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3marie - August 11th, 2007 6:00 PM

Dr. Jacobs,

I'm a 33yo female with Day 3 FSH of 10 and Day 3 estradiol of 78. I have asymptomatic endometriosis with a 2.5cm endometrioma on one ovary and two 1cm endometriomas on the other. My husband has low strict morphology ranging from 1.5 - 3.5% normal. We have decided to pursue IVF with ICSI. Given my relatively high FSH of 10 for my age (33), if I came to see you, what type of protocol would you recommend to maximize success -- a Lupron protocol, a microdose flare, a GnRh antagonist protocol, or something else?

Also, what are your feelings on the use of baby aspirin and Medrol during IVF? Are they of any use in women with endometriosis?

Thank you very much!
Marie

B. Jacobs, M. D. - August 12th, 2007 8:38 AM

First, I would test to determine if you are making an adhesion molecule felt to be important for an embryo to implant. Endometriosis can impair production of the adhesion molecule. Treatment of the endometriosis may help to restore prroduction. I would also do a follicle count of your ovaries. If you have a large number of small follicles vivible, I would use a long Lupron protocol. If you have only a few, I would use a microdose flare protocol. I do use a Steroid, like Medrol after retrieva, but I sopped using aspirin. There were some reports from Europe implying it may increase the risk of miscarriage.
Good luck.


3marie - August 12th, 2007 3:22 PM

Hi Dr. Jacobs,

Thank you so much for your quick response. Your replies are extremely helpful. I had a Day 6 antral follicle count of 11. Given this, would you favor the long Lupron protocol or the microdose flare?

Many thanks!
Marie

B. Jacobs, M. D. - August 13th, 2007 6:42 AM

Again, this has to be the decision of your program. I think a long Lupron protocol MAY be a reasonable one for you.
Good luck.


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