QuestionHI there, I am on day 6 of gonal-f 300iu and yesterday was told that my estrogen levels were the same as at my baseline visit 9 days ago. They saw only 1 follicle at ultrasound yesterday. My question relates to my cycle and if this could be the cause of either bad timing or a effect of the birth control pills I had been on. They put me on b/c pills for 2 months prior to cycle- skipping placebos so I missed one menstrual cycle. After discontinuing b/c pills 9 days ago I had bleeding that was heavier than spotting but lighter than my regular cycle. They did not put me on lupron or anything prior to this gonal-f so that is the only stimulation I have had. What is likely the problem here? Should I have been on something prior to the gonal? Could the b/c pills have screwed up my ovulation? Also I have only one ovary and a fully blocked tube- can that have any adverse effects on drug stimulation? Does this sound like they will cancel the cycle- it is my first and its been tough. Many thanks for your time.
AnswerHello Alexis from the U.S.,
The CD#7 estradiol level is an indication that you are not responding to stimulation at this dose. It has nothing to do with the birth control pill or the length that you took it. 300IU of only Gonal-F is a very low dose. It is one of the lowest protocols that I use. In addition, many clinics use both Gonal-F (FSH) and Menopur (FSH/LH), called a mixed protocol. There have been some studies that show better stimulation with the mixed protocol than the pure FSH protocols. In any case, you dosage should be increased, and I would consider doubling the FSH dosage as 450IU Gonal-F plus 150IU Menopur. That may help to resurrect the cycle and recruit more eggs. If you are too far into the cycle, this may not help because the dominant follicle will already be in place and the ovary will be ready to retrieve way before the new follicles have a chance to grow. In that case, you may want to consider either canceling the cycle and hoping for a better response at a higher dosage of medication or completing the cycle with the one egg and hoping that it is good enough to get you pregnant. I have had many pregnancies with just one follicle and one egg. You never know, it may be the perfect one and it would be a shame to give it up. But, you have to be prepared to have nothing to put back and the cycle will have cost you the same. So often it is an economic decision.
Good Luck,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf
