Hormone Assays A mature follicle produces Estradiol (E 2) approximately 200 pg/ml. E 2 levels in Blood are measured in conjunction with on essentially the same basis and schedule as ultrasound. E 2 levels in the blood indicate the degree of ovarian response to stimulation. As follicles, develop, they secrete increasing amounts of the estrogens. Higher the E 2, greater is the follicular development. Estrogen estimations are certainly required in women at risk for OHSS, adequate follicular growth but inadequate endometrial thickness. Estimate the level of serum E 2 on FSH day 5. If serum E 2 is <700 pmol/l the FSH dose can safely be increased by 75-150 units. If Estradiol is low on day-9 of the cycle, hMG, rLH or hCG is added to the rFSH. FSH is given until the day of hCG administration. 2,000 to 5,000 units of FSH are required.
GnRH antagonist (GnRH-ant) protocols These are used to prevent unexpected premature LH surge. TVS on FSH stimulation day 6; when the largest follicle is > 12 mm irrespective of the cycle day, Orgalutran 0.25 mg (GnRH-ant) is administered for 3 consecutive days. Alternatively 3.0 mg are given as a single dose. GnRH antagonists are used in selected cases where GnRh agonists down regulation have not been used. It can be done without prior pituitary suppression. Pituitary suppression started when premature LH surge is likely to occur. Gonadotrophins dosage is not increased early in the cycle.
Human Chorionic Gonadotrophins (hCG) administration is to prime the eggs before they are retrieved. hCG, which acts like LH is administered when > 3 follicles are > 18 mm and endometrial thickness is > 8 mm. Injection hCG 5,000 to 10,000 units is given and ovum retrieval done 36 hours later. rLH is now available and is being increasingly used instead of hCG.
Ovum Pick (OPU), Egg retrieval (ER) is the Oocyte recovery procedure is a minor surgical procedure that takes about half an hour. It can be performed under short acting intravenous or local anesthesia. Light general anesthesia is usually used for the comfort of the women unless she prefers not to use. It is done 36 hours after hCG injection.