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Thread: Endometriosis - Low Response To Stimulation

  1. #1
    Join Date
    Apr 2009
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    6

    Default Endometriosis - Low Response To Stimulation

    I have been impressed tremendously by the way you respond to each and every query of ours. Let me first of all express my gratitude for the guidance you give. It is really very precious for us, who are still in the phase of trying hard for starting a family.

    I am 31 years old suffering from Stage IV Endometriosis with persistent Chocolate cysts on both the ovaries, adhesions all around the uterus and tubes blocked. I have gone through 3 cycles of ICSI, 2 with my own eggs and one with donor eggs but all failed.

    During the first cycle, we could only get 2 eggs, out of which 1 had fertilized into a good quality embryo through ICSI and in the second cycle, we could only get 3 eggs and inturn 2 embryos. My RE identifies my case as “ low response to stimulation” and “reduced egg quality”. Hence we went for donor eggs during the third cycle and transferred 3 good quality embryos, which was again a failure.

    I also have a history of tuberculosis due to which the test for IgM antibodies come +ve, where as the PCR Test through TMA method of the menstrual blood had come –ve. With this, can I assume that TB would not effect my fertility?

    We are now planning to go in for an other cycle and request you to kindly guide regarding the tests I will have to undergo and the protocol which I can use for increased response to stimulation and for better egg quality( if in case this is where the problem is).

    Thanks once again..

  2. #2
    Join Date
    Oct 2008
    Posts
    387

    Default

    My pleasure. Sorry for the late post. Please see below:

    I have gone through 3 cycles of ICSI, 2 with my own eggs and one with donor eggs but all failed.

    A: I would need records to see what is happening as this is unusual.

    During the first cycle, we could only get 2 eggs, out of which 1 had fertilized into a good quality embryo through ICSI and in the second cycle, we could only get 3 eggs and inturn 2 embryos. My RE identifies my case as “ low response to stimulation” and “reduced egg quality”. Hence we went for donor eggs during the third cycle and transferred 3 good quality embryos, which was again a failure.


    A: You need to be tested for immune issues associated with severe endometriosis to determine if that is why you failed ED cycle.


    I also have a history of tuberculosis due to which the test for IgM antibodies come +ve, where as the PCR Test through TMA method of the menstrual blood had come –ve. With this, can I assume that TB would not effect my fertility?

    A: You would need to have the uterine cavity inspected carefully for evidence of Tb induces scarring.


    We are now planning to go in for an other cycle and request you to kindly guide regarding the tests I will have to undergo and the protocol which I can use for increased response to stimulation and for better egg quality( if in case this is where the problem is).

    A: I would be happy to review your records and advise accordingly. Might I recommend that you call us at 877-665-BABY and set up a free in-person or telephone consultation with me at SIRM-Dallas.

  3. #3
    Join Date
    Apr 2009
    Posts
    6

    Default

    Thanks a lot for your reply doctor..

    As advised by you, I would like to go in for Immune Testing before I go for an other cycle. Unfortunately, many doctors in India do not believe in Immune Testing and I am finding it difficult to find a doctor here in India for my next cycle.

    I would be greatful if you could share with me, if in case you have some information, about any good infetility doctors in India and about the Labs here which carry out standardised Immune Testing.

    I understand that it is quite silly to ask you about it, but it would be of great help if I could get some info. on this.

  4. #4
    Join Date
    Oct 2008
    Posts
    387

    Default

    If you wanted to proceed with the immune testing, please go to www.millenova.com and download their order form online. The main 2 tests to order are called NK assay test and anti-phospholipid panel. They run approximately $500 and can be drawn at your local 1ary doctor or OB-GYN and the blood sent to Chicago, IL. please note that I have no financial affiliations to this lab. They are one of three reproductive immunology labs that do the appropriate testing. Unfortunately, contracted labs like LabCorp and Quest do not. Feel free to put my name as the requesting physician. I will be happy to recommend an option once results are available (approx 7-10 days). Take care.

  5. #5
    Join Date
    Apr 2009
    Posts
    6

    Default

    Thanks a lot doctor,

    My RE is planning to go for "agonist protocol with oestrogen and progesterone priming". Can you pl. provide your opinion on how it would work for poor responders with endometriosis?

    I have read about the agonist/antagonist conversion protocol with Estrogen priming that you use at SRIM. Is is different from "agonist protocol with oestrogen and progesterone priming"? If yes, what would be the effect?

    Thanking you,

  6. #6
    Join Date
    Oct 2008
    Posts
    387

    Default

    I do not advise progesterone as it has no priming whatsoever.
    “ESTROGEN PRIMING, FSH-DOMINANT PROTOCOL” FOR CONTROLLED OVARIAN HYPERSTIMULATION IN “POOR RESPONDERS”.

    Here is how the “estrogen priming protocol” is implemented. The patient takes the BCP and after a period of 8-20 days, adds Lupron at 5 units daily. A few days later the BCP is stopped while Lupron is continued until the onset of menstruation, at which time Antagon/Cetrotide, 125 micrograms is given and the first of two doses of estradiol valerate (E2V-Delestrogen) is administered…3 days apart. One week after the first E2V injection, the woman switches to daily E2V vaginal suppositories and FSH –gonadotropin (Follistim, Bravelle or Gonal-F) injections. During the first few days, FSH is administered in a high dosage whereupon the dosage is significantly reduced for the remainder of the cycle. Monitoring by ultrasound and blood E2 concentrations begins 7 days after FSH is started and this also marks the time that we first require that the patient presents herself in-person at SIRM). In some cases, rather than switch from Lupron to Antagon/Cetrotide with the onset of menstruation, we continue the Lupron but at a microdose of 2U daily. hCG is given when appropriate follicle development has been achieved at which time, the Antagon/Cetrotide or Lupron is stopped.

    This “estrogen priming, FSH-dominant protocol” usually requires a few more days of FSH injections, than would otherwise be necessary with alternative protocols. However, it appears to be well worth the commitment as it has yielded excellent results in "poor responders” with raised CD3 FSH levels, many of whom had experienced repeated prior IVF failures, had failed to stimulate well with previous regimens, and had produced poor quality eggs/embryos ...or combinations of the above mentioned.

  7. #7
    Join Date
    Apr 2009
    Posts
    108

    Default good RE in India

    Hi "tryinghard",
    Sorry for barging in.
    I am also in India and am looking for a good RE here. I stay in New Delhi. What about you? Is your RE good and would you recommend him/her to me?

    Thanks so much in advance
    Kiran19

  8. #8
    Join Date
    Apr 2009
    Posts
    6

    Default Reply to Kiran99

    Hi Kiran,

    I apologise for replying so late. I had done both my cycles with Dr. Firuza in Mumbai. She is pretty knowledgable but is too busy to discuss the details with you. But you can very well mail your issues to her and she replies prompltly.. Hope this will help you.

  9. #9
    Join Date
    Apr 2009
    Posts
    108

    Default ref your reply

    Hi Tryinghard,

    Thank you for the info. Will communicate with her via email.

    In how many cycles were you successful with the IVF treatment from her?

    Best wishes
    kiran

  10. #10
    Join Date
    Sep 2012
    Posts
    2

    Default same here

    Quote Originally Posted by tryinghard View Post
    Thanks a lot doctor,

    My RE is planning to go for "agonist protocol with oestrogen and progesterone priming". Can you pl. provide your opinion on how it would work for poor responders with endometriosis?

    I have read about the agonist/antagonist conversion protocol with Estrogen priming that you use at SRIM. Is is different from "agonist protocol with oestrogen and progesterone priming"? If yes, what would be the effect?

    Thanking you,
    hi, i am in mumbai too. tried with dr firuza parikh after a failed ivf with another doc post lapro(due to grade 4 endo). now ovarian response is quite poor and thrice the cycle was dropped as follicles failed to grow. now she is suggesting donor eggs. but i guess implantation will still be an issue. where are u doing ur immunologic tests? also let me know if u come across something else that can help us. thanks.

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