Friday, May 15, 2009

to Estrogen Priming Protocol

This purpose of this blog is to pull together information on a form of IVF: Estrogen Priming Protocol. In my questioning Dr. Google for details about this protocol, details were few and far between, but I found them bit by bit. Hopefully the research on my own behalf will help out some more of you struggling with infertility., particularly my fellow poor-responders.

What is the Estrogen Priming Protocol (EPP)?
Like BCPs in longer IVF protocols, estrogen is used in EPP to down-regulate FSH receptors. By providing external estrogen, the hope is that the pituitary gland will think a follicle is developing (follicles product estrogen) and will thereby reduce the amount of FSH (Follicle Stimulating Hormone) it pumps out. This "break" in follicular development give the ovaries a little time off at the spa, and allows the RE (Reproductive Endocrinologist, aka puppetmaster) to take control of the woman's cycle. In addition, it will promote estrogen dominance in the follicular fluid, which is believed will help protect the developing eggs.

Estrogen is given in the cycle before the actual IVF stim cycle - varying from all cycle long or just the week before, depending on your clinic's preference and your own personal situation.

Why EPP?
EPP is an aggressive form of an IVF Antagonist Protocol. It is used for low/poor responders -- often women with high FSH and/or over 35 years of age. It's a sort of "slow burn" methodology — the hope being that they slow you way down and protect egg quality while allowing you to stim longer. In addition, the slower stimming allows the hope that all active follies can catch up to each other, allowing for as many mature eggs at retrieval as possible. This would be an appropriate protocol to consider if you have a low antral follicle count, and not for anyone who responds well to fertility medications or is at risk for OHSS (Ovarian Hyper Stimulation Syndrome). If EPP were a nation and they needed a motto for their coinage, it would very likely be: Quality over Quantity – In RE speramus.