Suboptimal response to ovarian stimulation

The age of the female partner and day 3 FSH level will generally predict the ovarian response to ovarian stimulation. The stimulation regimen and dosage used will depend on these factors. If suboptimal response is evidenced by low levels of estradiol or low egg numbers (less than 4 eggs) these issues will be discussed individually with the couple and recommendations made. There are a number of options:

1) The IVF cycle may be converted to superovulation\IUI if the semen analysis is normal and tubes are patent,

2) The cycle may continue to egg retrieval albeit with a lesser chance of success, or

3) The cycle may be discontinued and a more aggressive stimulatory protocol used in a subsequent cycle. This protocol is commonly known as the “Flare protocol”. This entails premedication for one cycle with the birth control pill and high dose FSH treatment used on day 3 after commencement of the GnRH agonist. The GnRH agonist used with the Flare protocol utilizes a lower dosage to facilitate better ovarian response.

If these more aggressive stimulatory protocols fail to produce an appropriate ovulatory response consideration should then be given to egg donation.