Maximum FSH dose - what does your clinic do ?

Hello all,

we had what was meant to be our last IVF attempt (for bub #2) last month (the 8th cycle in past 2 years), but the cycle was cancelled before transfer after 3 eggs collected (1 mature didn't fertilise, other 2 immature -> delayed ICSI, didn't progress well).

I have a bit of a dilemma facing me now that my DH and I agreed to give it "one last shot" as we feel we didn't get a proper go with nothing to transfer.

In the clinic we were treated when living in Adelaide last year, their maximum FSH dose given (Puregon/Gonal-F) was 300 iu. They agreed to go up to 325 iu as this what my Perth clinic had me on just before I moved over. I only ever got 1 or 2 follicles from that dose. My advise from the Adelaide doctors were that studies showed that any dose over 300 iu made little or no difference in folllicle growth, and there are some opinions that overdosing the FSH can actually be detrimental to the eggs.

HOWEVER, now that I'm back in Perth, my clinic want me on 600 iu, the maximum dose at this particular clinic. Now, I was skeptical, but I did two 600 iu cycles: 1 which was cancelled due to development of a cyst, and the second which again only resulted in 1 mature egg (the last cycle, that was cancelled due to no embryo).

They want me to go on 600 again for my next cycle, after a 6 week bout on the pill.

I'm now concerned that I should just stick with 300 as my previous clinic recommended, as I'm worried that 600 would possibly worsen my chances. I'm considering not telling my doctors this as I don't want to feel pressured to up my dose after a mid-luteal blood test (which happened last time).

Thanks if you've kept with me so far on this very very long post... but my question is this:

Do you know what your particular clinic give as a "maximum dose" and what has been your advice on doses higher than this ?

Thanks again ... you girls/guys have been such a huge support over the past years.

Hiya,

Not sure of maximum dose but I was on 450 and the FS is reducing it to 300 next time because she says high dose can reduce quality of eggs. So if you are not getting quantity on high doses you should try for optimum quality.

Hope that helps!

Good luck :)

Hi deni,

First cycle i was on 175, next they up'ed it to 200 and then last was 225. I thought it was good to increase it each time, but in hindsight, even though i got more eggs each time, each cycle only resulted in two blastys, and if i was gokng to do another cycle, the FS said he would pull it back a bit as producing so many eggs probably knocked me about a bit and wasnt good for me when transfer time came around. I dont know if they have a max though??
Good luck!!

Thanks for your replies girls.

I've decided to get a second opinion, and made an appointment for a phone consult with the professor back at Repromed (Adelaide), I've also requested getting a new batch of CD2 bloods done to double check FSH and AMH, which my Perth clinic agreed to and I will do tomorrow. (My AMH is very low and FSH very high according to the figures from my Perth clinic). I think I'll feel a lot better knowing that the hormones have been double checked and then I can send all the info to the doc in Adelaide and have a realistic discussion about whether it's worth pursuing another IVF go or not, and what dose etc.

Hi deni,

I have just had my first IVF cycle cancelled due to poor responds - or i should say no responds... i had 0 eggs to collect ... i am only 33 but my AMH is below 1 and my FSH is high as well.. they started me on 300 then upped it to 350 after 2 days then to 450 which is my clinic max ( i am in sydney) anyhow i now had my failed cycle reviewed by all DR in the clinic and they told me i only had one more option with a different protocol this one will be the opposite a very low FSH with combination of a growth hormone to help me/my ovaries and is supposed to be for "cases like me" ( makes me wonder why they did not put me on it the first time round) so may be its worth your while asking about it as this growth hormone is supposed to increase my chances by 50% ...but if that does not work they will tell me to walk away...

All the best with it - i hope it all works out xoxo

Hi Denu,

I have had two cycles...one down reg where I started on 350 gonal f then went all the way up to 475 before I had my collection. I got 14 eggs of which I got 6 embryos to transfer.
My antoganist cycle I was on 600 the whole time....I got 13 eggs and again 6 to transfer.

Out of all of this I have had 1 MC at just under 9wks from a FET from the first lot of embies....then a chemical on the last FET. This time around I got another chemical from the fresh transfer. I have one more transfer left (we transfer two each time).

But I know I get pregnant easily (we have MFI) so I am starting to worry about the quality of my embies....I know my age is against me but I dont understand why I keep getting BFP's only for them not to develop....my FS says its just about finding the right embryo but I am concerned about the huge doses of drugs I am on.....but then if I wasnt on those doses would I not get any (or many) eggs.....

If this last transfer doesnt work I will defiently be thinking about asking a few more questions over what effects these large doses may have on my embies.....

Goodluck I guess we just have to trust our FS in the end and realise IVF like everything is also a topic where all people have different opinions on what treatment is best.....

Thanks for your replies girls.

Gecko, yes my AMH is also <1 and my FSH is 13-15 which is on the high side for day 2. I'm going to discuss with the Adelaide consultant via telephone , as well as keep my appiontment with my perth clinic to discuss in September. I've already done growth hormone for two cycles, and for me personally I didn't have any difference in amount of eggs collected (and in one of those cycles, didn't have anything to transfer either). The growth hormone regime for those cycles was injections at day 21, day 2, 4 and 6.

My perth doctor wanted to try me on a new regime for growth hormone, a very low daily dose, in conjuction with DHEA. Not sure which regime was offerered to you but they're worth a shot if you haven't tried it before - doctors are seeing some merit in the treatment even though studies are still ongoing.

I'm not doing growth hormone this time around, mostly because we're now leaning on the side of not going ahead with another cycle.
But if you haven't tried it before, and can afford it ($300 per injection for the 4-injection protocol) , it's definately worth a try. Given your younger age, you would probably have a better chance of success :crossfingers:

Jackliky- isn't it frustrating when you first go into IVF you expect the doctors to have all the answers, but so much is still unknown .. but in saying that I guess new treatment methods are being discovered each year... hope you get that sticky BFP soon.

Best wishes to you all

Thanks D, i appreciate all the info :) the thing is that my AF has still not returned since i stopped the drugs :(... so i am kind of in limbo as i do not want to take any Med's to bring it back...

waiting waiting...

WIsh you all the best with this cycle D xox