MINIMAL AND LOW DOSE STIMULATION ( LOW DOSE IVF)
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Minimal Dose Stimulation involves the use of very low doses of oral or injectable medications to help the ovaries produce multiple follicles and egg cells. 

By producing a limited number of follicles with minimal doses - we are stimulating the growth of those several follicles/cells that are hopefully the most likely for that month to fertilize and develop into healthy embryos.

With Minimal stimulation IVF, we begin stimulating the follicles to grow starting on day 3 or 4 of a natural cycle.  By using less medications, we have the advantage of monitoring the patient less often - fewer injections and fewer blood test and office visits.

Prior to using minimal dose stimulation, all patients must undergo a screening cycle to determine
1. The baseline levels of FSH, LH, and Estradiol during the menstrual cycle.
2. Levels of Estradiol, and Progesterone several days before ovulation and several days after as well.

By understanding the hormone levels in a natural cycle - we are able to present to the patient a better understanding of exactly how her natural cycle works.  We are especially interested in deficiencies in Estradiol in the days that proceed ovulation as well as the levels of Estradiol and Progesterone on days 3, 6, 9, and to coordinate these levels to the thickness of the endometerium after ovulation has occurred.

We use our baseline screening study cycle to help determine which medications and what doses of medications are likely to benefit the patient.

In addition to the screening cycle, we also take into the consideration

1. Past response to medications
2. Baseline hormone levels
3. Antral follicle count
4. Patients age
5. Past fertility efforts

There is no one protocol for minimal dose stimulation.
However the following protocols are examples that might be applicable, based on the patient's individual persona.

1. Clomid Only
Patients given clomid tablets days 2 to 6, or 3 to 7.  This oral medication increases the production of FSH and LH which in turn causes several follicles to develop.  No injections for stimulation or ovulation are used with this protocol.

See Example of Clomid Only

2. Clomid HCG
Some patient who do not ovulate with clomid only or patients who have a low Estradiol and/or Progesterone after ovulation are encouraged to take clomid with HCG.

See Example of Clomid HCG

3. Clomid Repronex HCG
Clomid Repronex HCG is an excellent protocol for patients who
1. Have irregular cycles
2. Whose follicles who do not develop beyond 16mm.
3. Endometriumal lining is thin at the time of ovulation and/or after ovulation.

See Example of Clomid Repronex HCG

Low/Moderate Stimulation
Some patients require low doses of daily injections to achieve adequate follicle development.  Patients who benefit include

1. Do not respond to clomid
2. Have moderate elevation of FSH on a baseline study. 
3. Unexplained infertility.
4. Few follicles seen on baseline study.

Daily injections are done usually starting day 3 or 4 after a baseline Estradiol, LH, FSH is obtained.  It is important to be sure there are no significant cyst on either ovary.  Therefore baseline of sonogram is done during the menstrual cycle.

Patients are seen every other day or some cases every third day to follow the growth of the follicles.  Sonograms and blood testing if needed are done.

When several follicles reach a mature size - HCG is given.

The advantage of low dose stimulation is that there is much less risk of hyper-stimulation and multiple birth.

Because we do not expect to have any follicles even with high dose stimulation - patients have the benefit of stimulating their best follicles/eggs and hopefully the follicle will be stronger and more developed from an endocrine standpoint.

There are many medication choices to pick from.  The dose and particular medications chosen is a function the screening cycle and past response to medications.

See Example of Low/Moderate Stimulation