# High Vs Low Stimulation in 40+ women



## coldhandswarmheart (Nov 22, 2014)

Hi there
I'm new to FF so apologies if I'm posting in the wrong place or this has all been covered before. 

I'm very confused. I'm 41 (just!), DH is 32. After one silent miscarriage 18 months ago, and after usual agonising process of tests ( all negative for anything obvious, my AMH is 5.2, my FSH is 6.7, DH tests all fine), we were advised to go for IVF because of my age.

I did lots of research and met some consultants, we had to go privately as our NHS won't provide past 40, and went with Dr Simone Rofena (under Dr George) at Zita West as we felt we connected with him really well, he was incredibly understanding and all staff were great.
Moreover, he was very convincing re the argument for reasonably high stimulation for me (450iu FSH), as his philosophy was always  - "if you want to win the lottery, you buy more tickets". He said that in his and Dr George's experience, this produced better results.

We also met with Gita Nargund at Create, who although absolutely lovely and very persuasive in her argument for the exact opposite - ie smaller number of eggs in older women produces better results as egg quality is better - we didn't go with them, as we felt overall the clinic organisation was very haphazard and disorganised and I also had a really bad experience with an internal scan there.

Anyway, with the "normal" IVF at Zita West, I produced 10 eggs, 7 of which were retrieved as viable, 5 of which fertilised, 3 of which went to Day 3, 2 of which were put back (one lost along the way), both high Grade 2, but sadly, BFN. 

The biggest shock to me of all of this since then, and I feel so stupid for not knowing this before, is that the grading of embryos by the embryologist bears little or no relation to their quality. Having had a good, if fairly brutally honest, follow-up appt with Dr Simone, I feel now much more realistic about our chances (1 in 10 eggs being viable/good enough quality to go to full term pregnancy). 
As the protocol produced exactly what he'd expected, and as he's explained to us, his feeling was we didn't really need to hugely change anything going forward to a 2nd attempt, as he felt he'd rather stick with what worked,  which makes sense to me. The only thing is he said he might do is up the dose of FSH to 600iu for the first few days, in the hope of me producing one or two more eggs. 
(just FYI, we also did immunity tests recently, which Dr George is an expert in, which showed slightly high NK assay cells in me, so are having that treated with them, as another box ticked!). 

BUT, now I'm really confused. Especially as we really only have money, just, for one more go which is slightly killing me in the pressure of it all.  Having talked it all over with DH he is keen we go one more time with Dr Simone at ZW, on the basis that, bar actually getting pregnant (I know that sounds mad, but you know what I mean!), everything else went exactly as he'd predicted (number of eggs produced, my response etc) and also that we had such a positive experience there generally. I was pretty much in agreement. 
However, the more research I do, the more I keep coming back to the philosophy of "less is more" in older women, it seems to be mainly along the lines of, that the quality is better on lower numbers of eggs as the body does it's own sort of self selection. 

So sorry if this a long-winded way of asking - I just wondered what other FF ladies over 40's experiences were? And whether you had any advice as to what works best? (I am heartened slightly by my lowish FSH, although v aware my AMH not great!).
I'd be so grateful for any thoughts.
Thank you SO much ladies
xxxx


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## Beldon (Feb 6, 2013)

Hi Jib2014,

I'm also now 41 and I've had 5 cycles, the first 4 were long protocol and the last was short protocol, the numbers of eggs retrieved per cycle was always 6 on cycle 1, 3 & 4, 4 eggs on cycle 2 and 5 eggs on cycle 5. On cycle 2 and cycle 5 I got pregnant; had a miscarriage on cycle 2 and luckily I'm 13 weeks pregnant from cycle 5 (early days!).

I don't know if it was the short protocol that made the difference or the DHEA, CoQ10 or assisted hatching, a change of clinic to one with a more relaxing atmosphere or simply that I'd finally got some decent eggs.

10 eggs sounds like a good number to me so if you're happy where you are I wouldn't move to a clinic that I didn't have much confidence in, that'll just be more stressful! Are there any other options where you live?

Good luck with whatever you decide,

B x


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## DippyGirl (Mar 10, 2005)

Hi Jib

I always liked the philosophy of Gita Nargund, I like the low stimulation philosophy it seems to make more sense intuitively. Statistically of course more eggs means more embryos means more chances to get that one viable embryo, cos one is all that it takes. I'm 42 and for my last 3 cycles I have produced plenty of eggs and we've had a reasonable fertilisation rate but not a single BFP. My recent cycle I produced 15 eggs we transferred 2 and had 4 for freezing. I did some random goggling and found some information that the grading doesn't seem to correlate to a viable pregnancy, but maternal ages does.

My own feeling about high stimulation is 
that it results in lots of eggs and some eggs that maybe wouldn't have ever matured naturally are brought on
that your body in it's wisdom knows exactly which egg is the best one to select
that it only takes one

Of course statistically the more eggs, then the more embryos then the higher the chances of a pregnancy but I'm not sure that the body behaves like that. At the end of the day you have selected two excellent clinics with excellent reputations, I think either of them can help you, you are ONLY 41 and have a younger partner (apparently older ladies with younger partners have better fertility) and there is no reason why it wouldn't work for you. Dr Beer (immune doctor) always said that with the right treatment women should be conceiving up to 46 with their own eggs.

I'm sure that the other girls will be along with some better opinions soon, I tend not to over research these days, it's been a long 12 years off and on, but its been my privilege to know some amazing women who fell pregnant against all medical advice well into their 40's. I also found this article very encouraging
. http://www.theatlantic.com/magazine/archive/2013/07/how-long-can-you-wait-to-have-a-baby/309374/

As a complete aside, my understanding of your post is that there is no structural for you to need IVF (blocked tubes/other) while you wait to decide/save up for the next treatment so my advice would be to get yourselves as healthy as you possibly can (check out the nutritional testing at foresight, I tested high for lead which I was advised would make conception very difficult, shame I didn't test years ago I thought I had covered that and my nails are amazing and strong since I started the supplements), consider some relaxation techniques including meditation (cost effective) reflexology and acupuncture, check your ovulation time your bms carefully (a friend swears by every second day around ovulation) and have some fun while you do it!

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## churchmouse41 (Jan 10, 2014)

Hi. I am 41 (42 next week) and 21 weeks pregnant with a Create baby!

My AMH was identical to yours. My AFC was freakish good each cycle (15 to 1. 

I had two rounds of mild IVF on 175 of Gonal F. First round I had 11 eggs collected. 9 fertilised. I had two perfect 3 day 8 cell embies transferred - BFN. From that cycle I had another 2 3 day 8 cells frozen which I used for a subsequent failed FET. I have two blasts left on ice from that cycle. 

The next cycle was the same protocol. I had 13 eggs collected, 6 were immature (tiny follicles knew before that  they'd be no good). 7 fertilised. I chose to freeze all for various reasons and was left with 6 8/9 cells 3 day embies - all good quality. 

A month or so later I threw caution to the wind and had 3 (what was I thinking!) transferred. BFP - in fact 6 week scan showed two sacks, but only one fetal pole/heart beat. The result has just kicked my mobile phone off my belly!

All my treatment was this year. I decided to start with the Create approach but I was ready to move on for reasons unconnected to the protocol if the last try had not worked out. My difficulty in identifying another clinic was that it really does seem as though only Create are committed to the mild and natural approach and I did not feel confident that other clinics would embrace it so fully. 

I have friends being treated at two other top London clinics at the moment. The level of drugs they are on terrifies me! What concerns me more though is that alternatives seem to be off the table even for discussion. 

I don't know if this helps - but this was my experience and obviously the approach can and does work. At create you would need to accept fairly early on that you are unlikely to be treated by NG direct. 

Do PM me if you have any questions.


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## Whoppie (Nov 15, 2014)

Hi,

I am already 43, hubby is 37 and we just had our sixth cycle.
Last one was the highest dose of 450 and this was our worst cycle..

But everybody reacts different.. 

My dr is now suggesting natural ivf.. So very low stimulation to have 1-2 eggen


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## Flyby (Feb 25, 2012)

I'm 45 and conceived my son at 44 through a Clomid stimulated cycle. Previous to that I had four failed injectable cycles then tried stimulating with Clomid and freezing to transfer a couple of months later due to Clomid affects on the uterus lining. This, I think may have been the key to success since Clomid allows the body to use its own hormones and is therefore a much gentler process and I would think a better thing for egg quality. So in my experience a gentler stimulation protocol may produce slightly less eggs but could be more able to apchieve a pregnancy for an older woman. Good luck whatever you decide, I know how difficult it is to make a decision with limited time and money! Flyby xx


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## Pippi_elk (Feb 7, 2013)

Not sure I can advise on either protocol...but looking at Beldons results...seem shes got bfps from cycles with lower eggs despite different protocols both times.

I was 42 on 1st ivf and stim with 400 IU FSH for 2-3 days and then 200 IU for another approx 8-9 days, resulting in 12 eggs......3 good quality to transfer, none of the embryos remained were good enough to freeze on day 5.result was a chemical pregnancy.
I was 43 on my 2nd cycle....same protocol, slimmed for exactly same length of time...got 15 eggs. 3 high predictors transferred, v v low beta but basically a BFN. We got one frozen blastocyte of medium quality from 2nd cycle and that resulted in a BFP. I'm now 16 weeks pregnant.

I was happy to be on the long protocl rather than a short protocol after reading this...
http://www.bioline.org.br/pdf?mf08014
But that's not what you are asking...but they do say long protocl is best as it gives similar development of all follices and produces larger number to give best chance. I did a quick search and couldn't find any papers comparing natural v long protocol.

I'd still be inclined to go with first clinic....even in younger couples IVF does nt always work first time and maybe its too soon yet to change clinic and protocol.

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites


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## goldbunny (Mar 26, 2012)

it sounds to me like you did pretty well responding to that protocol, and 5 out of 7 eggs fertilising isn't to be sniffed at, good luck with your next go. i had high dose stims and long protocol. it worked for me but took three goes.


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## coldhandswarmheart (Nov 22, 2014)

Thank you so much all for your amazing support and all that info and for taking the time to let me know your experiences - so incredibly useful.

I think having done more research, and having read really carefully all your fantastic responses, the thing that just keeps hitting home to me time and time again - is that it is SUCH an individual thing. No matter how close in age, AMH, FSH readings, number of attempts etc etc, every woman is so different in her response to these drugs and the stimulations and all of the treatments (including all the natural stuff like acupuncture). I think it's almost that you have to come to realise that even with the greatest medical treatment in the world, no-one can ever guarantee you a baby  - ultimately fate, God, or whatever, will be the one that decides why some women will fall pregnant naturally at 46 and others have problems at 20. And some go years trying every possible medical intervention, to then fall pregnant for no discernible reason. 
And I think that's what makes this journey so hard -  that no-one can tell you where the end of it is. 

Anyway, to his credit I'm having a phone consultation (ie free!) with our Dr this afternoon, after I sent him an email with all of my concerns. So hopefully will get some sort of (partial) resolution from that.

Thanks once again for sharing your thoughts and stories, I really appreciate it 
Best of luck to everyone
xxxx
xxxx


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