* Author Topic: Low AMH / High FSH Cycle Buddies - Part 6  (Read 124987 times)

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Offline AdelineX

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Low AMH / High FSH Cycle Buddies - Part 6
« Reply #250 on: 21/02/18, 17:14 »
Helen- yes, microdose flare is the protocol I was offered and it is clear to me now they have a preset course for older patients- first they offer the Menopur only protocol, then microdose flare, then mini IVF, etc. Your first try with them was Menopur only, if I remember well...
The microdose variant I was offered implied estrogen priming for 7 days, then Diphereline 0.1 from day 2 of menstruation, then from day 3 375 Gonal F, followed by Gonal f+Menopur from day 6. I am not convinced this is the best approach, since two other drs warned me of the drawbacks of this protocol for poor responders. The literature is split on the issue, so I am really tempted to go ahead with estrogen priming and short antagonist. The Dr said she is certain the microdose flare is the best approach in my case, but she also said  she could not make me do something I have doubts about. Of course I have doubts, they give the same treatment to whole categories of patients. I insisted on estrogen priming, Gonal and some LH activity later in the  cycle.
I take 12.5 thyroxine to lower TSH, it was 2.80 a few weeks ago, will retest one of these days. I have autoimmune thyroidism, was hyper now it goes hypo. I will take steroids for immune suppression, Dr.  Prescribed 8 mg but if I get to transfer I will have a much more aggressive treatment since I have elevated anti -thyroid antibodies.

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    Offline MA66

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    Low AMH / High FSH Cycle Buddies - Part 6
    « Reply #251 on: 21/02/18, 17:44 »
    Hello ladies

    Just a quick post as I'm running out the door, but I've read all of your posts and just wanted to say:

    I'm sorry I didn't mean to mislead anyone with my comment about hearing that 25% of the genes pass through the umbilical cord to a DE embryo.  Thank you Briss, Mac78 and ShadyWheat for explaining.  A patient I met at Zita West told me this so I presume she read the original article that the article Mac78 posted disproves!  I wanted to believe so didn't read up on it!  But sorry, I didn't mean to mislead.  Thanks for sharing the article Mac78 and for the explanations.  It makes more sense to me about shaping the genes.  At least this is something I guess.

    LXP, I'm so sorry for the BFN.  Do take care of yourself and plenty of treats.  You have so many positives you can take away and you can get to transfer, this is all a numbers game so next time.  Big hugs

    LauraC81 and Mac78 thank you for the ubiquinol information.

    Sunshine122, I'm keeping everything crossed for a natural positive for you.  I do believe the universe guides us, so you never know re your birthday dates lining up!

    tily - I'm so sorry your egg didn't fertilise.  I just don't know what to say but big hugs.  I understand your DH trying to protect you and place a limit on things.  My husband is saying the same 2018 deadline.  I have it in my head as a useful soft guideline.  Yay re the fostering, how wonderful that that has come out of this situation.

    Mac78, Wow.  You are one strong lady.  I am sorry to hear you had such a start in life.  I'm sure you are due a break!  Thanks for sharing.  I;m glad to hear that your interview when well. FC

    Helenbeau, I found your words inspirational.  Thank you for sharing that.  I'm going to take some of that onboard.

    klik - I'm so pleased your hysteroscopy went as good as it could have and that its all done now.  FC for a natural FET now.

    Annakay - You have nothing to be ashamed of.  I don't think it's selfish.  It's the way you feel and that's perfectly OK.  People's feelings change all the time.  But, if yours don't that's fine too.  We are all different, thats what makes the world work.  I think we all go through stages.  I'm in a similar situation with my parents!  And my past, living with other family members, and the effect this now has on me and my relationship with them.  Everything has an affect.  I just try to manage it so that I limit the hurt now as an adult.  However my DH is always saying why do you have a relationship with them, but, like you, they are still my parents and I love them for that, what they deserve is not for me to judge.  Thanks for sharing.  I'm sorry to hear about your cyst and the delay and the DE chat again!  FC are cysts go quickly!  Can I ask what they have given you to try and get rid of the cyst please?

    Hi to everyone else x     

    Offline Helenbeau

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    Low AMH / High FSH Cycle Buddies - Part 6
    « Reply #252 on: 21/02/18, 18:48 »
    Hi Anna, yes Dr Hana said it was difficult to know which protocol because I had just menopur and it went great first time but not great the second time and she suggested the flare but gave no details. I donít think Iíll be cycling there again anyway because if I go again I will be single so impossible to cycle in Reprofit.
    Can I ask you about the thyroid thing. Iím tempted to take a small dose of thyroxine. My mum takes it. Iíll go back to the doctor and ask but they have become very unhelpful and I donít know where else to go. My anti elevated antibodies are elevated at 14 (shouldnít be more than 4) but my anti TPO is normal. I read that auto immune thyroid problems will have elevated TPO. As mine isnít then maybe I donít have an auto immune problem but the anti thyroid antibodies could suggest this? Iíd rather take a steroid as precaution. Ironically I was prescribed it as precaution before I had the tests and now they say I donít need it although I think the tests suggest maybe I do. What do you think compared to your results? Iíll try Dr Hana again but no comment as yet. Thanks for the advice thanks 🙏🏻

    Offline tily

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    Low AMH / High FSH Cycle Buddies - Part 6
    « Reply #253 on: 21/02/18, 18:52 »
    Hi ladies,

    Just a quick one for Annakay and the LH discussion. Mine is normally hovering around the 10 mark at baseline. Have you read Dr Sher's blog about high LH? The protocol he is suggesting is interesting? Sounds a bit like one of the protocols you had mentioned which involved taking an antagonist in Luteal phase?

    http://haveababy.com/fertility-information/ivf-authority/age-aneuploidy-and-ovarian-reserve-why

    Also, I read another article that mentioned that HRT can cause spontaneous pregnancies in POI and this might be due to lowering levels of LH. I primed last cycle and my LH was still 10 at baseline so not sure how much HRT one would need to take to reduce LH. Starting to think LH is the big baddie not FSH...

    Hi to everyone else. No real news, felt like a just had a bad dream that I went for an egg collection last weekend and the egg didn't fertilise and then realise it actually happened.

    Offline tily

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    « Reply #254 on: 21/02/18, 18:57 »
    Here's the other link...


    https://www.nichd.nih.gov/health/topics/poi/conditioninfo/treatments

    What do you ladies think?

    Offline LauraC81

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    Low AMH / High FSH Cycle Buddies - Part 6
    « Reply #255 on: 21/02/18, 21:34 »
    Helenbeau:  Sorry I can't offer any advice but FX for you getting it sorted.

    Tily:  Sending you all the hugs.

    Everyone else:  Lots of hugs and babydust to you all xx

    Offline AdelineX

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    Low AMH / High FSH Cycle Buddies - Part 6
    « Reply #256 on: 21/02/18, 23:26 »
    MA66 thank you for your kind words. It is hard, on top of everything else. DH no longer speaks to his parents (long, ugly story), but I can't do the same. My father has advanced stage Parkinson's disease and if I ceased all contact with them they wouldn't be able to manage things on their own. As for cysts, there are 2 possible approaches - BPC for a 21 days, but it can be oversuppressive for poor responders with low ovarian reserve. I took BCP before my first IVF and it probably supressed me. The second option is progesterone in the luteal phase, from day 16, followed by estrogen priming (days 19 or 20 for 7 or 10 days), or simply BPC after cyst confirmation (after days 14-15, or when ovulation was supposed to occur).

    Helenbeau - high Anti-TPO levels are the sign of autoimmune thyroiditis, be it Graves or Hashimoto's. Which antibodies are elevated in your case? The autoimmune component is diagnosed if one ore more of these antibodies are elevated, they are all anti-thyroid antibodies - anti-thyroid peroxidase (anti- TPO), anti-thyroglobulin (TgAb) or anti - thyroid-stimulating hormone receptor (Anti-TSHR or LATS). You should definitely ask an endocrinologist about taking thyroxine and after 2-3 weeks of treatment you should monitor TSH. If any of these antibodies is out of range then it definitely shows your body has some autoimmune activity and steroids are indicated to prevent embryo rejection.
    My antibody levels are all elevated, I've had Graves disease for many years. Now, after so many years, my thyroid has been partly destroyed by the attack of antibodies, that's why it went from hyper to hypo. In fact, I blame Graves and the autoimmune component for the premature depletion of my ovarian reserve. It is still incredible to me that I'd been seeing an endocrinologist for 6 years and not even once did she mention anything about fertility check ups, not even after I refused surgery to remove the thyroid because I wanted children at some point (it is hard to pinpoint the right dose of hormones once the thyroid is gone). However, I do not encourage you to take thyroid drugs without seeing a dr. first.
    Some studies suggest selenium is beneficial for autoimmune thyroiditis, I think you can include it among your IVF supplements.

    Tilly - I know dr. Sher is a firm believer in the importance of LH control in IVF and there is a lot of scientific literature that supports his opinion. Excessive LH is detrimental to egg development, and follicles may become atretic or prematurely luteinized is exposed to high LH levels in the early follicular phase. LH 10 at baseline (you mean day 2?) is high. HRT mimics the normal cycle of progesterone/estrogen and it sends a signal to the pituitary gland that it doesn't need to overstimulate the ovaries by releasing a lot of FSH and LH. In theory, the agonist/antagonist conversion protocol is great for poor responders who have elevated baseline LH levels. In practice, the protocol is very long and extremely expensive, and few clinics outside the US use it.
    The variant I had in mind was estrogen priming and late luteal antagonist to lower LH and FSH and hopefully get rid of the cyst. I didn't do it in the end, because premenstrual antagonist can oversupress ovaries as well. Dr. Sher's protocol uses antagonist from the beginning of menstruation precisely because he wants to avoid a premature LH surge. However, one can always monitor LH during stimulation, and, if it goes up, an antagonist can be introduced. In your case, if your LH is 10 at baseline, you should discuss this with the RE and ask about solutions - perhaps a few days of agonist or antagonist before menstruation to lower LH and FSH levels before stimulation ?
    The bad dream sensation is a good sign - it protects you a bit from the bitter reality of this awful experience. Sending you warm hugs...

    Hi to everyone!

    Offline Helenbeau

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    « Reply #257 on: 22/02/18, 12:27 »
    Anna, I have high anti thryroglobulin but TPO is normal. Maybe I need steroids for the next transfer? Think Iíll bring it up, again x

    Offline MA66

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    « Reply #258 on: 22/02/18, 14:27 »
    Hi, thank you for the information AnnaKay, your knowledge blows me away!  As much as I try to understand what you are saying I don't think I do much, so I am grateful for you answering my questions many of which I am sure you have already explained!  I still don't understand the basics of what a flare protocol is and what an antagonist is???

    Do you think it would be worthwhile me adding selenium to my supplements as I have high TSH, usually around 3.  I'm awaiting the results of my latest test and will push create to prescribe levo but do you think selenium might help?  Also I think I've read that this is a useful supplement for the man too? 

    Thanks for your help.

    Offline AdelineX

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    « Reply #259 on: 22/02/18, 23:15 »
    Helen, yes, you should bring up steroids for immunity suppression. High levels of antibodies may signal some sub-clinical condition.

    MA66 - an antagonist (specifically, a GNRH antagonist) is used to prevent a LH surge that could trigger ovulation prematurely in an IVF cycle. Both GNRH agonist and antagonists interfere with the activity of the pituitary gland, the master gland that controls the hormonal flow in the body (it is, in its turn, controlled by the hypothalamus).
    The principle of the flare protocol is simple - at the beginning of the menstrual cycle, a GNRH agonist (Lupron, Decapeptyl etc) is used. Agonists have a special effect on the pituitary - first, they make it release a massive amount of FSH and LH, then they suppresses it, blocking the internal FSH and LH supply. The first stage, when the pituitary is stimulated to release a lot of FSH and LH is the actual 'flare'. Since the second stage of agonist action means the pituitary no longer releases FSH and LH, these 2 hormones must be administered exogenously, as injectables.
    The massive amount of FSH and LH released by the pituitary may help recruit more follicles and it helps their growth in the first stage of follicular development. Although studies show that it is a good protocol for poor responders, some REs believe that too much LH (released together with FSH) is not good for follicles and egg quality at an early stage. 
    The literature is split on the selenium issue- some studies show improvement in cases of autoimmune thyroiditis, others show no improvement. However, it is not harmful, worst case it just has no effect. It is good for male fertility, too. Ask Create about it, they can confirm if it's ok to take it.