IVF poor responder: what's the best protocol?

Hello, I am new to the forum, and would like to get advice on effective IVF protocols for poor responders to stimulation. I am 40 years old, and have just failed my first ICSI cycle. I did an Antagonist cycle, had only 3 eggs retrieved, and only 1 made it to a compacted morula on day 5. It was transferred but didn't stick. For my next cycle, my doctor initially wanted to repeat the Antagonist cycle, but after I asked him to consider other protocols, suggested the "Long Down Regulation" cycle. This involves taking 3 weeks of birth control pills, then a week of Lucrin injections, finally, 10-14 days of FSH injections and the trigger before egg pick up.

Has anyone with IVF low response used this protocol? How has it worked for you?

I would also like to hear about how your doctors managed implantation, whether anything can be done to maximize implantation success.

Many thanks! As I don't have medicare in Australia and am paying out of pocket, the next cycle is probably the last I can afford. Therefore I really want to be prepared going into it. I really hope I get some feedback here. Thanks!

Down reg always worked better for us, but what really made the difference in the last cycle (where we got 8 suitable embryos, one is my now 8 month old DD 😍) was a higher dose of FSH, in our case Puregon, it's a fine line though, too much and you can overstimulate, too little and you don't get enough. Having said that i overstimulated on a cycle with lower FSH anyway.

The other option is too do a PGD cycle, which is a bit more money, but means the embryos get tested so you KNOW it's a genetically normal embryo being implanted. I think if I ever do another cycle I will do that, rather than stuffing around with potentially abnormal embryos.

Good luck. It's a hard journey, so I wish you all the best xo

Myturn,
Thank you so much for replying, and congratulations on your baby! Can I ask how many units of Puregon were you on in the successful cycle? 300 is the maximum my doctor would prescribe, and I was on that amount last failed cycle. My AMH is <=1.1, and antral follicle count was 4. To get 8 eggs in your cycle, your situation must have been better than mine. Did you do an Antagonist cycle too? Was the result poorer with the Antagonist protocol?

Sorry for asking such specific questions! Many thanks!!

Maryamm

Yeah, my AMH isn't that low. I did do antagonist a few times. I would always get one embryo, but they weren't great quality. Once I got two embryos to freeze, but the down reg cycle always got better quality embryos. I am probably not a super low responder, there are definitely other girls in here who respond worse than I. I was also 34-36 when I did those cycles. I think I was on 325 maybe. But I started on 125 in my first stimulated cycle. It was a while ago so I would have to check. Every dr is different and every woman responds differently too, so it's hard to compare one woman's cycle to another. Your dr will know your situation, so hopefully you trust him to make the right decision. I would tell my FS to throw everything at my next cycle to make sure I get the most out of it.

My first simulated cycle I only got 5 eggs and only 1 embryo from that. It was antagonist. My last down reg cycle I got 16 eggs and had 8 embryos from that. So that was amazing. I couldn't believe it.

My first down reg cycle I got 3 eggs, and one became DS.

My first antagonist cycle I got 8 eggs, and none of them made it to transfer .

There is no one 'best' protocol. We are all different, and we respond differently at different times as well.

5 eggs with one making it to transfer sounds pretty normal to me.