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Since the editorial about Term Stimulation was published in Fertility Sterility I started to receive requests from physicians to help with desperate cases where patient has failed several IVF cases due to poor egg quality but was not ready to accept donor eggs and willing to try anything to achieve pregnancy using their own eggs. At that time, Term Stim was largely a theoretical concept and our expectations were set very low. But shockingly to me and the physician the very first time, where we used the stimulation protocol that would look more than strange to any sain physician has worked.
First case of Term Stim
Case report (with Albert Ichmelyan, MD, PhD). Patient 37 years old. G-o, P-0
This case is of particular interest because it demonstrates that not only Term Stimulation™ achieves better results than conventional stimulation, but also that it seems to be improving oocyte quality compared to the natural cycle. Curiously, the husband’s sperm, in this case, was also a suspect.
Cycle 1. Long protocol, follicles-4, MII-5, 2PN-1, arrest on day 3 with a high rate of fragmentation
Cycle 2. Natural. MII-1, 2PN-0
Cycle 3. Natural. MII-1, 2PN-0
Cycle 4. Natural. MII-1, 2PN-0
Cycle 5. Natural. MII-1, 2PN-1, arrested at 2 cells
Cycle 6. Term StimulationTM
Our strategy here (which subsequently was successfully repeated in other cases) was to suppress patient’s own FSH and then allow it to gradually rise and provide the “stimulation” instead of injecting external FSH. Rise by 3 units a day is equivalent of injecting 150 IU or recombinant FSH or 300 IU of Menopure.
Result of Term Stim. Follicles -7, MII-5, MI (matured in vitro to MII)-2, IVF – MII-2 with donor sperm 2PN-0. ICSI – MII-5 with husband sperm – 2PN-4. Blastocysts – 2 (from oocytes injected with husband’s sperm) – frozen. First frozen transfer did not result in pregnancy. Pregnancy was established with the second transfer. The patient delivered a healthy boy, 9.5 lb, 22.4″ at 40 weeks.
Please note that every case is unique. Not many patients respond to such a small amount of estradiol by this level of FSH impression and most require Ethynyl Estradiol.