# Long or short protocol for over 40 good responder



## bisayan (Sep 24, 2015)

Hello, 

I know this has been asked before but just wondering what other people's experiences are. I've gone through 3 IVF treatments and am about to embark on our 4th one. Due to my low AMH (6) and initial low AFC, I was initially put on a long protocol. After 2 x responding better than expected (+12 fertilised eggs each time) we were given the choice between short and long protocol for our 3rd one but decided to stick with the long one.

I did all 3 IVF at Guys and had immunes treatment at Dr Gorgy's - both advised there was no difference between long and short. For our 4th attempt I am inclined to try the short protocol however I read that long protocol was better for older women. Anyone else heard this or anyone over 40 who had success with short protocol?


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## Beside_the_seaside (Oct 9, 2012)

Hi - you write "...For our 4th attempt I am inclined to try the short protocol however I read that long protocol was better for older women".

I've heard the opposite to be fair. I thought that *short *protocol was often recommended for older women - I think it's because long protocol can sometimes leave women over-suppressed and then slow to respond (or very little response) to stims when they're given? So if you're inclined to give short protocol a try, maybe it's worth it, even just on the basis of trying something different?

What is your fertilisation rate like? Has anyone considered your DH side of things? Have you tried ICSI, or even enhanced versions of ICSI (like p-ICSI) to improve your fertilisation rate? It might not be an egg quality issue at all.

Just one other point - you say your AMH is "low" at 6. Perhaps it's lower than ideal, or even lower than average for your age, but I honestly don't think it's low as such. I've heard there are no real concerns until AMH dips below 3, but to be fair, plenty of women get pregnant with even undetectable levels of AMH. So please don't stress about that.


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## bisayan (Sep 24, 2015)

Thank you for your response Beside_the_seaside. Yes, from browsing through forums I also gather that short protocol is actually often recommended for older women. My doubts stem from what Dr Sher writes on his website about older women having too high LH/testosterone levels which can be harmful to the eggs (http://haveababy.com/fertility-information/ivf-authority/ovarian-stimulation-in-poor-responders) and which aren't sufficiently suppressed during the short protocol.

On the other hand you're right - I think I need to try something different. My fertilisation rate was always quite good, around 75% with at least 2 blasts for transfer each time but never any to freeze. My DH side seems fine. We asked about ICSI but were advised to stick with IVF. Interesting you mention oversuppressing on the long protocol. I definitely took quite a while to respond during my 3x long protocols, 16 days stimming each time with one time being nearly cancelled.

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