Infertility/Fertility/poor stim response


I started my third round of IVF tuesday evening. I am on 375 gonal f and 150 of menopur. I have used the same protocal with all three rounds. My first round was a year ago and they retireved 7 eggs, two were transfered on day 5, no pregnany. The second round of IVF they retirved 6 eggs only 3 fertilized and we did a day 3 tranfer, no pregnancy. With my second cycle i had a slow response and they retrieved on day 14.
I started my medicaton on tuesday and had my first estrogen level drawn today and had my first ultrasound which really showed 7 tiny follicles all under 7mm. my last anti-MH was 0.6 and I am 37. My husband and i conceived without any troubles with our first son who will be 3 in april.
My question for you is what do you think of my current protocal, are you concerned by my lack of response or is it two early to tell this early in the cycle?

Thank you


Hello Shannon from the U.S. (Ohio),

Yes, I am concerned that your doctor is using the same protocol again considering that your response was so poor the previous two times.  You are basically on 525IU of FSH (follicle stimulating hormone).  The maximum protocol that I and many specialists use is 600 IU (450/150) and I would certainly push you to that level.  1 or 2 additional eggs and embryos could certainly help since that is the only way that we can overcome the age factor.

In terms of your response, I think the ultrasound might be too early.

Good Luck,

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

Monterey, California, U.S.A.

for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf.  I now provide personalized fee for service consultations/advice/direction via email and payable via Pay Pal.  If interested, contact me via my email at  This service will allow you to have your own personal on-demand infertility expert


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Edward Joseph Ramirez, MD, FACOG


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.


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.

American College of OB/GYN, American Board of Obstetrics and Gynecology, American Society of Reproductive Medicine, California Medical Association, American Association of Gynecologic Laparoscopists, Fellow of The American College of Obstetricians & Gynecologists

American Journal of Obstetrics and Gynecology, Wall Street Journal, Monterey Herald, SERMO, Women's Health and Fertility Blog

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

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