# Short Protocol -v- Long Protocol



## Melanie244 (Nov 15, 2013)

Hello 

Does anyone have experience and/or medical knowledge re short protocol versus long protocol ?

My (limited) understanding from friends who are doctors and my own research is that women over 40 who have low amh should ALWAYS be offered SHORT protocol because it's safer.... fewer symptoms from shorter drug-taking timeframe.....less likely to over suppress ovaries as no major down-reg .... 

However, my Consultant says they use long protocol on everyone (?!?!?!?!?!!) ..... I think perhaps that indicates a laziness on the clinic's part rather than sound medical opinion...in that I believe long protocol is much easier for the clinic/administrators as they have better control over the woman's cycle ....i.e. if Consultant is away or on day off and/or specific dates fall on a Saturday or Sunday...they can more easily schedule around all that by using long protocol.

Does anyone have experience and/or medical knowledge why a 42 year old woman with low amh should be put on long protocol?  

Your opinions would be MUCH APPRECIATED.

Many Thanks


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## Hbkmorris (Apr 7, 2010)

Hello Melanie 

I have had experience of both protocols and I can confirm from my own history having a low AMH short protocol was much better for me. I actually had Flare short protocol as my FSH was normal. 

With my first cycle my clinic also shared that of yours where everyone should have long protocol and this was so that they could control me and when I'd be in for scans etc.. Nothing was tailored. After going through 3 long weeks on Buserelin (over xmas) and 3 amps of menopur a day.. 4 days prior to egg collection my cycle was cancelled due to poor response with only 3 follies all of which were under 10mm. After much debate and research I instructed my consultant to refer me for an AMH and low and behold low AMH was discovered therefore long protocol on such low dose menopur would never of worked for me. 

My 2nd and all other IVF/ICSI cycles have been short flare protocol and although I obtain a low to medium amount of eggs ranging from 12-6 they all seem to be quite good quality and it's just my body failing a BFP. I moved clinics in January last year and they to have echoed this and continued with Flare protocol being best for me. 

I would question them and if you do have a low AMH then you would prob be best with short protocol and a higher dose of stimulating drug. 

Best of luck to you. xx


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## Melanie244 (Nov 15, 2013)

Thanks very much for your reply Hbkmorris.

I am finding it hard to find any evidence why I am being put on long p.

I will insist on short p. Really appreciate your reply and notice you're trying again this year. Fingers crossed for you


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## goldbunny (Mar 26, 2012)

when i started ivf i had heard of milder/shorter ivf and was really scared that they told me pretty much what you have been told... that they were using long protocol and that was that no options..

i really thought they were wrong but due to being too anxious to shop around i felt i just had to go with it.

my first cycle they downregged me the minimum time and started stims even though i hadn't completely down regged. i thought at the time this must be standard ... anyway BFN that cycle.

my second and third cycles (aged 42) they downregged me a long time...by the end of downregging i was so miserable!. But on both these cycles i got BFP. (though i m/ced one, hence the third cycle) 

so, although i really was scared that they had it wrong, and, with an amh of 4.54 on my second cycle and an antral follicle count of TWO on my third cycle.. (so not much petrol in the tank)...

i really can't argue with the decision in the end, and neither can the little guy with his feet in my ribs. 

i know some people suit one or the other of long or short protocol, for me complete shutdown/long downreg seems to work, i genuinely don't think there should be a hard and fast rule... all we can do is compare treatments/case studies and experience and try and make all the information available.

a good clinic should listen to concerns but also be able to draw on all the relevant information.


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## goldbunny (Mar 26, 2012)

ps i used both gonal f and menopur and had a reasonable response... cycle 1 11eggs 4 embies, cycle 2 7 eggs 6 embies (got three frosties that time!) and cycle 3 8 eggs 5 embies (1 frostie) 
overall 26 eggs, four frosties one micarriage and one small kicking being due in 3 months..


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## Hbkmorris (Apr 7, 2010)

Goldbunny, congrats on feet in your ribs.. how wonderful that must feel (in a bizarre way). 

Like you I to have had a fair amount of eggs and always had some to freeze.. hopefully after having a hysto and I'm thinking of trying a natural FET with my frozen eggs from 2012 I shall have the old rib kick.. gosh here's praying xx


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## Melanie244 (Nov 15, 2013)

Thanks very much for your reply Goldbunny....hope you're enjoying every minute of your pregnancy ..... yes....I agree decisions should be based on clinic experience. ...which is why I was shocked to hear everyone does long protocol at mine. When I asked my Consultant about it she said they would facilitate my request for short protocol 'if that'll make me happy' ...!!!!!!!!!!!! Was told there's no medical advantage with either in terms of pregnancy outcome for over 40s.  So my rationale is therefore why prolong the procedure?

Regardless of treatments. ....I just want to be a Mom and am delighted it's worked out for you. It must be so special to feel the little one kick 

Hbkmorris. ... here's hoping 2014 will be your best year so far.


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## goldbunny (Mar 26, 2012)

there's a real dilemma between 'trust your clinic' and 'push for the choices/decisions you feel comfortable with'. I have done a bit of both over my three cycles. Sometimes you have to just go with it and other times you have to really push to get them to do things the way you'd like. *shrug* in the end you are the one who has to live with the end result. Sometimes it helps to be able to blame the clinic, on the other hand, sometimes you need to feel like you did everything you could. Bit of a head-scratcher if you ask me. An example, i had an ovitrelle trigger on my first two cycles - which apparently for many people has a worse outcome than a pregnyl trigger. BUT - on my third cycle when i was prescribed the pregnyl trigger (apparently it had been unavailable on my first two cycles) i flipped out and said no way, i'm not changing now! i didn't want to, in the event it didn't work, spend my whole life thinking that changing the trigger had been the thing that went wrong! SO even though i knew in theory the pregnyl was better i stuck with what i knew and got them to get me the ovitrelle instead. Worked for me though...

i accepted the long protocol even though i was in grave doubt about it.. but then i had to push to get immunes testing, and to do a third fresh cycle rather than use my frosties.... 

like i said, sometimes you roll with it and sometimes, push for what you believe in. But don't get too stressed about it either way.


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## Amber72 (Apr 25, 2013)

Hi Melanie,

I don't have any medical knowledge only my own experience.

I am 40 and have a low AMH of 0.57 and my consultant recommended a long protocol. I did question her on this choice over short and she said in her experience this would be the option with the greatest chance of success for me. As I was self funded And only had one shot at this I had to trust her judgement and go with the flow. 

It was more expensive as I had to buy more drugs than a short protocol and I was on the maximum dosage but I did end up with two follicles, two eggs two embies and a single BFP.

I think you are right to question decisions because in the end you have to be happy with any choices that are made In case you don't get the outcome we all wish for. 

Good luck on your tx.


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## Melanie244 (Nov 15, 2013)

Thanks very much for your reply *Amber*....

I'd love to know the reason your Consultant chose long protocol with low amh ..... mine says she's not hopeful because mine is "very low" and as far as I recall is around 6.1? I'll tie myself up in knots worrying about it! The bottom line is your choice was thankfully successful ..... congratulations ....I'd say you're just counting the days 'til you meet your little boy 

& Thanks again *Goldbunny *- I need to take your advice re not getting too stressed about it!


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## angelica_wales (Oct 10, 2012)

I had 3 goes of stimulated iui with a reasonable response on the very low iui dose (75 of menopur) and got a bfp first go so my consultant assumed that my AMH would be normal but the rsults came back as borderline low for my age so I was put on the short protocol. There wasn't really a discussion.  My dose last time and this time is 375 menopur. I got 7 eggs last time,  5 fertlised,  2 transferred (bfp followed by mc), 1 frosty (ab quality). 

I can't compare with long protocol as I've only ever had short. I've never even thought of asking about long. Short protocol is the same as iui (apart from the dosage) and I like that it's all over within a couple of weeks.

My clinic insist on quality over quantity - you only need 1 good one!


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## fififi (Mar 16, 2011)

Like others my clinic prefers long to short - think timings fit their needs better. When I questioned it as previous clinic wanted to do short they said they found LP got the best results.
In my case it didn't as my body was so shut down it took much too long to get going again. I was on pretty high dosage of menopur (300) but after 2 weeks of stims just one egg. Subsequent cycles have been SP and for me a much better response.

Whichever you do end up doing its important to believe that it's the one the clinic think will work best and not to think about the negatives / regret not doing the other one. Everyone is different and unfortunately past 38 every cycle is a gamble - but lots do pay off


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## Melanie244 (Nov 15, 2013)

Angelica. ...thanks so much for your reply. ....yes I too like the idea of treatment for shorter timeframe. It's consoling when floundering amongst all the negative statistics to remember it really just needs ONE good one! Here's hoping and praying for all of us 

Fififi ....thank you too for your reply. ...it's nice to hear you had a reason given for your clinic choosing lp for you. ....though interesting to know sp worked  out better. 

I appreciate all ladies on this thread writing responses....helps as a newbie to learn from others


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## Altai (Aug 18, 2013)

I had 2 goes of short ivf protocol. First  with gonal f- vey poor response. 
Second - 300 iu menopur, not really many follicles either. 

For my 3rd, the clinic wants me to try short flare protocol. 
So, I'll start downreg on D2, and I'll be on 450 iu of menopur (ouch!). 
While I agree that protocol has to be changed, am concerned whether high doses could compromise egg quality, which is big issue given my age.

When I asked about LP, the Dr said he wouldnt recommend it for over 40 with whatever fsh/amh level. 
But honestly, not keen on long downreg. 
My amh-16, fsh-5. 
Am wondering if you could give some insight from your experiences.
What max doses have you been on, ladies? 

I am tempted to ask to decrease dose and start perhaps with 375-400 max...
But don't want to compromise attempt..

Thanks,
Good luck to all

A.


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## Hbkmorris (Apr 7, 2010)

Hiya, I've some insight for you. 

My 1st ICSI I did long protocol with buserelin & menopur (3amps) my cycle was cancelled due to poor response. I then had my AMH tested and came back as low so I had short flare protocol. Buserelin on day 2 of AF then by day 3 start 6amps of menopur.. I got 9 eggs 6 mature for ICSI, 2nd cycle 12 eggs 9 mature for ICSI, 3rd cycle 9 eggs collected and 8 eggs frozen and cycle 4 6 eggs and 5 fertilised with IVF.. With all of my cycles I've had top grade embies/blasts transferred and frozen. I believe the short flare protocol give me the best egg quality and my clinic say it's quality over quantity! I'm still waiting for my BFP but that's due to my body and implantation failure. 

I changed clinics for my last IVF and they can't believe it's never worked for me as the quality is amazing (looked at under new embryoscope). The only difference my new clinic changed was menopur amount. They said there was no difference from having 6 amps to 5 amps to which I agree now after having a cycle on 5 amps. 

If I can help more just shout.. I love short flare.. Suits me perfectly xx


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## fififi (Mar 16, 2011)

Altai - I was switched to short protocol and 450 menopur. In my case it made a very positive difference. The dosage of menopur is still within norm - I too was scared of what I perceived to be a high dosage. For me it enabled me to produce enough eggs to have sufficient embryos to go to day 5 blasts and I had good grades too. Sadly despite BFP I lost babies due to a chromosomal problem.
I went from having so few follicles that EC was nearly abandoned to having about 6-8 good sized ones. It's not such a high dose it should effect quality, plus your clinic should review your progress so if the 450 dose is too much then can change it down. From the crazy amount of research I did it does seem easier to slow down follicle growth than start it off. I'd agree with your clinic and hopefully that change is the one you need    

On the practical side a 450 dose is a bit more of a faff to mix but my clinic told me to continue with just the one injection.

Wishing you lots of luck and hope you're posting with BFP soon


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## teapot73 (Jul 6, 2013)

Hi, the highest dose of Menopur for me was 450 units during short protocol 1.5 years ago (I was 38 then), got 8 eggs and 5 fertilised but had only 2 good quality embrios on day 3 and they never got implanted. I am with a new clinic now and they suggested minimal stimulation during natural cycle (only 150 units Menopur), not sure if it works out well but we'll see.


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## Altai (Aug 18, 2013)

thank you ladies for your replies.
I guess I have to go with 450 to see what my response would be. it's all trial & error....expensive trial & error.

I was on 150u on my 1st cycle & didn't work for me. and I think it was too high cost just for one-two egg/s. 



best of luck to all.
hoping 2014 will be our best year so far


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## Melanie244 (Nov 15, 2013)

Altai....the very best of luck to you....sorry I couldn't help with dosages. ...I haven't yet had first IVF....but so many experienced and helpful women on this forum ...hope you found answers.

Hello again to Hbkmorris ...Angelica and all ttc.

Babydust to all


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