What is an Estrogen Primed with Antagonist Cycle?

I just gave my self my first shot for this IVF.  And, boy has the meaning of shots to me changed a lot since I was in college!

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I just want to reiterate that I am not a doctor so this is in NO WAY medical advice.  But, if you have similar issues to me, this may be information that would be helpful to consider when speaking with your doctor.

I am doing an Estrogen Primed with Antagonist Cycle.  So I put on my estrogen patch yesterday evening and I took my first shot of Ganirelix this morning.  A more detailed post with the drugs used in my Estrogen Priming Protocol is here.

This is a protocol doctors use for people who have a poor response to fertility medications because typical BCP or Lupron cycles may suppress the ovaries. An antagonist like Ganerelix and estrogen are used during the pre-treatment cycle.  Using an antagonist like Ganerelix during the pre-treatment cycle prevents premature recruitment of follicles that can reduce the number of follicles available for stimulation.  And estrogen is used to provide optimal conditions to help the young follicles to grow.

I have read that studies show that this protocol allows more slow and even growth of follicles resulting in improvement of embryo quantity and quality. Although, your doctor may not want to use this protocol because there is less control over the cycle planning as stimming can start on any day.  Luckily, my doctor is cool with this type of cycle.

I am a good candidate for estrogen priming because my FSH fluctuates but is always quite high. I've never had an FSH reading below 9 and my high FSH level was 28.5. 

My AMH is also super low.  I've only had my AMH tested two times.  The first time it was .2 and the next time it was .37.  These numbers are very bad and generally are indicative of low ovarian reserve. 

My antral follicle count, however, does not match these low numbers.  Whenever doctors look at my ovaries early in my cycle they say that they look good and that there are a substantial number of follicles in each ovary. This is a clue that something else is going on besides low ovarian reserve and early menopause and points to what we know now to be a fact.  That I have immune issues that need to be treated to have a healthy pregnancy.

Still, I am a good candidate for an E2 Prime protocol because generally I do not respond well to follicle stimulating hormones.  Way back in 2012, I started my journey by doing medicated IUIs.  On 150 units of Gonal F, I only made 2 eggs.  On 250 units of Gonal F, I still only made 2 eggs.  This is a poor response indeed.

Finally, I am already an estrogen prime success.  For my 2 and only IVFs, I did an estrogen prime with antagonist protocol with 450 gonal f and 150 menopur, and I made 6 eggs the first time and 12 eggs the second time.  The first cycle was a bust because we didn't, but we should have, used ICSI.  And the second cycle with ICSI, I made 3-4 genetically normal good looking 5 day blasts.  I believe this is a real success if you consider my dismal hormone readings.  I am not going to be talking much about the fertility clinic where I did my first IVF because I had such a horrific experience there.  But, I do have to give them credit for choosing this protocol for me. 

All right, let's do this!

XO,

Natalie