Mini IVF for Poor Responder

hi ladies,

I just switch from Prof Wong to Dr Roland Chieng. After going through our STIM regimen at NUH, he conclude I belong to Poor Responder category after 3 round of IVF(2 fresh transfer cycle, with no frozen embryos, 2nd Round was cancel as 2 eggs are not mature. 2 x D3 embryos for transfer )

My biggest challenge is border low AMH though my FSH is pretty good. (0.644ng/ml or 4.6 pmol, fsh 3.3 iu/l)

Though he is confident of our case(me at 37 with 1 chemical pregnancy recorded in last round) but I like to know what are the alternate recommended protocol for poor responders? He will put me on mini/mild IVF for round 4 & he also manage my expectation that it’s a longer journey for me because it’s going to be quality over quantity. Despite max dosage & injection, I only manage to get 2-3 eggs for each cycles..

He is very confident of getting 2 blastocyst with lesser medication using Virtus. He also suggest embryos banking but play by ear.. we will be meeting him next Sat for 2nd round of review....

While I’m mentally prepared for the long haul, but hope to hear some encouraging stories..
 


Hi,hellokittygirl. I am also under mini/mild ivf. My fsh is very high. I don't test AMH. But from ultrasound, i am low reserve. During ivf stimulation, i only eat medicine. No injection. I am wondering if there is other choice for mini/mild ivf. How's your consultation with dr roland?
 
Hi,hellokittygirl. I am also under mini/mild ivf. My fsh is very high. I don't test AMH. But from ultrasound, i am low reserve. During ivf stimulation, i only eat medicine. No injection. I am wondering if there is other choice for mini/mild ivf. How's your consultation with dr roland?
Hi dear

I will be starting my 4th round with Dr Roland in Jan.. he want me to take a longer break, enjoy my holiday after my last chemical pregnancy.. so I can’t provide any new advice now.. his only comment from our 1st consultation is I’m poor responder, my ovaries doesn’t produce a lot of eggs despite high dosage so he will keep to the same med(Gonal F, Menopur) but lower amt or lesser injection.. maybe he will have new med for me, I’m not sure but was told he do wonders on STIM regimen.

he said he will be able to retrieve the same number of eggs but he is aiming for higher quality.. he also advise me to do embryos banking which I believe make sense now since my intent is to have more eggs and blastocysts for frozen transfer..

I did my own research & realize mild/mini IVF works very very well for low AHM & poor responders.. but there are also 2 types, one is mild IVF, one is natural IVF which doesn’t involve injection except trigger shots but patient is on oral med. it’s really relying on body natural ovulation to retrieve the egg which is supposedly to be the best. so guess you are on natural protocol?

If u don’t mind me asking, Is this your first time doing IVF? Due to the high cost, doc & patients prefer to proceed with the standard IVF for the first time. It’s also kinda trial & error to find out what is the best for individual patients .. your ultrasound scan doesn’t show a lot of follicles so that’s why your Dr want u to do mild IVF?

I wish you all the best & hope to hear good news from you!
 
I have done two round of ivf in SGH. First round get two eggs and both are fertilised. Second round got two eggs also but both are not fertilised. No ET yet. Have 2 freeze embyo from first round IVF. Maybe will transfer the embyo in November. I am thinking what i should do if i fail the FET.

I only on oral medicine(clomid) except the trigger shot. It should be natual IVF. From the untrasound, i only have three follicles. Due to my age and high fsh and low reserve, dr say strong stim may not works. So she only ask me take medicine for minimum stim.
 
I have done two round of ivf in SGH. First round get two eggs and both are fertilised. Second round got two eggs also but both are not fertilised. No ET yet. Have 2 freeze embyo from first round IVF. Maybe will transfer the embyo in November. I am thinking what i should do if i fail the FET.

I only on oral medicine(clomid) except the trigger shot. It should be natual IVF. From the untrasound, i only have three follicles. Due to my age and high fsh and low reserve, dr say strong stim may not works. So she only ask me take medicine for minimum stim.
 
I have done two round of ivf in SGH. First round get two eggs and both are fertilised. Second round got two eggs also but both are not fertilised. No ET yet. Have 2 freeze embyo from first round IVF. Maybe will transfer the embyo in November. I am thinking what i should do if i fail the FET.

I only on oral medicine(clomid) except the trigger shot. It should be natual IVF. From the untrasound, i only have three follicles. Due to my age and high fsh and low reserve, dr say strong stim may not works. So she only ask me take medicine for minimum stim.
Hey dear, not sure why my reply is missing.

Anyway, I also guess as much that you are on clomid. I use this for my IUI as well, though I didn’t succeed but many ladies do so trust your Dr on his treatment..

Don’t worry so much abt follicle count.. for any IVF cycle, it’s definitely quality over quantity, but of course having both would be best.. :)

To share with you an encouraging story, my colleague SIL see Dr THH for IVF(for 2nd one) just less than 3 mths before she turn 40. Dr immediately schedule her as she want to use her grant, so she starting STIM 2 weeks later, did 5 days injection, 1 follicle, 1 egg retrieve & fertilize.. and she is pregnant now. Because it’s only 1 follicle, 1 egg, the whole family didn’t believe it will work, including her.. so u see, we just need 1 golden egg.. for you, u have 3 now, so stay postive! :)

For me, my follicle count range from potential 6-9(min 18mm during trigger) but in the end, ended with 3-4 eggs retrieved.. I’m not sure my dropout is so much though.. my new Dr say the general stats should be 80% but in my case, it’s 50%.

So long we don’t give up, we will find that golden egg!
 
Hey dear, not sure why my reply is missing.

Anyway, I also guess as much that you are on clomid. I use this for my IUI as well, though I didn’t succeed but many ladies do so trust your Dr on his treatment..

Don’t worry so much abt follicle count.. for any IVF cycle, it’s definitely quality over quantity, but of course having both would be best.. :)

To share with you an encouraging story, my colleague SIL see Dr THH for IVF(for 2nd one) just less than 3 mths before she turn 40. Dr immediately schedule her as she want to use her grant, so she starting STIM 2 weeks later, did 5 days injection, 1 follicle, 1 egg retrieve & fertilize.. and she is pregnant now. Because it’s only 1 follicle, 1 egg, the whole family didn’t believe it will work, including her.. so u see, we just need 1 golden egg.. for you, u have 3 now, so stay postive! :)

For me, my follicle count range from potential 6-9(min 18mm during trigger) but in the end, ended with 3-4 eggs retrieved.. I’m not sure my dropout is so much though.. my new Dr say the general stats should be 80% but in my case, it’s 50%.

So long we don’t give up, we will find that golden egg!
Thanks for your encouragement! Yes. We should be optimistic and think positively. ☺
 
Clomid will make lining thin. I think that's one reason for failed iui.
For me, my lining had always been in the acceptance range, either 8mm or 9mm so likely not the reason for IUI failure in my case.. probably more so for those ladies who face thin lining.. But IUI chances are not very high to begin with, maybe 20%, so we didn’t pin hope on IUI. We wanted to do IVF immediately but Prof Wong insist we must complete 3 IUI first so no choice, need to listen to him..

For me, under clomid IUI, I only have 1 single follicle, so also not sure if there is egg or not.. but for u with only clomid, u can have 3 follicles which to me is very good result.. ur chances are already better!
 
For me, my lining had always been in the acceptance range, either 8mm or 9mm so likely not the reason for IUI failure in my case.. probably more so for those ladies who face thin lining.. But IUI chances are not very high to begin with, maybe 20%, so we didn’t pin hope on IUI. We wanted to do IVF immediately but Prof Wong insist we must complete 3 IUI first so no choice, need to listen to him..

For me, under clomid IUI, I only have 1 single follicle, so also not sure if there is egg or not.. but for u with only clomid, u can have 3 follicles which to me is very good result.. ur chances are already better!
My Dr also say it is very good result that i can got two eggs for each ivf cycle with clomid only. My fsh is high. Worry about the egg quality. Maybe that's why the two eggs are not fertilised in the second round. Does dr roland recommend any supplement to improve egg quality? My dr said nothing can help.
 
My Dr also say it is very good result that i can got two eggs for each ivf cycle with clomid only. My fsh is high. Worry about the egg quality. Maybe that's why the two eggs are not fertilised in the second round. Does dr roland recommend any supplement to improve egg quality? My dr said nothing can help.

Do you know the size of the follicles?
I asked Dr for any supplement, he just gave me folic acid and aspirin.
 
I have done two round of ivf in SGH. First round get two eggs and both are fertilised. Second round got two eggs also but both are not fertilised. No ET yet. Have 2 freeze embyo from first round IVF. Maybe will transfer the embyo in November. I am thinking what i should do if i fail the FET.

I only on oral medicine(clomid) except the trigger shot. It should be natual IVF. From the untrasound, i only have three follicles. Due to my age and high fsh and low reserve, dr say strong stim may not works. So she only ask me take medicine for minimum stim.
How many days are your frozen embryos?
 
I'm a poor responder, with AMH 14.4.
First ivf got cancelled as there's only 3 follicles after a week of stim.
Second ivf almost got cancelled but I decided to push ahead. Towards e end of 2 weeks stims several more follicles appear.
My other challenge was one of my ovaries was too high. So 3 follicles could not be retrieved during ET.
Eventually 4 follicles retrieved from e lower ovary. 4 mature eggs. 2 fertilised. Transferred 2 D3 embryos.
I'm now 8 weeks pregnant, still cautious abt how the pregnancy will go but nonetheless delighted tat I made it to another milestone.
Hope all poor responders don't give up! Look for the doctor that can support you in your journey.
 
I'm a poor responder, with AMH 14.4.
First ivf got cancelled as there's only 3 follicles after a week of stim.
Second ivf almost got cancelled but I decided to push ahead. Towards e end of 2 weeks stims several more follicles appear.
My other challenge was one of my ovaries was too high. So 3 follicles could not be retrieved during ET.
Eventually 4 follicles retrieved from e lower ovary. 4 mature eggs. 2 fertilised. Transferred 2 D3 embryos.
I'm now 8 weeks pregnant, still cautious abt how the pregnancy will go but nonetheless delighted tat I made it to another milestone.
Hope all poor responders don't give up! Look for the doctor that can support you in your journey.
Did the dr propose using natural IVF? What protocol were u using and the dosage?
 
I'm not sure what type of ivf.
These were the jabs i took

Stim day 1 - 5
gonal F 300 + Menopur 75

day 6 - 7
gonal F 300 + Menopur 75 + Centrotide

day 8 - 11
gonal F 300 + Menopur 150 + Centrotide

day 12
Menopur 150 + Centrotide + Suprefact Trigger shot

Throughout the whole stim period, my lining was 10. My last blood test was on day 9, showing my E2 level was 4500ish, which is quite strange because i only had 7 follicles. I think tats why i was triggered with Suprefact instead of Ovidrel.

Clearly my body reacted out of norm to the drugs. My doc says 450 (300 gonal f + 150 menopur) is max dose and he cannot go higher. Yet I only yield 7 follicles, despite my high AMH.

So don't give up even if you have few follicles yah!
 
I'm not sure what type of ivf.
These were the jabs i took

Stim day 1 - 5
gonal F 300 + Menopur 75

day 6 - 7
gonal F 300 + Menopur 75 + Centrotide

day 8 - 11
gonal F 300 + Menopur 150 + Centrotide

day 12
Menopur 150 + Centrotide + Suprefact Trigger shot

Throughout the whole stim period, my lining was 10. My last blood test was on day 9, showing my E2 level was 4500ish, which is quite strange because i only had 7 follicles. I think tats why i was triggered with Suprefact instead of Ovidrel.

Clearly my body reacted out of norm to the drugs. My doc says 450 (300 gonal f + 150 menopur) is max dose and he cannot go higher. Yet I only yield 7 follicles, despite my high AMH.

So don't give up even if you have few follicles yah!

May I the size of your follicles?
 
Dont give up hope. Some follicles undergo a sudden growth spurt towards the end of your stim. Late bloomers.

What is your drug dosage?
 
Dont give up hope. Some follicles undergo a sudden growth spurt towards the end of your stim. Late bloomers.

What is your drug dosage?

Looking at your drug dosage, you do responded well
I was given BCP for 21 days
Day 2 Baseline scan shows 4 Antral follicles on the left and right ovaries.
I was given Injection Start Gonal-F 300 IU + Pergoveris 150IU for 6 days.
on 7 day scan , only 2 follicles (3mm, 4mm) on the left.
so it was abandon.

This month it is worse. Day 2 scan only see 1 antra follicles and 2 nos of 2cm fibroids.
The Dr will be doing Mild IVF.
I was only given clomid for 5 days.
 
Looking at your drug dosage, you do responded well
I was given BCP for 21 days
Day 2 Baseline scan shows 4 Antral follicles on the left and right ovaries.
I was given Injection Start Gonal-F 300 IU + Pergoveris 150IU for 6 days.
on 7 day scan , only 2 follicles (3mm, 4mm) on the left.
so it was abandon.

This month it is worse. Day 2 scan only see 1 antra follicles and 2 nos of 2cm fibroids.
The Dr will be doing Mild IVF.
I was only given clomid for 5 days.


Before my first cycle, I was on 11 days of BCP. Then day 2 started stim. Cancelled after a week due to poor response.
Second cycle I was not given BCP. Just started stim straight away on CD2. I feel e BCP suppressed my body n lowered e antral count.
 
I'm a poor responder, with AMH 14.4.
First ivf got cancelled as there's only 3 follicles after a week of stim.
Second ivf almost got cancelled but I decided to push ahead. Towards e end of 2 weeks stims several more follicles appear.
My other challenge was one of my ovaries was too high. So 3 follicles could not be retrieved during ET.
Eventually 4 follicles retrieved from e lower ovary. 4 mature eggs. 2 fertilised. Transferred 2 D3 embryos.
I'm now 8 weeks pregnant, still cautious abt how the pregnancy will go but nonetheless delighted tat I made it to another milestone.
Hope all poor responders don't give up! Look for the doctor that can support you in your journey.

Do you know the size of your 3 follicles during your first IVF? mine was cancelled because my 2 follicles very small on Day 7 (3,4mm)
Why your second IVF almost got cancel?
 
Do you know the size of your 3 follicles during your first IVF? mine was cancelled because my 2 follicles very small on Day 7 (3,4mm)
Why your second IVF almost got cancel?

Between 6-8mm.
Almost cancelled bcos small yield. Doc believes that with my AMH 14.4, I am able to produce more follicles so he doesn't want us to waste the money for this round.
But I went to read research papers and 25% of women end up responding poorly despite having normal AMH.
 
Between 6-8mm.
Almost cancelled bcos small yield. Doc believes that with my AMH 14.4, I am able to produce more follicles so he doesn't want us to waste the money for this round.
But I went to read research papers and 25% of women end up responding poorly despite having normal AMH.

May I know your age and which Dr you are seeing?
 
Did you see any tcm or take any supplements?

Yes I did. N also ate these. I'm not sure how much of these helped in conception but took them anyway.

Like many other ivf-ers, i followed a strict diet during D1 of cycle. I was also on acupuncture and TCM powder concurrently.

Just sharing what I did in addition to the stim jabs/post retrieval jabs and progestrone suppositories:

During stim:
daily 6 egg white, 2 portion of fish (like threadfin, salmon, cod fish), 1 avocado
alternate days red bean soup
wore socks to sleep
5 acupuncture session
2 pkts of TCM powder daily

the day before transfer:
1 acupuncture session

transfer day:
1 acupuncture session after transfer

post transfer to week 7 pregnancy:
alternate days Chicken Essence and Red Date Longan Water
wore socks to sleep
2 pkts of TCM powder daily

From week 7, I started having nausea n had a lot of problem getting food into my system. I was not puking, but u had this bad taste in my mouth n I just couldn't eat. Once I feel better I intend to go back to my tcm n get supplements.

After bfp, prof continued to see me n will discharge me to gynae after first trimester. I really appreciate all the support he gave me (and all ivf moms under his care). I believe the progesterone and estrogen support is very important in helping us keep our baby until the placenta forms.

I'm happy to chat more with you if you like. U can pm me your number.
 
Yes I did. N also ate these. I'm not sure how much of these helped in conception but took them anyway.

Like many other ivf-ers, i followed a strict diet during D1 of cycle. I was also on acupuncture and TCM powder concurrently.

Just sharing what I did in addition to the stim jabs/post retrieval jabs and progestrone suppositories:

During stim:
daily 6 egg white, 2 portion of fish (like threadfin, salmon, cod fish), 1 avocado
alternate days red bean soup
wore socks to sleep
5 acupuncture session
2 pkts of TCM powder daily

the day before transfer:
1 acupuncture session

transfer day:
1 acupuncture session after transfer

post transfer to week 7 pregnancy:
alternate days Chicken Essence and Red Date Longan Water
wore socks to sleep
2 pkts of TCM powder daily

From week 7, I started having nausea n had a lot of problem getting food into my system. I was not puking, but u had this bad taste in my mouth n I just couldn't eat. Once I feel better I intend to go back to my tcm n get supplements.

After bfp, prof continued to see me n will discharge me to gynae after first trimester. I really appreciate all the support he gave me (and all ivf moms under his care). I believe the progesterone and estrogen support is very important in helping us keep our baby until the placenta forms.

I'm happy to chat more with you if you like. U can pm me your number.
Do you know will follicles still grow after trigger shot?
My left is 15mm and right is 18mm.
Trigger shot tonight at 9pm.
I intend to go accupunture later to help the left one.
 
Do you know will follicles still grow after trigger shot?
My left is 15mm and right is 18mm.
Trigger shot tonight at 9pm.
I intend to go accupunture later to help the left one.

They didn't measure the follicles during ER, or maybe they did, but they already knock me out haha... so I don't know the sizes.

Oh yes, and after ER, they gave me a Ovidrel shot. Maybe because my trigger was lupron.

All the best for your ER and ET. Focus on positive energy and happy thoughts. I got my husband to put on socks for me immediately after I came out of theater both times after ER and ET. During implantation period, don't move too much if possible. Self care is most important in your 2ww.
 
They didn't measure the follicles during ER, or maybe they did, but they already knock me out haha... so I don't know the sizes.

Oh yes, and after ER, they gave me a Ovidrel shot. Maybe because my trigger was lupron.

All the best for your ER and ET. Focus on positive energy and happy thoughts. I got my husband to put on socks for me immediately after I came out of theater both times after ER and ET. During implantation period, don't move too much if possible. Self care is most important in your 2ww.

Hi
Before the Dr order the trigger shot, does your Dr do blood test for you to see any surging of LH? If the LH is not surging still can allow the follicles to grow one more day?

Not transferring the egg, will freeze and store.
 
Hi
Before the Dr order the trigger shot, does your Dr do blood test for you to see any surging of LH? If the LH is not surging still can allow the follicles to grow one more day?

Not transferring the egg, will freeze and store.

No. In fact my last bloodtest was done on day 9.
Why does your doctor suggest freezing? I tot ohss risk then will freeze?
Due to only 2 fertilised embryos in my case, we went ahead to transfer on day 3. Scared they cannot make it to blast stage outside so better just transfer, at least got chance to let my body nurture the embryo.
 
No. In fact my last bloodtest was done on day 9.
Why does your doctor suggest freezing? I tot ohss risk then will freeze?
Due to only 2 fertilised embryos in my case, we went ahead to transfer on day 3. Scared they cannot make it to blast stage outside so better just transfer, at least got chance to let my body nurture the embryo.

Hi
sorry for the late reply.
There are 2 schools of thoughts. Some Drs feel that embryos grow better in the uterus environment.
my Dr and the fertility centre believes that embryo that can make it to blastocyst is the fittest.
Also I am collecting as many embryos as possible as time is not on my side.
Also my lining is too thin for embryo to implant.

Also now the statistic shows that blastocyst and FET has higher success rate.
First is due to the fast freezing technique and also the embryo is transferred to when the uterus is at the right condition.
 
Hi
sorry for the late reply.
There are 2 schools of thoughts. Some Drs feel that embryos grow better in the uterus environment.
my Dr and the fertility centre believes that embryo that can make it to blastocyst is the fittest.
Also I am collecting as many embryos as possible as time is not on my side.
Also my lining is too thin for embryo to implant.

Also now the statistic shows that blastocyst and FET has higher success rate.
First is due to the fast freezing technique and also the embryo is transferred to when the uterus is at the right condition.

All the best :) trust your doctor and trust your body! Jiayou.
 
Hi, I do hope this chat is still active? I have high fsh of 12.5 and also low antral follicle count of 2. Anyone else planned for ivf with only clomid? Are there any success so far?
 
Hi, I do hope this chat is still active? I have high fsh of 12.5 and also low antral follicle count of 2. Anyone else planned for ivf with only clomid? Are there any success so far?
Hi

I have DOR too. doing clomid cycle with trigger shots and have 1 day 6 blastocyst
 
Hi, DKCH. That's very good to have d6 blast. Are you in your tww or already bfp? How many cycles did you have to go through before embryo transfer? My doc suggest to do like 3 cycles to accumulate embryos before transfer.
 
Hi ladies, just receive the Day 5 update, I have 2 Day5 blastocysts which I still can’t believe..

Though we still have the final stage to clear but at least for sure, I see a huge improvement on mini IVF protocol. And this is only my 1st cycle, I really didn’t expect this result..

Dr Roland suggested embryos banking to me which I agree & he would do the ET once I have 2 blasts, but after discussing with Hub, we will do another round(or 2) of egg collection to store my embryos.. afterall age matters.

So while I’m celebrating my small “win” for now, I’m already gearing up for April round!

Wishing all baby dusts.
 
Hi ladies, just receive the Day 5 update, I have 2 Day5 blastocysts which I still can’t believe..

Though we still have the final stage to clear but at least for sure, I see a huge improvement on mini IVF protocol. And this is only my 1st cycle, I really didn’t expect this result..

Dr Roland suggested embryos banking to me which I agree & he would do the ET once I have 2 blasts, but after discussing with Hub, we will do another round(or 2) of egg collection to store my embryos.. afterall age matters.

So while I’m celebrating my small “win” for now, I’m already gearing up for April round!

Wishing all baby dusts.
Congratulations ! Do you know your grade of your blastocysts?
 
hi ladies,

I just switch from Prof Wong to Dr Roland Chieng. After going through our STIM regimen at NUH, he conclude I belong to Poor Responder category after 3 round of IVF(2 fresh transfer cycle, with no frozen embryos, 2nd Round was cancel as 2 eggs are not mature. 2 x D3 embryos for transfer )

My biggest challenge is border low AMH though my FSH is pretty good. (0.644ng/ml or 4.6 pmol, fsh 3.3 iu/l)

Though he is confident of our case(me at 37 with 1 chemical pregnancy recorded in last round) but I like to know what are the alternate recommended protocol for poor responders? He will put me on mini/mild IVF for round 4 & he also manage my expectation that it’s a longer journey for me because it’s going to be quality over quantity. Despite max dosage & injection, I only manage to get 2-3 eggs for each cycles..

He is very confident of getting 2 blastocyst with lesser medication using Virtus. He also suggest embryos banking but play by ear.. we will be meeting him next Sat for 2nd round of review....

While I’m mentally prepared for the long haul, but hope to hear some encouraging stories..
How much Cetrotide did your dr gbe you?
 

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