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I have low Amh. We are going to do a Microdose lupron flare protocol. We have the choice of two clinics, one uses 50mcg lupron twice per day starting day 1 and the other does 100mcg twice per day for two days before stepping down to 50mcg twice per day. How do we decide which one to go with?

I would base the decision on which you feel most confident with as the difference in protocol is relatively minor.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Would the 100mcg twice daily at the beginning result in too high LH then becoming detrimental to egg quality? Or would it be a positive thing resulting in more 'flare' and the extra LH be beneficial?

I really cannot comment on the specifics of protocols.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

Thank you for the replies.

My other question is about whether to split the 600IU of Gonal F between am and pm or do all at once.

Has there been any studies on this or from clinical experience does it seem to make any difference, particular for older women or with DOR?

There is no benefit I am aware of in splitting the dose. Most of our patients take all their gonadotropins in the evening.

Arthur L. Wisot, M. D.
Reproductive Partners Medical Group
Redondo Beach, California

If you start Microdose lupron 2 wks prior to menses does it mean natural FSH and LH are suppressed during the time the normal natural flare would happen? Ie do you not get your natural flare? Does this impact negatively or positively on your stimulation cycle, especially if you are a poor responder? I am afraid that any sort of suppression is not good if you are a poor responder?

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