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Hope After a Failed Ovulation Induction: A New Study at CHR

Dr. Barad explains a scenario we've witnessed here at CHR where some women produce follicles after discontinuing induction medications.

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I want to talk to you for a little bit about an interesting phenomenon that we have observed here at CHR. We have some patients who, while going through an ovulation induction, don't respond at all (even to high doses of medications for ovulation induction). And this can be a very frustrating experience for patients who have committed to a cycle and are spending lots of money on medications--sometimes these medicines can cost hundreds or thousands of dollars in a particular day-- and there's no response at all. After about 8-10 days of stimulation or attempted stimulation with no response, most centers would advise stopping (no point in throwing in bad effort after after good). And we stop as well, but something we've noticed over the years is that oftentimes when we stop this medication, the ovaries wake up. And within a few days after stopping the medication, a follicle or two will appear, grow, and we have done retrievals on those follicles and gotten healthy eggs and nice embryos and transfers and even on occasion gotten pregnancies; which is kind of paradoxical given that they didn't respond when they're using these thousands of dollars worth of medication, but they within a week or so after stopping the medication produced a follicle because it's at least one good egg. So we've called that "rebound," and in order to capture that rebound effectively, we've begun sort of following women every three days or so after stopping the medication in case we can catch this rebound phenomenon. And in practice we found we were able to get follicle growth and retrieve an egg in about half of women who otherwise would have had cancelled cycles. So the question arises, why does this happen? And we don't really understand why it happens. One hypothesis is that the hormones that you produce after we stop the medication may actually be more effective than the medications that were giving you. And so in order to better understand it, we've organized what we call this "Rebound" study, in which we're offering women who have gone through ovulation induction and had no response, to continue to monitor for about 10 days or so after the cycles been cancelled. We'll be doing ultrasounds and blood tests during that time if you choose to participate in the study. And there will be no charge associated with those visits or blood tests. If we do see a response and the follicles are growing, then you would then re-enter another IVF cycle. We might give you a little bit of medication--not lots of medication--- and then hopefully get to retrieval and a transfer. Our goal in the study is to better understand what's happening to the hormones you produce in your blood in that two weeks or so after we stop our injected medications. And we'd like to find this out to better understand where this rebound is coming from and we hope that you'll be willing to participate in that with us. Obviously, you'd have to be in a cycle here to begin with and then if you don't respond in that cycle, you'd signed a consent to participate in the study (if you choose to). We would then monitor you, continue to monitor you, for about 10-12 days to look for a response. If there's no response after 12 days, then it's unlikely there's going to be a response and then we go back to the drawing board together. So if you're interested in this and you're going through a cycle, talk to us more about it and we'll tell you more. Thank you.

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