Infertility/Fertility/Iui drug dose

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Question
Hello again Dr. Ramirez,

I have just had a cd8 scan and it turns out I have a 26mm follicle!
I had another follicle at 15mm but my iui was cancelled because of the over ripe follicle.
Please can you explain if it is normal to have such a big follicle only on cd8?
I had 100iu gonal f cd3-4 and 75iu cd5-7 and cd8 told to stop medication and wait for period.
Previous cycles I had 50iu gonal f and 75iu but only produce 1 follicle.
This time even with higher dose I seem to have the same but the higher dose made my follicle grow too fast.
For my next cycle my consultant has suggested 150iu gonal f for 2 days then 75iu after that folliwed by scan cd8.

I am worried that I will again produce only 1 follicle and that my follicle will grow super fast!
I spoke with my consultant about this but he said I had an "odd" cycle and that it shouldn't happen again. I'm worried he is second guessing everything and wasting my money.

Please can you suggest a different protocol for me or is the only way to get more follicle means more fsh?
A friend suggested a combo cycle with clomid and fsh but my friend is not an expert and ai dont want to suggest this to my consultant on my friends opinion.
Thank you so much.
I desperately await your knowledgeable input.

Kind regards

Zaara

Answer
Hello Zaara from the U.K.,

I'm sorry but I don't provide protocols because there is a high variation among Physicians and there is no standard protocol.  

If you are reacting too quickly, one option is to signficantly decrease the Gonal f dosage and increase very slowly.  I do go down as low as I can at times with patients like you.  The other option is to use Clomid in combination (mixed protocol) as your friend suggested or just use Clomid or Femara alone.  With IUI the goal is to only ovulate up to 3 eggs, so you don't really want too much stimulation.  Clomid and Femara tend to do that the best and they cost significantly less.

Good Luck,

Dr. Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
info@montereybayivf.com

Monterey, California, U.S.A.

for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate.  I also now provide an Email Concierge Advisory Service with a 1 year subscription for patients that want easy access to me to answer questions along their journey (women's health, infertility, pregnancy).  Contact me at ejrmd@montereybayivf.com if you are interested in continuous access to me.

Infertility/Fertility

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Edward 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 19 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, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

Education/Credentials
Medical Degree from Stanford University, Residency at Tripler Army Medical Center, Reproductive Training at Pacific Fertility Center, San Francisco

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