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Hello Dr. Jacobs,
What do you feel is the appropriate time between stopping birth control and starting stimulation meds? Also, what are your thoughts on the length of time on birth control before starting a cycle? My observations of 2 facilities re: the time between stopping birth control and starting stims varies by a day or more. Additionally, one facility limits time on birth control before a cycle and one does not. I am about to try a 3rd IVF cycle. The first - chemical pregnancy. 5 months later 2nd cycle - cancelled due to low response to stims. The 2nd cycle I was on birth control 44 days and the first 32 days. My FSH prior to the 1st cycle was 6.5. It is now 9.3. This time they suggested I limit my time on birth control. I was given the highest dose of stims they give both times. Originally we underwent IVF due to MF infertility. Now it appears we have an additional problem!
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The vast majority of the couples in my practice have more than 1 problem. For my IVF patients, I have them use birth control pills for at least 1 pack, before starting stimulation on pill day 28.
Good luck.
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Do you mean they take active pills for 28 days? Or would they take active for 21, then sugar pills for 7 then start stimulation?
Do you think the length of time on birth control (if it was too long) could inhibit response to stimulation?
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It really does not seem to matter how many months the pills are taken, as long as there is a week after the last hormone pill (# 21 in the pack) and the beginning of the FSH stimulation.
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I know you are very busy and this forum you provide is truly priceless. Sorry for so many questions, but could you go into a little detail about why you wait one week? My facility and one other I know of only waits 4 days. Obviously as you can see I have had one cancelled cycle and want to be as knowledgeable as possible about the protocol they are putting me on. I value your opinion. What do you use for your "flare" protocol and do you include Lupron as well?
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I use a microdose flare protocol for my patients who are poor responders to the FSH products we administer.
Good luck.
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Could you explain what goes on in the body between the final active birth control pill and the start of stimulation meds?
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The hormone levels from the birth control pills fall. The result is similar to the natural fall of estrogen and progesterone in an ovulatory cycle.
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