Protocol for Poor Responder
9 Replies
kidake - November 8

I am 41 years young. Conceived my daughter naturally at age 38. My first IVF cycle....they retrieved 7 eggs (4 mature and only one "normal" after PGD). I ended up miscarrying. My E2 was only 762 when my RE had me trigger. My third day FSH level has always been between 7-9. I am 41 years young.


Do you recommend BCP's in poor responder's protocol's? Not sure why my RE is adding them this cycle.

What are your thoughts on PGD? Should I do it again this cycle?

What protocol would you recommend?

Any input would be great!


B. Jacobs, M. D. - November 9

I cannot make recommendations to someone who I have not evaluated as a patient. For my patients who are poor responders, I use a micro-dose flare protocol, after birth control pills. I am uncertain if PGD provides much value for chromosome analysis of embryos. If you find embryos with the correct complement, great. Since it is common for embryos to have more than 1 cell line, you may sample an abnormal cell in a normal embryo.
Good luck.


kidake - November 9

Thanks Dr. Jacobs. One more question....does the length of time (being on BCP's) make a difference? Due to my schedule, I can only be on them for 2 weeks (not the 3 weeks my RE is recommending). Will it hurt my cycle outcome that much?


B. Jacobs, M. D. - November 9

It seems that for MOST patients 7 to 10 days is adequate.
Good luck.


lenlance - November 14

Need some advice on estrogen level. I went in on day 10 after taking tamoxifen and follistim. Only had one follicle at 10.7mm and some small ones. My estrogen level was 289.3 and they want to cancel my cycle for poor response. Can you please explain what this number actually means? Do i have any hope of more follicles developing?


B. Jacobs, M. D. - November 14

A mature follicle will produce enough estrogen to create a blood level of 250 pg/ml to 350 pg/ml. You had only 1 mature follicle. I assume they wanted more than that. I would.
Good luck.


lenlance - November 15

Today is day 11 and have been taking follistim for 4days now. Yesterday estrogen level was 289 with one good follicle. My question is today i started having EWCM, does this mean am about to ovulate? Can it be stopped with antagon to try and let the small follicles grow? or should the cycle just be cancelled?
please assist


B. Jacobs, M. D. - November 15

Cervical mucus is a sign of high estrogen levels. Contrary to popular mythology, it does NOT signal ovulation.
Good luck.


lenlance - November 17

i was told to take the trigger shot and only had one good follie and several small ones under 10mm. do you think the small one will have caught up by er 36hrs later? is there hope of them fertilizing as well?


B. Jacobs, M. D. - November 17

No, you are not likely ot get more than 1 mature egg.
Good luck.



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