# IVF long protocol versus short protocol



## over40andpositive

Hi everyone,

I am 42 (43 at the end of october) and my blood tests are good.  I have spoken to two clinics in Denmark regarding IVF.  One clinic said because of my age they suggest short protocol and then I spoke to another clinic that said there is no difference and because I will be coming from abroad that they suggest long protocol as they do with everyone coming from abroad because it is easier to schedule your trip.  WHAT!!! I am so confused.  Anyone have any experience on this topic....I would greatly appreciate your thoughts!!!


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## CrazyHorse

What is your AMH? If it is very low, short protocol may work better for you because your ovaries don't start from a state of being very suppressed by the down-regulating.

HOWEVER, I am 40 with very low AMH, and had poor results on short protocol due to a dominant follicle developing on each ovary. I was much more successful this time around with long protocol. 

Everybody's different, and it's hard to know which will work better for you until you've tried one and seen how your body's responded. But very low AMH and high FSH might indicate trying short protocol first.

Wishing you best of luck!


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## beattie2

There is more control using the long protocol, with the short protocol it is more of a case of going along with your body, although my doctor usually put me on the pill for a month which gives you more control re timing- so maybe the clinic could look at this if they think the short protocol would be a better option ?. I think response is a very individual thing- Response wise I have always done exceptionally badly on the long protocol or any protocol that involves down regulatiing my ovaries.( even when I was much younger) What worked best for me was the short protocol using orgalutaron to prevent early ovulation. Hard to know what works best until you're into a cycle, but if you have a low reserve short protocol is usually regarded as a better bet Good luckx


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## over40andpositive

Thank you beattie2 and CrazyHorse !

My FSH is 5.2 and my AMH is 8,05 ng/mL or 57.4 pmol/l (very high) 

It is so difficult figuring out which clinic abroad to use and I find it weird that most of them will decide which protocol from just talking to me over the phone...


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## spudlin

I had long protocol for my first attempt and they think I was too 'shut down' and had a poor response  

Starting short protocol tomorrow, had provera to induce af as my cycles are so off


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## Blondie71

Hiya I cycled with Serum in Athens and Penny the clinic director seems to do short flare protocol on most of the older women there incl myself with great success.

My AMH was 55 so very high also, I had 17 eggs with both my egg collections (first one at diff clinic with diff meds).


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## over40andpositive

Good luck Spudlin!

Thanks for your story Blondie71!


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## Hbkmorris

Hello Ladies, 

It's so lovely to read all your different stories and to those BFP or who has a tiddler. Congratulations to you, you have full filled me with hope. 

Over40. It is a bit of a mare when clinics have two different thoughts and again I do understand why the one overseas has suggested long protocol for timing issues. But they could control you and you could do short protocol if you were to be over there for the whole cycle around 14 days so it is possible. I've read lots about Serum and Dogus (Cyprus) and if this next cycle doesn't work I'm pretty sure to say I'll go to Dogus next year. 

Like so many of the ladies have said, long protocol isn't always the best with older ladies and eggs despite your AMH levels really. 

I had my first cycle when I was 35 on LP and it was cancelled 3 days prior to EC due to poor response. I then investigated to the hilt and found out that Short Flare Protocol would be best for me in the long run and it has been. 

For me my problem has been the bodged job of my hydro left tube that my previous hospital did prior to starting IVF.. The clip was in the wrong place and it was stuck to my bowl & bladder.. Thankfully I've now had this removed (June 14) so I'm just getting ready for cycle no 6!!    

Beattie.. May I ask you something. My new consultant (I moved clinics Jan 2013 to an amazing private clinic who have been brilliant) My consultant tailor makes protocols based on previous IVF outcomes and he is tweaking things this time as I'm now the ripe old age of 40! He to is putting me on the pill which I shall start on day 2 of my forthcoming bleed. Did you have any side affects such as headaches/migraines? I always suffer hormone headaches which turn into migraines and I'm terrified I'll have a permanent headache whilst on the pill... It's been that long since I ever took the pill I don't remember what it was like but of course all them years ago I was young and no strange hormones!! 

Spudlin.. You must be a day down now.. How you feeling? Ooooh how exciting. I'm wishing you all the very best. 

Bondie.. Hello again, we've spoke many a times. Hope you are doing ok flower? 

Lots of luck and love ladies. Feels good with it being Friday. xxx


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## Greyhoundgal

Your AMH is fairly similar to mine so you'd probably get a good crop - I got 24 last time on LP. However, I wouldn't want to do LP again as I got OHSS which is more likely if you produce a lot of follicles. 

Ultimately LP or SP do work for different ladies. What you need to be sure of with your clinic is that they treat you as an individual, and don't just stick you on a one protocol fits everyone regime. We are all different and we all need to have our own little tweaks and changes that are just for us. Try and understand how flexible any clinic will be with you and make a decision from that.

Good luck  

Grey xx


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## CrazyHorse

hbkmorris said:


> He to is putting me on the pill which I shall start on day 2 of my forthcoming bleed. Did you have any side affects such as headaches/migraines? I always suffer hormone headaches which turn into migraines and I'm terrified I'll have a permanent headache whilst on the pill... It's been that long since I ever took the pill I don't remember what it was like but of course all them years ago I was young and no strange hormones!!


I'm 40 and have a long history of frequent migraines, so I sympathise. I have many different headache triggers, and hormone changes can be a factor for me too -- at the beginning of my period is one of my worst times when I'm on a natural cycle. However, I never had major problems with hormonal BCP.

The thing that just about killed me on the current cycle, though, was buserelin -- headaches EVERY. SINGLE. DAY. If I do another long protocol cycle, I'm going to try any other drug but that! Seriously, it was terrible. Not saying that would necessarily be the case for you, but definitely bring up your migraine history with the doc if they want to put you on buserelin, and make sure you have a good supply of your migraine meds available if you do end up taking buserelin.


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## Hbkmorris

Hi Crazyhorse..

I so SO sympathise with you as they are just vile aren't they. I'm the same day 1 headache over the right eye then by day two full on migraine which leaves me feeling sick and struggle to concentrate at work. 

I'm so hoping the pill doesn't do this to me, 3 weeks of that would push me over the edge. 

My first IVF cycle was long protocol with Buserelin over xmas! Well like you I was terrible, headache non stop for 3 weeks and would you believe it within 2 days of Menopur it totally lifted and by day 3 I was back to normal so please hang on tight till you get your stims inside you.. Normality will resume flower. How long have you been on them? That's once of my reasons for moving onto Short/Flare Protocol.. I couldn't bare the down regging.. With my short flare I inject buserelin on day 2 of my bleed and on day 3 menopur and I never had a headache so don't be put off by buserelin all together. Any DR drug causes you this.. even the sniffer! Go short.. so much easier, less stressful and no headaches!! 

All the best xx


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## CrazyHorse

Not to worry, I'm already on the tww for this cycle. Unfortunately, for me, the stims did not fix the headache situation, although it did take me from having a round-the-clock headache that ramped up to full-on migraine on a daily basis, to being headache-free part of the day and then having a migraine *almost* every single day. This continued until the buserelin stopped. So I think for me, the low hormone levels of down-regging caused a constant low-level headache, and then the buserelin still acted as a specific migraine trigger even when my hormone levels soared back up. It's just a bad drug for me.

I did short protocol on my first cycle exactly because I was worried about down-reg headaches, but unfortunately I had a dominant follicle problem and we cancelled EC and converted to IUI. I ovulate early, and it seems like my body just picks a dominant follicle too early if there's not some sort of suppression prior to CD1. If the current cycle fails, I'm going to discuss with the consultant whether we can use BCP for suppression, then start Cetrotide on CD2 or CD3, as it didn't worsen my migraines last time.


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## Hbkmorris

Oh Crazyhorse.. I'm sorry of course you are. How you finding things on the old 2ww? you feeling ok?

Oh my you really have struggled with this cycle then. Anyone who say's to me 'Oh it's only a headache' I could totally punch their lights out. Least you are now on the home run.. May I ask do you ever worry that WHEN you are pregs you may get the hormone headaches then? I'm terrified of it.. 9 months of headaches is enough to want to have your head removed. Though I'd pay the price to have a beauty at the end of the time. I have everything crossed for you and test day isn't that far away.. woohoo 10th!!!   

It will work and you are not going to need another cycle  

My cycle is different this time with a few tweaks. So I start the pill on day 2, scratch day 21. Next bleed day 2 start 150iu Menopur and 150iu Fostimon day 5 scan, have intralipid around this time. I'll then have a scan and bloods every day if not every two days there on and at some point when I'm told I start injecting Cetrotide (I guess to stop OV). By which point I'd of lost the plot along with the will to live! 

I've never took Cetrotide nor Fostimon before so it's going to be interesting to see how they work with my negative body. x


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## CrazyHorse

Eh, the tww always sucks, but as you know it sucks so much worse on an IVF cycle than on a natural cycle because there's so much riding on it. I'm all right, though.

I don't worry too much about headaches in pregnancy, as I usually feel better in the higher-estrogen part of my cycle. The primary rescue drug I rely on for migraines is zolmitriptan, and I'm OK with taking it every now and then during pregnancy. Animal testing suggests that large doses of zolmitriptan may reduce fertility in terms of getting pregnant, but what data there is in animals and humans does not show a statistically significant association with birth defects, miscarriage, low birth weights, etc. I discussed it with a perinatalogist in the U.S. (specialist in high-risk pregnancy) at the start of our IF journey, and he wasn't worried about it at all. 

And, yes, anyone who has the temerity to say "it's just a headache" will get an earful, if I'm not too busy vomiting.


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## Hbkmorris

Oooh do you need to get a px for those or can you buy them over the counter? I'd be happy to try them if and when I have a serious headache/migraine. Nice to see you have the reassurance from the specialist too. 

May I ask are you on estrogen patches? I shall be sticking them on my leg again this time and I didn't realise that they may help with the headaches so that's interesting to read. 

Ha ha Yeah, i'll swipe them whilst you've got your head down the loo! Lol xx


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## Blondie71

Hi HBK glad to see it's all starting for you soon  your protocol sounds good, Fostimon is somewhat similar to puregon I believe which is what I did in my protocol!! Can't wait to see if tubes/hydros out has done the trick 

I too am a terrible migraine sufferer with full on vomiting/auras etc I sometimes get them 2 x a month and unfortunately have to battle thru the days looking after boys till it passes, I never had one while pg tho and not until my boys were around 6 months old so they are def period-cycle related in my case, I hope menopause sorts that one out lol


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## CrazyHorse

No, you have to have a prescription. There's several different types of triptan drugs for migraines these days; sumatriptan is usually the first one they try you on, but it doesn't work for me. Not everyone is a good candidate for the triptans -- if you have high blood pressure or a history of transient ischemic attacks, for instance, that could be a problem.

Different doctors have very different approaches to how cautious they are with prescribing drugs where there is limited data on their safety in pregnancy, if you are trying to conceive or may be pregnant. It's prudent to read the drug monographs and use Google Scholar to look for studies on any drug you are interested in and might take while pregnant; then you can have an informed conversation with your doctor about the best treatment approach for you, and talk about what level of risk you can live with versus the severity of the effects migraines have on your life. If you have a GP who is super-cautious and doesn't like giving maybe-pregnant ladies anything besides paracetamol, or who is not knowledgeable about migraine treatments, ask for a referral to a neurologist, or consider changing GPs. I think that if the majority of migraine sufferers were men, you'd be able to purchase sumatriptan for 50p at a vending machine!

No, I'm not on any estrogen patches. Did your clinic say why they were prescribing them? Whether they help with the headaches purely depends on what your personal reaction to estrogen is. But if you felt lots better on long protocol once you started stims (which put your estrogen levels way up), then estrogen probably won't make your headaches worse, at any rate!


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## Blondie71

If you ever go abroad ask pharmacy for tablets called RELPAX they are amazing only sorry I didn't stock up loads when I was in Dubai as 20 mins after taking no trace of migraine at all.... they sort all your electrolytes out which cuts off migraine


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## Hbkmorris

Bondie.. Hello.. I know it's been a long 20 months coming and as you say I'm hoping the NO hydro tube is the hidden key to my success.. Finger, toes and twinkles crossed    I'm loving the thought of a headache free life, mine too are defo hormone related as I get them either when ovulating or on day 1 of my bleed.. these day's it is defiantly day 1 of bleed until around day 3. I've a friend who has an apartment on the palm and is in fact over there for xmas so I'll make a note of that drug and ask her to get me some (hoping they sell them there also) for after my babies arrival!!! Ah check me out with my   Ha ha  

How are the boys? how have you found having twins? Now I'm over 40 I can have 3 make!! Just got to   I get three beauties. I've dreamt twice about having twins.. Both times I woke up in panic and sweat and mainly only because I'm doing this on my own lol.. the thought though does fill me with absolute joy.  

Crazyhorse.. I shall defiantly keep that in mind. My GP is pretty good to be fair so if all fails I will go and see her and ask her to refer me as I'd rather know what's going on and how best to tackle it. Many thanks for such info. 
They seem to give estrogen to a lot of ladies more so of a certain age as it can decline as we grow older. They also had all my history so would of seen I do suffer from hormone heads so that would be another key as to why they add it to a cycle. To be honest I've never asked (I know my levels are normal as I only read them the other day as I handed over my day 2 full blood count to the nurse). I'm happy to take it and I change the patches every two days then at pregnancy every 3-4 days I think she said.. Not sure for how long you are on them though.. I'd say not that long. 

Oh roll on 6pm when I can sign off work. I'm so tired today I need matchsticks to keep my eyelids open!


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## beattie2

Hi, to answer you question hbkmorris I did not get a side effects with the pill x


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## over40andpositive

Just wanted to thank everyone for adding to this thread!!!!  I'm still in search of a clinic but I am definitely going to take the advice of one of you beautiful people (I can't remember who wrote it   ) but i am not going to go to a clinic where i feel life that they are not looking at me a s an individual!!!!

be well!!!

good luck to us all!!!!

over40ANDPOSITIIIIIVE!!!!


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