Jump to content
Anyone tried this for Poor Responders??
3 replies to this topic
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”.
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.
Posted 29 January 2006 - 01:15 PM
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.
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.
lining up for IVF/ISCI#5 - perhaps, maybe???
1 user(s) are reading this topic
0 members, 1 guests, 0 anonymous users
Today, on White Ribbon Day - and every other day - we're teaching our son to say no to violence against women.
If there is one thing the owners of Tillings Cafe can be certain of, it is that the eatery won't win the award for Britain's best baby-friendly coffee shop any time soon.
A woman who admitted to dumping her newborn baby down a Sydney drain has reportedly been allowed to give him a name.
Are you feeling used up by life's stress, family problems and a demanding job you can't turn off? Many people are way beyond work-life exhaustion. They are functioning as robots.
The world's biggest chocolate-maker says we're running out of chocolate.
A baby who was born at 23 weeks has survived her first week of life outside the womb.
It might sound like temporary insanity, but almost obsessive nesting as you near your due date isn’t uncommon – even if you’re not usually a particularly clean person.
The baby found abandoned in a Sydney drain may have been alone for up to six days without being fed, leaving many asking how he could have survived.
A child's excitement at Christmas time is a beautiful thing, but one dad ponders whether his toddler daughter is getting into the festive mood a bit too soon.
A new experience is radically altering men's views of childbirth.
Italian police have placed 12 doctors under house arrest on suspicion of promoting baby milk formula over breastfeeding.
Cara Simmons arrived at work to clean a large and beautiful house in time for a party planned for that evening. It was soon hers.
Every now and then your child does or says something that is truly memorable.
A few weeks ago, some dear friends of mine had their first baby. As the proud dad texted me a picture I had to fight the natural instinct to say “Enjoy every moment!”
Footage of Australian babies and children sleeping in their bedrooms are among the images on a Russian site showing live feeds from thousands of homes and businesses around the world.
Was there really a man who was actually there by his wife’s side as she laboured and gave birth to his child, all while he was making what he perceived to be meaningful eye contact with a midwife?
Tantrum Trolls are a small but growing species of predatory bottom-feeders who delight in picking on parents at their most vulnerable.
The death of children, siblings, and parents has long term impacts on the rest of our lives.
Love has nothing to do with mental illness. But love may drive a mother to do something about it.
We have a beautiful seven-month-old son, and his allergy rules our life.
A transgender man who breastfed his first baby - despite having his breasts removed as part of his transformation from female to male - has now had a second child.
A Canadian couple were slammed with a million dollar medical bill after their daughter was prematurely during their babymoon.
One in every five dollars spent at supermarkets goes on cigarettes or junk food, according to industry data.
There is no doubt mums have a right to continue breastfeeding after they have returned to work, but one teacher in the US has taken it to the extreme.
We have 4 family passes to give away to see Disney Live! presents Three Classic Fairy Tales, touring Australia this December/January.
Got bored kids? Quickly find the best activities for kids wherever you are in Australia with the Essential Kids app.
Top 5 Articles
To celebrate the release of PADDINGTON, we are giving five lucky winners the chance to win a family pass to the exclusive Australian Premiere in Sydney on December 7!
We were green and uninitiated, perhaps a little naïve when it came to the favourite toy responsibility.
She looks him up and down and then touches his chin, but baby Lindsey still isn't sure this clean-shaven man is her dad.
Medical experts say intense fitness routines can be done safely during pregnancy - if the mums-to-be follow some guidelines.
Are our hopes, dreams and expectations for our children what they really need?
Before even giving birth, Katie Myers' maternal instincts warned her something was wrong with her baby.
Some dads-to-be don't miss a beat when their partner is pregnant; others struggle with a range of issues and can become withdrawn, right when their support is needed most.
Katharine and Kris Camilli devised a clever trick to immortalise their family and friends' reactions to their exciting pregnancy news.
"After 30 years on television, I had become what I despised: a painted doll who spent an hour a day and close to $200 a week putting on a mask."
I am secure, confident and strong, but the responsibility of protecting my children can almost bring me undone.
There are so many ways in which parenthood changes us as women, but one of the most noticeable, for me, has been the changing state of my emotions.
Baby Maia was conceived against the odds, only to find she was sharing a womb with an ominous "foreign body".
They say dog is man's best friend, but this playful pooch seems to have chosen a jumping baby as her number one buddy.
New paernts can get frustrated when their newborn gets fussy and can't settle down. When you're feeling overwhelmed, try some of these simple tips to help soothe your baby.
The data-lovers at nameberry.com have been at it again – this time, they’ve discovered the names that are continually rising up the ranks, ready to take out some top spots in the next few years.
Ideally, you want to give food that isn’t expensive to make, isn't too difficult to create, and freezes well; stews, bakes, soups and pasta sauces are perfect.
Some pregnancy products come to market and are just awesome. Others just leave you scratching your head.
Two children who were given to the wrong families at birth will soon learn if they will be returned to their biological parents.
How many weeks til Christmas?
Get the "Santa" shopping done without the kids in tow.