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.


#3 rob6712col

Posted 29 January 2006 - 01:15 PM

"PG Ment'd"

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.

#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.

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

1 user(s) are reading this topic

0 members, 1 guests, 0 anonymous users


The device that allows you to bottle feed and use your phone at the same time

"It dawned on me that I could do some catch-up work while he fed, but I needed something to help me hold a bottle and my smartphone."

Mum posts photo of c-section scar to prove she gave birth

A new mum angered by people suggesting women who deliver their babies via caesarean section have not "given birth" has challenged that misconception by sharing a photograph of her scar.

Olivia Wilde and Jason Sudeikis welcome daughter

Actress Olivia Wilde and her fiance Jason Sudeikis are parents again.

Nurse cuts off part of newborn's finger

A newborn baby is without the tip of one finger after a nurse accidentally cut it off with scissors.

See the new Thomas & Friends clothing range for girls

It's a long overdue move for kids and parents alike.

Finally, someone's come up with a way to stop doona thieves

If you've ever shared a bed with a dyed-in-the-wool doona stealer you'll know how frustrating it can be.

Family rituals to make mealtimes easier: mums share their tips

Special rituals, as well as favourite cutlery and plates, can make dinner times less challenging and a lot more fun!

Toddler pours entire bag of dog biscuits down the toilet

Most mums of toddlers have a funny horror story about the time they turned their back for 30 seconds only to find mayhem on their return.

Surgeons successfully separate 13-month-old twins conjoined at head

Surgeons at a New York City hospital have separated a pair of 13-month-old boys who were congenitally joined at the head, completing a rare operation that carried a risk of death and severe brain damage, their mother said.

'Do I call the parents or an exorcist?'

Babies can sometimes get themselves into unusual positions while sleeping, but this youngster has the makings of an acrobat.

The complicated grief of losing your babies

In the park near our house my partner and I have a bench. We paid to have it put there last year after our twin boys Fred and John died.

How the way you’re born and fed can affect your immune system

Vaginal or caesarean, bottle- or breastfed: it all influences our gut microbes and future health.

Depression made me a crummy friend - but I'm working on it

Getting well and falling in love with my son has brought a feeling words simply can't describe. But I didn't expect it to be a little heartbreaking, too.

Mountain Buggy Bagrider makes travel so much easier with baby

Haven't we all needed more hands when travelling with babies and toddlers?

'I look like a troll!': mum shares postpartum hair regrowth woes

Rather than hiding her postpartum hair regrowth, author Giovana Fletcher has photographed and shared it.

A police officer saved a baby's life, forever changing his own

With his bald head, light goatee and bulging arms covered in dark tattoos, Officer Kenneth Knox is an imposing figure.

The tandem breastfeeding photo that got a mum's Facebook account shut down

A mother of six from the US claims that Facebook disabled her account because she posted a photograph of herself tandem breastfeeding a stranger's baby along with her own.


Top 5 Articles


What's hot on EB

Win a Hawaii beachfront resort holiday for two!

Enter now for your chance to win 1 of 4 trips for two to Hawaii, staying at Outrigger resorts in Waikiki.


Vintage Toys

The toys of your childhood

Take a trip down memory lane with these vinage and retro toys that you may have had in your childhood or your parent's childhood.

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.