For some patients who do not respond to the rFSH injections used in the ovarian stimulation, or who cannot have high estradiol levels, there is an alterntive program, known as the “natural cycle”.

For this cycle, the patient can either not have any medication to stimulate the ovaries or have clomiphene citrate tablets. She will then see the doctor by D7 or D8, depending on your cycle and your doctor. If there are at least 1 good follicle, then a low dose rFSH may be given to prevent the follicles from dying. Usually GnRH antagonists are given to prevent a spontaneous LH surge. When the follicle reaches a good size, the OR will be planned. Only 1 or 2 eggs are recovered in this regime. As there are so few eggs, ICSI will be done to ensure that the sperm is delivered into the egg. The embryo(s) will be replaced either on D2 or D3.

The great advantage of this regime is that the patient can cancel it without having any injections if the first U/S scan shows that there are no follicles. It is also less stressful, and cheaper as the hormone injections are much less.

Pregnancy rates with this regime is 27.3% per ER in 2006 in our Centre.

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