Theoretically the withdrawal bleed should commence after 3-5 days. Delay in onset is usually due to the fact that one has recruited a follicle (breakthrough recruitment) and is left with a functioning corpus luteum cyst that is still producing progesterone, therefore delaying the onset of the period. Alternatively one has to assess the uterine cavity to exclude any underlying problem.

- Week 21 answers kindly provided by Dr. Stephan Volschenk -

If you are fit and train regularly there is no reason to stop either before, during or after an IVF/ICSI attempt. A healthy body will ultimately house a healthy pregnancy. The issue is the amount of trainings – remember, anything in excess is detrimental.

- Week 21 answers kindly provided by Dr. Stephan Volschenk -

There are no risks in not waiting the desired time interval. It is all about physiology and common sense. It takes the ovary about 70-80 days to recruit a new cohort of primary follicles and it takes the body 6 weeks to return to normal.

- Week 19 answers kindly provided by Dr. Stephan Volschenk -

There are 2 main groups:
1)    Recombinant products, ie genetically engineered (eg Gonal F and Luveris)
2)    Highly purified menotropin (eg. Menopur)

The literature indicate that the difference in outcome is not significant and it is mostly up the attending doctor to decide what he/she would like to use. However, should you have a poor response/outcome with one, you might like to change the approach the next time. The important thing is that the attending doctor be familiar and comfortable with the medication used, whatever it might be.

- Week 19 answers kindly provided by Dr. Stephan Volschenk -

It all depends on how long the follicles took to get to a mean diameter of 17-18mm. If they reached 17-18mm diameter within 11-12 days, the chance that the cycle might work is always there and the percentage success will depend on your age. However, if they drag their heels and do not progress as planned by enlarging by at least 2mm every 24 hours, then the chances of the cycle working is pretty slim regardless of age. One then has to determine why this has happened, rectify the cause and try again, possibly with a different protocol.

- Week 19 answers kindly provided by Dr. Stephan Volschenk -

The long protocol is the most commonly used protocol throughout the world and involves starting the leuprolide down regulation of the pituitary gland during the luteal phase of the cycle preceding the IVF cycle. The short protocol entails starting the leuprolide on day 2 of the cycle in which the IVF is done and then starting the stimulation on day 3 of the cycle. This is the so called “flare” protocol in which the leuprolide leads to an outpour of pituatiry FSH and LH which theoretically helps with egg recruitment. The antagonist protocol involves the use of cetrorelix, a tailor made drug for IVF, which is started on day 6 of stimulation or alternatively when the leading follicle reaches a mean diameter on 14mm.

- Week 19 answers kindly provided by Dr. Stephan Volschenk -

60 – 90 days is an appropriate time frame. This is due to the following:

1)    It takes at least 6 – 8 weeks for the physiology to return back to normal.
2)    The ovary needs 60 – 70 days to recruit a new cohort of follicles.
3)    It takes a good 6 – 8 weeks to get over and work through the  emotional trauma of a failed cycle

Recruitment of primary oocytes in the ovary ( get the follicles to pre-antral stage) is a paracrine function of the ovary and is independent from FSH or LH hormones. It is therefore an ongoing process that is not influenced by external factors like the COC pill etc. I therefore have no idea why clinics “jump” from one cycle to the next.

- Week 18 answers kindly provided by Dr. Stephan Volschenk -

A “chemical” pregnancy, or more commonly used term “biochemical” is when the embryo has implanted into the endometrium, but is too early to be detected on ultrasound and the only way the diagnosis can be made is by blood test.

- Week 18 answers kindly provided by Dr. Stephan Volschenk -

The ideal time is 60 – 90 days.

- Week 18 answers kindly provided by Dr. Stephan Volschenk -

Unfortunately it is not that simple, even for a PCO. The difference between a PCO ovary and a non PCO ovary is the fact that the PCO ovary has many many more pre antral follicles than a non PCO ovary. When you stimulate the PCO ovary, you recruit most of that follicles, if not all, in some way or another – hence the risk of OHSS. At the end of the attempt the ovary has to go essentially through the same process as the non PCO ovary. Therefore it ends up being the same for both PCO and non PCO.

- Week 17 answers kindly provided by Dr. Stephan Volschenk -