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Low dose or high dose stims for DOR? Does it make a difference?

Updated: Nov 4, 2020

Not one week passes without someone in my Facebook group complaining a high dose stimulation cycle failed her and she was directed towards donor eggs.

Obviously, it comes a time in the fertile life of every woman, when her eggs will no longer be good. And when the body really can't deliver anymore, the science can't do much about it. But until this happens, the vast majority of women I come in contact with (virtually) prefer to exhaust every possibility of using their own eggs.

You probably know it already, IVF works by narrowing down the chances to finding the better egg. The more eggs you produce, the better chances you have for success. This is why some clinics turn off clients with low AMH and diminished ovarian reserve, for fear this clients won't be able to respond well enough to treatments, to produce enough eggs to ensure a positive outcome. This in turn, will result in negatively affecting their success rates, and you wasting money.

Those clinics will probably serve you the donor egg speech even without considering treating you.

There are of course other clinics, the majority of them actually, who really believe they can do well, and take you in. They treat you just like they treat their "fertile"patients (let us not forget for a moment that IVF was initially conceived to overcome male fertility issues and tubal problems) and therefore they try to make you produce as many eggs as possible, cause the more eggs the merrier the IVF, right?

Even more than that, they will put you on higher doses because they know your DOR makes your ovaries pretty lazy, and they believe higher doses of stims compensate for your ovaries' lack of reactivity. This was indeed the approach until a few years ago. Since then, lots of studies have been performed and science has come to other conclusions.

What I am going to tell you next, is my own personal experience.

I started my IVF adventure in March 2014, on my 40th anniversary.

My RE was one of the most appreciated REs at an amazing hospital in Paris, and I just loved his calm and poise, and the patience with which he answered all our questions. All my tests were perfect, except for my AMH who came back at 0.5 only to throw me into a black despair. Little did I know about AMH  back then, or that I shouldn't pay too much attention to it. I had gotten pregnant precisely 10 months ago, naturally, like I always did, on the first month trying. Unfortunately and very unfairly, I lost our little boy at 16 weeks because of an incompetent cervix, that I later corrected through surgery in USA.

My RE told me the same story most of your REs tell you: your AMH is low, we have to be pretty agressive in order to make the most of these ovaries of yours. He started me on an agonist, a French kind of Lupron, and high doses of Gonal F. My AFC was between 9 and 11 on CD3. Not stellar, but not bad for my age either. As the days went by and my retrieval approached, I could see my follicles disappearing: 11 became 8, then 6, then 4...eventually that cycle we got 3 eggs.

To say I was disappointed would be a huge understatement. We converted to IUI and when I asked him what the heckity heck happened, he shrugged and told me morosely: "Your AMH is 0.5, what did you expect?" Yeah, I wanted to scream...

But I didn't, and when I got a BFN, I went to see him again, and I asked him how did he prefer to proceed for the next cycle? Should we try an antagonist protocol? You see, in the meantime I had discovered fertility groups, I started to read studies, articles, and educate myself. My journalistic self didn't allow me to follow blindly and pushed me towards finding out the "truth", my truth.

He told me "Oh, but the antagonist protocol is not ok for you, I don't believe in it, I prefer this protocol and it works so well for my patients".

I knew then it was time for us to part...I don't believe in making the same mistake twice, especially not on purpose. And I left. For another famous French clinic, a public one this time.

Horrible conditions, famous doctor. 4 IVFs (high dose and only local anaesthesia for retrieval) and 1 IUI later, still BFN. Not even one chemical, not that I would have wanted one!

I would like to give him this, though: he tried! He changed protocols every cycle. We did Gonal F, Pergoveris, Menopur, Puregon. We did testosterone priming (the worst for me, 2 AFC instead of my usual over 9)we did estrogen priming (he was the first RE to ever use this protocol, he invented it).

We did everything! The only thing we didn't do was low dose, though. Whatever he did, I was on 450 FSH and some 150 LH and the best result I ever got with him were 3 lousy eggs, with a 100% fertilisation rate, giving me 3 lousy embryos.

One day, I went to see him and I told him I was willing to go to London to a clinic I have heard of where they did low dose for their DOR patients. Unless he accepted to try the low dose protocol another RE in NY gave me over the phone, after having studied all my medical records.