Tuesday, 6 October 2020

 


Step up dose gonadotropin for I V F backed up by regular Folliclular monitoring and measurement of serum E -

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Low dose step up protocol of gonadotrophins for IUI --aim is to have monofolicular growth to avoid multiple pregnancy -This is called COH( Controlled ovarian stimulation . May be combined with letrozole too .

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Usual method of administration of letrozole / Clomiphene
::: Usual method of administration of Letrozole or Clomiphene. This is called simple Ovulation induction . No added gonadotrophin usually, may be added on day 3 & Day 8 if specialists so desires in poor responders. But CC may be given up to 150 mg at the discretion of specialist. Similarly letrozole can be administered 20 mg only as a single dose on day 3. Other options are combination of CC at morning and letrozole at evening for 5 days .Yet another option is extended CC or extended letrozole for 10 days which may be incremental dose if doctor so desires , For instance 2,5 mg letrozole for first 5 days, another 5 days Letrozole at 5 mg daily dose .Even then response is suboptimal one can increase the dose of letrozole up to 7,5 mg OD along with close monitoring of D F diameters and E 2, Such extended period of letrozole is warranred in women who poor responders e.g. a) previous failed induction (by scrutiny of old records) b) who are aged > 35, or c) AFC 4 or d) AMH 0.5 or less. ,Timed coitus is the rule in simple induction but occasionally IUI may be contemplated if oligo/ asthenooospermiaow dose step up gonadotrophin ::Low dose step up protocol of gonadotrophins for IUI --aim is to have monofolicular growth to avoid multiple pregnancy -This is called COH( Controlled ovarian stimulation) . May be combined with letrozole too .

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