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I just met with my doctor today, and I'm concerned about the protocol she is planning. I am 42, AFC avgs 6, normal day 3 fsh / e2. During IUI, I get 2 - 5 follicles using 225iu bravelle.
This is the protocol:
Start BCPs day 3 of cycle preceding IVF.
Add 10 units Lupron on day 19 preceding IVF
On CD 2 of the IVF cycle, lower Lupron to 5 units and continue until trigger, also start 225 fsh / 150 menapur.
I'm concerned that the length of time on Lupron will over-suppress me, and that the dose of fsh is not high enough.
Would really appreciate any input from you.
Thanks very much,
Sophie
Dear Sophie,
In all fairness, your physician examined you personally, knows your history better as well there is a controversy over the issues of over- suppression and aggressive stimulation for IVF.
That being said, I recently had a 42 year old patient with a normal e2/fsh, an AFC of 6 who I stimulated
for IVF starting day 1 of her cycle to avoid potentially over suppressing her. I also gave her estradiol and pretreated her with DHEA in an attempt to maximize the number of follicles we could stimulate during the recruitment phase of her cycle. I additionally, stimulated her with a higher dose of gonadotropins and suppressed her with ganirelix when her lead follicles were 14 mm after her follicles were recruited (selected for maturation for IVF cycle).
I have seen too many patients with borderline ovarian reserve respond inadequately after suppression and then have a more robust stimulation in a cycle where they did not experience this "over-suppression."
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