On the day of trigger the only drugs being administered are the trigger injection and the GnRH analogue or GnRH antagonist. No stimulation drugs should be administered because deciding to trigger essentially means that one has come to the end of stimulation and that follicle maturity has been obtained, hence no more stimulation.

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

Whether doing AI or IVF, the optimum follicle size remains the same. The ideal size for AI is 18mm. During IVF the ideal time to trigger would be when the 3 leading follicles are between 17-18mm mean diameter.

- Week 13 answers kindly provided by Dr. Stephan Volschenk -

Changing the trigger from one agent to another is highly unlikely to influence the number and quality of the oocytes as all these agents have been scrutinised by doing randomised control trials before releasing the drugs for commercial use on the market.  See attachment from the Cochrane Review.

Recombinant versus urinary human chorionic gonadotrophin for ovulation induction in assisted conception
Al-Inany HG, Aboulghar M, Mansour R, Proctor M
Urinary human chorionic gonadotrophin was used for several years to trigger ovulation. Similar man-made drugs, recombinant human chorionic gonadotrophin and recombinant luteinizing hormone, have been developed. This review found there was no difference in pregnancy rates or adverse effects between urinary and recombinant human chorionic gonadotrophins. High dose recombinant LH was associated with lower pregnancy rate and the pharmaceutical company manufacturing the product has withdrawn it for clinical use.

- Week 12 answers kindly provided by Dr. Stephan Volschenk -

There is no 100% guarantee that ovulation will follow after the administration of Ovidrel or any other ovulation inducing agent. The best way to confirm ovulation would be to scan or do serial progesterone levels. Ovulation usually occurs 36 to 44 hours after the administration of the ovulating inducing agent.

- Week 2 answers kindly provided by Dr. Stephan Volschenk -

The ovary can only deliver according to its potential during the stimulation process. Poor response to stimulation usually means poor ovarian reserve potential (Diminished amount of oocytes left in the ovary – e.g. As in Early Ovarian Aging)

- Week 2 answers kindly provided by Dr. Stephan Volschenk -

The longest period should be 3-4 months. Waiting too long to withdraw can lead to endometrial hyperplasia (abnormal thickening of the lining) If pregnancy is not an issue, staying on the pill will give the added benefit of monthly shedding. If a pregnancy is wished for, the best route to follow would be ovulation induction

New literature supports the fact that excessive stimulation is detrimental to the outcome of an IVF cycle from the point of view that it has a negative effect on the endometrial lining from an implantation point of view. According to ISMAAR, a milder approach may lead to a better outcome.

ANSWER

There is no clear evidence in the literature to date of an increase in cancer rates among IVF patients. However, there is definite evidence that continuous use of clomifene citrate for 12 consecutive months, may lead to ovarian cancer. Untreated PCOS has an increased prevalence of endometrial cancer.

- Week 3 answers kindly provided by Dr. Stephan Volschenk -

ANSWER

The longest period should be 3-4 months. Waiting too long to withdraw can lead to endometrial hyperplasia (abnormal thickening of the lining) If pregnancy is not an issue, staying on the pill will give the added benefit of monthly shedding. If a pregnancy is wished for, the best route to follow would be ovulation induction.

- Week 3 answers kindly provided by Dr. Stephan Volschenk -