Estrogen Priming Protocol

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chrissybits Posted: Mon, May 2 2011 4:23 PM

Another question... I've seen others write about the Estrogen Priming Protocol. I'm looking for more info so I can ask my dr about it next week. How does it work? Is this something you can do after BCP? I need them as to keep from having a dominant follicle that prevents others from growing. But I really want to try this.

IVF Baby Boy: born Feb. '12; FET Baby Girl: born Dec. '13

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nell replied on Tue, May 3 2011 8:26 AM

I know very little about it tbh, but i think you do it insetad of BCP's? I know silverdollar did an estrogen prming protocol for the same thing - one early dominant follicle.

Me 32yrs, DH 37yrs

Chronic spotter from 4DPO, Small intramural fibroids, Low AMH yet also PCO.

3 fresh IVF's - 2 BFN and 1 chemical pregnancy. All with thin endometrium Sad 1 FETCancelled due to thin endometrium, just 5mm

FET March 2012. Low beta, just 20 at 9dp5dt and a super squinter on a FRER, doubling nicely. HB seen but measuring 6 days behind. Scan at 7w+4 back on track. Baby Baby Girl born November 2012.

Back for a sibling FET July 2013 - BFP, no squinter this time Smile 6w+6 scan shows twins, 8w+3 shows triplets. Identical twins passed away at 11 weeks and 12 weeks, cause unknown. Singleton still ok.

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aliwat replied on Wed, May 4 2011 8:41 AM

Hi Chrissy!

The EPP is a protocol for poor responders. It really worked miracles for me - I wasn't responding well to any other protocol. Here's how it works:

Priming cycle:

  • Monitor for Ovulation Surge

  • Ovulation Surge is surge day 1 (SD1)

  • On SD8, start estrogen patches and change them every other day until period arrives. Once period arrives, leave the last patch on for four days or until it falls off.

  • On SD9, start Ganirelix injections, one per night for thee nights total until SD11.

Stimming cycle:

  • Baseline u/s is done on CD2. E2 will be slightly elevated from the estrogen patches. FSH will be lower than normal.

  • Start 450 Gonal-F and 150 Menopur on CD2. Continue for approximately 10 nights.

  • Add Ganirelix in nightly after lead follicle is at 13mm.

So basically it's just a regular antagonist protocol with priming in the luteal phase prior to stims. The ganirelix shots in the priming portion will help prevent a lead follicle.

Let me know if you need more info - I have now done this protocol 6 times. Good luck!

-Ali Flowers

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chrissybits replied on Wed, May 4 2011 7:53 PM

Thanks for the detailed info! I go to talk to my dr on Monday, and I hope he is aware of this. I'm feeling like this current cycle of BCP is a waste though... and trying not to be frustrated, unless there is a way to do this protocol after BCP  :- /

ETA: one of the reasons for the BCP was because I had a cyst, so I guess it was necessary.

IVF Baby Boy: born Feb. '12; FET Baby Girl: born Dec. '13

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aliwat replied on Thu, May 5 2011 11:08 AM

I understand - this whole process is incredibly frustrating!

Are you a poor responder or have any signs of DOR? Just curious.

Also, just FYI, most cysts will resolve on their own in 1-2 complete cycles if you want to skip the BCP next time. I have had some GIGANTOR ones (back when I took Clomid) and even those went away quickly.

Good luck at your appointment Monday! Let me know if you need anything!

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silverdollar replied on Thu, May 5 2011 8:32 PM

The estrogen is taken in the luteal phase to dampen down your body's natural FSH. It's a form of suppression, but is not nearly as suppressive as BCP's, and works well for some women with DOR. It's not generally the first protocol considered, but is worth asking about.  Here is a link that explains a bit about different IVF protocols:

Also, you can proceed with stimulation with a cyst as long as it is not actively secreting hormones.

Me -33 DH -33 TTC #1 since 2008. Text book regular cycles, great temp charts & well timed intercourse. All initial diagnostics normal. Started as unexplained IF, now high FSH/ DOR.

  • Jan -March 2010 3 rounds of Clomid + timed intercourse
  • April 2010 Laparoscopy & hysteroscopy . Stage 1 (mild) endometriosis, and a small uterine polyp removed.
  • June 2010 IUI #1 with Letrozole, early ovulation of one lonely follicle due to high FSH levels. Told about low ovarian reserve.
  • July 2010 IUI #2 with Gonal-F, responded well with 3 mature follicles
  • Aug 2010 IUI #3 with Gonal-F, responded really well 4 equally mature follicles.
  • Oct 2010 IVF attempt #1 Microflare Protocol: CANCELED/converted to IUI d/t poor response (4 follicles) and lining issue
  • 4 months of DHEA and hysteroscopy D&C Feb 8th to clean up the lining
  • March 2011 IVF attempt #2 Natural Start Antagonist Protocol-CANCELED d/t dominant follicle and low follicle count (3)
  • April 2011 IVF attempt #3 Estrogen Priming Protocol with Antagonist -AFC =4, 3 follicles responded, 3 eggs retrieved, 2 mature and fertilized, 2 high grade embryos to transfer. Lining perfect in thickness and pattern. April 23 (11dp3dt) beta =236 April 26 (14dp3dt) beta =1167 -BFP!!! We did it, we beat the odds. Baby girl born Jan 6, 2012

Back up the bus... natural surprise conception with baby #2 while still breastfeeding!

Follow my Blog


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chrissybits replied on Fri, May 6 2011 6:19 AM

Are you a poor responder or have any signs of DOR? Just curious.

Yes, in Dec I was diagnosed with DOR. At that time my FSH was 10.7 and my AMH was 0.4. Sad I usually have about 7 antral follicles. Last week, because of the cyst I only had 5. My first IUI in Jan. I only had 1 follicle mature and was labeled a poor responder, but with my new RE, he had me on BCP before the second IUI and I had 3 mature follicles, although it still didn't work. Each time I was on 3 viles of Bravelle (I think 225 total). He was very pleased but I am growing tired of this. It's been a roller coaster ride with my first dr scaring me by telling me I was running out of time and it was very serious and we needed to go straight to IVF right away. The first dr ended up not being a good fit for me. And while I like my new dr tons more, he is less concerned at this point. I just don't want to waste any more time or money. My insurance doesn't pay for a DIME so everything is out of our pocket. It seems to me like the EPP is the best protocol for DOR, so it sounds to me like it doesn't make sense to do anything else.

Thanks to everyone for the information. It's hard to find on the Internet, so I really appreciate hearing from those who have been there.

IVF Baby Boy: born Feb. '12; FET Baby Girl: born Dec. '13

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coops replied on Fri, May 6 2011 9:32 AM

My doctor (the one whose blog Silverdollar linked to above) seems to like to use an antagonist protocol with BCP as suppression for those with DOR as a first attempt. That's what he planned for me. it didn't work out because it seemed the BCP didn't suppress me ENOUGH and I still had cysts and elevated estrogen after 2.5 weeks. So I ended up doing a standard lupron cycle (except I didn't use BCP) which is unusual for a "poor responder" but it worked. However, I think I'm a freakish case where I definitely have low reserve but such active follicles/persistent cysts that I need the extra suppression. Or maybe it was a one time lucky cycle.

Anyway, it's definitely good to ask about EPP so you can know if your doctor is open to and experienced with it if necessary, but like SD said, it's not usually a first attempt.

Good luck! I'll be rooting for you!

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aliwat replied on Sat, May 7 2011 9:54 PM


Are you a poor responder or have any signs of DOR? Just curious.

Yes, in Dec I was diagnosed with DOR. At that time my FSH was 10.7 and my AMH was 0.4. Sad

Just to give you some hope, my AMH was .4 when I got pregnant with my son. .4 is a lucky number to me! :)

Good luck to you - I think EPP sounds like a great step in the right direction for you! Flowers


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dancingmama replied on Fri, May 13 2011 10:14 PM

Chrissybits - I went through the long lupron protocol and it didn't work for me. I think I was oversuppressed...

Next cycle,  I will do an antagonist-agonist protocol with the estrogen priming (it seems to be as someone on this thread describes--- but to prevent cysts and dominant follies at first I will be on BCP and then a few days of lupron only...then switching things up to Ganirilex (as opposed to staying on Lupron as with the long Lupron protocol) and then an injection of Estrogen in there before starting stims where then the Ganirilex and a couple doses of Estrogen continue...It seems that this protocol works for many...

Anyway, there is a Dr. Sher (I forget his clinic group name--but google him along with IVF) that says that some form of this protocol is what he uses for all patients who are DOR or not...I think it is worth talking to your doc about....I know REs like to do the 'regular' protocols first, but I wish they had done this first....but you never know what is going to work....It is just an expensive experiment, you know...?

Good luck!

me 43 dp 46;  4/11 IVF#1 BFN Angry;  7/11 IVF #2 BFP ChickPray

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yogisomething replied on Sat, May 14 2011 9:42 AM

My RE's approach with estrogen was a bit different, so just to give an alternate perspective... she started me on estrogen pills on about day 3 of my cycle after a scan showed that I already had a good-sized follicle growing, indicating my FSH was not just high (I think it was around 12 at that time) but also really out of whack.  I have DOR and usually show between 3-5 antral follicles but that includes the ones on my left ovary, which isn't very reliable.  We ended up with three follicles the cycle I was on estrogen, which was great, although one of them got stuck and needed a trigger shot to ovulate.  That cycle was BFN.  We went right into IVF the next cycle (starting with about 8-10 days on BCP) and got one follicle and (as you can tell in my signature) one BFP.  So I don't know if the estrogen helped or not but the hope was that it calmed down the FSH response and gave us better odds at IVF.  

FWIW, the other thing my RE encouraged was taking DHEA for a few months prior to IVF, if you want to ask your dr about that as well.  She tested my hormone levels before we started the DHEA and the results indicated very low levels of the growth hormone (sorry, I can't remember the name), which I guess can play a role in DOR.  It's all very anecdotal and my RE was clear with us that we could choose to take it or not, that it might help or it might not, but that in her experience there were some positive results.  Again, I don't know if the DHEA helped or not but the hope was that it supported the follicle growth.

I sympathize on the costs issue - all of ours was out of pocket too.  But hopefully you will get the result you are hoping for soon!  Best of luck to you.

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hopeful711 replied on Thu, Jun 14 2012 1:07 PM

Hi Aii,


My name is Danielle. I just found out that I will be starting the estrogen priming protocol when I get my period.

My 1st cycle was a micro dose lupron. Only retreived 4 eggs, 2 implanted day 3 (8 cell) = BFN

Can you direct me to where I can find more information about this protocol? I am trying to layout a calender

and get all of my questions ready for our follow-up on Monday. I started acupuncture last week and I would

love any suggestions on dos & dont's during my next cycle.


I look forward to hearing from you.




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