Seeking Advice re: Protocol
EDIT: Just found out neither embryo was euploid. I'm heartbroken and not really sure where to go from here.
Hello! I just completed my first ER at 41. I am seeking advice or recommendations as I am preparing for my second ER to start soon and am awating the PGTA testing results for my two embryos (due to find out in two days and spiraling a bit). I will ovulate tomorrow and will likely start Estrace again the same day I get my embryo testing results.
Stats: I'm 41, never been pregnant, first time trying through IVF.
0.632 ng/mL AMH
9.5 mIU/mL FSH
AFC=8 (but I had a cyst which was obstructing the view of one ovary so could be more?)
Protocol:
After ovulation, I primed for 10 days with Estrace
Once completed, 4 days of:
Ganirelix 250 mcg daily am
Once completed, 4 days of:
o Clomid 100 mg, Take two 50 mg tablets by mouth tonight
o Ganirelix 250 mcg, inject prefilled syringe subcutaneously this morning.
o hCG-microdose 25 units, Inject 25 units of microdose hcg subcutaneously (in belly) tonight.
o Menopur 225 IU, mix 3 vials Menopur powder with 1ml sterile saline into 1 syringe and inject subcutaneously this evening
o Follistim 225 units, dial to 225 units and inject subcutaneously this evening
Once completed, 3 days of:
o Clomid 100 mg, Take two 50 mg tablets by mouth tonight
o hCG-microdose 25 units, Take 25units microdose hcg subcutaneously (in belly) every morning and evening.
o Menopur 300 IU, Mix 4 vials of Menopur powder with 1ml of sterile saline into 1 syringe and inject subcutaneously in the evening
o Follistim 300 units, dial to 300 and inject subcutaneously this morning
Once completed, 7 days of:
o Ganirelix 250 mcg, inject prefilled syringe subcutaneously this morning.
o hCG-microdose 25 units, Take 25units microdose hcg subcutaneously (in belly) every morning and evening.
o Menopur 300 IU, Mix 4 vials of Menopur powder with 1ml of sterile saline into 1 syringe and inject subcutaneously in the evening
o Follistim 300 units, dial to 300 and inject subcutaneously this morning
Trigger day was all morning medications per usual and then:
450IU OF FOLLISTIM AT 9:55PM FOLLOWED BY 80IU OF LUPRON (LEUPROLIDE) IN THE LOWER ABDOMEN. IMMEDIATELY AFTER YOU ARE TO ADMINISTER 10,000IU OF PREGNYL (THIS MEDICATION MAY BE CALLED HCG OR NOVAREL) AT EXACTLY 10PM IN THE UPPER OUTER QUANDRANT OF THE BUTTOCKS
o Ganirelix 250 mcg, inject prefilled syringe subcutaneously this morning.
o hCG-microdose 25 units, Inject 25 units subcutaneously (in belly) in morning.
o Follistim 300 units, dial to 300 and inject subcutaneously this morning
o Follistim 450 units, dial to 450 and inject subcutaneously this evening- INJECT AT 9:55PM
o Lupron 80 units, Take Lupron 80 units by subcutaneous injection. You may have to take 2 injection (40 units each) due to syringe increments.- INJECT AFTER FOLLISTIM
o Pregnyl 10000 units, MIX 1ML OF SALINE WITH THE ENTIRE VIAL OF POWDER. MIX SOLUTION. WITHDRAW ENTIRE SOLUTION AND INJECT IN THE UPPER OUTER QUANDRANT OF THE BUTTOCKS AT 10PM
Results:
9 eggs were retrieved.
4 eggs were mature and exposed to sperm utilizing ICSI (intracytoplasmic sperm injection, or the injection of one sperm into one mature egg).
3 of your mature eggs fertilized normally.
2 of your fertilized eggs developed to the blastocyst stage and were considered suitable for biopsy;
Here are the grades of your embryos in storage:
Frozen on Day 5:
#1: 4BB
Frozen on Day 6:
#2: 4BB
I'm very anxiously awaiting testing results (due to find out on 6/10) and just wanted to see if anyone had recommendations for me to discuss with my RE. I was very disappointed about the maturity ratio of eggs. I'm guessing they will start me at 300 follistim and 300 menopur this time, but I've heard the higher doses can impact egg quality. Thank you for any insight you can provide!