Minimal Stimulation IVF
In patients with low ovarian reserve noted when the Antimullarian hormone (AMH) value of <1.0 ng/ml and few follicles are seen on the transvaginal ultrasound, the traditional IVF protocol may result in none or two eggs with one or zero quality embryo for transfer.
We have found that in these cases it is better to use a protocol that exposes the ovary to smaller doses of medications and lead to better quality embryos instead of bombarding the ovaries with maximal hormonal stimulation. With the minimal stimulation protocol we initiate stimulation around day 3 of the menstrual cycle with a combination of Clomiphene Citrate along with gonadotropins injections like Gonal -F (Follicle stimulating hormone) and Menapur( Follicle stimulating hormone and luteinizing hormone) .
The purpose of Clomiphine combination is the reduction in the dosage of the injections used and a smoother control of egg (oocyte) growth, which will hopefully translate into better quality. Monitoring will be performed with a transvaginal ultrasound and hormone levels of estradiol progesterone and Luteinizing hormone around days 3, 6, 8 and 10 until the leading follicles reach the size of 20- 22 mm.
The stimulation can be repeated in the following menstrual cycle or at another month until we are able to accumulate at least two good quality embryos or two genetically normal screened embryos. Patients are encouraged to repeat ovarian stimulation and retrievals in order to preserve their fertility if they desire future conceptions.
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