I have had one cancelled IVF cycle with a day 3 FSH of 8.4.  I did the Long protocol with 150mg of Bravelle 2x’s per day.  The first monitoring appt had 5 follies.  By the third, and final appt, three stopped growing and I was only left with 2.  So the cycle was cancelled.

Second cycle we did the flare protcol with 225mg of Bravelle 2x’s per day.  My FSH was 8.5.  First monitoring started with 9 follies, gradually reduced to 5 on retrieval day.  At the actual retrieval only two oocytes were obtained. 

I tried to talk to my doc about DHEA, his response was he didn’t like how the study was managed.  It was a control group instead of a blind study.  Since follicle development isn’t a self reporting thing, I didn’t see why this was a problem.  I also brought up ditching the BCP’s as they made me sick both cycles.  (Til the day I die I will swear they dried out my skin and mucus membranes!  I got nose bleeds and sinus infections to follow both times on BCP)  He said they were necessary, kept me from getting cysts, although I have never had an issue with cysts…  I also brought up antagonist protocol, he didn’t like that either.  He wanted to do the flare again.  I decided I need a new RE.  I started acupuncture on my own, but didn’t bother to tell him…

Is there any hope any of this stuff about DHEA, ditching BCP in a flare protocol or an antagonist protocol can work for me?? 

I really don’t think I am bad off in terms of elevated FSH.  If my ovaries are failing, I’m pretty early on in the process, right??? 

Another issue that may be important is that I have what has most recently been diagnosed as stage 2 endo.  I don’t know if it should really be called that since this was the 4th lap I have had for it since 18.  At 18 my left ovary was bound down to the abdominal wall and covered with so much adhesion material it was severely compressed.  Is this ongoing issue with what my OB calls “aggressive” endo the cause of my FSH problem??

Thank you for your time.

I am sorry that you have been through so many difficulties, but am glad to see that you are proactively trying to seek some answers in the literature. The endometriosis is likely not the direct cause of low response, but rather your surgical history. We know that aggressive or extensive lysis of adhesions, ovarian cystectomy and cautery (burning) can all reduce ovarian or egg reserve. I agree with your RE in that the data regarding DHEA is not strong enough to support its routine use in low response patients. In some cases, patients must consent to all the potential risks of empiric (i.e., it’s just a trial/test) off-label medication before we allow our patients to take supplements such as DHEA. While DHEA is sold over the counter, there are potential risks, including lowering seizure threshold in patients with previous head injury; so it is not entirely benign. Your questions about your protocol are excellent ones. In our practice, we do incorporate the use of antagonists. While the microdose lupron protocol is best supported by the literature for low responders, small studies have shown comparable outcomes with antagonist cycles. As for your reaction to OCs, some REs do forgo the use of OCs in certain patients with low response (recent data suggest that unlike patient with normal response/ovarian reserve, patient with low reserve may not necessarily demonstrate increased follicular response after OC suppression). I suggest you make an appointment with your RE to discuss your concerns. The issue of low response is a very difficult one, and the medical research /literature is far from complete. Sitting down to address each concern may help you and your RE arrive at the best plan for your next protocol. Good luck!