to get the right egg

Thanks again

Hun i hope i am not speaking out of line but know that Holly wont mind if it will assist a fellow BBer!

I know that her DH also has no sperm issues but they still went ahead with ICSI and this is the first cycle that have had a BFP from! so i dont think it is reflective of just sperm problems

Im sure she will pop in here or PM her xx