In cases of excessively poor ovarian response, I apply the embryo banking protocol in natural or mildly modified natural cycles until a sufficient number of embryos are cryopreserved, which may vary in every case, based on the woman’s age and history criteria. Therefore, when no response to drug stimulation is expected, the natural cycle is monitored with FSH and estradiol blood level measurements on the second menstrual day, followed by ultrasound and estradiol and LH measurements on the eighth day.
In cases that there are chances of ovarian response to clomiphene citrate (serpafar, clomiphene citrate) or letrozole (femara) then these drugs can be administered orally from the second to the sixth day, hoping that more than one oocyte will manage to be chosen to maturate for egg retrieval. It is a difficult struggle which is often successful even in very difficult age groups, where the success rate is down to single digits.
Τhe main difficulty of this protocol lies in the continuation of the embryo banking process in more than one cycles..
In this race one must be prepared to face the following unpleasant possibilities:
- The follicle may be empty
- The follicle may be driven to early ovulation without any warning
- The egg may not be suitable for fertilisation
- The egg may not be fertilised smoothly
- The egg may be fertilised smoothly but it may not continue smoothly the expected divisions and eventually it may not be lead to a proper embryonic quality that can be successfully cryopreserved
The incidence of the above phenomena is approximately 25% but in cases with overcharged ovaries the relative incidence may be higher.
Therefore, you will need to arm yourselves with patience and persistence, and hopefully with the right methodology and support from our entire team, we can quickly achieve our goal.
