# Views on level of stimulation drugs: is 450iu too much?



## jo_11 (Apr 1, 2009)

Hi ladies,

I wonder if any of you have any experience or views of the level of stimulation drugs used during tx?

Including a failed cycle turned IUI, DH and I have now been through 5 cycles now, and it's all getting a bit draining tbh, both mentally, emotionally and financially.  We're currently having our full Chicago immune testing undertaken, but I've also starting thinking of the next cycle... my motto is 'got to have a plan'!  I think it's the only thing keeping me from going   

For 4/5 cycles I've been on maximum stim drugs of 450iu, and we've had good quality embryos each time at day 3, which seem to go downhill a bit by day 5.  Not exactly sure why this is happening, and maybe the immune testing may shed some light on this.  Or is it the combination of drugs, or the dose??

In terms of actual meds, these have been:

1.  375iu Gonal-F, plus orgalutran - antagonist SP.
2.  300iu Gonal F, 150iu Menopur, 100mg clomid, plus cetrotide - antagonist SP.
3.  450iu Gonal-F, plus cetrotide - antagonist SP.
4.  450iu Gonal-F, plus Synarel - agonist SP.
5.  300iu Gonal-F, 150iu Merional, plus Suprecur - agonist SP.

The eggs collected, and what was transferred is in my signature.

I've heard that there is a school of thought that says 450iu is too high a dose... I'm not sure if this is supposed to affect quality or quantity or both.  Does anyone know?  

I'd be really grateful for any thoughts/experiences/views.


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## niccad (Apr 28, 2009)

Hi J0 - I don't think 450 is too high... I was on 450 for the first few days of my last stims and then up to 600 for about 5 days! With my AMH levels & age I knew I would be on a high dose and as long as your bloods are being carefully monitored you will hopefully be on exactly the right dose to get all your follicles mature. 

In a previous cycle when I only had 4 follicles & i was also on 450iu it was definitely too high a dose - but that was because that 450 was feeding only 4 eggs....

Good luck with your next cycle...     that it's the one xx


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## jo_11 (Apr 1, 2009)

Niccad:  Firstly, congratulations of your BFP!  That's really useful to know about your stim drugs... I didn't realise ARGC went up to 600iu    Do you know why/when they upped it; was it because there were more follies to feed??  What's your AMH btw?  I'm not sure how much bearing this has on things... mine is low but I seem to get a good number of eggs.  Which medication(s) were you on as well.  

And also (sorry, another question!!), did ARGC advocate the use of LIT and the other immune tx?

Thank you!


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## niccad (Apr 28, 2009)

Hi Jo.... This was my breakdown of bloods, scans and drugs (I was on fostimon and merional):

Day 1 - 300F and 150M
Day 2 - 300F and 150M
Day 3 - 300F and 150M
Day 4 - 150F and 450M
Day 5 - 150F and 450M
Day 6 - 150F and 450M
Day 7 - 150F and 450M
Day 8 - 150F and 450M
Day 9 - 150F and 300M
Day 10 - 0F and 450M
Day 11 - 150F
Day 12 - 75F and 225M

ARGC do blood tests every day and the dose depends on the results - both FSH levels and LH levels. Basically had blood test in the am & got phone call each afternoon to tell me the dose. They also did a scan every other day. They do this to make sure you are getting the optimal level of drugs each day to maximise the quality of the follies (they are more interested in quality than quantity)... 
ARGC knew that I'd done LIT but I had it before I went there. It's not something they routinely suggest. They really advocate NK immunes etc and routinely test every patient at the beginning of stims. 

I used suprecur to DR and luckily didn't need cetrocide (although they do give it to girls often at ARGC depending on blood tests - it's the LH one they monitor closely for this & some girls have 2 blood tests a day to check it). I also had intralipids during stimming and started steriods on day 5ish and started on clexane. I've been on aspirin for ages... I also self prescribed a load of vitamins to help with my egg quality this time. After ET I was on gestone, ritodrine (it's a uterus relaxant) and clexane and I'm still on clexane and cyclogest now... 
My AMH was 5.93 when it was tested last year. My FSH has always been under 10 but my estrogen levels were high alongside it so i guess the FSH readings were hidden a bit.. 

I hope this ramble helps. My embies always looked great on day 3 too... but this was the first time I went to blast and out of my 4 'perfect' day 3 embies only 2 made it. I know immune stuff was a big issue for me, but I really think my egg quality wasn't great - even though they always fertilised and looked great up til day 3. I read that day 4 is when the sperm really integrates with the egg too... 

When are you planning to start cycling again? I'm with you on the 'plan' thing. After each of my negatives I went on a massive search to investigate that massive question 'why?'. I hope that NK tests throw up some answers for you. Where did you have them done? 

Nic xx


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## jo_11 (Apr 1, 2009)

Nic,

Yes, your 'ramble' is massively helpful, thank you so very much  

Can I be REALLY nosey and ask for the blood results too?  Out of interest, which protocol were you on? I see you were DRing, so was it LP? Not sure why you mention Cetrotide though, unless you were doing the 'flare' SP, so stopped the DR drug? I'm at the Lister, always SP, and if you're on antagonist (Cetrotide), they do your LH and E2 at scans, but on the agonist (Suprecur, Burselin, etc.) they don't bother with LH as there's no chance of ovulation (although I can see that ARGC look at it to check levels). I guess I could ask them to look at both FSH and LH during scans, although I've only ever had c.3 scans during a cycle.

I'm having my full Chicago immunes done through Dr Gorgy, and had 13 vials of blood  taken on Tuesday for this. DH had 6 vials, plus a sample, so they can karyotype his sperm. I'll get an opinion from Dr G about the results, but will then be taking the results to the Lister to see what they say - they are pro me getting these tests done. I know the Lister is massively anti LIT though as they think it's outdated and v dangerous. Not sure what I'll do if this is on the list of recommended tx.

Yes, I've been told by Drs that the sperm/egg info 'meets' on day 4 too, which is where ours go a bit wrong. I'm not sure if it's an egg problem, or sperm problem, or just bad luck (but I don't really 'buy' the bad luck thing). DH's sperm karyotype will hopefully sort out if it's a sperm problem, and the Lister is getting IMSI in the New Year, so if there are issues, hopefully they can be overcome by this. If it's an egg issue, I'd like to know. I'm having karyotype done, and we're considering CGH on the polar body of my eggs; it's all a lot of £££ though, so we may 'wing' it on the next cycle and see what happens, esp if I need immune tx. If it is an egg issue, we'll move to DE.

DH is keen to have another cycle immediately but I obviously want to wait for the immune results first, plus as the Lister is getting IMSI in the New Year, I'd like to see if we're candidates for that. So, I suspect Jan or Feb we'll go again... I'm now half wondering if I need to go and see ARGC - argh, more choices!

I think I may ask for Fostimon rather than Gonal-F next time, or just ask 'why not'? And I was on Merional too last cycle, and it was my best result so far; I wonder if I need more of that?

Thanks again, and sorry for _my _ramble.

Jo
x


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## niccad (Apr 28, 2009)

Hello...

do you mean the blood results whilst I was stimming? If so then I don't have them. I just looked at my file every day when as i at the clinic to see if they were in line with what I thought they should be. I was on long protocol and at ARGC they sometimes give centrotide on this protocol too if your LH goes up. ARGC's thinking is that you can still ovulate on suprecur, burselin etc if the levels aren't high enough (could just be if you have a cold and the right quantity hasn't been absorbed), but I think they also tend to stim for a bit longer so that all the eggs are mature...

I saw DrG too... It's a lot of testing isn't it. Like you I was a bit weary of LIT but decided to do it anyhow as i was using DH blood. I was also anti humira but on this last cycle bit the bullet as i thought it might be the answer. Are you taking supplements to improve egg quality... There's a girl on here called Angel bumps who has some really good suggestions on vitamins. I ended up taking loads of them but who knows if it was them that made the difference!?

Merional is similar to menophur and Fostimon is the newer version of gonal F. Merional contains some LH whereas fostimon doesn't which is why some clinics use them in combination to get your LH level correct... It's all so complicated isn't it....

I'd be interested to see your DrG results when you get them... 
x


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## Helenahandcart (Nov 22, 2010)

I have been on 450iu menopur for both failed cycles. 1st cycle was an antagonist cycle using menopur and orgalutron, i felt fine all throughout stim phase, result was 8 follicles, 8 eggs, removed too early, all immature.

2nd cycle was 450iu menopur and buseralin, flare cycle, i felt dayum rotten throughout, but result was much better, 8 large follicles, 5 mat2 eggs!!! The clinic didn't convert to ICSI when sperm wasn't interested, so this is why i'm peed off.

I asked professor Balen why some people were using 600iu menopur and i was only getting 450 and he said that evidence shows that not only is 600 unproven to work better than 450, but it can also be detrimental to the cycle !!! Who knew?


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