Posted by: Angie | 2005/12/14

IVF and egg donation

Hi Doc,
I am 36 and went through two cycles of IVF - both cancelled due to one month not enough big folliicles (on day 9) although I had only had gonal on days 5;7 and 9 with clomid on 4-8 and the next month gonal f everday from 5 - 9 but there was one huge dominant follicle. At the end of that month I got a period which was normal but at the end of the next month (with no meds) I had an extremely heavy period (I think there was a cyst) and now there has been no period since then for 2 months. Do you think I could be peri-menopausal? What is the normal protocol for IVF - isnt the ovaries down regulated first? And lastly what is the procedure for egg donation? Does the fertility clinics provide the donor through renew website or doe they have them on their books? Oh and do you have to qualify to be a recipient of donor egg?

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Our expert says:
Expert ImageFertility expert

Dear Angie

There are several issues which you have raised in this question which are very important.

The first one is that of the type of protocol used in a fertility induction cycle.
In your situation I would very strongly recommend that you go along with a down-regulated long protocol cycle. There is strong evidence to suggest that you have a problem with selection of a dominant follicle and that you have a tendency to produce ovarian cysts very easily.

Secondly, I do not believe, given the information, that you are peri-menopausal. However, I would strongly recommend that you do a careful hormone evaluation of your ovarian reserves as this might impact further on the type of cycle down regulation you will require.
It is my opinion that you will respond much better to a high dose controlled down regulated cycle and that you would produce reasonable eggs.

A this point I would not recommend that you look at the donor option immediately, but only consider such options if all else fails.

There is also the probability of doing IVM (In Vitro Maturation). This can be done even in the absence of a dominant follicle and can also be done with limlited ovulation induction where the follicles do not go 9 - 10 mm. The eggs are then extracted and matured in the lab with the use of gonal-f and other similar drugs and this is then fertilised and transferred as one would do in an IVF cycle.
The technique is becoming increasingly popular and has shown to be almost as effective if careful patient selection is done.

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