Monday, July 1, 2013

Protocol Question

Hello Donor Egg Peoples,

I would like to ask a favor. Would you mind leaving me a comment with your protocol? I am curious about what is typical for other people in the DE IVF world, for fresh and frozen cycles. I am feeling really sad after my failed fresh DE IVF, but want to give my frozen DE IVF followup cycle the best possible chance. So, if you wouldn't mind sharing, I would love your input!

Here is the protocol I was on for the fresh cycle:

Lupron 10 units then 5 units once estrogen starts
Vivelle patches in a dizzying array of on-off designs that have left rectangles of adhesive still on my belly
Estrace 2x per day administered vaginally (hellooooo, pantiliners)
Once day of retrieval has happened, PIO injections in the morning with continued estrogen support
Three days before pregnancy test, 100mg progesterone suppositories
Baby aspirin throughout
Valium day of transfer, 45 minutes to 1 hour before procedure

For a frozen cycle, the patches are replaced with injectable Del Estrogen every three days, everything else stays the same.

Thanks for your help!


  1. Here is the protocol we used:

    Lupron - 10 units/day for 30 days leading up to transfer and then stop.

    Vivelle Patches - Started with one patch changed every other day and worked my way up to four patches at one point before we settled on two being the magic number. Still swapping patches every other day.

    Estrace pills - 2mg every evening starting 2 weeks prior to transfer and continuing there after (still taking them each evening)

    HCG - 5K trigger shot two days prior to donor egg retrieval. 1K shot two days after retrieval, 1K shot day of transfer, 1K shot three days following transfer.

    Medrol - 64mg steroid (4 pills daily) starting the day of egg retrieval. Nastiest tasting med!

    Valium - 5mg day of transfer.

    PIO Injection - started with 1.5ml the day prior to retrieval, continued with 2.0ml (I was slow to respond during my mock cycle) for 2 weeks post transfer. Dropped back to 1.5 ml once pregnancy confirmed.

    Baby aspirin and PreNatal Vitamin Daily.

    My doc also added synthroid for me 2 days prior to transfer. He said my Thyroid wasn't elevated, but it was close so they will keep me on that throughout pregnancy.

    Hope this is helpful! Happy to answer any questions!

    1. Thank you, that is helpful! I forgot about the doxycycline the day of transfer. Interesting that they did HCG shots, I will have to ask about that. And they did PIO as part of your mock cycle? Ours stopped with the lining check. Do they check your progesterone and estrogen levels after the transfer? I only took Medrol once and that was when I had assisted hatching with a fresh cycle of my own (agreed, it's nasty). Interesting, interesting! I am just trying to gather information before my consult, trying to figure out if there is something new we could try because I am so frustrated and need to put my energy into something... :) What clinic do you go to in Colorado? THANK YOU SO MUCH for your help!

  2. Hey Jess! Happy to help in any way!

    They had me do PIO for I think 10 days during my mock cycle just to see how I responded and how my lining looked. I was slow to respond so they kicked it into high gear for our transfer cycle. I have had weekly estrogen & progesterone checks since the transfer.

    We went with Conceptions Reproductive Associates. Their success rates are just as impressive as CCRM's and from everything I've heard from patients who have been to both clinics, CRA rocks the house on awesome patient care in comparison. I love, love, love these people.

    Please let me know if you have any other questions! I can even email you my protocol sheet if you think it would be helpful! :)

    1. Thanks, Lindsey! I agree, it's so important to have the patient care you deserve. Thank you so much for all of your help! I'm hoping you see this, but here's another question: Why did you do a single embryo transfer? Is there a medical reason? I just notice that a lot of people who get pregnant have SETs, and I'm wondering if there's something to it.

    2. The SET was a combination of personal choice and recommendations from our embryologist and RE. When we first met for our DE consult, our RE told us our odds of success with DE IVF were very high 85 -90% and that number did not increase significantly with implanting multiple embryos if we had a good day 5 blast. Neither the DH or I are particularly keen on multiples. We've always wanted one baby at a time if we could help it.

      When we met with our embryologist on the day of the transfer we were both firmly in the SET camp, but I would have been swayed if he strongly recommended two. We had a fully formed day 5 blast that was already hatching so he assured us that our success with this one would be just as good as with two so that's what we did. I have to tell you though, that during the wait before our beta, I drove myself silently insane second guessing the decision and wondering if we should have transferred two instead of one.

  3. Decreased Lupron to 5 units on cycle day 1 (after being on it for about two weeks before getting my period- started it on cycle day 21 of previous cycle). Started one baby aspirin per day on cycle day 1.

    Applied 1 Vivelle patch and changed it every other day, adding one additional patch each time, until I got to 4 patches. Switch those every three days. Still doing that.

    Medrol for five days, once daily, days 15-19. Doxycycline for five days, twice daily, days 15-19.

    Began Crinone (vaginal progesterone), one on day 16, twice a day after that.

    Last Lupron shot on cycle day 17.

    Embryo transfer on cycle day 21. Continuing Vivelle, 4 patches changed every three days, and Crinone twice a day, and baby aspirin once a day.

    Hope this helps! Though honestly, from everything you have written, I think you may have just had bad stinkin' luck.

    1. I would say that your protocol and mine are pretty similar, if you swap out the crinone with the PIO. I am noticing that a lot of people are doing progesterone support 2x/day, and I plan to ask about that. Plus the Medrol, which seems to be a common thread, too. Of course, my sample is two people so this isn't the most scientific of studies. :)But, I do think it's interesting that you are both from totally different clinics and the Medrol is a link that I seem to be missing. I don't know why you would use it for assisted hatching to keep your body from wanting to reject and not use it on someone like me who is a pro at rejecting embryos EVERY SINGLE TIME... I will ask! I'll ask you the same question as Lindsey and if my delay in responding means that it gets lost in the shuffle, I'll write another little post. Why the single embryo transfer? Is that clinic protocol for a blast transfer, or was it a personal choice? Again, I'm noticing a trend with SETs and pregnancies, beyond the two of you! :)

      Agreed. I do have stinking bad luck. There may be nothing to change about this protocol except the timing, but I feel like I have to do some kind of research and change something up because this sort of horrible frustrating disappointment puts me into "How can I fix it" overdrive, even though I know I'm not an RE! It helps keep me sane. Otherwise I'd probably be overwhelmed with tears all the time, instead of just once or twice a day. This too will pass!

    2. My clinic gave me the choice of Crinone or PIO, but Crinone is so much less of a hassle for me. I def think you need to ask about Medrol. I didn't ever take it for regular IVF cycles though, and that involves embryos too... but I switched clinics for DE.

      If this transfer hadn't worked, I would have done a scratch biopsy too. My doctor is a huge fan for past implantation failure cases. I discuss this on my blog about a month ago. I think I link to some studies, but let me know if not.

      As for one embryo or two, my clinic lists these stats: 60% success with SET, and 70% pregnancy rate with two, but a 50% chance of twins. So for a 10% increase in chances of getting pregnant, it brings a half and half chance of twinning. As you know, twins have a higher risk of health complications. So I was pretty adamant about only doing SET if possible. With donor egg the clock is not ticking so I Have years ahead to try for kid #2 if I should decide to.

      I really feel that your bad luck has affected me too. I wanted so much for you to get pregnant and I am rooting for you. It's gotta work next time.