Jump to content

Anyone tried this for Poor Responders??


  • Please log in to reply
3 replies to this topic

#1 Laney

Posted 29 January 2006 - 10:10 AM

I've been corresponding and am waiting on a telephone consult with a Dr at SIRM in USA.  They have a lot of success with poor responders and this is their main protocol for them...

Has anyone tried anything like it here in Australia??


Agonist/Antagonist Conversion Protocol (A/ACP)
The GnRH Agonist/Antagonist Conversion Protocol (A/ACP) :

It is our position that some form of pituitary blockade, either in the form of a GnRH agonist (e.g. Lupron, Buserelin, Nafarelin, and Synarel. Decapeptyl) or a GnRH antagonist (e.g. Antagon, Cetrotide, Cetrorelix, and Ganarelix) is an essential component in ovarian stimulation of “poor responders” undergoing IVF. If this is not done, a progressive rise in LH –induced ovarian androgens (male hormones ….mainly testosterone) will inevitably affect follicle/ egg development, resulting in compromised embryo quality.
The follicles/ eggs of women on GnRH-agonist “flare protocols” are exposed to an exaggerated Lupron-induced LH release, (the “flare effect” while the follicles/eggs of women, who receive GnRH antagonists starting 6-8 days into the stimulation cycle are exposed to endogenous LH -induced ovarian androgens( especially testosterone). This might not be problematic in “normal responders” but could be decidedly prejudicial in “poor responders” and older women where endogenous basal LH levels are often raised and the ovaries may be inordinately sensitive to LH and where excessive exposure of follicles and eggs to testosterone could severely compromise egg development and thus embryo quality.
exhausted of its LH and residual minimal LH is present in the circulation by the time stimulation with gonadotropins begins, the above mentioned adverse testosterone-effect is largely negated. On the down side is the fact that prolonged administration of GnRH agonists such as Lupron (such as with the GnRH agonist down-regulation protocol could suppress subsequent ovarian response to ovarian stimulation with gonadotropins, by competitively binding with ovarian FSH receptors.
We introduced of our Agonist/Antagonist Conversion Protocol (A/ACP) more than a year ago in an effort to counter this effect.
With the A/ACP, low dose Antagon/Cetrotide is commenced at the onset of spontaneous menstruation or following bleeding that follows initiation of GnRH agonist (e.g. Lupron) therapy using a long-down-regulation protocol arrangement. We currently prescribe the A/ACP to most of our IVF patients regardless of whether they are “normal responders” or “poor responders”. Preliminary results suggest a significant improvement in egg number, egg/embryo quality as well as in implantation and viable IVF pregnancy rates. The A/ACP has however, proven to be most advantageous in “poor responders” where additional enhancement of ovarian response to gonadotropins may be achieved through incorporation of “estrogen priming”. We have reported on the fact that the addition of estradiol for about a week following the initiation of the A/ACP, prior to commencing FSH-dominant gonadotropin stimulation appears to further enhance ovarian response, presumably by up-regulating ovarian FSH-receptors.
There is one potential draw back to the use of the A/ACP, in that the sustained use of a GnRH antagonist ( e.g. Antagon/Cetrotide) throughout the stimulation phase of the cycle, appears to compromise the predictive value of serial plasma estradiol measurements as a measure of follicle growth and development in that the estradiol levels tend to be much lower in comparison to cases where agonist (Synarel, Lupron) alone is used or where a “ conventional” GnRH antagonist protocol is employed ( i.e. antagonist administration is commenced 6-8 days following initiation of gonadotropin stimulation). Rather than being due to reduced production of estradiol by the ovary(ies), the lower blood concentration of estradiol seen with prolonged exposure to GnRH-antagonist, could be the result of a subtle, agonist-induced alteration in the configuration of the estradiol molecule , such that currently available commercial kits used to measure estradiol levels are rendered much less sensitive/specific. Thus when the A/ACP is employed, we rely much more heavily on ultrasound growth of follicles along with observation of the trend in the rise of estradiol levels, than on absolute estradiol values. Thus we commonly refrain from prescribing the A/ACP in “high responders” who are predisposed to the development of severe ovarian hyperstimulation syndrome (OHSS) and accordingly where the accurate measurement of plasma estradiol plays a very important role in the safe management of their stimulation cycles.
It is remarkable, that while using the A/ACP + "estrogen priming " in “poor responders “ whose FSH levels were often well above threshold limits, the cycle cancellation has consistently been maintained below 10% ( i.e. much lower than expected). Many of these patients who had previously been told that they should give up on using their own eggs, and switch to ovum donation because of “poor ovarian reserve”, have subsequently achieved viable pregnancies at SIRM using the A/ACP with “estrogen priming”.


#2 CeeBee

Posted 29 January 2006 - 10:20 AM

Very interesting indeed!!  

Sound similar to what a few other people have mentioned to me previously (can't remember if that was called 'agonist protocol') but I have it on my list of things to discuss next time I visit my doc.  Will print this off and ask him to read it.

Sounds 'right up my alley' - pls keep us informed.

CeeBee

#3 rob6712col

Posted 29 January 2006 - 01:15 PM

"PG Ment'd"



Hi,
I have read what you posted and am perhaps a little confused however I believe that this is what I did.  I am a poor responder with my first ivf only getting one egg which did not make it over night. I was on Lucrin and Puregon. My 2nd ivf cycle I was on Cetrotide and Puregon and a short cycle.  The whole cycle of injections only went for 13 days and then I had epu.   On this protocol I got 4 eggs, 3 fertilised, 2 put back on day 5 and a successful singleton pregnancy was achieved (DD born 30/8/05).

If you would like to know more then please pm me.  I know that cetrotide was not widely used and still a little "experimental" here in OZ when I had it and it was very expensive but truly worth it for us.  We used SIVF in Canberra for our ivf and it was icsi as we also had a male motility problem as well.
Cheers
Robyn

#4 s-m

Posted 29 January 2006 - 07:49 PM

I know that Antagonist cycles are done here but with Cetrotide starting about day 5 I think. I am with the same clinic as Robyn and my FS said there is some evidence from animal studies that Cetrotide damages primordial follicles and hence could affect fertility in FUTURE cycles. I have done a flare cycle and it didn't make any difference to my egg quantity and quality however I am not a poor responder numbers-wise by any stretch of the imagination.

Steph
lining up for IVF/ISCI#5 - perhaps, maybe???


1 user(s) are reading this topic

0 members, 1 guests, 0 anonymous users

 

How to talk about your pregnancy at work

The workplace isn't always a friendly place for pregnant women. Yet working women inclined to conceal a pregnancy from prying coworkers may be better off opening up and carrying on, according to a new study.

Tell us your story to win!

To celebrate Mother's Day this year we are giving you the chance to win one of five great prizes simply by telling us your story.

Where to get help to help your baby sleep

There is so much pressure about having a baby who sleeps 'all night' , it's no wonder you worry about your baby if she wakes in the night.

Vintage baby names having a comeback

What makes some names have comebacks while others silently fade into oblivion? A few factors come into play.

When your partner doesn't want you to breastfeed

Dads can have many reasons for not wanting their partners to breastfeed their baby, but both parents should learn more about it before making a final decision.

Model mum Sarah Stage shares post-baby selfie

Most new mums would recoil at the thought, but Sarah Stage has shared a post-pregnancy selfie just four days after giving birth.

I'll admit it: I have last child parenting fatigue

If you're a new mum and feeling ignored by the older mum/the old hand/the has-been, please know, it's not you, it's me. Blame the last child parenting fatigue.

Exhaustion is not the same as tiredness

Having a new baby isn't tiring - it can be downright exhausting.

Five posterior babies, four home births

I was on a high. I'd done it all by myself with no help from anyone.

Mum's list of birthday gift demands goes viral

We're big fans of kids' birthday parties - but this is one bash we're glad we didn't get an invite to.

Kate Middleton to receive 'loyalty discount' for second birth

Everybody loves a bargain - including the Duchess of Cambridge.

Fish & chip shop owner's sad note goes viral

A lengthy note put on the window of a fish & chip shop has gone viral due to the writer's serious doubts about the romance of travel.

Pregnant women need good nutrition advice, not judgment

Pregnant women are under pressure to do all the "right things" to have a healthy child. It results in women feeling judged about their decisions.

When your child wants you to have another baby

Giving your child a sibling when you don't want to have another baby can be a complex issue.

William Tyrrell's mum speaks out: 'We hope he is still alive'

The mother of missing toddler William Tyrrell says she has a vision that somebody "picked him up and moved him on ... that's the only way ... to explain for him not to be there".

Family comes first for 23-year-old Tommy Connolly

Most 23-year-old blokes spend their hard earned cash on fun times with mates or romantic dinners with their girlfriend, but not Tommy Connolly.

Newborn all-girl quintuplets 'doing great'

The first all-female quintuplets born in the United States were delivered last week, at 28 weeks and two days.

Model mum's big baby silences critics

He may be less than a week old, but baby James Hunter has already helped his model mum silence her critics.

Jammy, Hula Hoop, Rage: Reddit reveals most unusual baby names

A recent Reddit thread has revealed some of the more creative names in the world.

Woman awakens from coma, learns she gave birth

A US woman awakened this week from a four-month-long coma that doctors had feared would be permanent and learned that she had given birth to a baby boy, according to her family.

'Give us a break': mum sent shocking letter over Facebook baby pics

Posting a lot of baby photos doesn't make you a bad person. It may make your Facebook feed a little irritating, but it doesn't make you a bad person.

In defense of the dads who do so much

It's time to shift the focus off what dads aren’t doing and shine it on what they are.

The modern cloth nappies too cute to cover up

If you're only just joining the modern cloth nappy movement, or would like to spruce up your collection, we have to introduce you to Designer Bums.

How breastfeeding can affect your libido

When you’ve just had a baby, having sex isn’t usually top priority. In fact, for a lot of women it rates about as appealing as changing another dirty nappy.

Should pregnant women be allowed to use 'parent and child' car parking spots?

Is it acceptable to use these car parking spots when pregnant? How many of us would admit to doing it?

Healthy baby from sperm taken 48 hours after a man died

Fertility doctors have described their "most extraordinary case" - creating a healthy baby from sperm taken 48 hours after a man had died.

Sign up to our 30 days of #PlayIQ challenge

Sign up to receive 30 amazing tips and ideas for play with baby during the month of April and submit a picture or tip on our social wall for a chance to win an amazing Fisher-Price prize pack.

 
Advertisement
 
Advertisement
 
 
 

What's hot on EB

Last chance to win a year's supply of toys

You have less than a week left to win your child one of five Fisher-Price toy packs valued at over $600 each - hurry, enter today!

Childcare is a big problem, but there's more to it

Let’s keep talking about these issues and not allow them to be put into a neat little box that’s labelled ‘Fix childcare and everything is solved’.

Pink's awesome response to body-shaming trolls

When trolls felt the need to comment on 35-year-old singer-songwriter Pink's weight, her answer was an awesome ode to body love.

Fertility clinic offers egg donors $5000

A national chain of fertility clinics is offering egg donors a $5000 payment to cover their expenses, a first for Australia which is raising concerns the money could act as an inducement.

Baby boy abandoned in India amid fresh surrogacy concerns

Australian officials could do nothing to stop an Australian couple from abandoning their baby son, born through surrogacy in India, after they decided they did not want to bring him to Australia.

Herd immunity and community responsibility: how free-riders can make kids suffer

Individual choice works for haircuts and handbags, but not for preventing infectious diseases that kill kids.

Photographer captures 'unexpected beauty' of birth

If there is one thing Leilani Rogers knows about childbirth, it is that no two deliveries are ever the same.

Expectations vs the reality of making a toddler's clothes

Note to self: less sewing, more life. Not the party dress, but the party. The toddler, as usual, has it all figured out.

Mum meets 'dead' daughter 49 years after birth

In 1965, Zella Jackson-Price was told her premature baby girl had died shortly after birth.

How pregnancy probiotics can help you and your baby

New research suggests that taking specific pregnancy probiotics could be the answer to a range of common pregnancy side effects.

53 creative pregnancy announcements

Announcing that you're expecting can be a time to express your creativity, sense of humour and imagination. Check out how other parents and parents-to-be have broken the news to friends and family.

IKEA hacks for the nursery and kids' rooms

Are you one of those that know the whole IKEA catalogue by heart? Love their stuff but want to personalise it? Here's some inspiration to help you realise the potential of IKEA furniture and fittings.

36 baby names inspired by food and drinks

A French court may have ruled out Nutella as a baby name, but that doesn't have to stop you from taking inspiration from the supermarket (or bottle shop). See what parents in the US have chosen for their delicious little ones.

 

ENTER NOW!

Win a year's worth of toys

Last week to submit a picture of your baby at play for your chance to win. Visit the Play Wall to view our recent entries.

 
Advertisement
 
 
Essential Baby and Essential Kids is the place to find parenting information and parenting support relating to conception, pregnancy, birth, babies, toddlers, kids, maternity, family budgeting, family travel, nutrition and wellbeing, family entertainment, kids entertainment, tips for the family home, child-friendly recipes and parenting. Try our pregnancy due date calculator to determine your due date, or our ovulation calculator to predict ovulation and your fertile period. Our pregnancy week by week guide shows your baby's stages of development. Access our very active mum's discussion groups in the Essential Baby forums or the Essential Kids forums to talk to mums about conception, pregnancy, birth, babies, toddlers, kids and parenting lifestyle. Essential Baby also offers a baby names database of more than 22,000 baby names, popular baby names, boys' names, girls' names and baby names advice in our baby names forum. Essential Kids features a range of free printable worksheets for kids from preschool years through to primary school years. For the latest baby clothes, maternity clothes, maternity accessories, toddler products, kids toys and kids clothing, breastfeeding and other parenting resources, check out Essential Baby and Essential Kids.