My Estrogen Priming Protocol Cycle #1

Here is the day-by day breakdown of my cycle. It's just my experience, not indicative at all of how any one else might respond.

Sunday 5/24/09 (CD minus 7)
- Bloodwork to confirm I am mid-luteal phase. Confirmed.
- Apply first estrogen patch.

Monday 5/25/09 (CD minus 6)
- Ganirelix shot
- Keep estrogen patch #1 on

Tuesday 5/26/09 (CD minus 5)
- Ganirelix shot
- Keep estrogen patch #1 on

Wednesday 5/27/09 (CD minus 4)
- Ganirelix shot
- Change to a new estrogen patch

Thursday 5/28/09 (CD minus 3)
- Keep estrogen patch #2 on

Friday 5/29/09 (CD minus 2)
- Keep estrogen patch #2 on

Saturday 5/30/09 (CD minus 1)
- Change to a new estrogen patch

Sunday 5/31/09 (CD1)
- Keep estrogen patch #3 on
- 1st day of period, call to schedule baseline u/s and b/w

Monday 6/1/09 (CD2)
- Keep estrogen patch #3 on
- Baseline u/s and b/w. Confirms hormone levels are baseline and gets antral follicle count as a basis for cycle prognosis. In my case, antral follicle count is very poor, but RE decides to proceed.
- Start stimming: Gonal-f 450 (FSH) + Menopur 150

Tuesday 6/2/09 (CD3)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150

Wednesday 6/3/09 (CD4)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150

Thursday 6/4/09 (CD5)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150

Friday 6/5/09 (CD6)
- 1st follicle check u/s and b/w. E2 level 96.4. Right ovary has 2-4 follies<12mm

Saturday 6/6/09 (CD7)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150

Sunday 6/7/09 (CD8)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150

Monday 6/8/09 (CD9)
- 2nd follicle check u/s and b/w. E2 level 137. Right ovary has one 13mm follie, possible one more <12mm.

Tuesday 6/9/09 (CD10)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150
- Add in ganirelix antagonist shot to prevent natural ovulation

Wednesday 6/10/09 (CD11)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150
- Continue ganirelix

Thursday 6/11/09 (CD12)
- 3rd follicle check u/s and b/w. E2 level 254. Right ovary has 17mm, 8mm (teeny) follie. 2-4 tiny ones, too small to measure. Continued poor response.
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150
- Continue ganirelix

Friday 6/12/09 (CD13)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150
- Continue ganirelix

Saturday 6/13/09 (CD14)
- 4th follicle check u/s and b/w. E2 level 401. Right ovary has 18mm, 7mm. Left ovary cannot be seen. Continued poor response.
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150
- Continue ganirelix
- RE decides he is willing to proceed with IVF with just one follicle, if I am willing. Due to good/lucky insurance coverage, we decide to go for it.

Sunday 6/14/09 (CD15)
- Keep estrogen patch #3 on
- Continue stimming: Gonal-f 450 (FSH) + Menopur 150
- Continue ganirelix

Monday 6/15/09 (CD16)
- 5th follicle check u/s and b/w. E2 level 415. Right ovary has 25mm, 7mm. Left ovary cannot be seen. Continued poor response. Cannot wait any longer for smaller follicles with 25mm.
- Schedule egg retrieval for Wednesday at 10:30am
- Finally remove estrogen patch (gross)
- Ovidrel HCG trigger at 10:30pm

Tuesday 6/16/09 (CD17)
- Surgical instructions
- Nothing to eat or drink after midnight

Wednesday 6/17/09 (CD18, O-day)
- Husband provides semen sample to andrology lab at 9:30am
- Egg retrieval at 10:30am
- Surprise! Three eggs retrieved: the large follicle seen all along and two smaller ones that grew enough since Monday and/or were not seen on u/s.

Thursday 6/18/09 (CD19, 1dpo)
- Fertilization report: 1 of the 3 eggs fertilized. Not surprising as the 2 "surprise" eggs were likely not mature.

Friday 6/19/09 (CD20, 2 dpo)
- Waiting

Saturday 6/20/09 (CD21, 3 dpo)
- Egg transfer. Embryo was a grade 1, low fragmentation, given a HIP (High Implantation Embryo) stamp. As good as I could possibly hope.
- Acupuncture, before and after transfer.
- Beta scheduled for July 1st

Tuesday 6/30/09 (CD31, 13dpo)
- One day before beta, period arrives. BFN.

As you can see from above, I had a particularly poor and slow response, even on this aggressive protocol. However, I believe the RE and I may have learned some things, particularly in regard to adding the antagonist into the cycle earlier next time. Once the lead follicle started surging ahead, it was impossible to wait too long for the slower follicles to catch up. Maybe next cycle we can stop that lead follicle earlier.

Updated to add (July 2009): happy ending here. We had decided to take a break from all the meds over the summer and try IVF#2 in September. Shockingly I became pregnant naturally during my first cycle after the failed IVF above. Never give up, ladies! If somehow this low responder can get pregnant (in whatever way), then anyone can.