The differences in this IVF protocol vs my last-

There a few differences in this fresh IVF cycle vs my last-

• For one, I'm older...My first IVF cycle was started a couple of months before I turned 35, this cycle is starting a month before I turn 39!!!!

• My last IVF protocol was standard with birth control and Lupron. This cycle will be a more aggressive protocol with Follistim and Ganirelix (no birth control suppression).
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  This protocol is our favorite for patients with very low ovarian reserve, or those who have poor response after taking BCP. In this protocol, the pretreatment cycle is a natural cycle (no BCP). About a week after ovulation, a GnRH antagonist (Ganirelix or Cetrotide) is started to prevent premature recruitment of follicles, an effect often seen in premature aging ovaries. In addition, estrogen is used to provides the young follicles an optimal condition to grow in the future. Stimulation medications are stated on day 3 of the next menses and the antagonist would be used again later to prevent premature ovulation.

• My last IVF was the standard one, this time it will be "IVF w/ ICSI". Here's a ICSI explanation:

  The ICSI Procedure.

  In conventional IVF, after a woman's eggs are retrieved, they are left in a petri dish with sperm in order to achieve natural fertilization.
  ICSI takes place in the IVF lab. Just like with conventional IVF, the female undergoes ovarian stimulation with fertility drugs, and her eggs are retrieved and incubated in the IVF lab. Then, the semen sample is prepared in the centrifuge — the sperm cells are spun through a special medium to separate live sperm from most of the dead sperm and debris. The embryologist then selects a single live sperm, which is injected directly into the egg with a small needle.
  

  Who Should Use ICSI?

  ICSI is most often used in cases of male factor infertility. The procedure can achieve fertilization when the man has low sperm count, or poor sperm morphology (shape) or motility (movement), or the sperm have trouble attaching to the egg. It can also be used when a blockage in the man's reproductive tract keeps the sperm from getting out, in which case a testicular biopsy is performed, and testicular sperm are used.
  Patients may also choose to undergo ICSI when the male partner has variable sperm counts, there is unexplained infertility, or the couple has failed previous attempts at IVF. In fact, some fertility clinics use ICSI for all fertilizations.

Common reasons used for performing ICSI

1. Severe male factor infertility that do not want donor sperm insemination.
2. Couples with infertility with:
   • Sperm concentrations of less than 15-20 million per milliliter
   • Low sperm motility - less than 35%
   • Very poor sperm morphology (subjective - specific cutoff value is debatable)
3. Having previous IVF with no fertilization - or a low rate of fertilization (low percentage of mature eggs that were normally fertilized).
4. Sometimes it is used for couples that have a low yield of eggs at egg retrieval. In this scenario, ICSI is being used to try to get a higher percentage of eggs fertilized than with conventional insemination of the eggs (mixing eggs and sperm together).