February 21, 2009
I am 33 with thin PCOS and a LH/FSH ration of 3:1, non IR. After having a miscarrage with twins at 7 weeks, I became resistent to femara and was moved to the injectable menopur. My RE has a very conservative appoarch to injectables and does not want me to have more than 2 follicles. My first round of menopur, 75iu for 10 days, resulted in 1 follicle and a chemical pregnancy. I am currently on day 8 of my second round of menopur with 150iu for cd 3-4 and 75iu cd 5-10. My day 6 E2 was 32 (half of what it was on day 6 of last cycle). My RE will not increase my meds at this point as he says it is too late in the game to change the outcome of the follicle growth and quailty of the egg can be comprimised by stimming too long. If I don't have much going on on my next scan, he will cancel this cycle as he says that ovulation past day 17 is unlikely to yeild a good egg and has lower implantation rates. My fear is that I need a more aggressive appoarch to get my ovaries working and my RE is against using a pure FSH drug with me. Is this a standard appoarch to injectables?
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February 21, 2009
I can't answer if this is a "standard" but maybe one of the doctors can. I can however tell you that many doctors and facilities use various protocols with their patients. It is not uncommon for a doctor to want to be conservative to keep the number of possible multiples down. I can also share with you my own experiences. I have done several cycles using follistim and RE always started me off with 75IU. I'm pretty sure there were a few days were I had to cut the meds down in 1/2 during that cycles to let the follies mature a bit slower and let the small ones go away. When using follistim I always had around 5-8 mature follicles. When I moved to IVF I did use menopur with follisitm at a much higher dose but that is what is done for IVF. I also did one mini cycle where RE didn't want too much going on in there b/c I was going to have a LAP so I took clomid and one injection of follistim and did get only two follicles. We all respond to the meds differently and again, REs use different plans or protocols for their patients. If you really aren't happy with your plan and your doc doesn't want to change things you should consider switching. Make sure you discuss all details because your doc may have very good reasons for keeping you on that plan other than just being conservative. Lots of luck!!!