QuestionDear Dr,
I am 38 yr female, used to get pregnant pretty easy with other male partner; now due to my husband's antisperm antibody (low mobility of his sperm), we have to go through IVF, my FSH is 4.0 on D3, antral follicles are 25; in my 1st IVF cycle, I started suprefact 0.5mg/day x 14 days, then gona-f 225 IU plus luveris 75 IU x 3 days, on stim D3, I went BW and U/S, they found my E2 was too high 1137 pmol (normal range is 250-500), but US showed my follicles were not growing, so my 1st cycle was cancelled; I am so frustrated, I want to know if my ovaries responded quite well (E2 was so high), or my ovaries responded poor (total found 6-7 follicles range from 7-11mm), but I was stimmed for only 3 days? can you give me any idea?
Thanks a million !!!!
AnswerDear Alice,
Thank you for your question. I have to admit that I am a little confused. Your ovaries were certainly hyper-responsive, as evidenced by the high estradiol. They probably cancelled because of the threat of hyperstimulation syndrome if they were to continue the cycle until the follicles were the appropriate size. That is an okay choice, since it was so early in the stimulation I would not have cancelled but continued the stimulation then coasted you as necessary. We don't cancel in the U.S. because of the cost of medications and the cost of the cycle to the patients. We try to make the best of every cycle.
The good thing is, now your doctors know how you will react and can plan for a lower protocol in the next cycle. You were on a 300 IU protocol, so you probably can drop to a 150-225 protocol.
In terms of the ultrasound findings, the follicles were fine and appropriate for being on the 3rd stimulation day of the cycle. It generally takes 8-14 days for the follicles to reach the appropriate size.
I hope that answers your questions.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
