Egg retrieval protocols that got us the most blasts
TW euploids, spontaneous pregnancy, loss
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We just finished 5 rounds of egg retrievals (in the US), with a range of outcomes, so sharing what we learned in the process. I understand that the PPOS protocol is newer, but I think it achieved something similar to a luteal phase stim for us, and could also be something to look into!
This group has been really generous in sharing support and perspectives, so I hope some of this is helpful and helps you advocate with your RE team!
My age during most of the retrievals was 34-35, AFC 3-7, AMH 0.45-0.67; suspected endometriosis.
Round 1: Did mini-IVF with a different clinic, with no blasts (also ovulated early on one side). Had Mirena IUD in for this round. AMH was 0.84 ng/mL, age 33.
Switched clinics, removed IUD, and AMH measured at 0.49 ng/mL, then had 1 spontaneously conceived missed miscarriage (which turned out to be euploid), and 2 chemical pregnancies before and between IVF cycles.
Round 2-4: Microdose Lupron Flare (MDLF) was quite good the first time, so we repeated it, but it was a long protocol that was hard on my body, and we started getting less good results. All were with 1-2 weeks of estrogen priming, and with both Follistim + Menopur, and ICSI+Zymot.
* Round 2: 6 eggs retrieved, 4 mature, 3 fertilized, 2 blasts (both euploid) - stimmed 12 days
* Round 3: 7 eggs retrieved, 5 mature and fertilized, 2 blasts, 1 euploid - stimmed 14 days, slightly higher gonadotropin doses
* Round 4: 7 eggs retrieved, only 2 mature and fertilized, 1 blast (aneuploid) - we had some cysts at baseline this round, and stimmed for 15 days with very high dose, so it was all kind of off.
Took 2 months of rapamycin (5mg/week) in between Round 4 and Round 5. AMH tested at 0.67 ng/mL before Round 5. I stopped rapamycin before starting the PPOS protocol since it may work against the ovarian stimulation.
Round 5: Progestin-primed ovarian stimulation (PPOS), with Menopur only, 9(!) eggs retrieved, 8 mature, 6 fertilized, 3 blasts, of which 1 was euploid, 1 was aneuploid, and 1 was a "no result" due to insufficient sample. We kept ICSI+Zymot because my partner had slightly elevated sperm DNA fragmentation.
Supplements that I think helped: CoQ10 - 600mg / day, Vitamin D 2000 IU/day since it was <50 ng/mL during Rounds 2-5, Acai 1g/ day, NAC 500mg /day started around Round 4/5, fish oil 690 mg/day.
Partner also took CoQ10 and Vitamin D.
I also got a positive Receptiva (1.6) after Round 3 that we are hoping to address with a lap next week.