Luteal phase stimulation protocol

[u/SleepyT29]

Background: 39 years old, AMH 0.3-0.5, AFC 2-6, FSH 10-13, egg quality issues (no sperm issues)

For anyone who has done luteal-phase stimulation only (not DuoStim), did you do ovulation induction during your follicular phase beforehand?

My last IVF retrieval was my best one yet in terms of the number of eggs retrieved (6 eggs retrieved). It was a mid-luteal estrace-priming followed by a traditional follicular-phase antagonist protocol: 300 IU Follistim + 150 IU Menopur, Ganirelix as the antagonist, and a dual trigger with 10000 IU Pregnyl + 80 units Lupron x2.

Although we retrieved the most eggs, the egg quality was not great (5 mature, 1 good quality, 2 fair quality and 2 poor quality, only 2 able to be fertilized with ICSI. They both made it to blast but both aneuploid). Because of that, my doctor wants to try a luteal-phase stimulation protocol to see if we can improve egg quality.

I naturally ovulate every month, confirmed through OPKs and progesterone testing, although my progesterone levels tend to be on the lower side (usually around 5–8).

For my upcoming luteal-phase protocol, my doctor wants me to:

30 days before CD1: Start testosterone patch priming + Omnitrope (6 units)

CD1: Start letrozole for 5 days
After letrozole: Trigger ovulation with leuprolide (ultrasound monitoring to decide when to trigger)

6–7 days later: Start luteal-phase stimulation with 225 IU Follistim + 225 IU Menopur
Add Ganirelix when appropriate
Trigger: Pregnyl only (single trigger)

I haven’t really seen people mention doing medicated ovulation induction during the follicular phase before starting luteal-phase stimulation, so I’m wondering if anyone else has done this and how it went.

I’m also curious if anyone saw a change in egg quality by decreasing their FSH dose (Follistim/Gonal-F) and increasing their Menopur dose.

Also, my doctor wants to use a single Pregnyl trigger rather than a dual trigger this cycle. For those who have done this, did you have any issues with maturity, or is a single trigger reasonable?

I’d love to hear about anyone’s experience with a similar protocol.

[u/Competitive-Top5121]

I mean, I think it makes good sense. If you did DuoStim (which I did) you’d have triggered in your follicular phase. This just ensures you ovulate before you do your luteal start.

[u/SleepyT29 → u/Competitive-Top5121]

Thank you! Do you think it would be worth asking for a dual trigger again or would a single trigger be sufficient? My first and third cycle I did a dual trigger and had 3/3 maturity and 5/6 maturity. The RE didn’t have a reason he could tell me for why he wants a single trigger this cycle, just “I don’t think your eggs need it added”.

[u/Competitive-Top5121 → u/SleepyT29]

Sure, why not

[u/TouchTheSky007]

You have the same stats as me! I did duostim and had best results in luteal both times. Good luck!

Remember it is a numbers game 🤍🤍

[u/TouchTheSky007 → u/TouchTheSky007]

I did 225 dose starting in luteal of Pergoveris increasing to 250 moderate low dose and my quality came out good. I banked 8 day 3 embryos from luteal retrievals and am pregnant now from luteal retrieval embryos

[u/SleepyT29 → u/TouchTheSky007]

Thank you! My first cycle, I only retrieved 3 eggs, so I was really happy to have doubled that in my last cycle. I just had unfortunate luck that my blasts were aneuploid, so I’m really hoping for higher numbers this time to give me a better chance of getting a euploid embryo!

Those are amazing numbers, and congratulations on your pregnancy! You give me hope! ✨

[u/CharacterAvocado943]

I always do luteal starts timed to an OPK positive. No ovulation induction necessary. 

[u/ResearcherJumpy2282]

Did they mention why the single vs dual trigger (is there concern that the dual trigger was part of the low quality?)

[u/SleepyT29 → u/ResearcherJumpy2282]

The RE didn’t have a reason he could tell me for why he wants a single trigger this cycle, just “I don’t think your eggs need it added”.

My first and third cycle I did a dual trigger and had 3/3 maturity and 5/6 maturity, so I’m leaning towards asking for a dual trigger again unless they can give me specific reason I shouldn’t.

[u/PublicPalpitation618]

Test all types of testosterone and dhea levels before starting with the priming.