Baby 2 · IVF · Repromeda Biology Park, Brno

Repromeda — Cycle 2

Cycles: Cycle 1 (done — 3 oocytes) · Cycle 2 (projected)
Projected plan — re-anchored to the real cycle (Jul 3). Actual CD1 = Thu Jun 25; today is CD9. This is a natural priming cycle (no retrieval). Androgel runs daily through CD18 (Sun Jul 12) — last dose. Cycle 2 is an open long-vs-short decision (see consult questions); both begin stims at the next CD2, est. Jul 19–21 (CD25–27), and retrieve ~early August.
Cycle 2 protocol & medications

Two possible protocols — Dr. Filková decides at consult. Both follow Androgel priming, use Pergoveris, and end with a dual trigger; they differ in shape and dose. Doses adjust by monitoring.

Medication Role Dose When
Priming — prepare the ovaries
Androgel Testosterone gel (transdermal) Per clinic Started Jun 15; daily through CD18 (Sun Jul 12) — last dose
Downregulation — long protocol only
Gonapeptyl GnRH agonist (suppresses early ovulation) Daily From CD22 (Thu Jul 16) through stims — long protocol only
Stimulation — grow the eggs
Gonal-F Pure FSH 250 (short) / 350 (long) IU / day From next CD2 (~Jul 19–21); adjusted by monitoring
Pergoveris FSH 150 + LH 75 150 IU / day From next CD2; same time each morning
Ovulation control & trigger — time the release
Cetrotide GnRH antagonist (blocks early ovulation) 0.25 mg / day Short protocol only — added mid-stim (long uses Gonapeptyl instead)
Diphereline Agonist trigger 0.1 mg Trigger night, ~36 h before retrieval
Ovitrelle hCG trigger 250 mcg Trigger night, with Diphereline

Diphereline + Ovitrelle together = dual trigger (two hormones to mature more eggs, lower OHSS risk), same as Cycle 1.

Cycle 2 decision & questions for Dr. Filková

Two options for this cycle. Both retrieve around early August — the difference is protocol shape and dosing, not a lost month.

OptionDownreg / startStim doseRetrieval (est.)
Long protocol Gonapeptyl daily from CD22 (Jul 16); stim next CD2 (~Jul 19–21) Gonal-F 350 + Pergoveris 150 ~early Aug
Short protocol Next cycle CD2 (~Jul 19–21) — same as Cycle 1 Gonal-F 250 + Pergoveris 150 ~early Aug

Hard wall: departure Nov 18 → realistically ~3–4 retrievals left. Long and short net about the same count; DuoStim is the only path to more. Don’t do back-to-back long protocols.

Questions to ask
  1. Cycle 1 breakdown: of the 3 eggs, how many were mature (MII), how many fertilized (2PN), and where did they arrest? (Tells us if the bottleneck is egg count, maturity, fertilization, or culture — before we argue protocol.)
  2. v-LHβ dosing: my genetics show a variant LH-beta = “low response to rhFSH” (pure FSH like Gonal-F). Do we overcome that with more FSH, or by weighting toward LH activity (more Pergoveris / an LH-rich menotropin)? (See genetics below.)
  3. Long vs short: pooled data show no live-birth difference between long agonist and antagonist for poor responders. What’s the specific reason long beats antagonist for me — the runaway lead follicle / uneven sizes? And at AFC 4, could long over-suppress and give fewer than 3?
  4. DuoStim: given the fixed Nov 18 departure, would you reconsider luteal-phase DuoStim to fit more retrievals? If not, what rules it out for me — and realistically how many safe retrievals by mid-November (with vs. without a rest cycle)?
  5. Fallback: if this cycle underperforms, do we revert to short for the rest?
Genetic testing results (Jun 23, 2026) — PRIVATE
Private — do not publish. Repromeda PANDA Carrier panel, both partners. Full reports filed in Tests & Reports/ (that folder never deploys). Keep this section out of any sync to the public site.

Stimulation genetics — the part that drives the dosing question:

Gene / variantResultMeaning for stimulation
FSHR Ser680AsnAsn/AsnIncreased response to FSH (favorable)
FSHR c.-29G>AG/ANormal receptor sensitivity
LHCGR Asn312SerAsn/SerIncreased LH-receptor sensitivity
LHCGR Asn291Ser / insLQNormalNormal sensitivity
LH-beta (v-LHβ)
c.82T>C & c.104T>C		CarrierLow response to recombinant FSH (rhFSH)
Takeaway: FSH receptor is favorable — not “reduced FSH sensitivity.” The one flagged limiter is the v-LHβ variant → low response to pure rhFSH (Gonal-F). So the dosing lever is FSH-vs-LH weighting, not simply more Gonal-F. Keeping Pergoveris (which carries LH) is genetically sound.

Other findings:

  • Karyotype 46,XX — normal.
  • Fragile X (FMR1): 28/28 — normal. Low ovarian reserve is not explained by a Fragile X premutation.
  • FMF carrier (MEFV, likely pathogenic, heterozygous) — but Adam is not a carrier, so offspring risk is very low. No PGT-M needed.
  • Thrombophilia: no Factor V Leiden, no prothrombin mutation. MTHFR A1298C homozygous (clinically minor); report advises folic acid 400 mcg. No increased clotting risk.
  • PGT-A formally indicated in the report (matches the plan).
  • Adam: all clear — normal karyotype, not a carrier for any tested disease, no Y-chromosome microdeletion.
Priming phase — underway
Androgel (testosterone) priming
  • Started Mon Jun 15, applied daily through CD18 (Sun Jul 12) — last dose. ~4 weeks of androgen priming before stims start (~Jul 20); Cycle 2 runs back-to-back (no skipped cycle).
  • 1 box obtained at the Jun 14 retrieval (clinic’s last in stock).

EST. Estimated event · anchored to CD1 = Thu Jun 25 (actual). Priming is set; stim-cycle dates firm up once the protocol is chosen and the next period arrives.

Week of Jun 29 — priming
Mon
29
CD5
Tue
30
CD6
Wed
1
CD7
Thu
2
CD8
Fri
3
CD9
Sat
4
CD10
Sun
5
CD11
Mon 29
Androgel priming
Androgel
Tue 30
Androgel priming
Androgel
Wed 1
Androgel priming
Androgel
Thu 2
Androgel priming
Androgel
Fri 3
Today · CD9
  • Priming continues
Androgel
Sat 4
Androgel priming
Androgel
Sun 5
Androgel priming
Androgel
Week of Jul 6 — priming ends
Mon
6
CD12
Tue
7
CD13
Wed
8
CD14
Thu
9
CD15
Fri
10
CD16
Sat
11
CD17
Sun
12
CD18
Mon 6
Androgel priming
Androgel
Tue 7
Androgel priming
Androgel
Wed 8
Androgel priming
Androgel
Thu 9
Androgel priming
Androgel
Fri 10
Androgel priming
Androgel
Sat 11
Androgel priming
Androgel
Sun 12
Last Androgel dose
  • Priming ends (CD18)
Androgel
Week of Jul 13 — long/short fork & next period
Mon
13
CD19
Tue
14
CD20
Wed
15
CD21
Thu
16
CD22
Fri
17
CD23
Sat
18
CD24
Sun
19
CD25
Mon 13
No meds
  • Between priming & stim
Tue 14
Wed 15
Thu 16
Gonapeptyl starts — long only EST.
  • Daily downreg through stims (long protocol)
Gonapeptyl
Fri 17
Gonapeptyl — long only
Gonapeptyl
Sat 18
Next period likely (CD1) EST.
  • Next period ~Jul 18–20
Gonapeptyl
Sun 19
Stim-start window (CD2) EST.
  • Next CD2 ~Jul 19–21 — stims begin
Gonal-F 350/250Pergoveris 150
Next CD2 → retrieval — estimated
Stims → retrieval (~early August)
  • Stims start next CD2 (~Jul 19–21): Gonal-F 350 (long) / 250 (short) + Pergoveris 150 each morning. Long also continues Gonapeptyl; short adds Cetrotide mid-stim.
  • Monitoring scans in Brno ~stim day 6, 9, 11 (as in Cycle 1), adjusting doses and setting the trigger.
  • Dual trigger (Diphereline + Ovitrelle) ~36 h before retrieval, then egg retrieval ~early Aug (Cycle 1 ran ~12 stim days).
  • Exact days lock once the protocol is chosen and the period arrives — this fills into a week grid then.
↑ Back to top