# Protocol advise please



## LadyP (Jul 3, 2003)

Hi Peter,

I was hoping you could give me some help with regards which protocol to suggest we try next.. sorry it got really long.

A little background, my day 3 FSH was 6.5, I have had 2 IVF cycles. I turned 38 in October and DH was 39 in September. Endo (a high stage 3) discovered in Feb via a lap. No idea I had it as it is asymptomatic. One tube totally blocked, the other is barely patent (the doc managed to force a small trickle of dye but it wasn't a good flow and took a while). Small chocolate cysts on one ovary (probably the other too but it was glued down and the underside couldn't be seen). Fimbrae at ends of tubes gumed up with adhesions.

IVF 1 - 150IU Gonal-F after 15 days of downreg with buserelin. 3 mature follicles, 3 eggs. ER was relaxed, comfortable, woozy with minimal pain (one puncture on each side) and I felt so well after I went shopping. All 3 fertilised, 2 4-celled grade 1 (1 being best) embryos transferred at day 2 resulting in a biochem pg. 3rd embryo was considered too fragmented to freeze. 

IVF 2 - 300IU Gonal-F after 18 days of downreg with buserelin. 4 (maybe 5) mature follies, about 4 smaller follies. NO eggs recovered from the 2 follies on one ovary due to equipment malfunction & possibly doctor incompetence. 3 eggs from 3 follies on the other ovary after a doctor change-over. ER was very painful (I think a nerve was hit judging by the shooting pain in my hip which lasted until recently), involved 4 punctures (3 on the side no eggs were recovered from). I then spent 2 days in bed with a hot water bottle, sleeping. I apparently had more of the sedative than last time but it seemed to have no effect on me at all. Of the 3 eggs, there were 2 which fertilised normally and one was polyspermy (3 sperm) so was discarded. 2 nice quality (no obvious fragmentation) embryos (2 cell & a 3 cell) were transferred at day 2. A negative blood test followed but AF had already arrived by that point. I wasn't expecting anything else after the ER - after the amount of pain and bleeding I think my nether regions wanted nothing to do with implantation!

Now, despite the doubled Gonal-F dosage we still only ended up with 3 eggs and nothing to freeze. I'm not sure this really long protocol works for me. Would a different protocol be worth a try? If so what sort? Flare, LP... Is it worth doing ICSI just to prevent any more polyspermy issues? Should I be checked for NK/auto immune issues?

I'm definitely going to insist that any future ERs are done by the doc I had for IVF 1 and the 2nd half of IVF 2.

Just a little side-note, my sister (only 11 months younger than me) got pg on her first month trying. She has no endo that we know of.

Thanks and sorry again for it being so long.


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## peter (Oct 2, 2002)

LadyP said:


> Hi Peter,
> 
> I was hoping you could give me some help with regards which protocol to suggest we try next.. sorry it got really long.
> 
> ...


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## LadyP (Jul 3, 2003)

Thanks for your time Peter, 

It'll be a few weeks (6 or more) before we can get an appointment to see the consultant and I have lots of questions for him. In the meantime we're off touring for a week or so.

Thanks again.


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