Two unsuccessful cycles - any advice?

[LittleLadyBug4Me]

Dear Dr. Potter, can you please give me your advice?
I just closed another unsuccessful cycle. Last time I had 14 eggs, only 5 mature,embies did not look great from the beginning, ended with 1 normal boy (blast) and two normal girls that stopped growing. Three abnormals. 5 probe FISH. No BCP.
This time I had BCP for two months (I suddenly needed to postpone cycle, so thats why), only 7 eggs, 4 mature. All made it to day 5, all 4 looked beautiful, no fragments, but the end is 3 girls, 1 boy, ALL ABNORMAL, all had either trisomy 21 or 18 or both. Again 5 probe FISH.

I had Puregon (Follistim) both times, meds increased to 225, after 7 days to 250 units. (last time 200, then 225). Antagonist protocol both times.

I cycled on local clinic and we are insurance driven country. It exactly means that what is not covered by insurance, doctors are not really willing to do, because sometimes they are not even obliged to ask the patient to pay...strange and funny. So E2 was never measured which might be the gap but maybe not...

I am 37,5 but my pretesting was really good, FSH around 6,4. But I had higher LH 7,2 then FSH and my doctor says due to that fact I can get only FSH meds.
If I decide to go again, I would go to US. It will take me at least 6 months to save up so I will be 38 when cycle. I have two boys conceived on the first try, 6yrs and 2 yrs.

Is there anything in the protocol that can be changed to produce more mature eggs? Thank you.

[Dr. Potter]

Dear Dr. Potter, can you please give me your advice?
I just closed another unsuccessful cycle. Last time I had 14 eggs, only 5 mature,embies did not look great from the beginning, ended with 1 normal boy (blast) and two normal girls that stopped growing. Three abnormals. 5 probe FISH. No BCP.
This time I had BCP for two months (I suddenly needed to postpone cycle, so thats why), only 7 eggs, 4 mature. All made it to day 5, all 4 looked beautiful, no fragments, but the end is 3 girls, 1 boy, ALL ABNORMAL, all had either trisomy 21 or 18 or both. Again 5 probe FISH.

I had Puregon (Follistim) both times, meds increased to 225, after 7 days to 250 units. (last time 200, then 225). Antagonist protocol both times.

I cycled on local clinic and we are insurance driven country. It exactly means that what is not covered by insurance, doctors are not really willing to do, because sometimes they are not even obliged to ask the patient to pay...strange and funny. So E2 was never measured which might be the gap but maybe not...

I am 37,5 but my pretesting was really good, FSH around 6,4. But I had higher LH 7,2 then FSH and my doctor says due to that fact I can get only FSH meds.
If I decide to go again, I would go to US. It will take me at least 6 months to save up so I will be 38 when cycle. I have two boys conceived on the first try, 6yrs and 2 yrs.

Is there anything in the protocol that can be changed to produce more mature eggs? Thank you.I am sorry to hear of your difficulties. While I am a proponent of BCPs I think that 2 months is too long. I would be interested to know whether you have insulin resistance (a common cause for LH>FSH) as well as the remainder of your ovarian reserve testing such as antral follicle count and AMH if available. If you have insulin resistance, I would suggest metformin. I would suggest that you do a standard long protocol with BCPs for 7-21 days max. I would suggest a combination protocol. The exact doses I cannot say without having more information about your response, stimulating estradiol levels, etc. I hope that this helps and good luck..

[LittleLadyBug4Me]

Thanks a lot Dr. Potter. I will try to get the AFC and AMH results if they are able to provide it. E2 was never measured in both cycles, the standard is ultrasound only...so I have no clue. Not really helpful. I will contact my RE and ask them for my records and then turn back to you. I am strongly considering HRC end of this year, if these two results are reasonable.

[LittleLadyBug4Me]

What the combination protocol means? Thank you