Definition

This is the patient who responded poorly (collection of < 5 eggs) to stimulation in a previous IVF cycle. If there is no history of previous treatment, she is typically > 35, has < 6 primordial follicles in both ovaries, and day 3 FSH level is >8 mIU/mL.

Treatment Protocol

Start Estrofem tablets (1 tablet twice a day) 1 week before the anticipated menstrual bleeding. Stop the Estrofem tablets when the patient starts to bleed. Ask the patient to come for an ultrasound examination on the 2^nd day of her cycle. If there are no follicles > 8 mm in size and if the endometrium is thin start stimulating the ovaries. The typical dose is 450 IU of Menogon/Gonal-F/Puregon. After 5 days of stimulation send the patient to the American Hospital for ultrasound and follow-up of the treatment.