AboutEdward Joseph Ramirez, MD, FACOG Expertise I am a specialist in infertility and advanced gynecological care. I can answer questions about infertility, gynecology related ills, menopause...virtually anything that affects women's health. PLEASE tell me where you are writing from as I am always interested.
Experience I have been practicing as an Ob/Gyn and Infertility Specialist for over 23 years. Gynecology, advanced laparoscopic surgery, basic infertility, IUI's, IVF, reproductive surgery, and ovulation induction are all areas of my expertise. I am Board Certified. I have been doing In Vitro Fertilization in my clinic for 15 years.
Organizations American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, Society of Assisted Reproductive Technology, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists,Resolve-National Chapter, Open Path - Northern California, Board of Directors Monterey Medical Society
Publications American Journal of Obstetrics and Gynecology
Education/Credentials Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco
Question Hello Dr. Ramirez, Thank you for taking the time to answer my questions. I have secondary, unexplained infertility. I am going through the IVF process right now. I had an ultrasound this morning (day 7 of stim) and I only have 7 follicles (14, 14, 15, 15, 17, 13, 18). I was on Lupron (10 units at first and then 5 units) and 225 iu of Follistim. I'm 30 years old with an FSH of 6.1. This response seems really low to me. Shouldn't I have a lot more follicles? How many do you usually want to see in your IVF patients? My trigger shot is tomorrow and retrieval is set for Monday. I'm very worried that we won't get any good, fertilized eggs from this.
Answer Hi Kristen from the U.S.,
You are correct that this has not been a very good stimulation. 7 follicles is a low number for somone in your age group and FSH level. You are on a very low protocol so that may explain the low response. My typical protocol for someone with your FSH level would be Follistim 375 IU and Menopur 150 IU that steps down to Follistim 300 IU and Menopur 75IU. It is not that this is a better protocol, every clinic and doc has their own pet protocols, but I am more aggressive with my stimulations, and I prefer a mixed (follistim/menopur) protocol.
Based on your follicle sizes, you certainly can trigger (HCG) tomorrow. Your lead follicles will be approximately 20 and 19 mms (the two largest). However, again, I would do things a little differently since there are so few follicles. I would want the smaller follicles to have a chance to mature before retrieval. Therefore, I would probably wait an extra day for the smaller follicles to reach 16 mms (the minimum size for maturity) eventhough the larger follicle might reach 22 mms. They can get up to 24 mms without becoming over-mature.
Remember, every IVF center is different and protocols and outcomes can vary a lot. One person's way is not necessarily better than anothers. If you trust your doctor, then you have to trust in his knowledge and skills and abide by his protocols.
Food for thought,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
