Any advice to slow down stimulation?

Question

Hi ladies,
I am waiting for the PGT results from my second IVF cycle, but I wanted to get your opinion on how to adjust my medications for the third cycle based on your experience, as the 2nd isn’t looking promising. 
I am 33 with high AMH (>8) and PCOS, so my struggle is that I hyperstimulate easily and produce too few mature eggs so too few blasts. 
Cycle #1. Stimmed only 6 days before estradiol got too high. Used 150 gonal / 75 menopur for 4 days, then 75 gonal / 75 menopur for 2 days. Triggered (Lupron and 1500 hcg) on Day 7 with estradiol at 4,200 (yikes!) and >20 follicles, maybe 8 of which were >17 mm. Resulted in 17 eggs collected and 11 mature. 
Cycle #2. Again stimmed 6 days. 150 gonal for 4 days, then 37.5 gonal/ 75 menopur day 5, 75 menopur only day 6, and same trigger on day 7 with estradiol >4,500 and >20 follicles with 6-7 >17 mm. Resulted in 19 eggs collected and only 9 mature. 
The goal of the 2nd cycle was to stim more slowly to get more mature eggs but as you can see I stimmed just as fast with the lower doses and ended up with fewer mature eggs. 
I am seeking a 2nd opinion because my confidence in my practice is shaken, but while I wait for that appointment I would love to hear if there is an entirely different protocol that you PCOSers have tried!
UPDATE: all abnormal embryos AGAIN after my 2nd cycle - aneuploid not moscaic. My doctor is baffled and can’t explain it.

Answer

I dont have pcos, but had ohss symptoms for my retrievals and my goal was also to not overstim. maybe ask about a lupron down regulation protocol. I did that for my 3rd retrieval and we still got lots of eggs but they grew very slowly and my estradiol level was high but my symptoms were very manageable and was the only cycle we actually got blasts. They also took me off menopur pretty quick that cycle.  The first 2 retriebals we got no blasts.

Answer

I’m not a huge help as I really stayed out of my meds and trusted my doctor.     My first cycle I only stimmed 6 days and most where immature at retrieval but I had one leader that ruined the cycle.  
My second cycle they put me in BC to down reg for 6 weeks and added in something (sorry I’m not a better helper) to slow my growth.  I ended up stimming for 11 days.  
My third cycle we did the same as the second and ended up stimming for 13 days.  
Definitely talk honestly with your clinician about options and if you don’t feel comfortable at being heard by them look for another clinic.

Answer

I have pcos and my amh is over 9. I did all menopur protocol. Not sure if that helped my results or not. But worth looking into? My doctor did tell me ( hopefully I can explain right and remember correctly) but that menopur can vary what actual dose you get because it is from women’s urine. But gonal is synthetic. And so the dose is pretty accurate. 
￼I did 150mg of menopur morning and night. 
I did stims for 9 full days and then morning dose only on day 10. I did trigger of lupron and very small of hcg on day 10 evening. I got 32 eggs and 27 mature. All 27 fertilized between natural and icis. Standard for my clinic to do both. We don’t have male factor. Day 5 report was 10 frozen. We did genetic testing in 8 and three came back normal. 
Good luck to you and hoping you have amazing results!

Answer

For my first retrieval, I was on Menopur 75 and I forget the dose of Gonal (this was 2018) but I know it was adjusted several times throughout stims. I think I stimmed for maybe 10-11 days. They did stop menopur early on and I just continued Gonal. My AMH was around 6-7. I was never diagnosed with PCOS. Just a higher AMH. We had 29 retrieved. I also was on BC and Lupron for that retrieval so it was long protocol. I honestly can’t really  compare that cycle because my clinic did not ICSI and so we only ended up with 1 untested blast. 
We switched clinics for round 2, just this past Jan. After updating tests, my AMH was 14.55.  I had 30+ follicles on each ovary at baseline. I do not have classic PCOS symptoms. My new RE completely changed up my protocol. First, he wanted me to take fish oil, myoinositol, and metformin for at least 2 months. Then, I was on short protocol, no BC and no Lupron. I was nervous being on a completely diff protocol but it worked for me. I was on Menopur 75, Follistim 150. Dose never changed. They had me start Letrozole after my first monitoring ultrasound to lower estrogen. I think it was only for 5 days. It worked. I didn’t even know that was a thing. And I stimmed for 9 days. Triggered with HCG and Lupron. We had 24 retrieved, 12 mature, 11 fertilized with ICSI and we had 10 blasts to freeze! We did not PGS test though. That’s just my experience, I have regular cycles and to my knowledge I don’t have cysts. Just a higher AMH. Definitely doesn’t hurt to get a second opinion. Good luck:)

Any advice to slow down stimulation?

The Top Baby Tracker App: Embrace New Beginnings with Tender Care

The Top Fertility Tracker App: Your Path to Achieving Pregnancy

The Top Pregnancy App: Nurturing Your Journey to Motherhood

The Top Period Tracker for Empowering Your Menstrual Health Journey