A Detailed Description of the FSH Receptor up Regulation Technique Employed to Develop Metaphase II Oocytes for in Vitro Fertilization Embryo Transfer in Women with Extremely Low Egg Reserve who had Successful Pregnancies

Despite the publication of a form of mild ovarian hyperstimulation over 40 years ago and continued publication of many more scientific articles right to the present time showing that follicular sensitivity can be restored in many women with such severe diminished oocyte reserve that they were considered to be in actual menopause, this knowledge is not known by most clinicians treating infertility. There are slight variations in this technique when used in natural cycles vs in vitro fertilization (IVF) cycles where attempts are made to develop more than one dominant follicle if possible. FSH receptors can be restored by up regulating granulosa theca cells thus restoring follicular sensitivity to FSH by decreasing chronically elevated levels of FSH by suppressing FSH release by estrogen or by inhibition of the gonadotropin releasing hormone (GnRH) by GnRH agonists or antagonists. The preferred estrogen is ethinyl estradiol because it does not contribute to the measurement of serum estradiol (E2). The objective of this manuscript is to present day by day details of four cases with extremely low serum AMH levels who successfully conceived following IVF-ET. The potential benefit of also using dopamine agonists is explained to prevent autoimmune rejection of the fetus. It is hoped that this publication will influence reproductive endocrinologists to try this technique in patients with very severe diminished oocyte reserve rather than steering the patient into donor egg programs, which frequently are not preferred by the patient yet.