Prema tom protokolu dr. shera, decapeptyl se koristi samo do menge, onda 1 d.c. ništa, a od 2 d.c. prelazi se na antagoniste (pola uobičajene doze, npr. 0,125 mg cetrotide) sve do štoperice, te se nastavlja sa estrofemom 7-10 dana. Tek nakon toga kreće se u stimulaciju sa visokom dozom FSH (npr. gonal, cca 600 jedinica) koja se postepeno smanjuje, a tek pred kraj stimulacije ubaci se i malo LH (menopur). Cilj ovog protokola ne dopustiti porast LH na nivou jajnika (nije to isti LH koji se vadi iz krvi kako sam ja shvatila), koji je i inače visok kod low respondera a djeluje loše na kvalitetu i kvantitetu jajnih stanica. Taj protokol se zove agonist/antagonist conversion protokol sa estrogen primig-om. Na googlu upišite geoffrey sher, optimising response to fertility drugs in women with diminished ovarian reserve who undergo IVF, isto i An individual approach to ovarian stimulation for IVF is crucial.
Evo npr. verzija tog protokola prema iskustvu jedne amerikanke:

5th cycle:
age 36
two months following the 4th (and cancelled)cycle
flare protocol; same as cycle 2; only 1 egg retrieved, and grew to 8 cell embryo and transferred on day 3; BFN
6th cycle: AGONIST/ANTAGONIST WITH ESTROGEN PRIMING PROTOCOL

This is not the exact Dr. Sher protocol but what my RE created for me based on his theory.

day 4 of cycle before IVF:
low dose aspirin
lupron .5mg subcutaneously (.1ml)
BCP taken for 21 days

lupron stopped when period started.

protocol started on day 2 of period:

day 1 of cycle/protocol: (day 2 of menses):
cetrotide 0.125 mg subcutaneously
4 estradot patches (estradot patches to be stopped when lead follicle was greater or equal to 1.5 cm)

days 2 and 3 of cycle:
600 iu gonal f
0.125 mg cetrotide

days 4 - 6 of cycle:
525 iu gonal f
0.125 mg cetrotide

days 7 - 11 of cycle:
225 iu gonal f
0.125 cetrotide
75 iu menopur

day 12:
trigger shot

day 14:
ER
9 follicles; 9 eggs retrieved; 6 fertilized; 5 grew to 3 day embryo

2 embryos transferred, unfortunately BFN

HOWEVER

This was my best response to IVF drugs in four years. I'm not sure why I responded fairly well to the first flare protocol. My antral follicle count was very low by the time we did this cycle, lower than the number of eggs retrieved.

I do believe that this protocol is the reason why I responded so well for me. Others might see this as not a great cycle but for poor responders like myself you will probably agree that it's really good!


7th cycle:
FET
BFP!!!!! Twins!!!!! Due in June 2011.

So yes, I believe in the estrogen priming protocol; and all the other preparation I did beforehand to help ensure the best quality eggs possible.