# Menopur or Gonal F for older women with low AMH?



## katkat2014 (Nov 28, 2014)

I was wondering if anyone has any thoughts if Menopur or Gonal f is better for women over 40? Any experiences (please could you add your fsh and lh if you have it)?

Here is my background and sorry for long story. I have had several failed cycles, my fsh is about 8.9 and lh around 8 (but last month was 4.5) and AMH of 0.78 (or 5 in the other measurement). I will be doing a mild cycle, I have done 2 of those previously with Gonal F and femara and had good quality embryos/blast (2 each time, out of 9 follicles/eggs). But i always have a lot of immature eggs. The doctor thinks that menopur will give me a better result in terms of more mature eggs. But my concerns are these. When I was 38 I took Gonal f only and had 7 mature eggs (so no Menopur needed). When I did a high dose cycle with 300 Gonal (reduced to 225 at day eight) and adding in 150 menopur around day 8 and 3 of my 4 embryos were terrible quality and arrested at 2-cell stage (was is the Menopur or the high dosage?). And also I read that older women produce more LH when they are older and adding even more LH will damage the eggs. And then finally Dr S in the USA said to me on his forum he totally disagrees with using an LH/FSH product because of the latter issue with LH (he says the lh we measure is not the bio active form he is talking about which is high in women over 40). So you can see my dilemma here. My doctor seems to think it will be good for me to do a femara & Menopur cycle for more mature eggs, but I have huge doubts and I don't have the luxury of doing many more cycles, financially and age wise.


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## Dinapantz (Nov 26, 2012)

Apologies if ths response comes too late and I don't have any data BUT I'm undergoing fertility treatment for the 7th time and I was on 450 goal and 150 menopur.  This is the highest, legal dose + cetrotide.  I was only expecting 5 eggs and today I had egg collection and had 16.  I obviously responded very well to this regime and I'm delighted.  Hope this helps and good luck.


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## katkat2014 (Nov 28, 2014)

Thanks so much for your input dina and sorry for my late reply as have been abroad. How did you get on? Fingers crossed you had good embryo development! How was the quality on such a high dosage?


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## Claudia H (Oct 2, 2015)

Hi KatKat,

I am also interested in the whole menopur thing. I have had 4 cycles. For 3 of them I used Menopur only and for the other 1 I used Gonal F and Luveris. I have also heard that menopur wasn't good for older ladies due to having too much LH. But actually I seem to have had better quality embyros with the menopur than the Gonal F. IN fact, the Gonal F round turned out to be my worst round in terms of quality - no blast better than a 3BC. In Menopur rounds I have had fully hatched blastocyts and top quality ones to freeze too. But then again none of my fresh cycles have been successful...so I'm confused! I wish there was someone really knowledgeable that we could ask. I'm at a really good London clinic and I feel that if menopur was bad for older ladies surely they would know this and wouldn't be giving it to me? But how much should we just trust our doctor and how much should we advocate for ourselves? 

x


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## hambone1 (Aug 18, 2016)

Hello!
Thank you for posting this - I have the exact same question!  I recently had a gonal f (300) and cetrotide cycle that left me with mild OHSS and produced 15 eggs/9 mature/5 fertilised... with only 1 a good quality embryo (chemical pregnancy).  I can afford (both in terms of time and money) one more own egg cycle - and the clinic I am thinking of switching to has suggested using menopur instead of gonal f as they think it can help produce more mature eggs.  The doctor told me that as long as my LH level was low enough on day 3, we could try menopur.  My concerns are the same as yours.  I am heading to the fertility show in London on Saturday, and plan to ask every consultant there what they think/would suggest - and I will report back whatever I find out


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## Altai (Aug 18, 2013)

Hi,

I used gonal f on my first cycle and it was one of the worst cycles with only 2 eggs retrieved. 
Menopur gave me 7 eggs but only 4 mature. 
My best response was from combined oral plus low doses of fostimon. Fostimon is fsh only drug I think is 'naturally derived' while gonal is synthetic version. Somehow, fostimon suited  me better. 
I also used merional & menopur, as far as I remember no significant difference.


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## Claudia H (Oct 2, 2015)

Hambone - great that you are going to the show. Yes please report back what they say! I'd go too but can 't be in London this weekend. Its a great opportunity to ask - would LOVE to hear what they say! x


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## hambone1 (Aug 18, 2016)

Will do!!!!


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## Agaamh (Oct 15, 2016)

hello ladies, what about the mix of gonal f and menopur in the same protocol? Do you have any experience?
This approach is recommended by my clinic.


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## Claudia H (Oct 2, 2015)

agaamh - did they say why? i seen people use that but not sure why it's better than just straight menopur?


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## hambone1 (Aug 18, 2016)

Hi All (and thank you Claudia for reminding me to post!) -

As for the Fertility Show - it was really informative and would highly suggest going next year if you can - I ended up meeting with 6 clinics and there was NO consensus over Menopur (or other LH/FSH combos)  vs Gonal F (straight FSH).  I asked this question at a Q&A (the panellists were Dr. Nargund from Create & Dr. Christopolous from Hammersmith - it was a great panel) - both of them were adamantly against using Menopur, as they thought this would raise the LH too high and could also raise estrodial too high, especially in women prone to overstimulation.  I then met with IVf Spain - Alicante - and the doctor I met with (I was quite impressed with her, actually) suggested using an LH/FSH combination drug like Menopur since it more closely mimics the natural cycle and she thought led to better quality eggs.  Embryolab (Greece) said the same thing.  Barcelona IVF said it depended on the individual case, and that she liked to use a new drug on the market that only requires one shot, as it keeps the FSH levels more stable over the cycle and she thought led to more mature eggs (downside is that it is more expensive and not commonly used - I can't find the name of the drug).  

And so - no more clarity, I'm afraid, other than it seems to fall back on what people are comfortable using and what one's individual estrodial/LH levels are going into the cycle - and that the protocol needs to be tailored throughout the cycle based on response.    Also, everyone seemed to agree that the only supplements that seem to be of benefit are Ubiquinol, Vitamin D and Folic acid and a good diet.

One thing I did pick up was to check what the success rate with donor eggs was, as that is a good indication of the quality of the lab.  Since donor eggs should all be healthy, young eggs (with high fertilisation rates), clinics with good labs should be getting very high success rates with these.  Success rates with own eggs for older women is low no matter what the protocol, unfortunately - so getting more eggs seems to be the preferred aim - the quality is really not something we can do a whole lot to control - but to maximise success you want a good lab and an experienced doctor.

Good luck everyone!!!


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## Agaamh (Oct 15, 2016)

@hambone thanks for you report on the Show.
I just confirmed with my new clinic that I will do the estrogen priming protocol with a high dose of menopur and gonal F as well as femara.
I already had a long protocol with puregon  and slightly modified own cycle on low dosage of menopur and clomid.
In both cases the same results, two 8AA transferred back. Unfortunately unsuccsesful.
Now I also take DHEA, and high dosage of vit B complex and Mg,. I stopped with vit D3 and Coenzyme 10 as I am on detox now.
I will also have acupuncture (only three sessions).
X


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## hambone1 (Aug 18, 2016)

Hi All-
I've just confirmed my protocol as well - I will be using Menopur.  I am a bit worried to switch as I responded well to the gonal f, but am willing to try something different if it does anything to improve the #s of mature eggs.
I am curious about the gonal f/menopur combination, though - it sounds like the best of both!

Good luck!!!!!!!


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## katkat2014 (Nov 28, 2014)

Sorry haven't posted so long (I don't like people starting posts and then not following up). I guess the jury is still out on gonal f vs menopur. Well it could be my terrible eggs (I think that's the case) or the Menopur, but my last cycle was a bust. Again. I had decided to go with a mix of gonal and then adding in Menopur on cycle day 7 and although I had 10 eggs with this on my mild cycle, only 2 were mature! I meant to pgs test but nothing grew past day 3 so nothing to test and nothing was transferred 😐 when I say 8 were immature - it was actually because most of them were degenerate. My doctor things it's because we triggered too late, but I've triggered late a few times and I sill had more mature and better eggs then (when not using Menopur). I just wished there was clear rule on what protocol to use if you're a bit older. I am considering the agonist/antagonist conversion protocol  (no LH!) Or a clomid baking cycle as I think older women have success with this at Serum. But that's exactly the same thing. .. clomid makes your body use your own LH which is supposedly bad for older women ...but why do Serum use this for most of the women cycling with them? One thing I noticed, I had lot and Lots and Lots of ewcm this time,  I think my estradiol was super super high. Every day I thought I had ovulate already. Is that bad for eggs? Sorry for my monologue 

Hambone wishing you the very best of luck ☺☺ your post has been most useful. Please keep us updated!

Seems like we're all using entirely different protocols too. Menopur only. Estrogen priming with gonal and Menopur. Fostimon.  Etc etc ...


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## Agaamh (Oct 15, 2016)

Unfortunately, the doctors cannot offer us a "miracle" protocol. The protocol that worked well for somebody, will not work for another one...
I will Report on my mix protocol soon. 
Good luck for everybody X


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