How many rounds of IVF?
7 Replies
Annette - March 11

Dear Dr. Jacob,
Firstly, thanks for the helpful advice you provide on this website. Dealing with infertility issues and IVF, there are so many questions going through your mind, it's great to be able to go somewhere for answers and support.

I would be curious to hear your perspective on how many rounds of IVF you would recommend...

I have a daughter 3 years old, conceived naturally (and quickly) but we have been TTC for #2 for over 2.5 years. All my tests were clear although I showed signs of PCOS (pearl-like cysts but not overweight or facial hair issues etc.) and hubbie was fine as well. Ended with an 'unexplained infertility' diagnosis.

Tried Clomid for 3 months, then 2 rounds of IUI, first attempt at IVF was cancelled due to OHSS (200 IU dosage, around 15 follicles in each ovaries, but estrogen over 20K, unable to retrieve eggs).

Just completed second attempt at IVF with dosage halved and 3 days of coasting (estrogen levels went over 20K again). Able to take 10 eggs (from over 25 follicles), 7 fertilised and 2 survived to Day 5. Had 1 quality BC and one-morula stage transferred. Was due to test on Monday but AF arrived yesterday. Needless to say we are both devastated.

With 2 supposedly healthy people (we are both aged 36) who have been able to conceive naturally in the past, what is going on? How many rounds would you recommend we pursue vs. going back to trying naturally? Are there any serious long-term effects of IVF that we should be aware of (how much can the body realistic go through?)...



Barry Jacobs, M. D. - March 11

If you do not achieve a pregnancy in 3 to 4 completed treatment cycles of any protocol, that protocol will not likely produce a pregnancy. It is time to do something different. Most IVF protocols use LH in one of the medications. I do not. In our program, we get better quality eggs and embryos, without adding LH. If you have polycystic ovaries, yu are probably secreting more than enoufg LH, even on Lupron. For more information about PCI, please see our web site at <>.
Good luck.


Annette - March 12

Thanks for responding to my question. 3-4 completed cycles is still a long way off. When you refer to 'something different', what kind of options do you mean?

Regarding you comment on LH, are you referring to the trigger shot taken 36 hours before EC? In which case, I took Ovidrel. Are you suggesting not having the trigger shot prior to EC? (My daily FSH shots were Puregon and I also had Crinone 2 times a day for about 2 weeks).

I looked at your website regarding PCO, are you suggesting that limiting carbohydrates and taking Glucophage could help in my situation?

Are you also able to comment regarding the LT effects of IVF?

Sorry about all the questions,


Barry Jacobs, M. D. - March 12

The Ovidrel you used is necessary. It is hCG. Most ReproductiveEndocrinologists in the US stimulate ovaries with a combination of FSH and LH. None of the products you listed contains LH. Without having been involved in your care, I cannot make any meaningful recommendation as to alternative IVF treatment protocol.
Good luck.


Barry Jacobs, M. D. - April 20

Frankly, I do not know why, in our hands, we get better quality eggs and embryos, if we do not add any LH. I understand that our program isone of only 28 in the country who do not add any LH. Adding LH produced more follicles and eggs, but our pregnancy rates went up after we dropped the LH.
Good luck.


Barry Jacobs, M. D. - April 29

I do not why you are spotting. I have not had the opportunity to evaluate you. As far as poor follicle bevelopement, an alternative stimulation protocol may work better. If you do not have adequate ovarian reserve, you may need an egg donor.
Good luck.


B. Jacobs, M. D. - October 4

I would have to evaluate you and other findings before I can give you a valid medical recomendation.
Good luck.


kbat24 - October 4

I too have stage 4 endo and my left side does not work. I am no doctor, but I am sympathetic to what you are going through. I had laproscopy done in June and I am now going through my 1st IVF cycle (so its been 4 months since for me). In my opinion, I would go for the IVF. My insurance also does not cover IVF and we had to pay for everything out of pocket. And by no means, we are not rich.
I feel that its worth the try!!!! I don't know if I will go through it again, but atleast I'll know if I am capable of pregnancy or not. And if not, I'll move on.....
I am here if you ever wanna chat and I wish you lots of luck :)



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