Last updated: October 7, 2007
You can write to me at my email address.
This success story is from one of the ladies on the "Women over 40 with high FSH" message board. Her screen name is "Kiwichick". Kiwichick is just over 42 years old (in 2007) and her husband is 45. They have a daughter who is nearly three years old who was conceived after Kiwichick's high FSH diagnosis (FSH of 19.6) via Clomid and IUI. Their daughter is a success story also, but this summary will focus on Kiwichick's second journey to conception - ("TTC#2") - which took just over two years. Kiwichick's day 3 FSH readings while TTC#2 ranged from a low of 8.1 (with estrogen suppression) to a high of 18.8. Kiwichick did two failed IUI's using Clomid before moving on to IVF.
Kiwichick's baseline follicle count each cycle (i.e., her "antral follicles") were generally three to four. Normal ovulation was on the 14th or 15th day for natural cycles, and her retrievals in IVF cycles were generally on the 14th or 15th day also.
The first IVF was an MDF (micro-dose flare) protocol and was cancelled due to no response in July 2005. The second IVF in November 2005 included an antagonist and 450 Gonal F. It was unsuccessful but yielded 4 follicles, 2 eggs and 2 embryos. The third IVF in May 2006 resulted in a chemical pregnancy and included an antagonist, 450 Gonal F and 75 Luveris. It yielded 6 follicles, 6 eggs, 4 embryos (three of which were transferred). The fourth IVF in August 2006 was unsuccessful and included an antagonist, 450 Gonal F and 75 Luveris. It yielded 6 follicles, 3 eggs and 3 embryos. The fifth IVF in November 2006 was cancelled due to producing only one follicle. This cycle included an antagonist, 450 Gonal F and 75 Luveris. Along the way, up to this point, Kiwichick had also had three chemical pregnancies occurring in natural cycles between IVF cycles. In February of 2007, Kiwichick got pregnant naturally but unfortunately miscarried at seven weeks.
Kiwichick had been doing lots of research during this process and had discovered that many women over 40 were having success with low stim protocols. She had phone consults with both Dr. Check and Dr. Zhang (Cooper Institute and New Hope Fertility, respectively) and fortunately her local RE was open-minded enough to incorporate some of their techniques in developing a low stim protocol for her.
Her sixth IVF in April 2007 utilized a low stim protocol (antagonist, 150 Gonal F, 75 Luveris) and was unsuccessful but resulted in two follicles, two eggs and one embryo. Her seventh IVF in May 2007 was also low stim (details follow) and resulted in four follicles, four eggs and four embryos. All four embryos were transferred and Kiwichick is now pregnant with twin girls (due in March 2008).
As an interesting aside, in the IVF's prior to number six, the resulting embryos had been a mix of grade "3" and grade "4" (grade "5" is the best/highest grade in her lab). The embryos resulting from cycles six and seven were a mix of grade 4 and 5. So, there seemed to be a quality improvement for Kiwichick when moving from medium/high stim to low stim.
Kiwichick's protocol incorporated mild estrogen suppression (using estradiol valerate, which is the same as Estrace, 2mg from two days after ovulation until the start of the next cycle) and then a combination of Gonal F, Luveris and Dexamethasone. Kiwichick's FSH on day 2 of her successful cycle was 8.1, her E2 was under 40 and her LH was 3.5. From Day 2, she started with 225 Gonal F, 75 Luveris and 1mg Dexamethasone. On Day 4, she dropped to 150 Gonal F, 75 Luveris and 1mg Dexamethasone. On Day 6, she had her first ultrasound and bloodwork, which then occurred every 2-3 days after day 6. When the lead follicle was at least 14mm, she started Cetrotide and added an extra 75 of Gonal F. A double trigger shot was used and retrieval was done 36 hours later. Kiwichick had decided to proceed to egg retrieval if she had two or more mature follicles and an E2 of greater than 400. Turns out that she had four follicles and an E2 of 493 on the day before the trigger. ICSI and assisted hatching were utilized with fresh sperm. A day 3 transfer was done and acupuncture was done 20 minutes before and after transfer. Her post-transfer protocol for the first ten weeks of pregnancy was 2cc Gestone (PIO), 200mg P4, 2mg E2V and 1mg Dexamethasone.
Kiwichick has been a big believer in combining TCM with traditional treatment. She was taking various supplements including multivitamins/multiminerals, Vitamin C 1000mg, Vitamin E 200mg w/ Selenium, Fish Oil 3g, CoQ10 100mg, Zinc 15mg, Folic acid 5mg, Aspirin 100mg (after retrieval only), and DHEA 25mg (stopped before stims for her successful cycle). For the last two years of TTC#2, Kiwichick took Chinese herbs prescribed by her acupuncturist and she did acupuncture on day 1 or 2 of the cycle if possible, then once or twice each week before ovulation, on ovulation day if possible and once a week after ovulation.
I am providing the details of Kiwichick's journey (with her permission) to give you an idea of how one couple experienced many setbacks on the road to success and to give you an idea of how one person responded to different protocols. There are no guarantees in this process and what works for one person may not work for another, but the key point is to keep trying and to find an RE who is willing to try various options with you.
Note that I don't have any further details on Kiwichick's story, so if you have questions, I won't be able to answer them.
Last updated: October 7, 2007
You can write to me at my email address.