Menopur only protocol and Dual Trigger.

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try4no1
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Menopur only protocol and Dual Trigger.

Post by try4no1 » Sun Oct 25, 2015 9:12 am

Dear Dr Wisot

Thank you for such great information. I had contacted you a while ago regarding some previous IVF attempts. I currently in the process of undergoing my IVF 4 and I changed Dr due to moving and just a new start this is my history.

Me 30 pcos, dh 32 male factor

Ivf 1- menopur/gonal f and cetrotide triggered with ovidril and got poor response 2 eggs despite have. 20 follicles on US . Nothing to transfer due two embyros arresting before day 3.

Ivf 2 - down regulated with lupron, gonal f and menopur triggered with 10,000 hcg 13 eggs collected 9 fertilized, 2 transferred and 4 frozen, bfn

Ivf 3 - FET transferred 2 expanded blasts and Bfn

My baseline blood work prior to ivf 4 : fsh 7.5, lh 6.9, estrogen 29, amh 3.3ng/ml, progestrone 0.7, (only abnormality was slightly elevated prolactin 40- which is being medicated to be reduced) AFC >10 on each side so in total > 20.

Ivf 4 - we are doing a fresh cycle - my re wants to change it up stim me with menopur ONLY and then trigger me with a dual trigger 10000 hcg first and 8000iu of lupron at 12 hours and another lupron again 12 later. I have tried to find research on both menopour only protocol and dual trigger..

Do you know the reasoning on why a dual trigger would be considered and what are the benefits of a dual trigger. I know I responded a lot better when I had the full hcg trigger verses ovidril. But I only find info on either hcg or lupron trigger not both. Is this a common procedure for repeated failure ivf. My re is also being very aggressive in supporting the leutal phase poster transfer with steroids, estrogen tables and patches and both progesterone in oil and progesterone insert.

I know you can't comment on a protocol per say but if u know of research and medical indications for these types of protocols that would be helpful I am just trying to find more info but I can't not seem to find it.

Thank you for a great discussion board.

Dr. Wisot
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Re: Menopur only protocol and Dual Trigger.

Post by Dr. Wisot » Sun Oct 25, 2015 10:39 am

Using both Lupron and hCG is called a Lupron co-trigger and is used to prevent hyperstimulation, but not with 10,000 of hCG. We generally use 1000u of hCG because it's the hCG that causes hyperstimulation. So that's probably not the reason they are giving you at and I don't understand it when you did well with 10,000 hCG alone.

If you are above 225u daily I do not understand why all Menopur especially in PCOS when not enough LH is not a problem.

I don't understand why you are having a fresh cycle when most RE's are doing mostly freeze all cycles, especially in someone with a previous failure and especially with a Lupron co-trigger when you then need a much more aggressive luteal protocol.

:?:

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

try4no1
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Posts: 13
Joined: Wed Feb 26, 2014 10:03 am

Re: Menopur only protocol and Dual Trigger.

Post by try4no1 » Sun Oct 25, 2015 2:25 pm

Hi Dr winsot,

Thank you for the timely response. In regards to you questions. I will definitely ask my RE more the reasoning of the co-trigger. My belief and it is my belief only that when I did the first cycle the ovidril was not enough and it was done to protect me from ohss but in reality it was not enough of a trigger to mature all the follicles I had growing. There was question about doing 2 overdril instead of the co trigger but interestingly on my meds I received I was given a 10,000 noveral and thee lupron trigger actually states this will be used instead of ovidril?? So maybe they was planning on triggering me with hcg and overdril it really makes no sense and I am going to clarify this. But what are the indication for a lupron co-trigger? Just to prevent OHSS ? Does it ever help get more mature eggs..

As for tie menopur I am only on 150 or two vials what ever that is, I am worried I won't stim enough on that. Again what are the indications for why a menopur only protocol is used in your eyes what patient population do u have the most success with it.

As for the fresh I am not sure? We are doing a fresh cycle in general as my 2 frozen are of lower quaility and unlikely to make the thaw and not to mention are in a different state so I just want to use them for a back up basically if we go embryos to freeze this time I would use the other embryos from my previous Ivfs before using the newest frozen ones I am only thinking of my future fertility over the next years.

Are you saying that I should stim get the embyros freeze them and then do a whole new frozen cycle to actually transfer them? Is the aggressive luteal phase too much on a fresh cycle. I have never had such aggressive protocol after a transfer but figured everyone was different.

As for the pcos, I have also been pcos on US but most recently as far as I understand have not replicated the lh:fsh ratio and actual blood work abnormality so I often wonder if I typically respond in the same manner a pcos patient would or not. So far even with 13 egg retrieved last time I did not get OHSS with the 10,000 hcg.

I am a little lost now at where this new protocol is heading me and my understanding is that I have an implantation issue I have a feeling my new re thinks I have an egg quail it's issue!!

Dr. Wisot
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Joined: Fri Oct 14, 2005 11:16 am

Re: Menopur only protocol and Dual Trigger.

Post by Dr. Wisot » Sun Oct 25, 2015 3:24 pm

But what are the indication for a lupron co-trigger? Just to prevent OHSS ? Does it ever help get more mature eggs..

It is used only to prevent OHSS. You do not get more eggs. We do not think Ovidrel is as effective as hCG, especially if one is overweight.

what are the indications for why a menopur only protocol is used in your eyes what patient population do u have the most success with it.

There is benefit in using some Menopur but not above 225u. If yoiu are on a total of 150, then most would give it as Menopur, not pure FSH.

Are you saying that I should stim get the embyros freeze them and then do a whole new frozen cycle to actually transfer them? Is the aggressive luteal phase too much on a fresh cycle.

Yes. Success rates in general have been higher when that is done. We usually do not do fresh transfers when Lupron co-trigger is done. If Lupron trigger is used an aggressive luteal phase protocol is necessary. But not if you freeze all and transfer after a rest cycle.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

try4no1
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Posts: 13
Joined: Wed Feb 26, 2014 10:03 am

Re: Menopur only protocol and Dual Trigger.

Post by try4no1 » Sun May 29, 2016 2:50 pm

I just wanted to follow up on this.. We actually went through a fresh cycle menopur only with the dual trigger of hcg and lupron, I had presidesone steriod pack prior to transfer and continued support of estrogen and progesterone after transfer.

We got 13 egg after 14 days of stimulation (I think I was a little over suppressed it took a while for the follicle to grow). 10 fertilized and we had 6 at day 5.

We transferred 2 and froze 4 expanded blasts... Well 14 days later our beta was POSiTive ... And we are currently 28 weeks pregnant with a singleton boy.

I just wanted to offer hope and support to anyone going through this.. We did 3 fresh and 1 frozen and it was the last fresh that was our sucess. It is not an easy journey but it is so worth it... My little one is kicking me now as a write this all I can say is trust your doctors, try to relax in the process and sometimes it takes time and it will feel like it will never happen but it will and every needle, blood work and doctors visit is worth the end product.. We are only around 10-12 weeks away from welcoming our bundle of joy home... Never give up hope!!!

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