# IVF / ICSI stimulation protocol for 40 year old starting 3rd ICSI cycle



## Cocoa58 (Jul 19, 2013)

Hi
I'm new to the site and would appreciate advice on the recommended dose of stimulation for a 40 year old.  I appreciate that it varies some what between individuals, however I'm wondering if a lower dose may increase egg quality.

To provide a bit of background information, male factor infertility is our issue with a low morphology.  Our first IVF cycle was unsuccessful due to zero fertilisation, 8 mature eggs were retrieved following stimulation with 300iu Menopur daily.  In the second and third cycles we tried ICSI and my dose of stimulation was increased to 450iu Merional.  

I had 14 eggs retrieved during the first ICSI cycle, 9 of which were mature and 15 in the second ICSI cycle, 10 of which were mature.  2 embryos were transferred each time (considered either good or average quality), unfortunately BFNs.  So whilst slightly more eggs were retrieved with the higher dose, a proportion were immature and I'm wondering if we should try a cycle with 300iu Menopur/Merional to see if this makes a difference to the quality.  

We had 5 embryos the first ICSI cycle and 8 the second, however in both cases 2 were significantly better quality than the others.  I've been told that the embryo quality is due to egg quality, most likely due to my age, however I have wondered if the egg quality could have also been affected by the dose of stimulation used. We had no embryos to freeze on either cycle.  I would welcome your thoughts.  Many thanks.


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## Talkingfrog (Apr 17, 2014)

sorry to hear you have had two failed cycles. Everybody responds differently.  I am 40 and have just stimmed with 150 menopur.  I did however have a good AMH and had ohss on my last cycle so clinic did not do a high dose.  Ended up with 13 eggs, 1 of which was immature, 10 fertilised, 2 put back and none of the others up to being frosties. good luck.


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