Protocol-Egg/Embryo quality
7 Replies
jmr67 - January 15

Dr. Jacobs,
I know it is widely used, but I also understand there is some controversy with regards to the MDL flare protocol with respect to the resulting egg/embryo quality. What I heard is the initial high levels of androgens specifically in older patients could possibly be detrimental. Can you give me your thoughts on this?


B. Jacobs, M. D. - January 16

For my patients who are over the age of 35, I routinely use a microdose flare protocol Our pregnancy rates in that age group are almost as good as for our younger patients. Remember, age has a great deal to do with egg quality.
Good luck.


jmr67 - January 16

So do you disagree with the theory that initial high doses of androgens (produced with MDL flare) could be detrimental to egg quality? I have had two twin miscarriages. I know at 39 only 20-30% of my eggs are good but 4 out of 4 makes me think it could be possibly more than just bad luck and that a protocol change might be worth a try. Can you give me any advice or do you need to know more about my case? I have no known issues other than age. We do IVF/ICSI due to male factor (low count, good motility, low morphology). SCSA is in excellent range. Would it be worth another try with the same protocol?


chase - January 16


Did you also use LH during your stimming? I too am concern about the flaring effect of natural LH from the administration of microdose lupron. I would also like to know what Dr. Jacobs thinks of the impact that endogenous LH (produced from MDL) has on egg quality.


chase - January 16

jmr67, also

Have you had a full term pregnancy? Did you test for any immune issues or use decadron, baby aspirin, or herparin during the cycle? I have heard that these things have been instrumental in preventing miscarriages in women with a history of m/c after IVF. I am sorry to intrude but I am around your age and am having my 1st IVF with the MDL protocol. Did you use MDL all three times?
Thank you very much.


B. Jacobs, M. D. - January 17

Only about 1/3 of the eggs a woman make sin her life are capable of a successful pregnancy. The numbers get worse after the age of 35. We do not see a problem caused by the flare of both FSH and LH useing the microdose protocol. However, I use only FSH for stimulation. I do not use any product which has LH as a componant. We do not see a higher miscarriage rate.
Good luck.


jmr67 - January 17

Thank you Dr. Jacobs - that helps a little as I used Repronex which I believe has LH in addition to Gonal-F. I was wondering if you could respond about the part where I wrote I had 2 twin miscarriages and was thinking 4 out of 4 eggs might be more than just bad luck with the eggs. Do you agree there must be something else going on? Was wondering if you had any advice - try again? I know you may not have enough detailed information about my medical history but just in general 4 out of 4 bad seems like more than bad luck to me.

Chase - yes I used MDL flare all 3 times. Please check my profile and email me personally - I think we could possibly be alot of support for each other!


B. Jacobs, M. D. - January 17

although we usually do not perform an evaluation for recurrent pregnancy loss until 3 miscarriages, I would not object to such an evaluation for someone who requires IVF and has had 2 consecutive IVF losses. For more information about recurrent pregnancy loss, please see our web page, <>.
Good luck.



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