u/justanotherbeanboi

Hi everyone - this is going to be long so apologies in advance. This sub has been the biggest support through this journey and i couldn't have gotten to this point without you all. I will need to do this a third time and am looking for insights on how to improve things for this next round.

Baseline before treatment: AFC 7; AMH .247; high prolactin levels (now fixed with cabergoline).

First round:

BC priming 15 days. MDLF protocol (lupron 5units twice a day, 400-450 follistim (started at 400 and increased to 450 in middle of stims), 150 menopur, trigger with 10k pregnyl).

Baseline AFC 4. 2-3 were growing well. Follicle sizes before trigger 18, 15.3, 18.9. Estrogen before trigger 855.

Retrieved 2 eggs, maturation issues but 1 fertilized with ICSI, embryo development too slow and arrested before freezing possible.

Second round:

Estrogen priming 8 days starting on CD1 (2mg twice a day). Same MDLF protocol as last time (started follistim at 450 units and decreased gradually through stims until about 350 units).

Baseline AFC 12. 9 were growing well. Follicle sizes morning of trigger 14, 18, 31, 21, 12, 10, 12, 18, 11. Estrogen on morning of trigger 2756.

Retrieved 3 (doctor thought they'd get 6 based on measurements and estrogen). All 3 mature, 2 fertilized with ICSI, 1 embryo frozen.

Questions:

-what can I do to improve the synchronicity? I know the sized are a bit spread out, but my estrogen levels had everyone in my care team thinking that some of the medium ones could have eggs as well. I know I did a follicular start for estrogen priming, does luteal start work better to improve synchronicity?

-anything else you would recommend changing? Dose, protocol, trigger? I feel like im doing a lot of this myself, my doctor originally wanted to keep me on bc for round 2 but I advocated for estrogen because of what I learned in this sub.

Tldr - second er resulted in 1 embryo but lots of synchronicity issues (I think)...how to improve this to get a better outcome for round 3?