Comments on IVF Authority: Lupron Therapy and IVF

Please read my article elsewhere on theis blog on ...

2010-03-08T22:32:32.850-08:00

Please read my article elsewhere on theis blog on use of the BCP in IVF.

Geoff Sher

Dear Dr. Sher, How to determine BCP and Lupron ar...

2010-03-05T17:37:57.918-08:00

Dear Dr. Sher,

How to determine BCP and Lupron are needed in a cycle?
The reason I asked this is because I was told by a nurse from Gonal-F that I was over-suppressed and that's why I even didn't respond to 575 unit gonal-F which was considered high dose based on her opinion and my age (37).
Also, my best friend was on a protocol without BCP and micro-dose lupron. She is pregant. We are at same age. Both of us are poor responders. both of us never take BCP until do IVF. Both of us have FSH around 7-9.
Now, my doctor is put me on lupron + Cetrotide then + gonal-F 750, why?

Thanks,

Rebecca

It is basically the same. I cannot represent that...

2009-12-15T17:11:31.730-08:00

It is basically the same.

I cannot represent that using P4/Ganirelix premenstrually will yield the same results as an an "agonist) premenstrually would do. It might be OK but I am not sure.

Yes! you can simply increase the dose of Folistim.

Good luck!

Geoff Sher

Hmmm...what would you do instead of menopur? Just...

2009-12-13T18:52:59.963-08:00

Hmmm...what would you do instead of menopur? Just use a higher dose of follistim? (I may be getting a little out of my league here.)

My doctor does retrievals/implantations during the same week for all of her patients, so maybe that's why the long progesterone/ganirelix portion - to get me on their schedule...?

Even if it takes a long time to stimulate me, will the results (i.e., egg number/quality) be similar to a shorter stimulation period?

Thanks for wishing me luck - seems like I'm going to need it! :)

Thanks again,
H.M.

P.S. Couldn't find the exact title you mention in your blog, but I ran across this elsewhere on the web - is it similar to what you wanted me to read?

http://forums.haveababy.com/lofiversion/index.php?t865.html

If using Lupron as a trigger, is it injected intra...

2009-12-11T23:32:23.145-08:00

If using Lupron as a trigger, is it injected intramuscularly?

I do not recommend DHEA as it is an androgen and m...

2009-12-11T14:51:33.957-08:00

I do not recommend DHEA as it is an androgen and metabolizes to testosterone. Too much ovarian testosterione is not good for the eggs.

Ovidrel is not my fovourite either...UNLESS a double dosage is given. In the single dose I believe it to be less biologically active than 10,000U of hCG

In many cases, especially older women and/or women who have diminished ovarian reserve, Menopur and Repronex in large doses deliver more LH and thus LH-induced testosterone than is good for normal follicle growth and egg development.

In my opinion, 2 weeks of progesterone followed by a week of antagonist is too long. It is likely to suppress the final 5 day process of egg recruitment which is driven by the rising FSH level that occurs spontaneously preceding the initiation of menstruation. Since such prolonged premenstrual administration of progesterone/ganirelix will suppress FSH it could result it taking much longer than necessary to stimulate you.

Please read the article elsewhere in this blog entitled; "An Individualized Aproach to Ovarian Stimulation".

Good luck!

Geoff Sher

Ok. Read the posts. It sounds like you'd recomme...

2009-12-09T10:35:34.531-08:00

Ok. Read the posts. It sounds like you'd recommend an agonist/antagonist conversion protocol instead? Not sure I understand it completely, but it sounds like the key part is remaining on a low dose of antagonist during stimulation??? And you wouldn't stimulate with menopur at all?

As it stands, I'll be on estrogen and progesterone for ~2 weeks, then ganirelix for a week, followed by follistim and menopur and potentially more ganirelix (is this considered late antagonist?) before triggering with ovidrel. Does this sound ok? I'm not sure if my LH was high or not, and I did respond well to clomid, so maybe my DOR isn't super severe yet?

I want to understand as much as I can before going through this process, but it is a lot to learn in a short amount of time.

What do you think about DHEA supplementation, by the way? Dangerous because it could lead to too much testosterone? There seem to be some promising papers on it in the literature...

Thanks again!
Hopeful Mom

Thank you!!! You have really put my mind at ease....

2009-12-09T09:50:53.606-08:00

Thank you!!! You have really put my mind at ease.

Warmest wishes,
Hopeful Mom

Please read ny articlwes elsewhere on this blog re...

2009-12-04T15:54:25.538-08:00

Please read ny articlwes elsewhere on this blog regarding "Diminished Ovarian Reserve...". The last thing you need is a microdose flare protocol. The suggested protocol is a better one.

good luck!

Geoff Sher

Dear Dr. Sher, I'm getting ready to start an IVF ...

2009-12-04T11:11:30.431-08:00

Dear Dr. Sher,

I'm getting ready to start an IVF cycle and have been diagnosed with DOR (FSH after CCT of 12.5, I think). I had a miracle baby with a single IUI after taking the lowest dose of Clomid 1.5 years ago.

I'm wondering whether I'm on the right protocol (estrogen priming / antagonist). Do you think I would produce more and/or better quality eggs if I was using the microdose lupron protocol?

I haven't been able to find much difference in outcomes on PubMed, but it would be great to get a clinician's opinion. I will be 38 in Feb.

Thanks so much,
Hopeful Mom

Dear Dr. Sher, Hope all is well. We had a consult...

2009-11-07T11:02:20.784-08:00

Dear Dr. Sher,

Hope all is well. We had a consultation previously and I was looking to cycle possibly in December. Sorry I don't have any way to ask this privately. My husband and I would like to have a consultation on one of those Fridays but the office said you only were available next Monday and Tuesday and would be away for 2 1/2 weeks.

So we will go ahead and ask our question here. Is there an alternative to Lupron? After Channel 13's very negative report on Lupron recently, it became a worry. So we would like to know if there is any suggestion to replace Lupron during the IVF treatment.

Thanks,
Nancy

Thank you. Geoff Sher

2009-11-05T00:33:55.127-08:00

Thank you.

Geoff Sher