# Help! Ist IVF - Long or Short Protocol?



## Moth

Hi there

Just about to start our first IVF tx, i'm 41 (fsh 6.8 but amh 3.6   ) dp 37, low morphology. Had our TIC appointment today, and discover that we have the choice of having the long or short protocol. It's completely thrown me as i was sure due to my age and low AMH that i would automatically be doing the short protocol.

Do clinics like you to do the long protocol as they are in more control of your tx? I was told there is more flexibility on the long protocol (to change meds / abandon cycle e.g. if you are not responding well etc.) I don't want to choose the long protocol if it's to suit the clinic and not particularly to suit me!

Any thoughts out there? I could start tx next week if it's the s.p. but would rather make sure i've made the right choice as this is a 'once only' ivf attempt! What difference will another month make to my old eggs! 

Any info and opinions from you knowledgeable ladies will be a huge help  

Cheers  

Moth x


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## Happy Mummy

Hi,
I think you should do what your clinic tells you to do. 
each clinic has its own way of working.
I did 3 IVF, one long prot. I had a biochemical with SP, the others were early BFN. 
Long prot is more difficult for the patient as longer , more drugs and often headaches. However for some women it works better . Your clinic should know what is best for you, according to your hormones levels, age .
Lots of   for your treatment.
Future Mummy


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## sallywags

Hmm, it's horrible when they make you decide isn't it - it's much easier to  be told what you need!!

I'm not over 40, but had sp due to slightly struggling ovaries, and have to say knowing what i do now, i'm very glad i did.  the whole thing is over and done with in 2-3 weeks, including EC and ET.

Hopefully they will make a decision for you hun!


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## Pogo1

Moth,

Its very difficult to be asked to make this choice, especially as it is your first one and you don't know what your response will be. All my previous SPs were at the argc, where mostly women with an fsh over 10 would be advised to go on the SP, this was mainly because you would have to wait until your fsh came down to below 10 to start and the clinic wanted to grab the best cycle. I am now doing the LP to see if it makes a difference to the outcome. 

My only thoughts would be is that if you wanted to get on with it, then go for the short, but it is difficult to predict your responses on any of these until you try them. Some people respond better on SP and some on LP. Maybe worth talking it over again with the clinic.

Good luck!
Crystal
x


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## Happy Mummy

Sorry , read too quickly , and did not realise you had to make the choice   never heard that one before. 
If you don't know ( who would) ask your doc, what does he advise , and go with it. 
I prefer the SP , as easier and I am going to go for a 4th IVF soon, but will ask if I can have a SP as done both and the SP is the one when I got a chemical  . 
Future Mummy


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## suitcase of dreams

Hi,

Crashing your thread a little (I'm 38 so don't technically qualify for the over 40s I guess....) but I had a similar experience where the clinic basically said it was up to me whether to go long or short protocol. The consultant said that long protocol is the 'norm', it's what they have always done, so they have more data on success rates etc. Whereas the short/antagonist protocol (which is where you have 2 drugs during stimming - Puregon or something similar to stimulate eggs, and Orgalutran to stop you ovulating too soon) is newer so they have less data to go on but early indications showed very similar success rates and that the SP had been particularly successful with older women and poor responders. 

I went with the SP in the end for two reasons: the timing worked better overall, I could start sooner and it only took 14-17 days from start to ET, and also because I just didn't really like the idea of shutting my system down and then stimulating it up again. I know that sounds silly since any form of fertility tx involves pumping drugs/hormones into your body, but somehow the SP seemed less 'disturbing' of nature than LP....that's probably totally illogical, but it helped sway my decision at least!

First cycle I got 21 eggs, 14 fertilised, 2 grade 1 8 cells went back in, none of rest good enough to freeze....BFN. At review asked consultant if I should consider change of protocol and she recommnded not....2nd cycle 20 eggs, 14 fertilised, 2 grade 1 8 cells back in plus 3 to freeze. Am on day 3 of 2WW right now - fingers crossed!

Of course I can't compare SP to anything as haven't tried the long...but if the consultant has basically said you have equal chance with either, then SP is certainly fast - scan day 2, start stimms, EC usually around day 13/14, ET 1-5 days later. And you can start from day 2 of AF, so easier to manage if you don't have very regular cycles...

Sorry, turned out to be a very long reply and probably hasn't helped, but at the end of the day there is so little reliable data on success rates and the first IVF is often a bit 'hit and miss' as they learn about your body and how it responds. 
If you don't feel 100% comfortable making the decision yourself, I'd push the clinic a bit harder to make a recommendation - that's what they are there for after all!

Good luck with whatever you decide
Laura
x


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## Moth

Hi Future mummy, Sallywags, Crystal and Lauris  

Thank you so much for taking the time to reply to my post. I can't tell you how helpful it is to read your experiences/opinions. I feel so much better now that i've read your posts!  

I had a good think about it all last night and today and I've decided to make another appt with a consultant, just to discuss this further - before i take the plunge! 

Cheers again for your help - it's much appreciated.  I will update you when i've got my tx schedule in place!  

Good luck to everyone  

love 

Moth x


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## mrsaligee

Hi
I was never offered SP and have done two LP's, both negative.  I heard SP was better for older ladies and people with high FSH (like me).  I pushed for it at my last appointment and am going for it in August.  My womb lining is an issue and the thought of shutting it completely down with the ovaries seems silly as it would need a longer time to recover and thicken (my thoughts).

We'll see how it goes, don't know if that helps you!

Mrsaligee
xxx


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## Moth

Thanks Mrs Aligee

Yes, that's really helpful to hear - it's better to have a choice i guess and at least know our options. but to be honest, if i hadn't done so much research before my appt, i wouldn't have known any different.   I asked what tx i would be doing, and when they said i would be doing a long protocol, i asked why i wasn't doing a sp due to my age and low amh. I think as a rule, they tend to do the lp, especially as it's my first tx. I know what you mean about the 'shutting down' part - I think the thought of anything being shut down at my age is a bit scary!

Good luck for your tx in August,  let me know how it's going.

Moth x


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## anna the third

i agree, i'd prefer short as it has never made sense to me to shut down only to start up again!

could you begin on SP and see how it goes, being fully prepared to cancel and start again on LP if you didn't think you were responding well on short? 

you would be down a few scans and the meds but that's "all". (hmm, im £30,000 down already with nothing to show for it.) 

however, it might be worth it for the chance.


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## Moth

Hiya Anna

yeah, i think that's a question i'm going to ask as i'd be more than willing to change.

 try not to think too much about the money. Better to regret things you've done, rather than regret things you haven't done.  Who wants to be old, decrepid and full of regrets - not me  

Have you any tx planned for the future?

Moth x


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## anna the third

i think that wld make sense. 

however the main problem i have is chromosomes, i think - when the eggs/embryos divide, you simply cannot tell what is inside so though i produce a decent number and they get to blasts etc, nothing happens after that!

the other thing i want checked is implantation issues - that reminds me, have YOU had NK cells done? if not and youa re only doing one cycle, don't bother with the tests (around 800) but jsut DEMAND steroids. 25mg of prednisolone will suppress quite a bit of nk activity if you have a problem with it (as i do) 

The other thing is clotting. Again expensive tests, instead DEMAND clexane (heparin) as if there were a problem, it should help. Of course the scientific side of me says noone should be on meds for no reason but i think better to cover all bases than think "what if", exactly as you say.  

W.C.S. if, as we hope,  you have NO issues with NK cells or clotting, you will get a cold perhaps (as the steroids reduce immunity - for example, i had spots for the frist time in 20 years) and you will bleed extra long if you cut your finger/when they take blood on heparin. 

HTH

Good luck Moth!


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## Moth

Ooh you know your stuff Anna!  

Think i need to print that out to add to my list of questions! No haven't had any of those tests done. Will certainly be checking out what you've said at my consultation next week.

Cheers  

Moth x


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## anna the third

be aware that unless very "up" on things, the consultant will almost definitely be reluctant to accept issues such as immunes. eg UCH my previous clinic is extremly good but still says ther eis insufficinet evidnce for immune treatment. i just observe that most women on ff who have difficulty with no. 1 find number 2 MUCH easie, even getting natural bfps. that says to me the body "learns" something. i THINK it is the implantation cellular interaction, which noone knows much about in the world.  

maybe invest in this book which explains it all (in overwhelming detail I found anyway!) - is your body baby friendly by Dr Beer - in advance?


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## Moth

Maybe you need to start up a research centre!

Funnily enough, i read about that book last night.  Will have a look on Amazon  

Cheers

Moth x


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## Happy Mummy

Hi, regarding steroids, they can only be given if there is a need for them as otherwise can make things worse. Therefore tests are needed to see if steroids are needed. I doubt , first time it would be done, but I guess you can ask for the immune testing ( usually done after several BFNs and or miscarriages). 

Regarding NK cells, I personnally don't want to do the tests as if there is a " prob" there, treatment is too controversial for me and too many docs do not see the evidence it works. Even with Docs who do the testing.
I have implantation probs due to adenomyosis but there is no treatment for it. Not a health prob as such  just makes implantation more difficult. I had other immune testing done and all came back fine.

I read the dr De Beer book, very interesting. He was a very gifted individual. 

Future Mummy


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## anna the third

hi FM, i was at UCh which is possibly the most conservative clinic in the world. they gave me steroids on the abssi they could do no major harm. however, they can cross the placenta. why do you say they can cause harm if not needed? did you mean only if not needed or in general?


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## Moth

Hi Future mummy

Have you been diagnosed with adenomyosis? When i had my lap this year, they found no evidence of endo, even though i have most of the symptons. I asked the cons if it could be adenomyosis and she said yes but it's difficult to diagnose and can not be treated.  Just wondered what they said to you!

Cheers 

Moth x


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## Happy Mummy

OK, big news about adenomyosis. I went to Lister hospital yesterday and met a wonderful doc ( I have therefore decided to do a FET there and a fresh cycle there, if FET does not work). Her name is Dr Alison Taylor.
She says that there is more and more research about adenomyosis. She had just come back from a conference about adenomyosis in Barcelona!
She said that there is a team of London docs who have started treating it, ( can't remember if at guys or Saint Thomas hospital) if the adenomyosis is not too extensive and not everywhere, more like in a couple of specific points. They use hot ultrasound, so mimic a bit a laser, and without surgery, the heat diminish and/or hopefully destroy the adenomyosis points. For me , too late as I have extensive adenomyosis everywhere , inside the muscle. Not a health problem but halves my chances of pregnancy. 
You can get an appointment privately to see her, and she can reffer you? it is all new.
Alternatively ask your GP? it is a fact, it is now being treated in London but still very new, and the adenomyosis must be local , so that you can be treated.

Adenomyosis at the moment is only confirmed with MRI.
Not many docs know much about it and it is often misdiagnosed ( I used to be told I had fibroids!!!!)
Anyway, my treatment is going to be done taking it into account ( finally! my old clinic did not do anything about it) . So less stimm ( lower dosage ) and nat FET ( no drugs).

Future Mummy


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## Moth

Cheers for the info. I asked at my 1st consultation if this would be a problem - and was told no. But i have been worried that it's going to be an additional problem to go along with my underactive thyroid and old eggs!  

That's really interesting though, have been trying to find out info since i had my lap in Jan but there wasn't much, i could only find info about endo. 

Moth x


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## Happy Mummy

Anna, if your clinics says you can benefit from steroids then you should of course do it . I meant , it is better to not self medicate . 
Future Mummy


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## Happy Mummy

Hi Moth, just a little bit adenomyosis , according to docs, is not really a problem. But extensive adenomyosis can make implantation more difficult. This is what the docs have said to me. Itis difficult to find info about it, and until yesterday I thought there was no treatment at all. However , from what the doc was saying it is all new, and for specific cases.
Best of luck with your treatment!   

Future Mummy


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## Moth

I guess it's hard to tell if it's extensive or not but they didn't seem too concerned about finding out at the local hospital after i'd had the lap.    Anyway, hopefully it won't be a problem (if that's what i've got!)

 Good luck with your FET.  

Take care

Moth x


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## Happy Mummy

They could not have seen it from the lap I don't think as it is insidethe muscle of the womb. When I had my lap last feb they could not see it. The hysteroscopy can't either, but sometimes it can make some fold in the endometrium that look like fibroids on an ultrasound , and at the hysteroscopy it helps them guess it is adenomyosis if they see the folds. 
Only an MRI can confirm it for sure. At least all the docs I saw about it agreed on that point.
Maybe youcan ask your GP to refer you for an MRI if you really want to know for sure?
     

Future Mummy


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## Moth

Sorry, i meant that after the lap they weren't concerned with doing any other investigations to see if it was adeno.

I don't think i'll bother at the moment as i've go so many appointment between my acupuncture and clinic appointments - i haven't got time to fit in a trip to the GP   You know on the short protocol, how long do you stim for? Is it until your follies are of a good size? I can't seem to find much info, but i read somewhere that it took 14 days for someone's tx on a sp. so am a bit confused!

Cheers

Moth x


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## Happy Mummy

Hi,

SP is different for everybody.
My first SP I stimmed for 12 days. My second SP , it took 8 days!
Then when I did a LP, I stimmed for 8 days although I was ready at 7 but it was a sunday and my old clinic is closed on sundays! 
They also don't do EC and ET on week end ( unless they don'thave a choice, which is why they like to D/R you for a FET as they can control when you are ovulating, while the Lister hospital is opened 7 days a week so I can do a nat FET and much better for my adenomyosis not to have drugs apparently for a FET ).

Anyway, 14 days is a long time to stimm but it can happen.
If you have accupuncture during the stimms you may have a shorter stimm period as accupuncture boots your ovaries production  

Future Mummy


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## Sally Kate

Moth


If you haven't decided on the short Vs long protocol yet, just to say that some people react better to each and it doesn't seem possible to always reliably predict your own response with out trying.  I had a great response on short protocol first of all, changed clinics (long story), and was advised by a very eminent  Consultant to switch as I was likely to do well on long and potentially have better quality eggs.  Well, they collected 12 eggs but the cycle was cancelled as they all failed to fertilise or cleave.  Was advised by that clinic had we had probably reached the end of the road and this was indicative of a major egg quality problem.  However our original Consultant advised us to try again, and we've had good responses in two further cycles with normal fertilisation and cleaving (fell pregnant with twins but sadly subsequently lost the pregnancy). 

I think you just have to experiment and see what works for you (expensive learning curve though). Don't be afraid to get more than one opinion. As short is less gruelling, perhaps the easiest place to start?

Very best wishes


Sally Kate


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## Moth

Hi Sally Kate

I know it's in the lap of the gods what'll happen during tx, it's just horrible being in a situation that you have no control over   I have to confirm if i'm going on a weekend away with friends and this isn't possible at the moment with me not knowing what's happening - and as they don't know about the ivf, it's difficult keeping them hanging on!

I have another private appointment with a consultant next Friday (£££££   ), just to have a chat and talk things over. i'm 99% decided on the sp, but just want to make sure. You're right about it being an expensive learning curve - i can see why people end up have several attempts though - i guess you want to try out different treatments so that you know you've tried everything possible.

I'm sorry to hear of your loss and wish you luck with whatever plans you have for the future.

Thanks for the post

Moth x


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## Happy Mummy

Hi Moth, 
Could you not email the consultant instead? after 2 consultations with him, he should accept to answer your remaining questions for free via email?   
Future Mummy


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## Moth

Hiya Future Mummy

Thanks for the info on stimming - i guess i'll definately be booking my summer weekend trip at the very last minute as there's no way of knowing where i'll be in my tx schedule! 

I'm having acupuncture at the moment and starting next week will increase it to weekly sessions (have had 3 sessions so far over the past 6 weeks) - so maybe it'll help - i must say that this month, for the first time in about 2 years, i haven't had blurred vision and nausea with my af. Can't really afford the acupuncture mind you!  

I've actually booked an appt with a private consultant outside of the clinic - long story - will fill you in once i've been! The clinic have told me that they will support my decision even if i wish to do sp, even though they suggested lp (apparently this is their standard protocol - but i feel that because of my age and low amh the sp may be more appropriate - but hey, i'm no expert! what do i know!)   Our clinic isn't funded to open on weekends so i'm sure this is why they prefer the lp. 

Moth x


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## Sally Kate

Moth

Thanks for your reply.  

Sounds like you're doing all the rights things.  Time and opportunity are so precious at our age. And you are likely to get your best response in your first cycle - so it really matters that this is built around you and is not simply your clinic's standard treatment.  You might also want to check how closely they will monitor your response and use this info to calibrate your stimulation regime?  

Very best wishes

Sally Kate


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## Moth

Hiya Sally Kate

That's a good point, i'll make sure i know when i'll be monitored throughout the tx. Am now bog-eyed from reading so many web pages whilst compiling yet another list of questions! I could scream!

Will post here once i've had my appt next friday and let you know what's going on!

Cheers

Moth x


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## anna the third

hi Futuremummy ( good name) - no i completlely agree with you. my question wasnt clear now that i look at it again. i meant -did you read that the steroids are bad for those who definitely DON'T need them (ie those with maybe a naturally low immune response) or they have been found to be bad to take for the average immune responder? 

after all our reading, i sometimes think we know more than half the consultants we deal with. 

buckets of luck to everyone

anna xxx


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## Happy Mummy

Hi Anna,

I had the immune tests done ( apart from NK cells testing) and it all came back ok. I asked my consultant if I should have some steroids next IVF and he said no as there was no need for it having seen the results as steroids are quite powerful. There are always side effects to everything you take so if there is no need for it , it is better not to add anything to the normal cocktail of drugs. This is what he said and I agree. 
I am not sure why they would prescribe them in your case, but if there is a need and your clinic advises you to take them to say reduce inflammation of womb or reduce immune reaction, then of course you should take it, but if you are fine to start with, and your clinic does not think you need them why take them?  Only your clinic can advise you really, theyshould know if you will benefit from them or not. 
Future Mummy


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## anna the third

agreed - i have high NK hence why i am to take them. 
however they were prescribed for me BEFORE i knew about the NK. hence the query - I had been told they wld do no harm (20mg prednisolone) either way.


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## Demelza

Hi there,

Just to add my ha'porth. I'm now 43 and had the long protocol at Bristol last year - didn't respond to the injections at all and the cycle was cancelled. We were a bit felled by this as I had been ovulating perfectly regularly - I felt I could have done better by myself. The rather unhelpful Dr said there was a 70-80% chance of this reoccuring because of my age.

We then went to the Lister and had the short protocol, producing 8 eggs, though just ended with one to transfer, sadly BFN. But a much better result and I felt much better during the process too.

Currently on 2WW with donor eggs via Barcelona. 

A list for the consultation sounds a really good idea. For our appointments, DH would take notes while I listened and asked most of the questions - seemed to work well for us.

Acupuncture rocks - had it in Barcelona before and after transfer. 1st one she got rid of a mega headache, and the second I was totally blissed out - unbelievable considering I'd had my legs in the air 45 mins before! Don't know what was happening deep down but really helped with relaxing.

Best of luck to you all

Demelza


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## Moth

Hi Demelza

Thanks for adding your views. It's really helpful to hear other's opinions and experiences. I've heard from other ff ladies over a certain age who have also had similar experiences with the long and short protocols. Am trying to sort my final list of questions but no doubt i'll think of many more questions once i've left the appointment! - dp is working so will be going on my own.

I agree about the acupuncture , am finding it very relaxing too. 

 Good luck on your 2ww   Hope you get a bfp! 

Take care

Moth x


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## Moth

Hiya Ladies

Just a quick update.  Had my 'additional' private consultation appt yesterday. It went really well, and it was suggested that due to my age etc, i do the short protocol, which was what i'd expected the clinic to suggest last week.  

Had a long chat with the consultant and feel much better now that i've talked it over with someone. They were extremely helpful and because the appt was held in an office outside of the hospital, it was so much more relaxed. Have my tx schedule appt at the clinic next week, so at least i know what's happening - except i have  to wait for af to start, so not exactly sure when exactly jabs will be starting!

Thanks again for all your support and suggestions - it's been really helpful.  

Wishing you all lots of luck

Take Care

Moth x


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## Happy Mummy

Good luck Moth


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## Jeza

Hiya, 
I'm also not over 40, almost at 39.  I'm going through my first IVF at the moment.  I had my initial scan for follicles last week.  Disappointing as we only saw one follicle of a decent size.  We're going with that one.  Was expected as had high FSH and was told not to expect a good response from the drugs. 
Trying to remain possitive as it's not the end of this cycle yet.  I'm on LP and for sure next time I'll ask for the SP as it does seem less disruptive, and shorter...
I wanted to know how to get onto the link for slow responders (is that what it's called).  I can't seem to find it...Anyhow, another scan next week and I'm hoping there's a big healthy egg inside this lonesome follicle waiting to be born   
That may be all it takes...Anyone else has such a story with a possitive ending?  I feel like my body is closing down on me before it's time.  And I only met the love of my life 2 years ago, married last year.  It seems to have been all about having our baby since then...Jeza


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## Moth

Hi Jeza

Can't do links i'm afraid, but if you look in the drop down list at bottom right of page, after the list of counties , theres IVF GENERAL CHIT CHAT FOR THE UK, then you'll see the POOR RESPONDER page on the page that comes up. think they're on part 55 now!

It's disappointing when you get a poor response, but remember you only need one lucky embryo. I know sometimes they suggest cancelling treatment and converting to IUI (insemination) if you are having a poor response, but i couldn't do this as i have blocked tubes. However, i don't have a high FSH so i guess that affects your treatment options too. What drugs and doseage have you been on.

Apple Orchard has also had a poor response, she only had one egg but succeeded getting to embryo transfer. Like me, she is now on the 2ww! So fingers crossed, you have a juicy egg hanging around in that follicle! A friend from my clinic recently got pregnant with one frozen embryo transfer so i can happen! Are you going to have ICSI? We had ICSI due to my age and there being only two eggs, but just the one fertilised normally.

Your welcome to send me a personal message if you have any other questions, I'm no expert as this is my first treatment cycle, but sometimes it's good to talk to people who've been in a similar situation. If you don't know how to send a message, you click on the little scroll icon on the left of the screen underneath my user name  

Take care

xx


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