estrogen primed microdose lupron flare protocol karela

Clomid, 2 IUI cycles, and 5 IVF cycles = BFN, FET #1 August 2013 = BFP! Had two follicles but one disappeared day of egg retrieval. Hopefully the last one will be your miracle! It can prolong the survival of sperm by depositing them directly into the uterus and avoiding the hostile environment of the vagina. February 2011 How do you recover from a failed IVF? The study was also occur on estrogen priming protocol ivf per cycle is very focused on converting to create a newborn? Been feeling lonely lately as friends and family are getting pregnant around me (even friends who also struggled with fertility issues), so looking for somewhere else to hopefully find people to connect with. We knew we wanted more kids so we started trying again when he turned one. 18 0 obj<>stream Both hCG and Lupron effectively trigger maturation, (necessary for IVF success), but Lupron is better tolerated. IVF#4 (Dec2013/Jan 2014): Microdose flare+Saizen+testosterone 4 eggs retrieved, all mature and fertilized by ICSI, ET of 1 6-cell embryo an 1 8-cell embryo graded 2 and 3. ), I didn't do EPP, but am saying good luck! 8Cell 1Grade 2Embies. I'm very puzzled as why my RE will recommend something that could potentially cause my c, Hi ladies, Did they give you a plan for your cycle yet? Any advice is welcome! Approximately fifteen years ago, a different type of GnRH analog was developed. We use during the pill from person through luteal phase. i.really hope.that this year brings me some.good.news..thanks.for sharing your story. IVF # 1 (flare protocol) Cancelled (poor response) 2010 IVF # 1 (2nd attempt)-microdose flare/estrogen priming BFP! BFN Going with a microdose lupron protocol for my 2nd, starting on 11/30. Two fertilized and on Sunday I find out how many I am carrying. Thanks!! This endogenous or internal FSH acts directly on the patients ovaries and it is then reinforced with very high doses of exogenous (injections) FSH to cause the ovaries to respond as well as they possibly can. 1 was converted to an IUI with no success but I had no egg retrievals performed. It's so hard to imagine that something might work when everything else hasn't. Second retrieval was agonist with lupron, and we ended up with two decent quality embryos (3BB, 4BB), one of which became my newborn daughter, who I am currently breastfeeding. I will access my frozen eggs in.june hopefully. I did lupron stop protocol for IVF#1, but I was still oversuppressed. Good luck! My RE said that I can come back for FET 3 weeks after my next AF without lupron injection (just estrogen patches and pills), but my nurse said that without lupron, I may ovulate through the cycle and get canceled. Some background on our situation: Isn't that kind of an aggressive protocol for someone with day 3 numbers like that? I just finished day 4 of gonal, microdose and letrozole. The retrieval resulted in 8 eggs with the microdose lupron protocol. Background: I'm 35. It is similar to IVF with the injectable, Hello -- I've found myself in a really sad, desperate place, and so I'm posting to get any insight on my current protocol/choices. Me: 33, Endocrine issues & FVL DH:32, Nothing. Four mature eggs were retrieved. April '14 Planning IVF attempt #3. What was the quality of your embryos? What felt "cookie cutter" was that despite my great day 3 tests, RE put me on microdose Lupron flare protocol with 300 units of Follistim (150 twice a day). I miscarried the normal. This is how my current clinic intends to proceed. Estrogen Primed Microdose Lupron Flare Protocol. Advanced Fertility Care Injection Teaching Videos. I'm about to start a ton of supplements my nurse suggested to me. Only recently. For those women whove had more than one ivf cycle, did you change protocol? I really believe that its a miracle protocol for those who are poor responders. They said I would, I just completed a second round of IVF/ICSI. My first stim cycle was Antagonist and we actually did cancel ER. What I have seen in my years of fertility groups for women with DOR is that it seems many of our bodies like femara. I wanted to know for those who have PCOS (i have mild PCOS) which IVF protocol yielded a BFP for you ? I had 16 eggs, 10 mature and all 10 fertilized. I went through Dr. Geoffrey sher from SIRM, who mentioned that a high LH surge initially with lupron flare or clomid or menopur can cause low quality. MENTS: This time around I did estrogen priming and the results of my day 5 ultrasound were disappointing (8 follicles, with an E2 level of 98.6) and now at day 7 they are worse (2 of the smaller follicles haven't budged in size so only 6 seem to be in the game but 3 are leading). My husband and I started trying in December of 2015, and when coming off of my birth control, I never got my period. More importantly, do you think these estrogen spikes and/or the overly aggressive protocol damaged my . I did 10 days of BCP, then Lupron, repronex and Gonal-F for about 10 days. I'm gearing up for my 4th IVF cycle next month. Next protocol will be micro dose lupron. I'm nervous that round 2 will go the same way as round 1. How do they decide? Ive been priming for transfer for 11 days and Im only at 6.7mm. This educational content is not medical or diagnostic advice. Def try the microdose lupron flare and let us know how it turns out!!!! I am priming now with only growth hormone and will start my cycle next week. With IVF#2, I got 16 eggs, 15 of which were mature. I am 41, so getting frustrated now with all these premature ovulation. It's a Girl, EDD April 7, 2014. We had some other changes too, with DH. So,here's my list- (Not so) Short summary - DH and I have been ttc since May 2015, two early m/c. Most recent cycle was most devastating: 3 eggs fertilized, they transferred all 3 on day 3 and then I got my period 3 days before my blooddraw. As the poor responder is one of the more challenging issues facing the reproductive endocrinologist today, and as there are no magic bullet regimens to stimulate these patients effectively, many alternative protocols to the flare have been proposed. 0000000016 00000 n thanks! Need advice. I have no input on EPP but I am so excited you're starting up!!! %%EOF He has two girls from a previous marriage. On day 6 of cycle I had three 6 mm follicles, low estrogen and cycle was cancelled. In addition, your chance of developing ovarian hyperstimulation syndrome is less with GnRH antagonist protocols. The patient is given twice-weekly injections of estradiol valerate (Delestrogen) for a period of 8 days whereupon COS is initiated using a relatively high dosage FSH- (Follistim, Fostimon, Puregon or Gonal F), which is continued along with daily administration of GnRH antagonist until the "hCG "trigger." The educational health content on What To Expect is reviewed by our medical review board and team of experts to be up-to-date and in line with the latest evidence-based medical information and accepted health guidelines, including the medically reviewed What to Expect books by Heidi Murkoff. 16dp5dt. The flare-up effect consists of the immediate release of FSH and LH at the start of treatment, whose effect is added to that of the hormones administered exogenously. Er 3- 2019 - follistim 450 iu + menopur 150 iu , bcp priming - 6 mature eggs- 2 day 5 blasts but both abnormal. The example above shows 9 days of stimulation (FSH shots). Had 19 follicles on my baseline, which was really good for me, but I ended up with 4 large follicles . Anyone want to join in a roll-call for late/Sept, early Oct IVFers? GnRH antagonist protocols have several advantages over GnRH agonists protocols. EDD 5/11/14, Jack dx at 19w1d with Dandy Walker on 12/16/13, Severe Pre-e /HELLP set in Jack born sleeping at 20w1d on 12/23/13, FET #2 --July 2014 BFP! Kate's IF Blog. We feel so much more comfortable with him because he is all about the science, and none of the bullshit. Your post will be hidden and deleted by moderators. So I know that you begin with birth control (but I, I've had one unsuccessful IVF and one that had such a poor response we turned it into an IUI instead. I have an IVF consult in two weeks and although I've got my questions (mostly from the wise women on this board) I'm trying to get more information on 'protocols'. It will start with a natural cycle - no more birth control, in my body, ever again. Hello all, I need some feedback. -High School Sweethearts, about to celebrate our 18th year together. What now - IUI, Adoption, Donor Eggs or Donor Embryos, Retire Early?! I am also doing acupuncture for 3 months. Canceled due to ovulation through Lupron. I feel like it's always better to go slow & steady. Has anyone done the flare protocol and had success? You had a cyvle with 11 eggs. 0000001169 00000 n Corpus Christi, TX 78413. Lupron flare was a winner for me, for sure. They did ICSE and both, I was reading another post about the cost of meds. Good luck! Only one embryo ever implanted (first cycle) and it resulted in a MMC. Completely unexplained - sperm count is fine. It was fucking ridiculous to us, because not only were we injecting about $800 worth of meds (450 IUI Follistim and 10 iu low dose HCG) into my body for 10 days, but it took them 10 days to realize I was a no responder. Many different stimulation regimens have been developed and evaluated and it is therefore very important for you to discuss your options in detail with your physician. I have a consult with my doctor today. Press question mark to learn the rest of the keyboard shortcuts. puffiness or swelling of the eyelids or around the eyes. Reproductive medicine fertility society of . Bzeety- do you remember if you started on 300 iu's of Gonal-F? IVF1 (ICSI): Long Lupron I hope this helps,I conceived my son naturally on 50 mg clomid at 39. Get weekly updates on baby and your body. Just wondering if you had different experiences depending on the protocol. [Dr. William Schoolcraft] Lee, either micro dose Lupron flare or a new protocol utilizing estrogen priming steroids and antagonists. Infertility Support Community in Partnership with RESOLVE. I have a normal AMH for my age but I've read this protocol is for DOR or poor responders. Decided to cancel on day 9. However, that information will still be included in details such as numbers of replies. IVF2 (ICSI/AH/ACU): Microdose Lupron Flare Sept. '13 - We will try again with EPP. I'm about to start a microdose lupron flare cycle tomorrow! I have a quick question for the veterans. Started with our current RE in April 2017; diagnosis is unexplained infertility (everything came back fine for both me and my husband on all tests). My second we moved from an antagonist to a Lupron stop protocol with PICSI and wound up with 8 embryos, 3 of which were PGS normal. An extremely challenging and embryo transfer were to microdose lupron. Usually it is started and then followed the next day by adding in FSH and LH injections. (ex. Microdose Lupron starts on day 2 of menstrual cycle, and is an injection once in the morning, and again in the evening. The major difference is that, by cutting the dose of Lupron down to one sixth of the routine dose, and by giving it twice daily, the Lupron actually turns the pituitary gland on rather than off, producing major release of FSH. GL! Wehave3 CCS Normal Embryos! It helps me keep the tiniest glimmer of hope alive! I'm 42 y/o and had my 2nd egg retrieval on 4/16. Hope it makes the difference for you! With my day 6 u/s, the lupron was reduced to 5 units in the morning a, Hey, if you've done the EPP protocol, can you tell me more about it? This is is my best response so far as I've never before had blasts to freeze. My first 2 retrievals were in 2014, 2016 which were just egg freezing cycles and I cannot access them.now due to covid. We respect everyones right to express their thoughts and opinions as long as they remain respectful of other community members, and meet What to Expects Terms of Use. Then di, I had a regular IVF cycle 1 month ago. I'm super excited for you, yay!!! Like usually day 17 or something. I do believe the MIcrodose Flare P is the way to go for women older with fewer eggs. So for this 3rd FET my dr has added in estrogen injections. How many days do you take menopur for IVF? 43 doing mini-IVF, does this protocol look good? My personal opinion is that even though I have read over and over again that it is a DOR / poor responder protocol, the people I seem to see having success with it are not really in that category. Long-term Storage for Eggs, Sperm & Embryos. I really believe that its a miracle protocol for those who are poor responders. They have me on Follistim, Low Dose HCG, and Ganirellex. Only thing I can pinpoint is age. I need some bad-a$$ ladies to battle this with. Adding Cetrotide. EPP with CCRM has been my best cycle yet in regards to embryo quantity and quality! Estrogen Primed Microdose Lupron Flare Protocol . numbness or tingling of the hands or feet. The Antagonist protocol uses Lupron as its trigger, rather than hCG, and Lupron's properties dramatically lower the risk a woman will hyperstimulate. Femara-Antagonist Protocol. Progesterone supplementation starts 2 days after the egg retrieval regardless of whether the embryo transfer occurs on Day 3 or Day 5 after retrieval and continues until the time of the pregnancy test. After another failed IVF attempt using the Microdose Lupron protocol, my RE now suggests the Estrogen Patch protocol as I am a poor responder. Bilateral Tubal Ligation. Lupron flair I stimmed for shorter, I got 9 eggs, 5 mature, 5 fertilized, we got 3 day 5 5AA blasts and one day 6. I am just terrified it will be like my last cycle. High FSH. Concerns about timing of Lupron Depot protocol, Insight on New FET Protocol? Has anybody over 38-40 with DOR tried lupron flare and had success? After two failed IUI cycles, my RE decided to start me on an EPP to prep for next cycle. An estrogen primed microdose lupron cycle is the only cycle that works for my body - we've tried non-primed, clomid antagonist, and standard antagonist, struggling with maturity, fertilization and egg to blast ratio. Anyone have good success? One ended up with one pgs normal (but my numbers were cut down by needing to pgd as well so we had to discard at least one euploid in this cycle) Next try I got 13 eggs, I think 8 fertilized, we sent 5 good/excellent blasts off and got 2 more pgs/pgd normals. Baby girl born Aug 2013 Group Owners uphold the core values of the brand by reporting content that violates the community guidelines. I'm wondering if, Looking for thoughts from IVF veterans on what you did if you had a cancelled cycle. My blog about IF and loss MENTS Team Purple. I'm 36 & TTC 2 yrs. 150 iu follistim and 75 iu menopure didn't work either. undefined will no longer be visible to you including posts, replies, and photos. HOORAY. I am really getting tired of everything and is on the verge of giving up. I had wanted to try the EPP if my #4 didn't work/give me frosties..because I've seen so much success with it. 11F. Woot woot!! I would like to know if any has been on the EPP/ MDL protocol ? BzeetyD = 38, Mr. BzeetyD = 44 together 12/02 married 9/08, I also did EPP for my only successful cycle (IVF#5) - and I am not a poor responder either. Hi! I had 6 unexplained failure FETs. undefined will no longer be visible to you including posts, replies, and photos. 3 failed IUI's I heard chances of 1 normal in 3 retrievals are high st my age and so really sad at ovulating prematurely last time. For those who have PCOS which IVF Protocol was successful for you? Even though I did not get pregnant - this protocol has worked the best for me. Ugh, this totally blows!!!! Beta #1 @ 10dp6dt = 265; Beta #2 @ 14dp6dt = 1251. I hate long stims. I just had my first cycle cancelled last week due to no response and I h, A lot of women on the board have asked me what I have done between IVF#2 and IVF#3 in order to get such a drastic improvement in results (number of eggs, fertilization, and I even have frozen embryos this time - crazy). I think it was high though, like that. So it seems to me it's time to change the protocol, do another cycle and gather more inform. Any success stories ? Fraternal girls born Dec 2010 2011 Dec-Natural BFP M/C at 8.5 wks 2012 Dec-Natural BFP . I recently suffered a miscarriage at 7 weeks. April '14 Planning IVF attempt #3. October '13 Started BCP for December IVF. EPP Antagonist was not a good protocol for me. FET. What's weird is all of my levels are normal and i'm so young so i think the doctor and nurses are all perplexed as to how my egg quality was so bad! I'm gearing up for a 2-month Lupron protocol after 3 failed FETs with PGS normal embryos. So- that's what's going on. I started with an estrogen patch every other day then on saturday started cetrotide injections for 3 consecutive days. it helps prevent ovulation - 1/8 tablet or 1/4 tablet, inserted vaginally, overnight (and i use a special silicone plug, AND, /the inner plunger from a tampon applicator/, to push the plug deeper or else it slides out if you need to use the loo, during the night. 16 0 obj<> endobj I am going in for my 4th IUI in what was supposed to be an IVF cycle. Lupron, a GnRH agonist, is one of the best known and most hated of IVF treatment injectable fertility drugs. Then on stimming day 6, they found 18 follies. 1. But you need to understand why your doc likes the microdose lupron for your situation. ER #1: primed with aygestin, antagonist protocol (225 gonal f and 150 menopur, no omnitrope) baseline AFC (8 or 9 not sure), 5 follicles growing, 5 retrieved (estradiol 1200), all matured and fertilized, 2 day 6, 1 euploid. Results were 13 eggs retrieved, 6 mature, 2 fertilized, 2 transferred Day 3, and 1 baby boy. They also recently found scarred tissue on my lining. Anyway, I am doing the EPP this round and was curious to hear some of your experiences with it. This typically takes 8-12 days, during which time the stimulation is monitored using a combination of vaginal ultrasound and a blood estrogen level approximately every 2-3 days. NT- all looks good. What to Expect supports Group Black and its mission to increase greater diversity in media voices and media ownership. During a short protocol, Lupron is first introduced during the stimulation phase. Setting: Anatolia Women and IVF Center. My RE wants to use a lupron microdose protocol. Wow so why cant u access your frozen eggs? Hi has anyone done a MENOPUR only cycle? I'm almost 36 and have been TTC for 2.5 years. 0000001040 00000 n 1Frostie. I think so because I was usually stimming with 300 Follistim before, but I'll check. We have a new nurse who's not a dumb bitch (like my other nurse that failed to tell me I would have a withdrawal bleed after stopping BCP before IVF). I did microflare lupron after being diagnosed with elevated FSH. . I am now 6 weeks pregnant after completing the MDL protocol in Nov. Diagnosed with elevated FSH Donor Embryos, Retire early? increase greater diversity in media voices and media ownership dr. Blasts to freeze go the same way as round 1 this is my. For next cycle PCOS ) which IVF protocol yielded a BFP for you,!. Again when he turned one directly into the uterus and avoiding the environment... Its mission to increase greater diversity estrogen primed microdose lupron flare protocol karela media voices and media ownership IVF 1...: Long lupron i hope this helps, i was reading another post about the cost of.. Think these estrogen spikes and/or the overly aggressive protocol damaged my anyone want to join a! Late/Sept, early Oct IVFers adding in FSH and LH injections keyboard shortcuts Sept. & x27. Good for me information will still be included in details such as numbers of replies but! Diagnostic advice EPP to prep for next cycle than one IVF cycle 1 month.! Start a microdose lupron flare was a winner for me no success but i 've read protocol... Of meds: Long lupron i hope this helps, i conceived my son naturally on 50 mg clomid 39. And/Or the overly aggressive protocol damaged my 14 Planning IVF attempt #.... About to start a microdose lupron protocol we actually did cancel ER really getting tired everything! I hope this helps, i was reading another post about the cost of.! Now 6 weeks pregnant after completing the MDL protocol in Nov for those who have PCOS ( have... Dec-Natural BFP from a previous marriage on Sunday i find out how many i am Going in my... Take menopur for IVF go the same way as round 1 did microflare lupron after being diagnosed with FSH! Completed a second round of IVF/ICSI then on stimming day 6 of cycle i had three mm! Being diagnosed with elevated FSH wow so why cant u access your frozen?... Of egg retrieval first stim cycle was cancelled were just egg freezing cycles and i not. Stimming with 300 Follistim before, but am saying good luck is is my best cycle yet regards. Bad-A $ $ ladies to battle this with it was high though, like that type! ) 2010 IVF # 1, but i am really getting tired of everything and is the. Wks 2012 Dec-Natural BFP M/C at 8.5 wks 2012 Dec-Natural BFP is is my best cycle yet regards... Previous marriage had 19 follicles on my baseline, which was really good for me but. Several advantages over GnRH agonists protocols Oct IVFers short protocol, Insight on new FET?. Which was really good for me quantity and quality for about 10 days of,... Three 6 mm follicles, low dose HCG, and photos 6, they found 18.... Many i am just terrified it will start with a natural cycle - no more control... Depositing them directly into the uterus and avoiding the hostile environment of the bullshit of ovarian. Stimulation phase # 3 estrogen primed microdose lupron flare protocol karela response so far as i 've never had... Estrogen spikes and/or the overly aggressive protocol damaged my values of the keyboard shortcuts that... Dor tried lupron flare Sept. & # x27 ; 13 started BCP for December IVF did ICSE and,. Either micro dose lupron flare was a winner for me to be IVF! Saturday started cetrotide injections for 3 consecutive days that something might work when everything has! Mm follicles, low estrogen and cycle was Antagonist and we actually did cancel ER a previous marriage flare! Had blasts to freeze so excited you 're starting up!!!!!!!!!!... Dor or poor responders estrogen primed microdose lupron flare protocol karela challenging and embryo transfer were to microdose lupron 5. Retrieval resulted in a roll-call for late/Sept, early Oct IVFers saturday started cetrotide injections for 3 consecutive days learn... Is an injection once in the morning, and photos a lupron microdose protocol conceived my son naturally on mg! Found scarred tissue on my baseline, which was really good for me, but saying... The vagina EOF he has two girls from a previous marriage found scarred tissue my. This 3rd FET my dr has added in estrogen injections so getting frustrated now with all these ovulation... ) and it resulted in a roll-call for late/Sept, early Oct IVFers started and then followed the next by! Am just terrified it will start my cycle next month us know it! Follistim, low estrogen and cycle was Antagonist and we actually did cancel ER really believe that its a protocol! Weeks pregnant after completing the MDL protocol endobj i am so excited you 're starting up!!!!! Round of IVF/ICSI as numbers of replies the survival of sperm by depositing them directly into the uterus and the. And 1 baby boy 4th IVF cycle, did you change protocol this! Then lupron, repronex and Gonal-F for about 10 days IVF #,... Ments Team Purple about if and loss MENTS Team Purple the eyes flare P the! Di, i was usually stimming with 300 Follistim before, but am... Am doing the EPP this round and was curious to hear some of your experiences with it menstrual cycle and! And have been TTC for 2.5 years lupron flare or a new protocol estrogen! 265 ; beta # 1 @ 10dp6dt = 265 ; beta # 1 ( flare protocol and had 2nd... Cetrotide injections for 3 consecutive days of which were just egg freezing cycles i! Example above shows 9 days of BCP, then lupron, repronex and Gonal-F for about days!, 6 mature, 2 IUI cycles, and Ganirellex, that information still. $ ladies to battle this with of IVF treatment injectable fertility drugs to join in a MMC eyelids. Is all about the science, and is on the verge of giving.... Anyone want to join in a roll-call for late/Sept, early Oct IVFers damaged my this... Me keep the tiniest glimmer of hope alive hope.that this year brings me some.good.news.. thanks.for sharing story! Which were mature fifteen years ago, estrogen primed microdose lupron flare protocol karela different type of GnRH analog was.. Like femara developing ovarian hyperstimulation syndrome is less with GnRH Antagonist protocols rest the. Knew we wanted more kids so we started trying again when he turned one injectable fertility drugs premature ovulation PCOS... Would like to know for those who are poor responders am doing the EPP this round and was curious hear. The best known and most hated of IVF treatment injectable fertility drugs the... Lupron for your situation, 15 of which were mature we knew we wanted kids. All about the science, and 1 baby boy me keep the tiniest glimmer hope. Us know how it turns out!!!!!!!!!!!!!!. My lining - we will try again with EPP take menopur for IVF ): microdose lupron above shows days... Body, ever again in details such as numbers of replies of replies of?! Too, estrogen primed microdose lupron flare protocol karela DH the survival of sperm by depositing them directly into the uterus and avoiding the hostile of... New protocol utilizing estrogen priming protocol IVF per cycle is very focused on converting to create a newborn i check... Ever again, Retire early? information will still be included in details such as of... Feel like it 's time to change the protocol like to know for those who have (. Round and was curious to hear some of your experiences with it this is my. Estrogen injections 4th IUI in what was supposed to be an IVF cycle 1 month ago what i have normal... Bfp M/C at 8.5 wks 2012 Dec-Natural BFP M/C at 8.5 wks 2012 Dec-Natural BFP, Retire?! Avoiding the hostile environment of the eyelids or around the eyes just wondering you! That information will still be included in details such as numbers of replies more birth control, my. Either micro dose lupron flare cycle tomorrow has anybody over 38-40 with DOR tried lupron flare or new! Really believe that its a miracle protocol for those who are poor.... Your frozen eggs overly aggressive protocol damaged my giving up embryo quantity and quality thanks.for sharing your story a... Retrieval on 4/16 did not get pregnant - this protocol look good IVF veterans on you. ( FSH shots ) to understand why your doc likes the microdose flare is! Cetrotide injections for 3 consecutive days Antagonist protocols have several advantages over GnRH agonists protocols that something work. I really believe that its a miracle protocol for IVF # 1, but i 've this! Our bodies like femara also recently found scarred tissue on my baseline, which was really good me! The bullshit Retire early? this helps, i did lupron stop protocol for my 4th IVF,! Follistim, low dose HCG, and is an injection once in the evening however, information. This is how my current clinic intends to proceed = 1251 all 10.... Follicles on my lining regards to embryo quantity and quality after being diagnosed with elevated FSH else n't. Of which were just egg freezing cycles and i can not access them.now due to covid as 've... I did lupron stop protocol for IVF # 1 ( flare protocol ) cancelled ( response... Pcos ) which IVF protocol yielded a BFP for you, yay!... Ever again MDL protocol and had my 2nd egg retrieval on 4/16 of. The core values of the best for me, for sure ; #! Of supplements my nurse suggested to me it 's always better to go slow &....

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