* Author Topic: Best Protocol For Over 40  (Read 1155 times)

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Offline eskeech

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Best Protocol For Over 40
« on: 11/01/17, 17:17 »
I'm so confused. I read an article by the renown US Dr. Sher and he says a long down protocol is best for women over 40. But I have also read (and been advised) that a short protocol is better for older women because it is easier on their ovaries.
What are your thoughts? Experiences? Advice?
 ^idiot^

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    Offline Syd72

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    Best Protocol For Over 40
    « Reply #1 on: 16/01/17, 18:11 »
    Hi eskeech.  I can't help a huge amount as I found lots of conflicting information too but I can tell you my experience.  I'm 44 with good amh and fsh for age.  I spoke to the Lister who said short protocol and to Oxford who prefer long protocol.  I decided to go with Oxford and give long protocol a chance but just before we started we worked out I'm not in the country long enough (I live overseas) so I've ended up doing short protocol at Oxford.  I'm on day 9 of stimms today, I'm responding well (for my age) and hoping to do egg collection this Friday.  I was very disappointed when I found out I wouldn't be doing long protocol but now quite pleased I'm on short. 

    Have you chosen a clinic yet?  I would go with whatever they advise as they're the experts.  Very best of luck.

    Offline eskeech

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    « Reply #2 on: 17/01/17, 03:46 »
    Hi Syd72,

    I've found a lot of conflicting information, too. I have yet to finalize my treatment plan, but I'm pretty certain it will be short protocol. I'm going with Serum, in Athens. I am very happy with my choice and feel I will get the best care there, my only negatives are that it is very far away (I'm in Washington State) and the length of time I have to be there. Serum says long protocol can be very harsh on our older ovaries. They have found that gently stimulating women our age yields higher quality eggs, though maybe not higher quantity.

    I'm so excited for you! And very happy to hear so far you're responding well! Please keep me updated, if you like.

    Best of luck :-)

    Offline veracruz

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    Best Protocol For Over 40
    « Reply #3 on: 27/01/17, 15:53 »
    Hi everyone,

    I thought I would chime in on this one.  I was 42 yrs old on my first IVF cycle with ARGC - good AMH around 14.6 and FSH around 9, and they put me on the short protocol as they said that my ovaries at my age may not be able to cope with the long protocol.  I'm not completely sure any other pros and cons on this but I didn't question it.  Turned out BFN.

    I'm now 43 and on my 2nd cycle with ARGC and questioned if I should be doing anything differently - they insisted on short protocol again and again, I went with it.  I'm now in my 2ww and currently 10dp3dt.  My OTD is this Sunday but I could not wait and did a HPT... faint blue lines from a couple of days ago which I am hoping will be confirmed very soon.  Trying to stay cautiously optimistic on this!

    Eskeech -  I know all of this can seem overwhelming but I put all my trust in whom I believe was the best clinic for me and *fingers crossed* it works out.  I am sure you will make the right decision for you.  :-)

    Syd72 - have you made it to egg collection? All the best luck to you!



    Offline eskeech

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    « Reply #4 on: 27/01/17, 19:57 »
    @veracruz,
    Thank you very much for sharing your experiences. It's really good to hear.
    Fingers crossed those blue lines keep getting more blue!!!
    I've since spoken with Serum and am comforted with their response. They, just like ARGC, feel "older" ovaries can't cope with a long protocol. Additionally, they also advocate early ET for older women. CHR in NYC has found ET when follicles are smaller than 18-22mm results in a higher chance of success.
    Baby Dust to all!
    :)

    Offline scattykatty

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    « Reply #5 on: 30/01/17, 13:46 »
    Hi ladies,

    I've found this thread really interesting as I start thinking about cycle number 2. Was really disappointed by embryo drop out rate in my first cycle so am particularly interested in a protocol which will aid egg quality (I was surprised that quantity wasn't so much an issue for me). My clinic only does long protocol I think, and I think it's better for endometriosis patients like me, but with my quality issues and time not being on my side, I'm really interested in multiple embryo banking 'mild' ivf cycles, which might *might* = better quality embies? Any thoughts about mild ivf protocols with age/endo issues?

    Oh and eskeech, do you have a link for the NYC article about collecting when follies are smaller (I have my suspicions since I had 15+ follies on every scan but only 11 follies were collected from).
    Cheers!

    Offline Claudia H

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    « Reply #6 on: 30/01/17, 14:10 »
    Hello All,

    Please can I join your v interesting thread! We have just had our 5th failed transfer (4 fresh, 1 frozen) and I'm feeling pretty hopeless. The embryo was genetically normal and we'd just done an ERA that should my uterus was receptive. However it was a BFN like always.

    Whether we go again really depends on whether I can feel we can do something different this time. I have low AMH and usually get around 5-10 eggs so not loads. I'd love to get the number up in the hope of finding a good one. I've heard good things about Dexamethasone - anyone tried that?

    x

    Offline eskeech

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    « Reply #7 on: 30/01/17, 17:16 »
    @Claudia H,
    I'm so sorry for your struggle. I have never heard of Dexamethasone. A quick google returned a study (https://academic.oup.com/humrep/article/16/9/1861/2915883/Low-dose-dexamethasone-augments-the-ovarian) and an article (http://www.theatlantic.com/health/archive/2013/01/ivf-on-steroids-the-dangerous-off-label-use-of-dex-during-pregnancy/267187/) against it. 

    @scattykatty,
    That's interesting that long protocol is better for endo. Do you know why? I have endo, but as I'm older short protocol is being advised for me. From everything I have read and all the women I have talked to, short protocol seems better for older women.
    Here is the link regarding early retrieval: https://www.centerforhumanreprod.com/video-gallery/video/early-retrieval-triples-pregnancy-chances/


    Offline scattykatty

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    « Reply #8 on: 30/01/17, 22:55 »
    Thanks for the link eskeech - interesting although I don't have DOR will try to find the paper to read up a but more.

    As for long protocol I think the downreg basically shuts off the normal surges of oestrogen & progesterone from the previous cycle and, for example, can shrink cysts. I'm not sure of the exact theory I'm afraid. Might need to revise before my review appointment. Although mild ivf or short protocol is not something my clinic does anyway so would have to move. I just want to see evidence that it's at least ok for endo patients but haven't seen it mentioned anywhere...

    By the way what do the clinics mean by ovaries can't cope with long - that they might switch off and not respond to meds or something more subtle cf egg quality?

    Sorry for all the questions!

    Offline eskeech

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    « Reply #9 on: 31/01/17, 05:39 »
    @scattykatty,

    Here is what my clinic said to me about stimulation/ovaries:

    "Because of your age we try to avoid a long protocol because although its a more aggressive option it makes it harder for your ovaries to respond so you  need higher doses which we believe is counter productive as its unhelpful for egg quality.

    If follicle count is reasonable we usually try for a short antagonist program in your age group.  If follicle count is very low or FSH very high then its pointless to use stimulation and we try for natural cycle IVF."

    :)