# What do you think?



## AmandaB1971 (Feb 19, 2006)

Hiya

Sorry to bother you but would value your opinion on a couple of things!  They're not urgent so feel free to book mark me for another day if you're pushed for time! 

1.  We're going for another Consultation at our Clinic in a month in order to prepare for what will be our final go of tx.  Our Consultant has already agreed to give me gestone, preds etc in 2ww for next tx cycle to try and help.  However I am not a brilliant responder and so usually do SP was wondering though I've always used menopur to date, is that wise or would another drug be worth trying.  I'm not sure if there's any difference between Menopur, Puregon and Gonal F and don't want to make myself look stoopid by asking him! (whereas you already know I'm stoopid so its ok!! 

2.  I also have read a lot about aspirin in 2ww but I don't want to ask him about that either until I know whether I could take it - my DH seems to think that those with asthma can't take aspirin is this true?

Thanks so much Masv I really appreciate it! 

Axxxx


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## mazv (Jul 31, 2006)

Hi Amanda 

Definitely think it's a good omen that the consult is on your birthday       and I'm sure consultant won't mind you asking anything at all  They are used to dealing with hormonal women and I'm sure get asked all sorts from treatment cycles to where the car keys are    

Will try to answer as best I can!

Menopur, Gonal-F and Puregon are all types of gonadotrophins used to stimulate follicle growth but there are subtle differences between them. Menopur is a combination of FSH & LH, Gonal-F is follitropin alpha and Puregon is follitropin beta (human FSH is made up of 2 units of follitropin; an alpha and a beta) Basically thay all do the same thing and there have been various trials and reviews over recent years comparing these drugs to see if one is better than another. A lot of recent research has focussed on drugs that combine FSH & LH (Menopur is an example) to see what difference the addition of LH has to stimms response. There is some evidence that women (especially older >35) may respond better to this in terms of numbers of eggs and also some evidence that some aspects of embryo quality improve. Problem with the trials though is that numbers tend to be small (for obvious reasons) and the variables are so great that it's hard to eliminate bias and proove statistically that one drug is better than another   Bottom line in all the trials is that although egg numbers or quality might seem to be better the end result of live pregnancy rates do not appear to be much different (otherwise clinics would all use the best one  ). Probably need another few years of research and higher numbers of trial patients before there are enough numbers to crunch to see staistically if there really is a difference.

Hard to know really what makes one person respond well to drugs and another not   but age and reasons for IF certainly play a part in response. Our clinic always said that the average number of eggs per cycle was 7 so they were always aiming for that number in a cycle. My first cycle was Gonal-F and I got 3 eggs so I was swapped to Menopur and got 7 and 5 eggs on subsequent cycles. Clinic said that they sometimes got a better response with Menopur if Gonal F didn't have a good response and this was the case for me.

Aspirin is used in low dose in people with clotting issues/sticky blood where this is implicated in repeated early miscarriage or implantation failure (some evidence that these are linked by a similar mechanism but don't know exactly what causes them; finding that really would be the holy grail in reproductive medicine   ) Low dose 75mg is used to prevent the blood from clotting too easily. Again there is evidence both for and against this from the trials and it's still an area of contention for clinics- to use or not to use  

Asthmatics need to be careful with non steroidal anti-inflammatory drugs (NSAIDS) as they can trigger asthma attacks so you are usually advised to avoid using things like aspirin and ibuprofen. Not all asthmatics will react to them though but you can't tell who will and won't so the advice is always not to use unless there are good medical reasons for needing to prescribe a NSAID.

Hmmmm not sure if this makes any sense at all     Kind of hard to condense the intricacies of IVF treatments into a few paragraphs     
From my limited knowledge of IVF drug treatments and associated therapies the evidence base is quite grey and wooly   For every trial that says something works there's one that says it doesn't   This is why some clinics follow the recommended definitely know they work protocols and others follow the more 'cutting edge' approaches e.g. immune therapies. It really is a very personal decision for a woman as to which clinic and treatment protocol they want to follow, same goes for supplements and complimentary therapies too I suppose.

Right I really should stop now as you don't want me to go off on one of my rambles about the whole industry that surrounds IF and treatments   Unless you have a spare week to read that is      

Hope this has helped?

Love n hugs
Maz x


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## AmandaB1971 (Feb 19, 2006)

Thanks Masv for your reply!

I am now much clearer about the different stimms drugs and why they use them! That will help me to sort out my questions for the consultation! 

Thanks again hun

Axxxxxxx


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