follicular development

[misstilly]

I have a question about follicle development while taking injectable fsh. If a patient develops two 19 mm follicles on 75 units of injectable FSH and multiple develop, but the E2 level does not get above 400-500 would that patient be considered a poor responder, or in order to determine if a patient is a poor responder would she need to try higher doses of FSH and thesmall follicles also n see what the response is?

I also have a question about increasing injectable fsh during a cycle. If a patient needs to increase the dose during a cycle is this a bad sign (from 75-100)? In my case my estrogen is rising, but from CD 6-9 my E2 level only went from 90 to 154 and there only appears to be one lead follicle.

Thank you.

[Scott Roseff MD]

Hi,

Each mature follicle makes about 200 pg estradiol, so a level of 400-500 with 2 mature follicles would be expected.

Increasing the dose during a stimulation cycle is common. However, starting a cycle at 75 units generally makes one mature follicle (on average), so increasing the dose later in the cycle doesn't usually change the final number of mature follicles (we often end up with a number of follicles based on the starting dose of the injectable FSH medicine). I hope this makes some sense.

Good luck!
Dr. Roseff

[misstilly]

Thank you for your reply. Would it be likely that for this cycle increasing my dose will help make sure that just the one follicle I have at 14 mm develops properly?

One final question. What is the average starting dose to get 3-4 mature follicles (for women under the age of 30 with a normal antral follicle count).

Thank you.

[Scott Roseff MD]

Hi,

As a generalization, increasing the dose of stimulation medication usually causes a 14 mm to continue to grow. However, it's often not necessary to increase the dose of stimulation medicine to maintain follicular growth.

You can't come up with a dose of medicine that will predictably cause 3-4 follicles to grow; What I was trying to say was that 75 units often causes one follicle to grow, and more than 75 units often will cause multiple follicles to grow.

Hope this helps,
Dr. Roseff